Legislature(1999 - 2000)
03/20/2000 01:33 PM Senate HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE March 20, 2000 1:33 p.m. MEMBERS PRESENT Senator Mike Miller, Chairman Senator Gary Wilken Senator Drue Pearce Senator Kim Elton MEMBERS ABSENT Senator Pete Kelly, Vice-Chairman COMMITTEE CALENDAR SENATE BILL NO. 261 "An Act relating to needle stick and sharps injury protections and the use of safe needles by health care facilities and health care professionals; and providing for an effective date." -MOVED CSSB 261(HES) OUT OF COMMITTEE SENATE BILL NO. 275 "An Act relating to the school year for purposes of the postsecondary student loan program; and providing for an effective date." -MOVED CSSB 275(HES) OUT OF COMMITTEE PREVIOUS SENATE COMMITTEE ACTION SB 261 - See HESS minutes dated 3/8/00. SB 275 - No previous action to report. WITNESS REGISTER Ms. Wanda Katiszki Alaska Nurses Association 237 E 3rd Anchorage, AK 99501 POSITION STATEMENT: Supports SB 261 Ms. Donna Thompson No Address Provided POSITION STATEMENT: Supports SB 261 Mr. Cle Wade Alaskan Chapter of American Industrial Hygienists 3301 Eagle St. Anchorage, AK 99510 POSITION STATEMENT: Supports SB 261 Mr. Tim Bundy Assistant Chief Occupational Safety & Health Alaska Department of Labor PO Box 107022 Anchorage, AK 99510-7022 POSITION STATEMENT: Available to answer questions Ms. Maggie Flannagan 1722 Bellevue Loop Anchorage, AK 99515 POSITION STATEMENT: Supports SB 261 Ms. Donna Libal PO Box 1071 Homer, AK 99603 POSITION STATEMENT: Supports SB 261 Ms. Karen Willows 51305 Raven Canyon Homer, AK 99603 POSITION STATEMENT: Supports SB 261 Mr. Jake Mater Government Affairs Aventis Pharmaceuticals PO Box 490 Folsom, CA 95630 POSITION STATEMENT: Noted Aventis's concern about prefilled syringes Mr. Paul Neilsen Pharmacia (ph) No Address Provided POSITION STATEMENT: Noted concern about prefilled syringes Mr. Elmer Lindstrom Special Assistant Department of Health and Social Services PO Box 110601 Juneau, Alaska 99811-0601 POSITION STATEMENT: Commented on SB 261 Mr. Milt Byrd Chairman Alaska Commission on Postsecondary Education 3030 Vintage Blvd. Juneau, Alaska 99801-7109 POSITION STATEMENT: Supports SB 275 Ms. Diane Barrans Executive Director Alaska Commission on Postsecondary Education 3030 Vintage Blvd. Juneau, Alaska 99801-7109 POSITION STATEMENT: Supports SB 275 ACTION NARRATIVE TAPE 00-11, SIDE A Number 001 CHAIRMAN MILLER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:33 p.m. Present were Senators Pearce, Elton, Wilken, and Chairman Miller. The first order of business to come before the committee was SB 261. SB 261-PROTECTION FROM NEEDLE & SHARPS INJURIES CHAIRMAN MILLER announced his intention to move SB 261 today. He asked those wishing to testify to keep their testimony concise so that all participants can testify. MS. WANDA KATINSZKY, President of the Alaska Nurses Association (ANA), said the ANA represents a bargaining unit for the Central Peninsula General Hospital and the Providence Alaska Medical Center. She is also speaking to the committee on behalf of 6,000 registered nurses throughout Alaska. Ms. Katinszky gave the following testimony. First of all, I am a registered nurse and I was an Infection Control Practitioner at the time the initial federal OSHA guidelines on blood borne pathogens was published. I implemented the first needleless devices at Elmendorf Hospital in 1992, so I speak from first-hand experience. I wish to also thank Senator Kim Elton and his staff member, Angie Schmitz, for spearheading this issue on behalf of all health care workers. They have truly done their homework, and we are very grateful for their proactive stance on our behalf. Your first question, most likely, is "Why do we need this bill?" I wish we didn't. However, by an informal survey of different facilities throughout Alaska this past couple of weeks, we found wide variations in availability of safe needle products. I applaud those facilities who have done a good job implementing the federal guidelines, but what about those health care workers who do not have employers who have been responsive to these guidelines? It is due to the lack of response by employers that the American Nurses Association has championed this cause at a national level, six states have already passed legislation, and 20 other states are in some stage of enacting legislation. This problem of compliance was highlighted in the executive summary of the Maryland Study Group on Health Care Worker Safety which states "Although the OSHA blood borne pathogen standard includes language on the use of engineered sharps protection, it has not been an effective tool in promoting widespread use of engineered sharps injury protection." The outcome of this study group was to recommend passing state legislation there, which was enacted in 1999. Now, health care workers [indisc.] statistics that health care workers suffer annually between 600,000 and one million injuries from conventional needles and sharps, and nurses suffer the majority of these. We have to ask ourselves why this is allowed to happen when 80 percent of needle stick injuries are preventable with use of safer devices. Nationwide less than 15 percent of facilities have employed the use of these safer devices, even though they have been available since the 1970's and with the blood borne pathogen standards issued in the 80's, they've really proliferated and there are over 250 products on the market right now. We think it will take strong state legislation, instead of compliance directives, which is what we currently have, to protect health care workers. A lot of people will say, well, we already have standards at the national level, why are we doing this at the state level. Part of that is because compliance directives are interpretations of standards that can come and go with the administration that's there so we need a permanent solution which this legislation will provide. Passing a state law will set the standard in stone, so to speak, and remove the ambiguity of compliance directives. I think this bill makes good business sense. It does not require the employer to purchase any and all safety devices, but rather requires them to evaluate products, using front line workers to determine what works best in their facility. A scientific approach should be used by assessing the needle stick trends that they are having, then evaluate products to decrease the incidence of needle stick injuries that are occurring. If done correctly, the cost of implementing these devices will decrease over time due to cost savings realized from reduced exposure follow-up and treatment. Each hospital should already have this needle stick injury data. It's also been shown by Kaiser in California that the cost of needle stick devices has gone down and they've been able to decrease the amount of money they spent on post-exposure follow-up so there is data to support this. Now one of the things that I do want to bring up - there's some criticisms of this bill as far as the length of time that is required to evaluate products which is six months. Now, speaking from experience, I believe this trial period - anything less than this trial period of six months is shortsighted. This evaluation period does not mandate a device be used for six months, rather the evaluation period should be six months. That evaluation period would begin when you accept the needs of the service or that department based on the information you have of your current needle stick injury amounts or that the level of injury that you have - then you get other potential alternative products - you decide which ones you are going to trial. Another criticism that I heard was, well we don't want to trial period for six months if we know it doesn't work. Well, the bill doesn't say that. It just says, within that six month period, you want to be evaluating the products and part of that evaluation will be actually using the product. Another thing that I can speak from - from experience, is that if you don't include every department, you really will increase your costs so it's very important that those users at the table represent every nook and cranny of the hospital where a patient may start into the hospital - whether the ER or the doctor's office, and go through until they are discharged. Every player needs to be available to discuss this. So that's another very, very important part of this bill. As you know, and you are going to hear from some health care workers, once they have exposure to blood and body fluids, they must treat their personal relations with significant others as if they are carriers of blood borne pathogens. Now their exposure risks extend to their families as well. This can produce much fear and stress within the nuclear family and it interferes with their privacy on different levels. It includes taking measures to prevent transmission to disease to their spouse and children. I again ask, why do health care workers have to undergo this type of stress when we have products available and yet they're not being accessible to the health care workers? Of those health care workers who will contract a disease, the emotional and health concerns are much graver. It is estimated that 1000 workers annually will become infected, and I saw one statistic that said 5,000 health care workers every year contract either HIV, Hepatitis C, or Hepatitis B. According to the American Hospital Association, one serious infection by blood borne pathogens can add up to $1 million or more. Another nurse will hopefully be on to attest to a liver transplant that she received as the result of exposure to blood borne pathogens. Again, who will intervene for us to help prevent these serious infections? We believe now is the time to end this threat to our profession. So, on behalf of the nurses of the State of Alaska, I express our gratitude for your consideration of this bill. We believe it is a protection long overdue to all health care workers and we urge you to pass this legislation to protect not only our safety, but the safety of our families as well. I appreciate your time. There being no questions of Ms. Katinszky, CHAIRMAN MILLER asked Donna Thompson to testify. MS. DONNA THOMPSON, a registered nurse, gave the following testimony via teleconference. In December of 1989, while working at a hospital in Anchorage, she contracted non-A, non-B, non-C Hepatitis. In March of 1990, she was in a coma and was transported to Seattle for a liver transplant. During those three months, she had to have her children immunized and she had them stay at friends' homes for fear of transmitting the disease to them. She was unable to work due to profound weakness and an inability to eat. She returned to work in May of 1991, after a battle with the facility. Her medication costs about $600 per month. In 1992, she received a needle stick while administering medication to a patient. In 1998 she was diagnosed again with recurring Hepatitis, the same variety she was diagnosed with in 1989. She has since had two liver biopsies since then and is scheduled for a third next month. It has been a very difficult time for her family. Her oldest daughter had to quit college to care for her after her liver transplant. She said a safe needle policy is of utmost importance. Many nurses that she knows have received needle stick injuries - some are reported, many are not. The emotional and psychological stress a person goes through when they are facing an organ transplant is enormous. She stressed the importance of protecting health care workers in high risk areas. Number 1030 MR. CLE WADE, President of the Alaska Chapter of the American Industrial Hygiene Association, said his professional purpose as an industrial hygienist is to minimize and, if possible, prevent occupational illnesses. No one can debate the fact that exposure to blood borne diseases by needle stick is a significant hazard - not just to the employee, but to the employee's loved ones at home. It is a hazard that his organization is committed to minimizing. The Alaska Chapter supports SB 261. MR. TIM BUNDY, Assistant Chief of Consultation and Training, for the State of Alaska's OSHA Program, said he was available to answer questions. MS. MAGGIE FLANAGAN, a registered nurse and the health and safety officer for her union which represents nurses and a huge health care facility in Alaska, said that everyday that her co-workers go to work, they face deadly risks from dangerous needles. These risks are unnecessary and could be prevented with safer needle devices. Needle stick injuries are a serious problem at our facilities but this problem already has a solution in safer devices. Nurses are angry that in the facility where she works, one person in authority can block hundreds of health care workers from having the protection offered by these devices. These devices are on site, but some health care workers do not have access to them. SB 261 will give nurses the chance to participate in an evaluation committee that includes participation with front line workers of all medical specialties at her facility. SB 261 will provide for a better tracking system for needle stick injuries with a well defined sharps injury log. More data will be collected and facilitate the identification of high-risk situations or procedures which will enable supervisors to reduce or eliminate such hazards. Needle stick injuries are a silent epidemic. For the most part, you will not see the health care workers at Providence that have had the most serious consequences from these injuries. These people have had their lives devastated from acquiring diseases and they will not testify in public about their personal tragedies. To testify and go public with this only furthers their pain. She asked committee members to hear their voices through her words. Many of these people have suffered the consequences of their injuries in silence. They are afraid to tell their friends, their co-workers and their family members. It is known that 20 diseases can be transmitted through these types of exposures. The amount of personal suffering is unimaginable. There is a waiting time of months to see if a disease has been transmitted. Nurses worry about transmitting these diseases to their family members, a terrifying situation. Since talking to co-workers about this bill in the past couple of weeks, many have come to her in confidence and told her about pregnancies they have lost mid-term after contracting Hepatitis C from a needle stick. She has had transport nurses tell her they received needle stick injuries from transporting patients. Safer products also protect health care consumers. In Anchorage in December, a young child was exposed by a contaminated needle when a school nurse accidentally reused a needle on her. Had the safer needle device been used, that could not have happened. MS. FLANAGAN noted, as an ICU nurse for 19 years in several hospitals, she has found infants with needles in their beds, infants laying under bare needles, and needles in blankets with children. None of those incidences would have occurred with safer devices. In her unit, it is considered safe practice to tape needles into their IV lines when giving medication. The tape is not enough as this system fails with the best technique. Other patients at risk for these injuries are those who are sedated, confused, combative or having seizures. In the mental health setting, needs can be used as potential weapons against health care workers. In talking with her co-workers, she has heard stories of people being injured through needle sticks through no fault of their own. She asks that the blaming stop, no matter what the cause of the exposure. She has had a high-risk needle stick injury when drawing blood from an infant of a known IV drug abuser. She has had other near misses and she has had people tell her they have been reluctant to report these injuries. She asked committee members to support SB 261. Number 1396 MS. DONNA LIBAL made the following comments in support of SB 261 via teleconference from Homer. She has worked in the nursing profession for over 35 years and has been employed at South Peninsula Hospital for the past four years as an employee health nurse and infectious control nurse. She is also a member of Teamsters Local 959. Fortunately, the administration at South Peninsula Hospital is reactive and proactive in its concern about needle stick and sharps injuries. Its program evolved both in response to incidents and by considering the potential for injuries. Two years ago, the hospital found that manipulating needle "piggy-backing" connections for IV set ups was one of the major causes of needle sticks. They went to a needleless system. The South Peninsula Hospital is a small facility and between 5 to 8 exposures are reported each year, and half of those are due to needle sticks and sharps. Although the hospital does not have a reduction of big numbers to show a remarkable improvement, percentage-wise the picture is not worthy. Since 1996, there has been a 60 percent reduction in overall needle sticks and a 100 percent reduction in needle sticks due to piggy-backed IVs. MS. LIBAL said she has been asked about the need for SB 261 in light of the blood borne pathogen standards and whether the bill duplicates what is already in place. This is a matter of perspective. The OSHA blood borne pathogen standards address safety devices but the sections on engineering controls and workplace practices need enhancement and revision. To fully understand what OSHA expects, one would have to go to the federal enforcement directives. Regarding duplication, page 4 of the new OSHA directives is applicable. It states, "Although adoption of this instruction is not required, states are expected to have standards, enforcement policies and procedures which are at least as objective as those of federal OSHA." SB 261 will change lives, and that is the bottom line. Number 1536 MS. KAREN WILLOWS, a registered nurse since 1975, a South Peninsula Hospital employee for eight years, and a member of Teamsters Local 959, made the following comments via teleconference from Homer. She cares for many patients who are potential sources of blood borne pathogens. Since South Peninsula Hospital began using a needle-less IV system, nurses have been impressed with the ease of the transition and the general improvement of worker safety. It is now hard for nurses to imagine not using the safer system. Even though most IV needle sticks are relatively clean compared to intramuscular injections, the use of the needleless system when dealing with chemotherapy is essential to protect the nurse. Some of these medications used to combat cancer are so caustic that they require surgery and tissue removal if they leak out of the injection site or are inadvertently injected outside the vein. She encouraged members to pass a needle stick protection law. MR. JAKE MATER, Aventis Pharmaceuticals, informed committee members that he testified at a previous hearing but noted his company's exception to prefilled syringes. He pointed out an amendment had been proposed to address that concern. MR. PAUL NEILSEN, representing Pharmacia (ph), an Upjohn Company, noted he shares Mr. Mater's concern. He added that his wife is a nurse and she has had needle sticks - he believes this is an important issue. Number 1675 SENATOR ELTON commented that because OSHA is making new requirements, DHSS's fiscal note will probably have to be adjusted. MR. ELMER LINDSTROM, Special Assistant to the Department of Health and Social Services, informed committee members that when SB 261 was introduced, DHSS was not fully aware of pending OSHA regulations. After DHSS spoke to Mr. Bundy, it re-evaluated the fiscal impact of SB 261. Depending on the adoption of the proposed amendments, it is likely the fiscal impact will be reduced significantly, if not to zero. DHSS is concerned about a statement on page 1, line 12, regarding the production evaluation period of at least six months. The suggestion that the statement does not require that an item be in use for six months if it is deemed unsuitable in a shorter time period is not self evident. DHSS's understanding was that the product must be in use for at least six months in order to be evaluated. He asked for clarification of that language or that it be deleted. CHAIRMAN MILLER noted that no one else wished to testify on this legislation. He asked Senator Elton to give a brief explanation of the proposed amendments. Number 1776 SENATOR ELTON explained that Amendment 1 addresses, on page 4, the concerns of the manufacturers of prefilled needles. The amendment provides for a three year period of time before the standards envisioned in SB 261 apply to prefilled needles. Amendment 1 reads as follows. A M E N D M E N T 1 OFFERED IN THE SENATE BY SENATOR ELTON TO: SB 261 Page 4, following line 7: Insert a new subsection to read: "(g) Standards adopted under (b) of this section do not apply to the use of a drug or biologic prepackaged within an administration system or used in a prefilled syringe that is approved for commercial distribution or investigational use by the federal Food and Drug Administration if the standards exceed the requirements of the comparable Occupational Safety and Health Administration standards." Page 5, following line 12: Insert a new bill section to read: "* Sec. 2. AS 18.60.880(g) is repealed December 31, 2003." Renumber the following bill section accordingly. SENATOR ELTON moved to adopt Amendment 1. There being no objection, the motion carried. SENATOR ELTON explained that Amendment 2 speaks to the requirements of the Department of Labor. After speaking to staff at the Department of Labor, it was decided that a requirement that they compile and maintain a list of safer device information is unnecessary because other entities already do that. Amendment 2 requires the department to compile a list of sources of that information and reference them rather than to maintain its own list. A few of the entities that maintain these lists are the University of Virginia, the Food and Drug Administration, and the Centers for Disease Control. SENATOR ELTON moved to adopt Amendment 2 which reads as follows. A M E N D M E N T 2 OFFERED IN THE SENATE BY SENATOR ELTON TO: SB 261 Page 3, line 28, following "of": Insert "sources of information on" Page 3, line 31, through page 4, line 3: Delete "The list may be developed from existing sources of information, including the federal Food and Drug Administration, the federal Centers for Disease Control, the National Institute of Occupational Safety and Health, and the United States Department of Veterans Affairs." There being no objection, CHAIRMAN MILLER announced that Amendment 2 was adopted. SENATOR ELTON explained that Amendment 3 makes a technical change suggested by the bill's drafter. The provision that provides for the vaccination of health care workers was not covered in the title of the bill so Amendment 3 adds a short statement to the title and better defines the language. SENATOR ELTON moved to adopt Amendment 3 which reads as follows. A M E N D M E N T 3 OFFERED IN THE SENATE BY SENATOR ELTON TO: SB 261 Page 1, line 2, following ";": Insert "relating to the vaccination of health care workers against diseases transmitted by blood borne pathogens;" Page 3, line 24: Delete "increase vaccinations" Insert "encourage the vaccination of health care workers against diseases transmitted by blood borne pathogens" There being no objection, CHAIRMAN MILLER announced Amendment 3 was adopted. SENATOR ELTON moved SB 261 as amended with the attached and hopefully changing fiscal note. There being no objection, CSSB 261 (HES) moved from committee. SB 275-POSTSECONDARY LOAN PROGRAM:SCHOOL YR CHAIRMAN MILLER noted SB 275 was introduced by the Senate HESS Committee. The bill changes the definition of the school year to provide student loans for students attending schools that offer a two year degree within a 15 month time period. Charter College offers such a degree, and it is working on a four year degree program that a student could earn in 2+ years. SB 275 changes the requirement that loans be granted only according to the traditional school year. MR. MILT BYRD, President of Charter College and a member of the Alaska Commission on Postsecondary Education (ACPE), explained that the modification of the definition of a school year is consistent with the definition of the U.S. Department of Education. Historically, colleges and universities have offered two semesters of 15 weeks each or three quarters of ten weeks for a total of 30 weeks for the academic year. Language in the current statute assumes that students will go to school for nine months of the year to achieve 30 weeks of instruction. One can put together a fast track program whereby the 30 week instructional year can be offered in about 7+ months. That permits a student to complete a four year degree in 30 months or 2+ years. Charter College uses that structure. Currently, it offers a two-year degree and plans to develop into a four year institution. Charter College is concerned that students will need to pay four years of tuition for the fast track program but will be unable to get four years of loans. The modification of the current statute will simply provide that a 30 week period of academic instruction constitutes a full year and provides for one full loan. MR. BYRD said the House companion bill was slightly modified. The word "occurs" was changed to "begins" on page 1, line 6, to allow students who are on a fast track program to apply for two loans during the period from September 1 to August 31. That change was approved by the Alaska Commission on Postsecondary Education at its meeting last Thursday. SENATOR ELTON asked, if the word "begins" is used, why the dates of September 1 and August 31 are necessary. He asked if the bill could say that a school year means an academic period that is a minimum of 30 weeks of instruction time. MR. BYRD replied that would be fine from his point of view, but ACPE staff is concerned that the additional loan year be part of the record for reasons unrelated to this particular change. MS. DIANE BARRANS, Executive Director of the Alaska Commission on Postsecondary Education, forwarded to the committee the endorsement taken by the ACPE the previous week. In regard to Senator Elton's question, she said the terms and conditions for each school year are set and disclosed within the Alaska Student Loan Corporation's official statement. In order to accurately track those terms and conditions from one year to the next, a time period is set that they will apply to - the reason the dates are needed in SB 275. There being no further testimony on SB 275, CHAIRMAN MILLER moved to replace the word "occurs" with "begins" on page 1, line 6. There being no objection, the motion carried. SENATOR WILKEN moved CSSB 275(HES) from committee with individual recommendations and its zero fiscal note. There being no objection, it was so ordered. CHAIRMAN MILLER noted the bill has no fiscal note. MS. BARRANS told committee members the bill has no fiscal impact but that she would provide a zero fiscal note for the next committee of referral. There being no further business to come before the committee, CHAIRMAN MILLER adjourned the meeting at 2:20 p.m.