Legislature(2005 - 2006)BUTROVICH 205
03/29/2006 02:00 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Overview Update: Avian Flu - Department of Environmental Conservation, Department of Fish and Game, Department of Health and Social Services | |
| Overview: Personal Care Attendant Program - Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
March 29, 2006
2:03 p.m.
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Gary Wilken, Vice Chair
Senator Lyda Green
Senator Kim Elton
Senator Donny Olson
MEMBERS ABSENT
All members present
OTHER LEGISLATORS PRESENT
Senator Bettye Davis
Senator Charlie Huggins
COMMITTEE CALENDAR
Overview Update: Avian Flu - Department of Environmental
Conservation, Department of Fish and Game, Department of Health
and Social Services
Overview: Personal Care Attendant Program - Department of
Health and Social Services
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
KARLEEN JACKSON, Commissioner
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Commented on Avian Flu issues.
DR. RICHARD MANDSAGER, Director
Division of Public Health
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Commented on Avian Flu issues.
MATT ROBUS, Director
Division of Wildlife Conservation
Department of Fish & Game
PO Box 25526
Juneau, AK 99802-5226
POSITION STATEMENT: Commented on Avian Flu issues.
DR. ROBERT GERLACH, State Veterinarian
Division of Environmental Health
Department of Environmental Conservation
410 Willoughby
Juneau, AK 99801-1795
POSITION STATEMENT: Commented on Avian Flu issues.
JANET CLARKE, Assistant Commissioner
Finance and Management Services
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Commented on Personal Care Attendant
Program.
JON SHERWOOD
Office of Program Review
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Commented on Personal Care Attendant
Program.
ACTION NARRATIVE
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 2:03:48 PM.
Present were Senators Donny Olson, Kim Elton and Chair Fred
Dyson. Senators Gary Wilken and Lyda Green arrived as the
meeting was in progress. Also in attendance were Senators
Bettye Davis and Charlie Huggins.
2:04:38 PM
^Overview Update: Avian Flu - Department of Environmental
Conservation, Department of Fish and Game, Department of Health
and Social Services
CHAIR FRED DYSON announced that the committee would hear an
overview update on avian flu.
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services (DHSS), reminded members that the Governor through
Administrative Order 228 has asked all the state departments to
coordinate together to be prepared for the event there is a
pandemic influenza. Alaskans need to understand the difference
between the two kinds of flu, influenza or the bird flu, and how
they might be related. To help with that preparation, three
state experts were present - Dr. Richard Mandsager, Director of
the Division of Public Health, Matt Robus, Director, Division of
Wildlife Conservation, and Dr. Bob Gerlach, State Veterinarian,
Department of Environmental Conservation (DEC).
2:06:21 PM
DR. RICHARD MANDSAGER, Director, Division of Public Health,
Department of Health and Social Services, updated members by
setting the stage for them to differentiate human issues from
bird issues and why they are connected. He pointed out the
websites - AvianFlu.alaska.gov and PandemicFlu.alaska.gov. The
website is updated every Monday afternoon and included new
reports if worldwide situations change.
SENATOR WILKEN arrived at 2:08:57 PM.
2:09:07 PM
DR. MANDSAGER related that all the information and frequently
asked questions about wild birds and the influenza A, H5N1 virus
was on the websites. Transmission of the virus from birds to
human has an almost 50 percent mortality rate consistently
across countries.
2:10:23 PM
DR. MANDSAGER said another reason for concern is that previous
pandemics have been caused by influenza A viruses and we should
assume there will be three pandemics in this century. H5N1 is a
legitimate threat if it develops human-to-human transmission.
Last year public health law was updated giving the department
significant authority over human health and this year, HB 380,
the animal companion gives the appropriate authorities to the
department for animal disease control. Many of the new diseases
on the human side are zoontic diseases - they either come from
animals or they are transmitted back and forth from animals to
humans. Both sets of authorities are needed to protect
communities.
2:12:23 PM
DR. MANDSAGER showed a world map of the spread of the virus
dated March 24, 2006. In October, it was confined to Southeast
Asia and then moved eastward into Europe. Most of those
countries have had the disease in wild birds - a few countries
have had it in poultry. Human disease is much more scattered.
Southeast countries were filling in rapidly. The question is
will Alaska see this virus in birds?
He reported that the multi-agency coordinating committee that
was created in response to the Governor's administrative order
is now functional. Some organizations were meeting every two
weeks to drive the planning work. Community outreach visits and
working with communities would be launched next week.
2:14:23 PM
DR. MANDSAGER said if this becomes a human disease, communities
would have to become largely self-reliant. It would become hard
to share people between communities where power infrastructure
and airplane services are essential to get workers and medicines
where they need to go.
2:15:58 PM
MATT ROBUS, Director, Division of Wildlife Conservation, Alaska
Department of Fish and Game (ADF&G), said his division was
becoming more and more involved in the bird issues. He reported
that it is still primarily a disease of birds and first
developed in the domestic poultry of Southeast Asia. It has
moved back into wild bird populations and has caused a fair
amount of mortality there. As wildlife managers, the department
was very concerned about that.
SENATOR GREEN arrived at 2:16:36 PM.
2:16:43 PM
MR. ROBUS said the Homeland Security Department has convened a
collaborative effort between several different federal
departments, including Alaska wildlife managers, to plan for
early detection of H5N1. It is not certain that wild birds would
bring the virus in, but since Alaska is at the intersection of
Asian and North American flyways, and since we send migratory
birds throughout all four continental U.S. flyways, if we do get
it by wild birds, it would be a national issue in terms of it
begin carried elsewhere.
2:17:53 PM
MR. ROBUS said they had started sampling for the virus in 1998,
though in smaller way. More recently, a University of Alaska
study was piggybacked with government divisions to sample 8,000
or 9,000 birds and none has come back positive. This group of
agencies put together a national strategic sampling plan for the
early detection of the Asian strain of H5N1 and Alaska put its
own sampling plan together to gather 15,000 samples from wild
birds during the coming season - focused on priority species and
habitats. He said the state has been divided up and teams will
work in different locations.
He said the teams will obtain samples through five basic
strategies: 1) catch live birds and doing a tracheal or cloacae
swab; 2) collect hunter-killed birds, both subsistence and
regular fall season; 3) prepare teams of people ready to respond
to reported mortality and morbidity events and do necropsies; 4)
sample environment - water and fecal samples, because that is
how it would spread between birds; 5) put sentinel birds out in
a cage and then test them later to see if they had picked up the
disease.
2:21:57 PM
MR. ROBUS said in the meantime there is no reason to think it's
here and it is highly likely that it will be detected if it gets
here. Strategies for avoiding bird flu include wearing rubber
gloves when cleaning wild birds or gathering eggs for
subsistence, avoiding eating or drinking while cleaning birds or
putting fingers in your mouth or on your face and making sure
the work surfaces are clean. Meat from birds should be cooked
all the way through, which destroys disease organisms.
2:24:11 PM
ROBERT GERLACH, DVM, State Veterinarian, Division of
Environmental Health, Department of Environmental Conservation
(DEC), said that a coordinated, collaborative effort consisting
of the state's three agencies and the U.S. Department of
Agriculture has organized outreach education, surveillance and
response. H5N1 has not been found in North America where there
has been previous sampling. No pathogenic avian influenza has
been found in Alaska. He mentioned that low-pathogen viruses
have been found, but cause very little disease in wild birds.
His concern was that migrating wild birds would bring avian
influenza into the state where it would infect other wild and
domestic birds. When people have been affected by H5N1, it has
been through contact with domestic poultry. In Alaska they have
focused on educating people about preventing the disease.
Alaska has two-dozen or fewer commercial poultry operations and
they are not similar to operations in the Lower 48 where people
have to scrub in and out, for instance, to avoid disease.
Another concern was backyard birds for eating, exhibition or
pets. The third population was indoor pets that can be exposed
by things that are brought into the home from outside. The
virus can be contracted through fecal excretion and brought in
on shoes, for example. He has recommended a list of ways to
maintain a clean environment for domestic birds by restricting
access to wild birds.
2:28:45 PM
DR. GERLACH said the state is developing the capacity to test
for avian flu at the Environmental Health Lab in Anchorage and
the USDA is doing sampling around airports as well. The focus is
on interaction of wild with domestic stock. He said it is
important to provide the public with a consistent message on
this issue.
2:30:42 PM
DR. GERLACH said the state's response plan is well coordinated
and he exhibited previous outreach materials including a booklet
of wildlife diseases that hunters might see. Passage of HB 380
was important because it extends his authority to deal with
avian flu in pet birds.
2:31:56 PM
SENATOR DONNY OLSON asked what the chances are that other
animals like cats and dogs would pick up the virus.
DR. GERLACH replied that domestic and exotic cats can be
infected by the virus. In Germany, a Stone Martin was affected.
In New Zealand, weasels, rabbits and rats have been infected as
an experiment in a controlled environment. Pigs are also a
susceptible species. So, surveillance is needed in both wild and
domestic animals.
2:33:18 PM
SENATOR OLSON asked what the chances were of it affecting fish.
DR. GERLACH replied that this virus usually affects warm-blooded
animals.
2:34:24 PM
SENATOR OLSON said that it seemed like a tracheal swab would be
difficult to do on birds.
DR. MANDSAGER replied that he didn't mean to say that. What he
meant to say was that the ability to collect samples from people
who might be infected with H5N1 needs to be in place.
SENATOR OLSON asked if some birds should not be eaten by people
living a subsistence lifestyle.
DR. MANDSAGER replied that the birds could be cooked and eaten -
so long as the secretions were clear and not bloody.
2:35:46 PM
DR. MANDSAGER clicked on birds and animals - hunter safety - on
the website to demonstrate where to find safe handling
information.
2:36:42 PM
MR. ROBUS pointed out the booklet that has the department's
safety guidelines. He emphasized that the department needs
people's help in observing and reporting sick or dead birds. He
said the Fish and Wildlife Service is hosting a toll free line
for Alaska calls - 1-866-5BRDFLU.
2:38:01 PM
CHAIR DYSON asked if the bird flu has reached the Russian Far
East.
MR. ROBUS replied that he was not familiar with the exact
locations or the extent of the sampling there. He does know that
large shorebirds are currently migrating up the eastern coast of
Asian and are headed for the western part, the Seward Peninsula
and the Yukon Kuskokwim Delta in Alaska. He reiterated there has
not been a documented case of a person getting this disease from
a wild bird and that it doesn't jump easily from wild birds to
humans.
2:39:29 PM
CHAIR DYSON asked what birds come to Alaska from the exposed
areas.
MR. ROBUS replied Curlews and Godwits from the shorebird family.
Pacific Black Brant populations have a direct interchange
between North America and Asia; the Northern Pintail is a
dabbling duck that goes all over the Arctic and hops between
continents. A potential problem, if the virus gets here and
gets into our water bodies, is that breeding ducks from the
Lower 48 could carry it south.
2:40:41 PM
SENATOR ELTON asked how long it takes to turn a sample from
fieldwork.
MR. ROBUS replied there are screening and confirmation steps.
The initial screening has a 24-hour result for a presumptive
positive for this type of virus. However, to confirm that it is
actually H5N1, it has to go to the USDA lab in Ames, Iowa and
that test takes up to a week or so. The agency's response would
intensify with a positive indication.
2:42:03 PM
SENATOR ELTON asked if the presumptive level gets reached in the
initial screening, is the agency response more intensive
studying or is there a public component.
MR. ROBUS replied that in terms of managing wild birds, none of
the agencies involved think the spread of the virus would be
halted through culling massive populations of wild birds. If it
is found in wild birds, the wildlife management part of this is
trying to determine the prevalence and monitor it as it moves
around the continent. On the public side, the response would be
the department modifying its advice on how to use wild birds -
possibly through regulatory action on hunts in certain places.
Protection of domestic birds and animals and human health would
also be a concern.
DR. MANDSAGER added that this issue is the subject of much
discussion. First they would need to be reasonably sure that the
presumptive is probably true through more sampling. A
presumptive sample should not be kept a secret while waiting for
confirmation. Europe, for instance, notifies the public of
presumptive positives and that confirmation is being awaited. He
thought one of the things that was done wrong in the 1918
pandemic was that governments didn't tell the truth and lost the
confidence of the people.
DR. GERLACH added that his response would be different with
respect to domestic poultry, because initially, a quarantine
would be set up that would halt movement of the animals form the
premise. Nothing would be done about eradication until the
disease was confirmed. Whether it would be high pathogen H5N1 or
the North American version, the low-pathogen H5N1 strain, would
be reported. Either would result in a quarantine and hold order
on the birds. If it were confirmed, those birds would be
depopulated. Once the USDA test is done, it gets reported to
the World Animal Health Organization.
2:45:37 PM
CHAIR DYSON said that Dr. Gerlach informed him that without HB
380, he would not have authority in the non-domestic animal
kingdom, which is one of the reasons it is a priority.
DR. GERLACH agreed.
2:45:59 PM
SENATOR HUGGINS said he comes from a duck hunting family, a
number of whom died in the 1918 pandemic and it appears that the
disease shows up more in people that handle poultry and not much
in wild birds.
DR. MANDSAGER assured him that was correct. The European
experience over the last four months confirms that. There have
been a lot of positive wild birds scattered across many European
countries, but almost no domestic poultry has been affected -
most likely because of better practices in taking care of birds
in developed countries. There has been no human spread at all in
European countries.
2:47:41 PM
CHAIR DYSON thanked them for the diligence they are showing in
being prepared for what we all hope doesn't happen.
2:47:57 PM
^Overview: Personal Care Attendant Program - Department of
Health and Social Services
CHAIR DYSON announced that the committee would hear an overview
on the Personal Care Attendant Program (PCA).
2:48:32 PM
JANET CLARKE, Assistant Commissioner, Finance and Management
Services, Department of Health and Social Services, and JON
SHERWOOD, Office of Program Review, DHSS, said they would give
the department's presentation.
CHAIR DYSON recapped that from the last meeting it seems that
the PCA program has grown far more quickly than others and the
cost per client seemed disproportionate. He asked if more
people were enrolled and being subsidized through the PCA
program than should be.
MS. CLARKE answered by providing the committee most recent
information from Alaska in 2002 and some analysis that consisted
basically of two spreadsheets. Tripling of the average
expenditure per recipient from 2001 to 2002 was the largest
growth of the program; there has been modest growth since.
She also mentioned a letter she sent to the committee on March
21 after the presentation on PCA regulations and that included a
legal-sized chart of March 2005 data that shows how the new
changes in Alaska regulations compared to what is happening in
other states.
She explained that before April, one had to have only one daily
living activity to qualify for PCA assistance and now you need
two. All hours of service now need a prior authorization; other
states have caps.
2:53:20 PM
MS. CLARKE admitted that the department had not done a good job
in projecting this program. It missed the mark in the early
years when it was growing so fast.
CHAIR DYSON added there were no controls on who could use the
program either.
MS. CLARKE agreed and said the projected savings in their March
21 memo was very conservative. She said that as regulations were
implemented, their effects would be assessed. If individuals
were denied any level of service, they would have the right to a
fair hearing and an appeal. Services continue until they exhaust
those remedies.
2:55:05 PM
MS. CLARKE explained they also have to deal with the issue of
the growing senior population. Even if some people are dropped
off the program, more seniors are coming who would qualify for
it. She said it was possible for this program to save more than
$17 million, but she wanted to be cautious because of the
growing senior population. The newly implemented SB 41 audits
have caused a flattening out of expenditures for personal care
issues.
MS. CLARKE cautioned that she did not want seniors on the older
Alaskan waiver to be harmed through implementation of the
regulations and that good monitoring was needed. In its memo,
the department also recommended providing interim reports to the
Legislature - on July 15 and September 30, for instance. She
said the regulations have not all gone into effect yet, so she
didn't have hard data to do projections with.
2:58:25 P
SENATOR WILKEN thanked her for her timely response to the March
2 request. The thing that scares him is that the data they have
takes them only to the 2002 chart and that's just when the new
program kicked in.
So, if we think we haven't even gotten to the
expensive part, yet, where we climbed 180 percent a
year for five years.... if we look at this chart....
Alaska is spending $13,800 per person before our new
program kicks in. So, I looked at other states; I
looked at Arizona. They offer much more than what we
offer and they are spending $3,300, plus or minus.
Idaho is offering much more vision, hearing, brain,
HIV, dementia - they're offering a suite of coverage
in their state and they're at $6,600. And we're at
$13,000, almost $14,000. Montana - they offer about
what we offer - they're at $8,000. Washington - close
to us - about what we offer - $7,500. The point being,
the numbers just don't square on what we're spending.
The question is our coverage seems to be about where
other people are in our neck of the woods and why does
it cost us at least twice as much? And that's before
we get to the part where things really took off....
SENATOR WILKEN said he thought the regulations would lower the
slope, which they did, but it just flattened out. It didn't go
down.
3:01:38 PM
MR. SHERWOOD cautioned him about looking at personal care and
isolation, because different states use different strategies.
Personal care services in Alaska are a state-plan service that
is available to everybody that needs it. In some states they
limit it to offering it through their home and community based
waiver programs where people must be at the institutional level
of care. Also, the people who receive it may have access to
other supportive services, as well. A lot of other states rely
much more heavily on nursing homes to provide this kind of care.
Alaska has one of the lowest utilization of nursing homes of any
state. He said, "Although $20,000 a year sounds pretty expensive
for personal care, it's nothing compared to the cost of nursing
homes. It's not a one-for-one trade-off."
MR. SHERWOOD explained that the department's strategy is heavily
based on home and community-based care. As a result, more people
who have serious needs are served through this program than in
other states. This is an important component of the answer. He
was hopeful that implementing a standard assessment that will be
performed by an independent contractor would get them to
accurate data that would help their understanding of the
numbers. He also said the department didn't want to over-project
the possible savings because of the meteoric rise in Alaska's
senior population.
3:04:13 PM
CHAIR DYSON recalled a few years ago, it seemed that Alaskans
were doing what they should with taking care of their aging
parents and relatives. Some of those people would do more, but
have financial constraints and the state wants to subsidize
those folks a bit. However, his sense is that some people are
getting paid when they don't really need the money. He didn't
know how to sort for that kind of thing. He has talked with Ms.
Clarke for years about how foster parents are needed, but he
doesn't want people doing it as a moneymaking enterprise. He
asked if there was any discussion about this issue on a national
level.
3:06:15 PM
MR. SHERWOOD replied:
The federal government is promoting a program called
"Independence Plus," which has a lot of similarities
to Alaska's consumer directed personal care program.
Most states who participate in that program sort of
agree up front to a certain kind of cap - and states
calculate them differently - "Basically you agree to
less total service, have more flexibility in the way
you can spend your money, more control over it. These
require the use of waivers, which bring their own
administrative overhead.
He said the state has looked at those things, but it wants to
get control of the program it has now without throwing another
piece into the mix.
3:07:33 PM
CHAIR DYSON suggested that their funding may get capped at some
point and also encouraged them to continue looking for fraud.
MS. CLARKE recapped that SB 41 did a lot for the department as
far as requiring audits and those are an integral part of the
program. Better communication has been established within the
department, it has an audit committee, procedures and practices
are being set up and the Department of Law is helping them
developing sanctions. The department is doing significantly more
in that area than in the past.
3:09:52 PM
SENATOR ELTON said he was intrigued by comments about the
expanding senior population. He has heard it was growing six
times the rate of the younger population and he wanted a better
idea of the demographic changes that are coming up, because it
has huge implications to the state and how services will be
provided to that group of people. He also asked for a tracking
of the history of nursing home beds and the communities they are
in - to get some perspective on the issue. He also wanted to
know how nursing homes work in Juneau in relation to servicing
communities that don't have any, like Hoonah.
MS. CLARKE responded that she did a presentation for the Senate
Finance Committee and would be happy to meet with him and his
staff to go over the study that has a 20-year horizon.
CHAIR DYSON said that Dr. Mandsager reminded him that while the
population is growing older, it is also living healthier and
more competent for a longer period of time. The justification
for helping seniors should not lock-step with progression in
age. He asked them for any information they would have on that
issue.
3:12:49 PM
SENATOR WILKEN urged that this report needed to be updated next
year to keep things going forward.
CHAIR DYSON said the committee would write a letter for everyone
to sign asking for that updated report. There were no
objections. There being no further business to come before the
committee, Chair Dyson adjourned the Senate Health, Education
and Social Services Standing Committee meeting at 3:14:04 PM.
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