Legislature(2021 - 2022)BUTROVICH 205

02/16/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Invited & Public Testimony --
Heard & Held
-- Invited & Public Testimony --
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 16, 2021                                                                                        
                           1:31 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Mia Costello                                                                                                            
Senator Lora Reinbold                                                                                                           
Senator Tom Begich                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 65                                                                                                              
"An Act relating to immunity for consulting physicians,                                                                         
podiatrists,  osteopaths,  advanced  practice  registered  nurses,                                                              
physician assistants, dentists,  optometrists, and pharmacists."                                                                
     - HEARD & HELD                                                                                                             
SENATE BILL NO. 70                                                                                                              
"An Act relating to opioid overdose drugs; and providing for an                                                                 
effective date."                                                                                                                
     - HEARD & HELD                                                                                                             
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB  65                                                                                                                  
SHORT TITLE: LIABILITY CONSULTING HEALTH CARE PROVIDER                                                                          
SPONSOR(s): SENATOR(s) KIEHL                                                                                                    
02/03/21       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/03/21       (S)       HSS, JUD                                                                                               
02/16/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
BILL: SB  70                                                                                                                  
SHORT TITLE: OPIOID OVERDOSE DRUGS                                                                                              
SPONSOR(s): SENATOR(s) WILSON                                                                                                   
02/05/21       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/05/21       (S)       HSS                                                                                                    
02/16/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
SENATOR JESSE KIEHL                                                                                                             
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of SB 65.                                                                                         
CJ HARRELL, Intern                                                                                                              
Senator Jesse Kiehl                                                                                                             
Alaska State Legislature                                                                                                        
POSITION STATEMENT: Introduced SB 65 for the bill sponsor.                                                                    
JACOB KELLY, M.D.                                                                                                               
Alaska Heart and Vascular Institute                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified by invitation in support of SB 65.                                                              
ROBERT CRAIG, CEO                                                                                                               
Alaska Heart and Vascular Institute                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 65.                                                                            
STEVEN COMPTON, M.D., Secretary/Treasurer Elect                                                                                 
Alaska State Medical Association                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 65.                                                                            
JASMINE MARTIN, Staff                                                                                                           
Senator David Wilson                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional analysis for SB 70                                                                
on behalf of the sponsor.                                                                                                       
THERESA WELTON, Section Chief                                                                                                   
Office of Substance Misuse and Addiction Prevention (OSMAP)                                                                     
Division Public Health                                                                                                          
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified on the importance of continuing                                                                 
the standing medical order to allow distribution of naloxone,                                                                   
during the hearing on SB 70                                                                                                     
KAREN MALCOM-SMITH, founder                                                                                                     
David Dylan Foundation                                                                                                          
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 70.                                                                            
KATIE BOTZ, representing self                                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 70.                                                                            
ACTION NARRATIVE                                                                                                              
1:31:00 PM                                                                                                                    
CHAIR DAVID  WILSON called the  Senate Health and  Social Services                                                            
Standing Committee  meeting to order  at 1:31 p.m. Present  at the                                                              
call to  order were Senators  Costello, Hughes, Begich,  and Chair                                                              
Wilson. Senator Reinbold arrived shortly thereafter.                                                                            
        SB 65-LIABILITY CONSULTING HEALTH CARE PROVIDER                                                                     
1:31:39 PM                                                                                                                    
CHAIR WILSON  announced the  consideration of  SENATE BILL  NO. 65                                                              
"An   Act  relating   to  immunity   for  consulting   physicians,                                                              
podiatrists,  osteopaths,  advanced  practice  registered  nurses,                                                              
physician  assistants, dentists,  optometrists, and  pharmacists."                                                              
He stated  his intent  to hear an  overview of  the bill  and take                                                              
testimony  and  hold  the  bill   for  further  consideration.  He                                                              
invited sponsor Senator Kiehl and his staff to the table.                                                                       
1:32:13 PM                                                                                                                    
SENATOR  JESSE KIEHL,  Alaska State  Legislature, Juneau,  Alaska,                                                              
Sponsor of SB 65, introduced himself.                                                                                           
1:32:29 PM                                                                                                                    
CJ   HARRELL,   Intern,   Senator  Jesse   Kiehl,   Alaska   State                                                              
Legislature,  Juneau,  Alaska, stated  that  in Alaska  and  other                                                              
states,  healthcare   providers  will   seek  the  knowledge   and                                                              
expertise   of  fellow   medical   professionals   to  help   them                                                              
understand how to  help their patients in an  effective and timely                                                              
manner. These conversations  can be an official  consultation, but                                                              
more  often than  not, medical  professionals will  have what  are                                                              
called   curbside  consultations.   This  is   when  a   patient's                                                              
healthcare  provider has an  uncompensated, informal  consultation                                                              
with  another  medical  professional.   These  consulting  medical                                                              
professionals  are   often  specialists   and  do  not   have  any                                                              
relationship with the  patient under discussion. It  is a fast and                                                              
effective  way  of sharing  knowledge  and  expertise  and is  the                                                              
backbone  of   medical  care.  Two   years  ago  in   Minnesota  a                                                              
healthcare  provider who  had  no relationship  to  a patient  was                                                              
forced to  defend themselves against  a civil liability  case. The                                                              
fear is that by  not protecting those who have  no relationship to                                                              
a  patient and  are  sharing their  expertise  through a  curbside                                                              
consultation  providers  will no  longer feel  comfortable  aiding                                                              
fellow  healthcare  providers  in  that  way.  SB  65  will  allow                                                              
curbside consultations  to continue, but without  the potential to                                                              
become subject  to civil  liability for a  patient with  whom they                                                              
have no actual relationship.                                                                                                    
1:33:59 PM                                                                                                                    
SENATOR BEGICH  commented that there  had been good  conversations                                                              
last year about  a similar bill. He sees that most  of the changes                                                              
were incorporated in  this version of the bill. He  noted he spoke                                                              
to Senator Kiehl  a bit about the telehealth issues.  Now that the                                                              
emergency  order  which  extended  telehealth is  gone,  he  asked                                                              
Senator  Kiehl if  the  bill has  any relationship  to  telehealth                                                              
that could be explored.                                                                                                         
SENATOR KIEHL replied  he doesn't see a hook  to telehealth, which                                                              
is  generally  direct  patient   care  and  if  not  face-to-face,                                                              
camera-to-camera,   which   does   establish  a   doctor   patient                                                              
relationship.  There   is  a  duty  of  care.   Curbside  consults                                                              
frequently  involve  doctors  on  the phone,  but  the  consulting                                                              
doctor is not seeing the patient.                                                                                               
SENATOR BEGICH  clarified that in  a three-person  scenario, there                                                              
is  a  curbside  consult,  the doctor  who  is  dealing  with  the                                                              
patient, and the patient.                                                                                                       
SENATOR  KIEHL  responded  that  in that  scenario,  the  treating                                                              
healthcare  professional  may  seek  a  curbside  consult  with  a                                                              
colleague.  This bill protects  that curbside  consult as  long as                                                              
the  consulting physician  is  not laying  hands  on the  patient,                                                              
even virtually. Therefore, they would not be liable.                                                                            
SENATOR BEGICH  asked what  the estimated cost  is to  Alaskans if                                                              
this  bill  did  not  pass, in  terms  of  things  like  liability                                                              
insurance. He asked if that is what is driving the bill.                                                                        
SENATOR KIEHL  answered that cost of  liability is one  of the key                                                              
drivers.  The financial  cost would  be difficult  to figure  out.                                                              
The  potential   for  increased   medical  malpractice   costs  is                                                              
significant,  although he  doesn't  have a  number  for that.  The                                                              
potential  cost  to the  healthcare  system  as  a whole  is  much                                                              
greater.  The  potential is  the  effect  on  a doctor  who  might                                                              
previously  have  called  a  specialist  about a  transport  or  a                                                              
referral for  a workup. When  the answer can  safely be no,  a lot                                                              
of money is saved  compared to the specialist  not being available                                                              
for a free  consult and saying the  patient must be sent.  That is                                                              
a risk the state needs to avoid.                                                                                                
1:38:03 PM                                                                                                                    
SENATOR REINBOLD  asked if the bill  has any protection  in regard                                                              
to administering the mRNA vaccines.                                                                                             
SENATOR  KIEHL  replied  not  directly,   but  he  could  see  the                                                              
potential  implication. If  a healthcare  provider  had a  patient                                                              
who is  medically fragile or  has complicating medical  conditions                                                              
and wanted  to call  a specialist to  see if those  contraindicted                                                              
giving the  shot, the  state would  want them to  be able  to make                                                              
that call and SB 65 would help make that a safe call.                                                                           
SENATOR   REINBOLD  asked   if  the  bill   protects  the   person                                                              
administering the shot.                                                                                                         
SENATOR  KIEHL  answered  that  that  person  lays  hands  on  the                                                              
patient  and would  retain whatever  liability  that person  would                                                              
otherwise  have if  there  was a  bad  reaction  that might  cause                                                              
SENATOR REINBOLD advised  that safety with vaccines  will be a top                                                              
issue  with  her.  She  wanted   to  make  sure  there  were  zero                                                              
protections  regarding vaccinations.  The Judiciary Committee  has                                                              
talked  about   informed  consent  required  with   emergency  use                                                              
authorization  of vaccines.  She hopes the  long-term effects  are                                                              
fine, but no one  knows what they are. She is happy  to know there                                                              
is  zero protection  for those  people involved  with vaccines  in                                                              
this bill.                                                                                                                      
1:41:05 PM                                                                                                                    
SENATOR  HUGHES asked  about  a  scenario in  which  someone in  a                                                              
coffee line  asks a provider who  has not treated or done  an exam                                                              
of that person for  advice and that person takes  that advice, but                                                              
the person  has an  adverse reaction  when following that  advice.                                                              
She asked if this bill could relieve that provider of liability.                                                                
SENATOR KIEHL replied  SB 65 would not apply to  that scenario. SB
65 covers consultations between healthcare providers.                                                                           
SENATOR HUGHES asked him to point that out in the bill.                                                                         
SENATOR KIEHL  responded that  page 1,  line 7, provides  immunity                                                              
to  a consulting  healthcare provider.  Page 2,  line 20,  defines                                                              
the consulting  healthcare provider,  someone who provides  advice                                                              
to  another  healthcare provider  and  then  there  is a  list  of                                                              
licensed healthcare providers.                                                                                                  
SENATOR  HUGHES  referred  to  page 2,  line  14,  beginning  with                                                              
number  9, a written  report  is not created  as  a result of  the                                                              
consultation.  She asked  again about a  coffee line  conversation                                                              
in which one provider  speaks to another provider and  a report is                                                              
written  and patient  treated accordingly.  If  the patient  sues,                                                              
she asked if that  would be considered a written  report or should                                                              
the  bill specify  the  written  report must  be  prepared by  the                                                              
consulting provider.                                                                                                            
SENATOR KIEHL replied  that he doesn't know if  that clarification                                                              
would be  in any way  harmful. It matches  the intent  because the                                                              
liability shield  is provided  to the  consulting provider.  It is                                                              
not   strictly  necessary.   If   he  understands   her   scenario                                                              
correctly,  the   treating  provider  writes  the   report.  Their                                                              
liability  rests with  the treatment  they provided,  irrespective                                                              
of the report, but he sees no harm in that clarification.                                                                       
SENATOR  HUGHES  said  that  she   did  not  want  to  imply  that                                                              
healthcare  providers are  nefarious, but  she could  see that  if                                                              
someone  took some  informal advice  in the coffee  line and  then                                                              
there was  an adverse result and  the patient sued,  that provider                                                              
may try to create  a report saying they received  that advice from                                                              
another  physician in  order to  spread the  burden of  liability.                                                              
She could see  the need for clarification that  the written report                                                              
would  be by  the  consulting provider  to  prevent  that type  of                                                              
situation, even though  it would be rather unlikely.  She asked if                                                              
Senator Kiehl would entertain that as a friendly amendment.                                                                     
SENATOR  KIEHL  responded  that   he  had  no  objection  to  that                                                              
1:45:51 PM                                                                                                                    
CHAIR WILSON called on invited testimony.                                                                                       
1:46:11 PM                                                                                                                    
JACOB   KELLY,  M.D.,   Alaska  Heart   and  Vascular   Institute,                                                              
Anchorage,  Alaska,  said  SB  65  allows  physicians  to  provide                                                              
unencumbered clinical  expertise to  help patients across  Alaska.                                                              
Alaska's  value  and mission  is  to  take  care of  all  Alaskans                                                              
regardless  of location  and ability  to pay.  This allows  better                                                              
local  care and  leads to  decreased  inappropriate transfers.  It                                                              
allows patients  to be cared  for where  they are safer.  It would                                                              
ultimately reduce  cost. He  receives from 2  to 10 calls  a night                                                              
from  various  cities from  nurse  practitioners,  emergency  room                                                              
physicians, family  physicians, and other specialists.  It is nice                                                              
to  be able  to  support  them in  their  decision-making  without                                                              
concern about  litigation when  he has no  access to  the patient,                                                              
their  records or  data.  As a  heart failure  specialist,  people                                                              
have questions  for him about how  to titrate medications.  It can                                                              
be difficult to  transfer a patient to Anchorage  for an expensive                                                              
visit  when  a  slight titration  of  medications  would  lead  to                                                              
improved survival and quality of life.                                                                                          
SENATOR HUGHES commented  that it is important  to share knowledge                                                              
among experts  in the field. Now  that there is a precedence  of a                                                              
consulting  provider   being  sued   in  another  state,   she  is                                                              
concerned that it  might inhibit good conversations  and knowledge                                                              
sharing  between   providers.  She  asked  if  it   could  inhibit                                                              
knowledge sharing if SB 65 does not pass.                                                                                       
DR. KELLY  agreed that  it would make  providers more  reticent in                                                              
answering  specific questions.  He  would be  more  likely have  a                                                              
patient transported  to Anchorage to  one of the  larger hospitals                                                              
to provide care that could have been delivered locally.                                                                         
SENATOR  REINBOLD asked  if  SB 65  could  reduce his  malpractice                                                              
DR.  KELLY  deferred  the  question   to  Robert  Craig.  He  said                                                              
physicians  see  this as  allowing  better  quality of  care  with                                                              
fewer  restrictors.  It  is about  feeling  comfortable  providing                                                              
care and allowing people to get the best care they can.                                                                         
1:50:58 PM                                                                                                                    
ROBERT   CRAIG,  CEO,   Alaska  Heart   and  Vascular   Institute,                                                              
Anchorage,  Alaska,  said  he doesn't  anticipate  any  change  to                                                              
malpractice  premiums. That  is  not part  of  the motivation  for                                                              
support of  the bill.  The institute's  cardiologists are  on call                                                              
and available for  the state 24/7. That coverage is  not part of a                                                              
telehealth  obligation;  these  are  not their  patients  and  the                                                              
institute  is  not  reimbursed   for  the  call.  The  institute's                                                              
cardiologist in  Anchorage can take a  call any time day  or night                                                              
from  a  treating  physician.  The  cardiologist  has  no  patient                                                              
record or  relationship, which  places a  special burden  on their                                                              
doctors  to  be  open  to  potential  civil  liability.  They  are                                                              
primarily  interested in  giving timely  and accurate  information                                                              
to  another  treating  physician.  The  option is  to  advise  the                                                              
treating physician  to send the patient to Anchorage  or request a                                                              
formal  consultation, which  delays  care  and/or increases  cost.                                                              
The goal  of the institute's doctors  is to continue to  provide a                                                              
high level  of cardiology  service to the  state's providers  in a                                                              
high-quality and low-cost manner.                                                                                               
SENATOR  REINBOLD commented  on her  intentions when  the bill  is                                                              
heard in  the next committee of  referral, and expressed  a desire                                                              
to see malpractice premiums to go down.                                                                                         
1:54:39 PM                                                                                                                    
STEVEN  COMPTON,  M.D., Secretary/Treasurer  Elect,  Alaska  State                                                              
Medical  Association,  Anchorage,   Alaska,  said  he  is  another                                                              
cardiologist  at Alaska  Heart and  Vascular Institute  but he  is                                                              
there representing  the Alaska  State Medical Association  (ASMA).                                                              
The  institute estimates  it is  doing 10-20  curbside consults  a                                                              
day across  the state. Some  are urgent and  some are not  so bad.                                                              
Sometimes  the   referring  doctor  is  overly  worried   and  the                                                              
cardiologists  can calm  them down.  Sometimes it  is the  reverse                                                              
and  a  patient needs  to  come  in  right  away. Many  times  the                                                              
problem  can be managed  locally.  Alaska has  a greater need  for                                                              
this sort of  referral network and informal consultation  than any                                                              
other state  because of its  size. Because  it is so  large, there                                                              
are healthcare inequities.  Someone who lives in a  village in the                                                              
Yukon does not have  access to the same care as  someone who lives                                                              
in  a  big  city.  Alaska  has  excellent  telecommunications  and                                                              
expert opinions can  be provided to every corner of  the state. He                                                              
has  been practicing  in Alaska  for  20 years.  The consults  are                                                              
done for  free as  part of their  duty to  citizens of  the state.                                                              
About a  year and  a half ago  their insurer asked  to speak  at a                                                              
partner  meeting. The  insurer reviewed  the  Minnesota case  that                                                              
Senator Kiehl  alluded to  and a  few others  pending at  the time                                                              
and said this  will be a problem  if it is not nipped  in the bud.                                                              
The insurer  anticipated a potential  increase in rates,  and said                                                              
he needed  to talk there needs  to be a discussion  about curbside                                                              
DR. COMPTON  said the insurer said  the institute could  give very                                                              
general  ideas  about  how to  manage  a  case,  but if  there  is                                                              
anything  specific, the doctors  could potentially  be liable  for                                                              
anything that  happens with a  case. The institute's  insurers are                                                              
saying they  should either  not do this  or transport  everyone to                                                              
Anchorage  or address  this legislatively.  That is  why they  are                                                              
here. This  is not just a  cardiology issue. Every  specialty gets                                                              
these  calls from  around the  state.  All providers  do this  and                                                              
think this  is an important service.  He had not  appreciated that                                                              
until the conversation  with the insurer. This  is the lubrication                                                              
for  this whole  machine and  help avoid  inappropriate costs  and                                                              
help provide  excellent care in  remote places. The  ASMA supports                                                              
SB 65.                                                                                                                          
SENATOR REINBOLD  thanked Dr.  Compton for  his work and  powerful                                                              
SENATOR BEGICH agreed that his testimony makes a big difference.                                                                
2:00:07 PM                                                                                                                    
CHAIR WILSON  opened public testimony  on SB 65; finding  none, he                                                              
closed public testimony.                                                                                                        
He held SB 65 in committee.                                                                                                     
2:00:45 PM                                                                                                                    
At ease                                                                                                                         
                  SB  70-OPIOID OVERDOSE DRUGS                                                                              
2:02:56 PM                                                                                                                    
CHAIR   WILSON   reconvened   the  meeting   and   announced   the                                                              
consideration  of SENATE BILL  NO. 70 "An  Act relating  to opioid                                                              
overdose drugs; and providing for an effective date."                                                                           
Speaking  as sponsor,  he explained  that  the bill  started as  a                                                              
disaster  declaration by  former  Governor Bill  Walker in  Senate                                                              
Bill  91, which  passed  in  2017. The  intent  was  to allow  the                                                              
medical officer at  that time, Dr. Jay Butler,  to permit naloxone                                                              
to  be  administered  under  a   four  year  federal  grant.  This                                                              
committee  amended the  bill to  extend the  declaration for  four                                                              
years to allow for the federal funding.                                                                                         
CHAIR  WILSON  said  the  medical  office  still  has  funding  to                                                              
administer this  program. Naloxone is not a  controlled substance.                                                              
It  has  no   potential  for  abuse.  This   legislation  benefits                                                              
Alaskans  by saving  lives. It  translates to  direct savings  for                                                              
emergency  services  and  law  enforcement  and  gives  those  who                                                              
overdose  a greater  chance of living  and an  opportunity  to get                                                              
into treatment.                                                                                                                 
2:05:09 PM                                                                                                                    
JASMINE  MARTIN,   Staff,  Senator  David  Wilson,   Alaska  State                                                              
Legislature,  Juneau,  Alaska, presented  the  sectional  analysis                                                              
for SB 70 on behalf of the sponsor.                                                                                             
     Section 1: Repeals language regarding the sunset of the                                                                    
     original authorization.                                                                                                    
MS. MARTIN noted that Section 1 is conforming to Section 3.                                                                     
     Section 2: Repeals reporting requirement associated with                                                                   
     Substance Abuse and Mental Health Services Administration                                                                  
     grants and the opioid epidemic.                                                                                            
MS.  MARTIN  said  this  was  a   reporting  requirement  for  the                                                              
Department  of Health and  Social Services  (DHSS) related  to the                                                              
opioid epidemic and these grants.                                                                                               
     Section 3: Repeals the sunset date of the original                                                                         
     Section 4: Immediate effective date.                                                                                       
2:06:06 PM                                                                                                                    
SENATOR BEGICH  questioned the reasoning  to repeal  the reporting                                                              
requirement  since part  of the  value of the  report process  was                                                              
for the legislature to know the status of the opioid epidemic.                                                                  
MS. MARTIN  answered that reports  take a lot of  the department's                                                              
time, and  the information is  still available to  the legislature                                                              
if  requested.  The  report  made  sense when  this  was  a  pilot                                                              
program but  as it is continuing  into perpetuity the idea  is not                                                              
to make the department continue to report.                                                                                      
CHAIR WILSON  said that  he put the  reporting requirement  in the                                                              
initial bill  and neglected  to put  an end  date. If  the program                                                              
were to  end in June,  the department by  law still would  have to                                                              
report to the  legislature. He didn't want to  have the department                                                              
continue to do a  report if the federal funds end.  The report was                                                              
just on the federal funding of the program.                                                                                     
SENATOR BEGICH  commented that  the bill  also repeals  the sunset                                                              
clause, which  implies the  program will  be continuous.  He asked                                                              
the  reason  for  repealing  the   reporting  requirement  if  the                                                              
program is going to continue.                                                                                                   
CHAIR  WILSON  replied   the  department  has  many   reports  for                                                              
programs that  are no longer relevant  and he did not  want to add                                                              
to that for a  program that may eventually sunset.  He said he was                                                              
willing to amend the bill to reinsert  the reporting requirement.                                                               
SENATOR BEGICH  suggested keeping the reporting  requirement until                                                              
the state  is no longer getting  federal resources.  Otherwise, it                                                              
would  be  difficult  for  the legislature  to  keep  track  on  a                                                              
regular  basis.  He  offered  his  view  that  Section  2  is  not                                                              
necessary  because   of  Section  3.  If  the   sunset  clause  is                                                              
eliminated, there should be reports.                                                                                            
MS. MARTIN  explained that the bill  doesn't create a  program. It                                                              
allows the  chief medical officer  to issue a standing  order, but                                                              
it doesn't require it.                                                                                                          
SENATOR BEGICH  said the legislature  wanted a report so  it would                                                              
know when  that authority was exercised.  He said he  will support                                                              
the bill, but  he wants to do  the right thing with  the structure                                                              
of the bill.                                                                                                                    
2:11:41 PM                                                                                                                    
SENATOR  REINBOLD commented  on the  Opioid crisis,  and said  the                                                              
question of  why the report  is no longer  necessary, needs  to be                                                              
CHAIR WILSON  explained that  he threw  in the report  requirement                                                              
just to  follow the  federal funding  of the  new program.  If the                                                              
committee  wants the reports  continued into  perpetuity,  then he                                                              
is  open  to that.  The  department  can  speak about  the  effort                                                              
involved with the report.                                                                                                       
2:13:53 PM                                                                                                                    
SENATOR COSTELLO asked if the report is online or printed.                                                                      
CHAIR WILSON called on Ms. Welton to answer.                                                                                    
2:14:11 PM                                                                                                                    
THERESA  WELTON, Section  Chief,  Office of  Substance Misuse  and                                                              
Addiction Prevention  (OSMAP), Division Public  Health, Department                                                              
of Health  and Social  Services (DHSS),  Juneau, Alaska,  answered                                                              
that  the reports  are  available  online on  the  website of  her                                                              
office  and are provided  to the  legislature  by October  1 every                                                              
SENATOR  COSTELLO  asked  if  the report  to  the  legislature  is                                                              
printed or online electronically.                                                                                               
MS. WELTON replied both.                                                                                                        
SENATOR  COSTELLO  said  if  the   committee  wants  to  keep  the                                                              
reporting  requirement,  the committee  could  ask  for  it to  be                                                              
SENATOR REINBOLD noted  that there is no fiscal impact,  so she is                                                              
leaning  toward  keeping  the  report.  She  agrees  with  Senator                                                              
Costello  that   an  online  report   is  fine.   Hiland  Mountain                                                              
Correctional Center  is in her district,  and she knows  that this                                                              
medication is important and has saved lives.                                                                                    
CHAIR WILSON asked Ms. Welton to give her presentation.                                                                         
2:16:48 PM                                                                                                                    
MS.  WELTON said  she would  be  testifying on  the importance  of                                                              
removing the  June 30, 2021 sunset  clause to allow  for perpetual                                                              
authorization of  the standing medical order for  distribution and                                                              
administration of  naloxone, an opiate overdose reversal  drug, by                                                              
any Alaskan.                                                                                                                    
MS. WELTON  said an  overdose only takes  minutes. If  naloxone is                                                              
not randomly  available to  the individual  or individuals  around                                                              
the person  who overdosed, that person  might have to wait  for 20                                                              
minutes for  EMS (Emergency  Management Services)  to arrive  with                                                              
naloxone, which could be too late.                                                                                              
MS.  WELTON displayed  a graph  on  slide 3  showing the  national                                                              
trends   of    opioid   overdoses.   Overdoses    are   increasing                                                              
significantly,   especially  for   synthetic   opioids,  such   as                                                              
tramadol and fentanyl.                                                                                                          
MS.  WELTON  said too  many  Alaskans  have  lost their  lives  to                                                              
overdoses,   even  though   that   is  preventable   with   timely                                                              
administration of  naloxone. In Alaska  overdoses were one  of the                                                              
top  10   causes  of  death  in   2017.  Overdoses  can   cause  a                                                              
significant  medical  impact in  a  person  who does  not  receive                                                              
timely administration  of  naloxone. It takes  just three  minutes                                                              
for someone  who overdoses  to experience  brain damage,  a costly                                                              
and  life-long  diagnosis.  It  takes  three-to-four  minutes  for                                                              
paramedics  to arrive  at a scene  in Anchorage.  At times  people                                                              
die within  eight minutes of an  overdose. In rural areas,  it can                                                              
take  10-20   minutes  and   generally  much   longer  for   first                                                              
responders  to appear on  the scene.  People who survive  overdose                                                              
with brain  damage may also  have resulting kidney  failure, heart                                                              
complications, neurological consequences, and more.                                                                             
2:19: PM                                                                                                                      
MS.  WELTON  said  that  in  the  U.S.  and  in  Alaska  synthetic                                                              
opiates, primarily  illicitly manufactured fentanyl,  appear to be                                                              
the  primary driver  of  the increases  in  overdose deaths.  They                                                              
have  increased 38.4  percent from  the  12 months  leading up  to                                                              
June  2019 compared  to  the 12  months leading  up  to May  2020.                                                              
Overdoses from  May 2020  to September  appear to outnumber  2019,                                                              
marking  the highest  overdose  death  rate in  over  a decade  in                                                              
Alaska, next to 2017.                                                                                                           
SENATOR  BEGICH asked  why  there  is an  asterisk  after 2019  on                                                              
slide 5.                                                                                                                        
MS.  WELTON  answered  there is  a  lack  of  data for  the  final                                                              
quarter of 2019.                                                                                                                
SENATOR BEGICH asked if the numbers could be even higher.                                                                       
2:20:44 PM                                                                                                                    
MS.  WELTON   replied  that  is   correct.  Continuing   with  the                                                              
presentation,  she said  42 states  and the  District of  Columbia                                                              
have   enacted  naloxone   standing  orders.   The  World   Health                                                              
Organization, the  U.S. Surgeon General, and the  American Society                                                              
of Addiction  Medicine have  officially recommended  that naloxone                                                              
be  accessible  to those  who  are  closest  to the  person  using                                                              
MS.  WELTON  said  the standing  medical  order  currently  allows                                                              
naloxone  to  be   dispensed  to  any  individuals   who  are  not                                                              
prescribers,  a practice  that would  be  prohibited. Naloxone  is                                                              
not a  controlled substance,  has no potential  for abuse,  and is                                                              
safe  to use.  By removing  the  sunset date,  local and  regional                                                              
overdose response  programs, first  responders, the  Department of                                                              
Public  Safety, the  Department  of Corrections,  and the  general                                                              
public will  continue to have  the ability to directly  distribute                                                              
and use the life-saving drug naloxone.                                                                                          
MS.  WELTON said  with the  foundation  of the  standing order  in                                                              
2017, the department  was able to start the program  Project HOPE,                                                              
Harm-reduction  Overdose Prevention  and  Education. Project  HOPE                                                              
works  with community  organizations to  distribute or  administer                                                              
NARCAN, otherwise  known as naloxone, in Alaska.  Since inception,                                                              
127  community partners  have  distributed  over 41,000  federally                                                              
funded NARCAN kits.  Of the 320 documented  NARCAN administrations                                                              
originating  from Project  HOPE, overdoses  have been reversed  at                                                              
least  309  times. Alaskan  subject-matter  experts  believe  that                                                              
when there  was a 28 percent  decrease in overdose deaths  in 2018                                                              
compared  to  2017,  it  was  largely  the  result  of  a  maximum                                                              
distribution of  naloxone by Project  HOPE for lay persons  to use                                                              
across Alaska.                                                                                                                  
2:23:04 PM                                                                                                                    
MS. WELTON  said that timely  administration of naloxone  provides                                                              
opportunity   for  recovery,   and  saving   lives  saves   costs.                                                              
According  to  the  Society  of   Actuaries,  40  percent  of  the                                                              
economic burden  of the opioid crisis  is driven by  lost lifetime                                                              
earnings  for those  who died  prematurely. Nearly  33 percent  is                                                              
for excess  healthcare spending, another  15 percent is  from lost                                                              
productivity  in  the  workforce,  and  6 percent  is  from  costs                                                              
associated with criminal  justice. An estimated 29  percent of the                                                              
economic   burden  is   borne  by   federal,   state,  and   local                                                              
MS.  WELTON  said  the  current   standing  medical  order  allows                                                              
naloxone  to  be   dispensed  by  any  individuals   who  are  not                                                              
prescribers.  By  removing the  sunset  date, local  and  regional                                                              
overdose response  programs, first responders, the  Departments of                                                              
Public  Safety  and  Corrections,  and  the  general  public  will                                                              
continue  to have  the ability  to directly  distribute the  life-                                                              
saving drug  naloxone. Without  passage of  SB 70, naloxone  would                                                              
only be  available to those  with a prescription  or by  EMS. This                                                              
is  why it  is  imperative to  continue  to make  naloxone  widely                                                              
available to  save many  lives that otherwise  would be  lost from                                                              
2:24:45 PM                                                                                                                    
SENATOR  REINBOLD  commented that  the  bill  sounds like  a  good                                                              
idea.  She asked  how much  each  kit cost  and who  picks up  the                                                              
MS.  WELTON replied  the  cost for  the  naloxone  kits are  borne                                                              
entirely  by federally-funded  grants. The  approximate cost  of a                                                              
kit, which  contains two doses  of naloxone, additional  education                                                              
and harm  reduction efforts  and information  for treatment,  cost                                                              
less than $4.  There is no cost  to the user or  the distributors.                                                              
Project HOPE is  fully funded for both the substance  naloxone and                                                              
the  coordinator position.  The  state has  full  funding for  the                                                              
next two  years for Project  HOPE. There  are no state  funds used                                                              
for  the  kits.  The Office  of  Substance  Misuse  and  Addiction                                                              
Prevention  (OSMAP) is  applying  for another  federal grant  that                                                              
will provide complete funding it for five years.                                                                                
SENATOR REINBOLD commented  that at some point she  would like the                                                              
program to  be user  paid and not  government paid.  She suggested                                                              
the program needs to be evaluated and perhaps restructured.                                                                     
2:27:56 PM                                                                                                                    
SENATOR  COSTELLO  expressed  appreciation  for  the  program  and                                                              
those who  administer it. She said  the report is helpful,  but it                                                              
does not replace  a hearing and public testimony  and the learning                                                              
that  happens for  the  public when  legislation  that sunsets  is                                                              
before the committee.                                                                                                           
SENATOR  BEGICH asked  Ms. Welton  to describe  the experience  of                                                              
receiving naloxone, as he was sure that it was not pleasant.                                                                    
MS. WELTON  replied it is not  a pleasant experience  when someone                                                              
is administered  naloxone in an  overdose state.  Its biochemistry                                                              
blocks  the  opiate  receptors,  the "high,"  and  the  subsequent                                                              
medical event  of the  cascade of  an overdose  is stopped  in its                                                              
tracks.  People have  a tendency  to  wake up  angry and  confused                                                              
with an intense  headache and potential other  medical conditions,                                                              
but they  are alive. That  gives them an  opportunity to  get into                                                              
SENATOR BEGICH  said her response  underscores what  the committee                                                              
heard  from Dr.  Butler  on the  subject.  It  is very  unpleasant                                                              
experience.  To Senator Reinbold's  point,  he said he  recognizes                                                              
and acknowledges that  at some point people have to  pay the price                                                              
for their  actions.  He offered  his belief that  the report  does                                                              
not need to  be so lengthy. He  noted that the committee  heard an                                                              
executive order  related to  the departmental  split. He  asked if                                                              
that split will have any impact on SB 70.                                                                                       
CHAIR  WILSON asked  if  OSMAP would  stay  in  the Department  of                                                              
Health or be in the Department of Child Services.                                                                               
MS. WELTON  responded that  OSMAP would be  in the new  Department                                                              
of Health. The split would not impact OSMAP or Project HOPE.                                                                    
SENATOR BEGICH  wondered whether  the chief medical  officer would                                                              
be in a supervisory role.                                                                                                       
SENATOR REINBOLD  commented further on the importance  of personal                                                              
responsibility  related to the  opioid crisis.  She segued  to the                                                              
covid  crisis and  the  impact  that had  on  all  sectors of  the                                                              
population She  asked if there has  been an increase  in overdoses                                                              
and naloxone use since March 2020.                                                                                              
2:34:25 PM                                                                                                                    
MS.  WELTON  answered  that  the  state  has  seen  an  uptick  in                                                              
overdose deaths  in the first three  quarters of 2020  compared to                                                              
2019 and definitely  to 2018. Due to COVID  circumstances, getting                                                              
the kits built  this past year has been challenging  because OSMAP                                                              
relies  on volunteer  groups to  put them together  and OSMAP  has                                                              
had to  adjust to  social distancing.  The distribution  of NARCAN                                                              
kits by partners  has also been affected. It could  be that not as                                                              
much naloxone  has been  distributed in  2020 or  it could  be the                                                              
circumstance of  increased mental health complications  as well as                                                              
substance misuse.  Those numbers are being reviewed  and causation                                                              
SENATOR  REINBOLD explained  that  she is  trying to  look at  the                                                              
difference  between  lockdowns   and  non-lockdowns  on  regional,                                                              
state, and  national levels. She has  heard suicide is  up but she                                                              
did  not have  numbers. She  asked how  significant the  increased                                                              
number of deaths  is and what type of numbers she  had for various                                                              
MS.  WELTON   replied  she  was   using  approximate   numbers  as                                                              
represented  by the  bar graph.  For the first  three quarters  of                                                              
2018, there  were about 70 overdose  deaths and about 100  for the                                                              
first three  quarters of  2019, a  little over  100 for  the first                                                              
three quarters of 2020. She declined to comment on causation.                                                                   
SENATOR  REINBOLD  said she  is  looking  for actual  numbers  for                                                              
overdoses   and  how  much   naloxone  saved   lives.  She   wants                                                              
information from  March 2020  when it is  available, not  just the                                                              
first quarter, because  she wants to know the impact  of the covid                                                              
2:39:05 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 70.                                                                                  
2:39:22 PM                                                                                                                    
KAREN MALCOM-SMITH,  founder, David  Dylan Foundation,  Anchorage,                                                              
Alaska, said she  is a self-funded advocate for the  vast arena of                                                              
issues surrounding  stigma, including  healthcare, education,  and                                                              
law  enforcement. She  is a  member  of the  Alaska Mental  Health                                                              
Advisory Board.  Her testimony is  strictly personal and  does not                                                              
represent  the board. In  June of  2017, just  one month  short of                                                              
NARCAN accessibility  to  the public without  a prescription,  her                                                              
25-year-old  son,  Dylan,  passed   away  from  an  overdose.  His                                                              
dependency  followed  a  near-fatal   ATV  accident  when  he  was                                                              
irresponsibly  cut  off without  a  taper  after three  months  of                                                              
morphine and  oxycodone. At 25 he  relapsed and had  just returned                                                              
from  treatment when  he passed  away. The  man who  was with  him                                                              
called  911 immediately.  The first  responders  were there  right                                                              
away but  did not  carry NARCAN.  They could  possibly have  saved                                                              
him.  In addition  to  the  statistics  the committee  heard,  she                                                              
wants to  add that nationally, the  overdose rate is up  almost 38                                                              
percent for the first three quarters of 2020.                                                                                   
MS. MALCOM-SMITH  said that in her  work, she has come  into close                                                              
contact  with families  who are  experiencing the  same loss.  She                                                              
represents  other mothers  who have  experienced first  responders                                                              
not carrying  NARCAN. Lisa Sauder who  runs Bean's Caf?  is one of                                                              
them. They strongly  support SB 70 and strongly  encourage that in                                                              
the future, it  should be mandatory for first  responders to carry                                                              
NARCAN. She knows  eight people whose children's  lives would have                                                              
been saved.  Her son  was a  stellar human  being and citizen  who                                                              
had a  warrior's heart. Police  officers and emergency  responders                                                              
should carry NARCAN.                                                                                                            
2:44:37 PM                                                                                                                    
KATIE BOTZ,  representing self,  Juneau, Alaska, recalled  sitting                                                              
in one  of the legislative rooms  testifying for NARCAN.  She lost                                                              
a friend  around 2017 due  to an opioid  overdose. He hid  his use                                                              
of drugs  very well.  It is important  to her  that NARCAN  get in                                                              
the hands  of healthcare  providers and  the police department  to                                                              
help in  cases of  opioid overdoses.  It is  discouraging  to hear                                                              
cases of  police and responders not  having it on hand.  She asked                                                              
the  legislature to  make it  mandatory  for healthcare  providers                                                              
and police officers to have NARCAN on hand.                                                                                     
2:47:35 PM                                                                                                                    
CHAIR WILSON closed public testimony on SB 70.                                                                                  
SENATOR REINBOLD  thanked Ms. Malcom-Smith  for her  testimony and                                                              
for serving  on the  board of  the Alaska  Mental Health  Advisory                                                              
Board and  expressed sorrow  for her loss.  She asked her  to send                                                              
any numbers  that she has  about overdoses  and the use  of NARCAN                                                              
or anything about the impact since March to the chair.                                                                          
2:49:43 PM                                                                                                                    
CHAIR WILSON said  he heard the committee's concerns  and he would                                                              
offer a  committee substitute  (CS) that  leaves in the  reporting                                                              
CHAIR WILSON held SB 70 in committee for further consideration                                                                  
2:50:44 PM                                                                                                                    
There  being no  further business  to come  before the  committee,                                                              
Chair  Wilson adjourned  the  Senate  Health and  Social  Services                                                              
Standing Committee meeting at 2:50 p.m.                                                                                         

Document Name Date/Time Subjects
SB 65 version B.pdf SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 Sponsor Statement 2.4.2021.pdf HHSS 4/27/2021 3:00:00 PM
HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
HJUD 5/5/2021 1:00:00 PM
HJUD 5/17/2021 1:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 Sectional Analysis v. B 2.4.2021.pdf HHSS 4/27/2021 3:00:00 PM
HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 Letter of Support ASMA 2.11.2021.pdf HHSS 4/27/2021 3:00:00 PM
HHSS 4/29/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 FN Dept of Law.pdf HHSS 4/29/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB70 v. A.PDF SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Sponsor Statement 2.10.21.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Sectional Summary v. A 2.10.21.pdf SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Naloxone Standing Order Fact Sheet1-21-21.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Opioid Leg Report DHSS 9.28.20.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 FN DHSS.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 SLA 2017 SB 91.PDF HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Opioid Leg Report DHSS 2017-18.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Opioid Leg Report DHSS 2018-19.pdf SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 DHSS Invited Testimony - SHSS - 02162021 Clean.pptx SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Letters of Support, Redacted, 2.16.21.pdf SHSS 2/16/2021 1:30:00 PM
SB 70