04/09/2009 01:09 PM Senate L&C
| Audio | Topic |
|---|---|
| Start | |
| SB187 | |
| HB129 | |
| SB12 | |
| SB61 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
April 9, 2009
1:09 p.m.
MEMBERS PRESENT
Senator Joe Paskvan, Chair
Senator Joe Thomas, Vice Chair
Senator Bettye Davis
Senator Kevin Meyer
Senator Con Bunde
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 187
"An Act relating to the state's participation in the federal
Nationwide Mortgage Licensing System and Registry, and to
mortgage lending regulation and licensing; and providing for an
effective date."
MOVED SB 187 OUT OF COMMITTEE
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 129(RLS)
"An Act relating to the authority of the Real Estate Commission
to revoke licenses of persons convicted of certain crimes."
MOVED CSHB 129(RLS) OUT OF COMMITTEE
SENATE BILL NO. 12
"An Act relating to limitations on mandatory overtime for
registered nurses and licensed practical nurses in health care
facilities; and providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 61
"An Act establishing an Alaska health care program to ensure
insurance coverage for essential health services for residents
of the state, the Alaska Health Care Board to administer the
Alaska health care program and the Alaska health care fund, the
Alaska health care clearinghouse to administer the Alaska health
care program under the direction of the Alaska Health Care
Board, and eligibility standards and premium assistance for
health care coverage of persons with low incomes; creating the
Alaska health care fund; providing for review of actions and
reporting requirements related to the health care program; and
providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 153
"An Act relating to manufactured homes, including manufactured
homes permanently affixed to land, to the conversion of
manufactured homes to real property, to the severance of
manufactured homes from real property, to the titling,
conveyance, and encumbrance of manufactured homes, and to
manufacturers' certificates of origin for vehicles; and
providing for an effective date."
SCHEDULED BUT NOT HEARD
SENATE BILL NO. 126
"An Act amending the State Personnel Act to place in the exempt
service the chief economist and state comptroller in the
Department of Revenue and certain professional positions
concerning oil and gas within the Department of Natural
Resources; relating to reemployment of and benefits for or on
behalf of reemployed retired teachers and public employees by
providing for an effective date by amending the delayed
effective date for secs. 3, 5, 9, and 12, ch. 57, SLA 2001 and
sec. 19, ch. 50, SLA 2005; and providing for an effective date."
SCHEDULED BUT NOT HEARD
SENATE BILL NO. 175
"An Act establishing the Alaska Internet Access Authority and
the Alaska Broadband Task Force; and providing for an effective
date."
BILL HEARING CANCELED
SENATE BILL NO. 149
"An Act relating to the regulation of residential real property
mortgage lending, including the licensing of mortgage lenders,
mortgage brokers, and mortgage loan originators and compliance
with certain federal laws relating to residential mortgage
lending; and providing for an effective date."
BILL HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: SB 187
SHORT TITLE: MORTGAGE LENDING REGULATION
SPONSOR(s): LABOR & COMMERCE
04/08/09 (S) READ THE FIRST TIME - REFERRALS
04/08/09 (S) L&C, FIN
04/09/09 (S) L&C AT 1:00 PM BELTZ 211
BILL: HB 129
SHORT TITLE: POWER TO REVOKE REAL ESTATE LICENSES
SPONSOR(s): RAMRAS
02/13/09 (H) READ THE FIRST TIME - REFERRALS
02/13/09 (H) L&C
03/05/09 (H) L&C RPT 5DP
03/05/09 (H) DP: LYNN, BUCH, COGHILL, HOLMES, NEUMAN
03/25/09 (H) RLS RPT CS(RLS) NT 4DP 2NR
03/25/09 (H) DP: KERTTULA, GARDNER, OLSON, COGHILL
03/25/09 (H) NR: MILLETT, HERRON
03/25/09 (H) RETURNED TO RLS COMMITTEE
03/27/09 (H) TRANSMITTED TO (S)
03/27/09 (H) VERSION: CSHB 129(RLS)
03/30/09 (S) READ THE FIRST TIME - REFERRALS
03/30/09 (S) L&C, JUD
BILL: SB 12
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES
SPONSOR(s): DAVIS
01/21/09 (S) PREFILE RELEASED 1/9/09
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, L&C, FIN
03/09/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/09/09 (S) Heard & Held
03/09/09 (S) MINUTE(HSS)
03/25/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/25/09 (S) Moved SB 12 Out of Committee
03/25/09 (S) MINUTE(HSS)
03/27/09 (S) HSS RPT 1DP 3NR
03/27/09 (S) DP: DAVIS
03/27/09 (S) NR: THOMAS, DYSON, PASKVAN
04/07/09 (S) L&C AT 1:30 PM BELTZ 211
04/07/09 (S) -- MEETING CANCELED --
04/09/09 (S) L&C AT 1:00 PM BELTZ 211
BILL: SB 61
SHORT TITLE: MANDATORY UNIVERSAL HEALTH INSURANCE
SPONSOR(s): FRENCH
01/21/09 (S) PREFILE RELEASED 1/16/09
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, L&C, FIN
03/02/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/02/09 (S) Heard & Held
03/02/09 (S) MINUTE(HSS)
03/13/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/13/09 (S) Moved CSSB 61(HSS) Out of Committee
03/13/09 (S) MINUTE(HSS)
03/16/09 (S) HSS RPT CS 2DP 1DNP 2AM SAME TITLE
03/16/09 (S) DP: DAVIS, ELLIS
03/16/09 (S) DNP: DYSON
03/16/09 (S) AM: THOMAS, PASKVAN
03/16/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/16/09 (S) Moved Out of Committee 3/13/09
03/16/09 (S) MINUTE (HSS)
04/07/09 (S) L&C AT 1:30 PM BELTZ 211
04/07/09 (S) -- MEETING CANCELED --
04/09/09 (S) L&C AT 1:00 PM BELTZ 211
WITNESS REGISTER
LORRIE HOVANICK, Director
Division of Mortgage, Lending and Securities
Department of Commerce, Community & Economic Development
POSITION STATEMENT: Supported SB 187.
JOHN MARTIN, President
Alaska Association of Mortgage Lenders
POSITION STATEMENT: Supported SB 187.
REPRESENTATIVE JAY RAMRAS
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of HB 129.
MARGARET DOWLING
Staff to Representative Ramras
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on HB 129 for the sponsor.
SHARON WALSH, Executive Administrator
Alaska Real Estate Commission
Member, Alaska Association of Realtors
POSITION STATEMENT: Supported HB 129.
TOM OBERMEYER
Staff to Senator Davis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on SB 12 for the sponsor.
MICHAEL WALLERI, General Counsel
Tanana Chiefs Conference
POSITION STATEMENT: Opposed SB 12.
SUSAN JOHNSTON, Regional Director
Human Resources
Providence Health Services
POSITION STATEMENT: Asked them to wait until negotiations were
done to take action on SB 12.
ROGER LEWERENZ, Clinical Nurse Educator
Heart Center
Providence Health Center
POSITION STATEMENT: Supported the intent of SB 12, but didn't
support the bill.
MARILYN EDWARDS, OR/RN
Providence Health Services,
POSITION STATEMENT: Opposed SB 12.
VALERIE DAVIDSON
Alaska Native Tribal Health Consortium (ANTHC)
POSITION STATEMENT: Opposed SB 12.
ANGEL DOTOMAIN, CEO
Alaska Native Health Board (ANHB)
POSITION STATEMENT: Opposed SB 12.
JAMIE EASTERLY
Representing quite a few nurses in Ketchikan
POSITION STATEMENT: Supported SB 12.
NICOLE WELCH, Interim Chief Human Resource Officer
Fairbanks Memorial Hospital (FMH)
POSITION STATEMENT: Opposed SB 12.
STACY ALLEN, RN
Palmer Laborers Local 341
POSITION STATEMENT: Strongly supported SB 12.
NANCY DAVIS, President
Alaska Nurses Association (ANA)
POSITION STATEMENT: Supported SB 12.
KENDALL SAWA, Vice President
Patient Care Services
Ketchikan General Hospital
POSITION STATEMENT: Opposed SB 12.
ROD BETIT, President
Alaska State Hospital Nursing Home Association (ASHNHA)
POSITION STATEMENT: Opposed SB 12.
LIANN COX, Human Resources Manager
Wildflower Court
Juneau, AK
POSITION STATEMENT: Opposed SB 12.
KRISTI ARTUSOU, Director
Neurosciences
Providence Alaska Medical Center and
Member, National Board of Directors of the Certification
Corporation of the American Association of Critical Care Nurses
POSITION STATEMENT: Opposed SB 12.
LORRIE HERMAN, Regional Director
Government Affairs
Providence Health and Services
POSITION STATEMENT: Asked them to wait to take action on SB 12
until negotiations were finished.
DEBBIE THOMPSON, Executive Director
Alaska Nurses Association,
POSITION STATEMENT: Supported SB 12.
KATHLEEN GEDES, President,
Providence Nurses Union
Providence Alaska Medical Center
POSITION STATEMENT: Supported SB 12.
BARBARA HUFF-TUCKNESS, Director
Governmental and Legislative Affairs
Teamsters Local 959
POSITION STATEMENT: Supported the concept of SB 12.
SENATOR HOLLIS FRENCH
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SB 61.
ANDY MODEROW
Staff to Senator French
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on SB 61 for the sponsor.
BEVERLY SMITH
POSITION STATEMENT: Said she would be available to answer
questions regarding SB 61 at the next meeting.
ACTION NARRATIVE
1:09:09 PM
CHAIR JOE PASKVAN called the Senate Labor and Commerce Standing
Committee meeting to order at 1:09 p.m. Present at the call to
order were Senators Bunde, Thomas, Davis and Paskvan.
SB 187-MORTGAGE LENDING REGULATION
1:11:02 PM
CHAIR PASKVAN announced SB 187 to be up for consideration.
LORRIE HOVANICK, Director, Division of Mortgage, Lending and
Securities, Department of Commerce, Community & Economic
Development, said this bill brings state statutes into alignment
with federal law. It was brought forward to allow the state to
participate in the National Mortgage Licensing System (NMLS)
registry and to adopt emergency regulations to comply and
institute this participation.
She said that primarily the regulations that will need changing
involve the collection of fees from licensees to participate in
the NMLS system and to allow applicants to send their background
check fingerprint cards through the NMLS system; currently those
have to be provided to the department.
CHAIR PASKVAN asked the intent is to comply with federal law.
MS. HOVANIC replied yes - by July 30, 2009.
CHAIR PASKVAN asked if the administration supports this bill.
MS. HOVANIC replied yes.
CHAIR PASKVAN asked her to explain the fee of $50,000 for
joining the system.
1:14:22 PM
MS. HOVANIC replied that is what is estimated to be needed to
upgrade the state's systems and integrate them to interface with
the NMLS. It also has a training component.
SENATOR BUNDE said it has been the state's practice that the
cost to the licensee should break even with fees, and asked if
that would be the case with this one.
MS. HOVANIC replied yes.
SENATOR BUNDE asked if all licensees will be licensed in a
timely fashion.
MS. HOVANIC replied yes; taking it up in a larger bill would
make it harder for licensees to be licensed in time.
1:15:47 PM
SENATOR THOMAS asked if this was a reaction to the subprime
loans that were made when people were licensed for insurance,
but operated as mortgage lenders, as well.
MS. HOVANIC replied yes; and this is about making the collection
of licensees more transparent.
SENATOR THOMAS asked if the state becomes qualified or
disqualified from some things by doing it.
MS. HOVANIC replied if the state doesn't comply, federal law
requires HUD to take over the mortgage licensing in Alaska.
1:17:01 PM
JOHN MARTIN, President, Alaska Association of Mortgage Lenders,
supported SB 187. He said they worked on getting their licensing
statutes passed a couple of years ago; since that time Congress
has passed the Safe and Fair Enforcement Act (SAFE), which
pertains to mortgage licensing. It sets the minimum standards
all states must comply with by July 31, 2009. If the standards
are not met in time, an extension can be granted to those states
based on their good faith efforts to comply.
SB 149 was introduced to comply, but more changes are needed.
There is not enough time in this legislative session to iron it
all out. So they will work with the department and the Mortgage
Bankers Association to get final language. The state can apply
for an extension from HUD in regards to the SAFE Act based upon
pending legislation, the fact that present statutes already
substantially comply with the SAFE Act and by joining the
National Mortgage Licensing System and Registry (NMLSR). SB 187
will grant the state the necessary authority to join the NMLSR
which will also help Alaska get closer to compliance.
1:19:47 PM
CHAIR PASKVAN closed public testimony.
1:19:52 PM
SENATOR THOMAS moved to report SB 187 from committee with
individual recommendations and attached fiscal note(s). There
were no objections and it was so ordered.
SENATOR MEYER joined the committee.
At ease from 1:19 p.m. to 1:21 p.m.
CSHB 129(RLS)-POWER TO REVOKE REAL ESTATE LICENSES
1:21:46 PM
CHAIR PASKVAN announced CSHB 129(RLS) to be up for
consideration.
REPRESENTATIVE RAMRAS, sponsor of HB 129, introduced his staff,
Margaret Dowling, who would present this bill for him.
1:23:18 PM
MARGARET DOWLING, staff to Representative Ramras, said HB 129
makes a simple, but needed correction to existing law that says
the Alaska Real Estate Commission must revoke the license of a
real estate broker or an associate broker if that person has
been convicted of forgery, theft, extortion, conspiracy to
defraud creditors, or fraud. They can also refuse to grant a
license or they can deny renewal of a license. The problem is
that this language does not apply to Alaska's 1,460 sales
people; there are only 411 associate brokers and 483 brokers.
This issue was brought to their attention by the Real Estate
Commission. This is a field where customers place faith in their
agents' trustworthiness; they have unfettered access to clients'
homes, and they often assist clients with sometimes complicated
negotiations and financial transactions. HB 129 will empower the
Real Estate Commission to appropriately regulate their
profession including revoking and refusing to grant or deny
renewal of a sales person's license, which protects both the
profession and the public.
1:25:44 PM
SHARON WALSH, Executive Administrator, Alaska Real Estate
Commission, said that they and the Alaska Association of
Realtors supported HB 129.
CHAIR PASKVAN asked if the recent conviction for this kind of
crime is the first time for Alaska.
MS. WALSH replied that it was the first time she has encountered
this scenario, and she has been with the commission for five
years.
1:27:21 PM
CHAIR PASKVAN closed public testimony.
SENATOR BUNDE moved to report CSHB 129(RLS) from committee with
individual recommendations and attached fiscal note(s). There
were no objections and it was so ordered.
At ease from 1:27 p.m. to 1:30 p.m.
SB 12-LIMIT OVERTIME FOR REGISTERED NURSES
1:30:13 PM
CHAIR PASKVAN announced SB 12 to be up for consideration.
TOM OBERMEYER, staff to Senator Davis, sponsor of SB 12,
reviewed the intent of the bill. It prevents licensed nurses and
licensed practical nurses in health care facilities from being
forced to work mandatory overtime. It also requires reporting of
any overtime with the overtime designated as voluntary or
mandatory by the RN, and provides penalties. The intent is to
eliminate mandatory overtime for RNs unless overtime is due to a
grave and unforeseen event. Use of mandatory overtime in excess
of the bill's limitations will result in a report to the
Department of Labor and Work Force Development.
He explained that the overtime is beyond an agreed-to,
predetermined, regularly scheduled shift and it protects
patients from the dangers caused by overworked nurses. It
applies to all hospitals and health care facilities in the
state. Under this bill, a nurse may not be required or coerced
directly or indirectly to work more than 14 consecutive hours
without 10 hours of rest, beyond 80 hours in a 14-day work
period, or to accept an assignment of overtime if in the
judgment of the nurse it would jeopardize the patient's safety.
Nurses can volunteer to work additional shifts beyond this limit
so long as they do not work more than 14 consecutive hours with
the 10 hours of rest.
MR. OBERMEYER said that a number of concessions were made to
Alaska's hospitals. The 14-hour maximum work day with 10 hours
of rest exceeds that allowed in many other states, it permits a
2-hour transition for nursing supervisors to call in additional
help after 12-hour shifts. This provision was intended to help
remedy the problem of calling nurses back to work without
adequate rest after working a 12-hour shift. Exceptions have
been provided for flight nurses on medical transports, school
nurses on school-sponsored field trips and official state
emergencies. This bill limits hospital reporting hours to twice
a year and eliminates triple time penalties for egregious
violations, limits maximum fines and requires enforcement only
for knowing violations.
He explained that there are few official overtime complaints by
nurses due to their busy schedules and, to some extent, fear of
direct or indirect retaliation by employees, which is forbidden
under this bill. Many nurses have testified to overwork fatigue,
disruption of family life, unexpected shift changes, mandatory
overtime, and mandatory on-call over the course of several
hearings on a similar bill last year.
It has been estimated that 500,000 licensed registered nurses in
this country have left or are not working in the profession. He
explained that Congress is addressing the nursing shortage by
discussing bills for financial aid for education and more
rigorous regulation of overtime hours. The Journal of American
Medical Association October 2002 reported that nurses who suffer
from fatigue, increased workloads and shifts in excess of 12
hours greatly increase nursing errors and mortality rates among
patients who have common surgeries.
1:34:56 PM
They estimate about 98,000 deaths each year are attributed to
errors in hospitals. Nursing fatigue is one of the factors.
Other safety sensitive jobs like commercial airline pilots, FAA
controllers, railroad engineers and long-haul truckers have
established workload guidelines.
He said the nursing profession has to attract more young people
to replace the aging nurse workforce, the national average of
which is 46 years - 95 percent of them are women. In the year
2000, only 9 percent of RNs were under the age of 25 compared to
25 percent in 1980, which indicates that they are leaving the
profession. SB 12 will encourage employers to employ more nurses
rather than using mandatory overtime and mandatory on-call with
short staffs to fill routine and critical care positions on a
regular basis. The greatest beneficiaries will be the patients
who receive the care and safety they deserve.
1:36:26 PM
SENATOR BUNDE said that legislative findings on page 2, line 6,
states that health care facilities shall provide safe and
adequate nursing staff without the need for overtime. Research
has shown that there is a shortage of nurses and he didn't want
a health care facility to be in violation of the law if they
simply couldn't find nurses.
MR. OBERMEYER replied that that section could be removed.
SENATOR MEYER said one hospital has negotiated two 16-hour days.
Would this bill make that contract a violation?
MR. OBERMEYER replied that he was referring to North Star, a
part of Universal Health Services, Inc., the most profitable
hospital association in the country. Yes; it is an issue;
several of their nurses testified that they like these long
hours, but he didn't know if the average nurse in Alaska at age
48 wanted to work those hours every week. However, he recognizes
that some nurses want to work those long hours.
SENATOR MEYER asked why they wouldn't just let the employees and
management negotiate this personnel matter rather than making a
law about it that could make matters worse.
MR. OBERMEYER replied this country is facing a nursing crisis;
nurses are not coming into the profession, and there is an aging
population. These nurses are the backbone of the hospital
systems in the country; if they are overworked and have too many
patients to attend to, they will make errors. At the same time
it creates dissatisfaction with work among these nurses. He
agreed that most facilities want to work with their nurses, but
the bottom line is they find them somewhere. The irony is that
overtime that was designed many decades ago to try to encourage
employers to hire more people is no longer a limiting factor. It
has become a routine part of staffing and has no remedy.
1:41:21 PM
SENATOR DAVIS stated that she would prefer that the concerned
parties could negotiate a resolution instead of passing
legislation. Other states have had to pass legislation, because
they have not been able to agree among themselves. She has given
every opportunity for that to take place here, and she hoped
something would happened in the current negotiations between
hospitals and nurses, but she wasn't sure they could come up
with a solution on their own.
1:42:31 PM
CHAIR PASKVAN added that he met with a representative of
Providence Hospital this morning, and he was assured they were
working on this issue and expected to conclude negotiations in
May or June 2009. If they cannot reach a resolution, they would
not oppose this legislation next year.
1:43:13 PM
SENATOR DAVIS said she was glad to hear they had that discussion
with him; they had that discussion with her, too. But it would
be an injustice to not move the bill forward; her goal was to at
least get it to Finance this year.
SENATOR MEYER said he didn't see this as a Providence Hospital
bill, and they shouldn't hold it up because one hospital was
having negotiations.
1:46:10 PM
MICHAEL WALLERI, General Counsel, Tanana Chiefs Conference, said
it is a regional health corporation serving the Interior of
Alaska and operates the Chief Andrew Isaac Health Clinic. He
said he opposed SB 12 in its current form, because it covers
federal facilities. Some issues are unique to Indian health
service contracted facilities that would make the situation much
worse for them.
He explained that their nursing staff is composed of direct
hires which may or may not be subject depending on whether or
not the bill applies to federal facilities. But they also have
commissioner corps Indian health service employees who are
nurses operating under the Intergovernmental Personnel Act (IPA)
that this legislation would not affect. In this situation the
bill would apply to their non-IPA positions, but would not apply
to their IPA positions, which would increase the burden of
mandatory staffing over to the IPA nurses, which exacerbates
burnout and overwork among that group.
Additionally, he said the bill does not cover nurses who are
traveling outside of the borough. Fundamentally, he said, Alaska
is dealing with a nursing shortage. The University of Alaska
developed a comprehensive program to develop and train nurses
who would be uniquely qualified to serve Alaska and focusing on
the resident Native population, which will be less mobile. The
same thing was done for UAA's Licensed Clinical Social Work
program (LCSW). At first they tried to regulate the area and
that didn't work. They think they can do the same thing here.
1:49:46 PM
SUSAN JOHNSTON, Regional Director, Human Resources, Providence
Health Services, asked them to allow negotiations to conclude
with the Alaska Nurses Association before taking any action on
this bill. Their analysis has indicated this bill would increase
Providence's budget by $9.3 million.
Some of the potential actions they believe would be required by
Providence to insure compliance with this bill would be the
elimination of on-call and call-back nurses, the elimination of
some of their overtime that may lead to unintentional violation,
and moving their nurses from 12-hour to 8-hour shifts. Although
a move of this nature could potentially provide a significant
cost savings for Providence, it would also be a "dissatisfier"
for their nurses.
1:51:35 PM
ROGER LEWERENZ, Clinical Nurse Educator, Heart Center,
Providence Health Center, said he had been a nurse for 14 years,
12 of those at Providence. He is responsible for staff that work
in the cardiac catheterization lab as well as the cardio
vascular observation unit and the cardio vascular intervention
unit, a 24-hour nursing unit. The technical nature of the work
requires an extra one year of technical training. While many
other areas can supplement staff with nurses from the float
pool, he can't take just any nurse into the lab.
He explained that it is infrequent, but not unusual, for a nurse
to work more than 14 hours caring for patients there. Limiting a
nurse to 14 hours could jeopardize the availability of this unit
to provide care for a patient in an emergency. It's impossible
to schedule for emergencies. Anything outside of those hours are
covered by a "call team" which completes cases that are added
during the day. Because of that they occasionally stay longer
than 14 hours.
He agreed with the intent of this bill, and agreed that nurses
should not be scheduled for mandatory overtime, but this
scenario would be nearly impossible to implement. Many nurses
would be frustrated and quit their jobs. He summarized that he
wants the most competent nurses, not the most rested.
1:54:32 PM
MARILYN EDWARDS, Head OR Nurse, Providence Health Services,
opposed SB 12. Her immediate concerns revolve around safe
quality patient outcomes and a safe work environment for her OR
staff. Some of the concerns they have expressed are that
restrictions on overtime would mean her staff would work their
scheduled shifts and then go to other facilities in the area to
get their additional hours. They expressed other concerns that
the bill encompasses issues that are highly individualized by
circumstances and that SB 12 is a one-size solution to a problem
that does not exist at the PNCOR. They provide quality care to
all patients needing surgical intervention while providing
optimal work/life balance. She has 48 RNs who can choose to work
8, 10, or 12-hour shifts; 22 of them work full time; the other
26 work either a .9, .8 or .6. She has zero vacancies, and she
has one "traveler" whose contract is up this week.
MS. EDWARDS summarized that the OR staff like their current
shifts. They don't want their call assigned on days when they
are not scheduled to work. Current practice is to group their
workdays with their calls so that their scheduled off-days are
not encumbered with call responsibilities. This practice is
their preference and their professional choice.
1:56:54 PM
VALERIE DAVIDSON, Alaska Native Tribal Health Consortium
(ANTHC), said they were formed pursuant to federal law to
provide a range of medical and community health services to over
130,000 Alaska Natives; ANTCH and Southcentral Foundation
jointly manage the Alaska Native Medical Center (ANMC) in
Anchorage and employ 500 nurses. They do not support SB 12. In
January of this year ANMC was recognized for a second time as a
"magnet hospital," a highly prized award given by the American
Nursing Association. Only 5 percent of all U.S. hospitals
achieve this status and even fewer are designated a second time.
ANMC is the first and only Alaska hospital to receive it. She
explained that magnet hospitals have demonstrated that they meet
a set of criteria designed to measure the strength and quality
of their nursing including the ability of its nurses to
contribute to patient outcomes and with nurse job satisfaction,
low turnover rates and appropriate grievance resolution are part
of the standard.
MS. DAVIDSON said they don't support SB 12 or any bill that
legislates work schedules and ties the hands of managers who are
constantly juggling the demands of patient care against work
force availability, rising costs and chronic underfunding of the
Tribal Health System.
They have three primary concerns as the bill is written. First
is that it would have a detrimental and disproportionate impact
on patients in Alaska, especially in rural Alaska, but because
they are transferred into Anchorage for tertiary care it would
impact the Alaska Native Health Medical center as well. Second,
it conflicts with Alaska's long-standing policy of supporting
access to health care through allowing health care facilities an
appropriate degree of flexibility in scheduling direct health
care providers. Third, it creates the inaccurate impression that
it applies to federal and tribal facilities.
1:59:42 PM
She explained that in rural Alaska, when nurses aren't
available, patients must be diverted to another facility. The
challenge is that then those patients get diverted to the Alaska
Native Medical Center, which disrupts the continuity of care for
patients and poses an additional financial burden on an already
underfunded health care system.
MS. DAVIDSON said under federal law, a federal facility
performing a federal function is not subject to state regulation
even if the function is carried out by another entity. Congress
has not authorized state regulation of federal health care
facilities serving tribes.
She said the Fair Labor Standards Act was recently revised with
the benefit of comprehensive comments from nursing associations,
patient advocacy groups and health care facilities. It allows
for that degree of flexibility.
2:01:04 PM
ANGEL DOTOMAIN, CEO, Alaska Native Health Board (ANHB), said
they represent 24 Alaska tribal health entities and opposed SB
12. She said collectively they employ 7,000 Alaskans and provide
health services to approximately 130,000 Native customers. In
many areas they are the only providers of health services
servicing Natives and non-Natives, alike.
2:02:14 PM
JAMIE EASTERLY, staff nurse, said she represents quite a few
nurses in Ketchikan and that patient safety is their number-one
concern. They all support SB 12. She said that money is not the
issue, but rest periods are. She said it may be time to look at
nursing in a different form and reminded them that it was a very
big deal when pilots' time in an airplane was limited, but many
lives were saved because of it. They also need to think about
the new young nurses coming into this profession; some of them
don't come into nursing because they are not willing to give
their lives away to the hospital.
2:04:44 PM
NICOLE WELCH, Interim Chief Human Resource Officer, Fairbanks
Memorial Hospital (FMH), opposed SB 12, because their facility
has been able to work directly with staff regarding scheduling
to come up with the best plan to meet their patient needs. They
do so through a variety of shifts including 8, 10, and 12-hour
shifts as well as varying full-time, part-time and per diem
statuses and using on-call and call-back. They have not had to
mandate overtime and have been able to staff through the ability
to be flexible. The hospital needs to be able to maintain its
ability to work directly with its nursing staff and specific
patient needs. This flexibility also leads to their ability to
retain the nursing staff who are looking for creative scheduling
to accommodate their work/life balance.
2:06:07 PM
STACY ALLEN, RN, Palmer Laborers Local 341, said it represents
about 250 nurses at Alaska Regional Hospital. She remarked what
other industry lets the boss and employees work out matters of
public safety? She said so far the health care facilities and
the health care associations had not showed a willingness to
work together to come up with a solution; and this indicates to
her that it will take a legislative solution.
Most of her members work construction and are highly aware of
safety, but nurses don't have the choice of walking away from an
unsafe situation. They may be putting their licenses and
patients on the line; nurses are torn by this issue. People are
being driven out of the profession particularly in the OR and
the dialysis unit. The Local very much supports SB 12 as a
public safety issue.
2:07:37 PM
NANCY DAVIS, President, Alaska Nurses Association (ANA), Juneau,
said she has over 1,000 RN members. They have been working
together for over five years to address this issue of mandatory
overtime and excessive work hours for registered nurses and
licensed practical nurses. They support SB 12 because it
addresses both the patients' and the workers' safety. She
thought that they should be able to come together on the side of
safety and SB 12 facilitates that in a standard way whether a
nurse has a collective bargaining agreement or not.
2:10:11 PM
KENDALL SAWA, Vice President, Patient Care Services, Ketchikan
General Hospital, opposed SB 12. Overtime there is strictly
voluntary and he has heard of no complaints in the calendar year
of 2008 around inappropriate use of overtime, nor do they expect
any in the future as they continue their unrestricted practices.
To prevent burnout many hospitals emphasize creative scheduling
practices. One such practice is to allow nurses to work at
partial FTEs - .8 or .9 for 36 hours/wk for full benefits. This
is in the midst of a nursing shortage and to respond to an aging
nursing population.
2:11:43 PM
ROD BETIT, President, Alaska State Hospital Nursing Home
Association (ASHNHA), opposed SB 12. He said his members are
meeting the intent of the legislation already. Patient safety is
paramount to his members and their facilities are equal to or
better than those happening nationally. Mandatory overtime is
not used in their facilities to make up for short staffing. This
is what happens in other states, and that is what has caused
legislation to come forward there. Their chart indicates that
very little mandatory overtime has been reported; it was at API,
but that was addressed two years ago. Overtime is voluntary and
generally comes at the request of nursing staff rather than any
kind of mandating imposed by management. There are local
flexibility issues; Petersburg has reported being on 12-hour
shifts because the nursing staff asked for it. It is not cost
effective for many facilities to have 12-hour shifts because
they end up having 3/12s for 36 hours and lose 4 hours per week
per individual employee.
He pointed out that hospitals had taken a number of steps to
solve this problem; not the least of which was making
contributions to the University of Alaska to grow its nursing
program from 100 to 200 graduates each year.
2:14:33 PM
SENATOR THOMAS said they are already complying.
MR. BETIT responded that they are complying with the findings
and intent of the bill, which is to treat nurses fairly and to
provide top patient care. They are doing that by not using
mandatory overtime, for one thing, and by using other techniques
to get there. Temporary nursing hours is one of those
provisions.
SENATOR THOMAS said even though their longest shift is 12 hours,
he was still concerned with exemption language on page 3, line
14, that precludes anything longer than 14-hour shifts as long
as they were not back-to-back and there was a 10-hour break.
MR. BETIT responded that a number of exceptions are set out on
page 3 and he didn't know how they played out against each
other, but the 14-hour limit seems to be the most controlling
one. If someone has worked a 12-hour shift and has to stay
either voluntarily or mandatorily, that 14 hours comes into
play. There are times when that will happen either because the
nurse wants to do it or because there is a need, particularly in
rural facilities, where they don't have other staff immediately
available.
2:17:48 PM
SENATOR THOMAS asked what kind of impact the increase in the
University's nursing program had.
MR. BETIT replied it is having a positive effect. Every year he
tries to get a subjective opinion from his CEOs as to whether
they see the nursing situation as better, worse or about the
same. About 12 of them responded that it's the same, 8 said it
was worse and 4 said it was better; overall they are not seeing
a major deterioration, but the challenge is still there and the
vacancy percentage is still pretty significant in many of the
facilities.
2:19:06 PM
SENATOR THOMAS asked how it could be getting worse.
MR. BETIT replied that nurses don't come out of the University
nursing program ready to go to work on the floor of a hospital
or a nursing home. So, there is a real need to continue to build
those work ready programs or to have capacity for the larger
hospitals to actually train nurses that could then go out to the
rural areas.
2:19:50 PM
LIANN COX, Human Resources Manager, Wildflower Court, opposed SB
12. She explained that they are a small non-profit skilled
nursing facility with 57 beds and have 14 full-time nurses and 3
casual nurses. In the past three years they have had no
mandatory overtime at all. They have had no complaints about
overtime or the shifts. They have 8, 10, and 12-hour shifts and
try to be flexible based on what the employees want. SB 12 would
needlessly set a precedent for government intervention, she
said. Statistics reinforce their position that statewide the use
of mandatory overtime is rare in hospitals and nursing
facilities.
Further, she said, SB 12 would require them to document work
hour details for employees affected by this legislation and
since it is a facility that doesn't implement the mandatory
overtime, she didn't see why they would want to be additionally
burdened with the extra reporting.
SENATOR DAVIS asked if she had provided that information to the
committee.
MS. COX replied that she had commented through ASHNHA, but she
would submit the information she has today.
2:22:08 PM
KRISTI ARTUSOU, RN, Director, Neurosciences, Providence Alaska
Medical Center, said she also sits on the National Board of
Directors of the Certification Corporation of the American
Association of Critical Care Nurses. They are the largest
specialty organization in the country and represent over 500,000
nurses. They do not advocate mandatory overtime for staffing;
however, they also do not believe that government interference
is required for a nurse's ability to schedule her work hours and
to balance their work and personal life. So, she opposed SB 12.
She related how she worked overtime to get extra money to buy a
home, to raise kids, and to take trips with her children. At no
time were her patients in jeopardy, because she is capable of
deciding how many hours she can work. She is a nationally
recognized expert in critical care, progressive care, and
neuroscience nursing.
She said that nurses are resourceful individuals, but this bill
would directly impact a their ability to actually control work
hours and therefore, negatively impact their ability to provide
access to quality health care services for Alaskan patients.
2:25:31 PM
SENATOR THOMAS asked what part of the bill would preclude her
from working voluntary overtime.
MS. ARTUSOU went to the language that limits overtime to 14
hours. She explained that although 8-hours shifts are much
easier for a hospital and an administration to manage, 12-shifts
were created across the country to meet the nurses' need. Most
nurses in her units are on 12-hour shifts, but if they want to
stay the extra 4 hours; that would be a 16-hour shift. That
would not be permitted under this bill. What about the nurse who
works a 16-hour shift on Monday and Friday because those are the
days her husband is home to take care of the children, or the
one who choose to work back to back Wednesday Thursday?
2:27:17 PM
SENATOR THOMAS asked if she would like the bill if allowed 16
hours of voluntary work and still disallowed mandatory overtime.
MS. ARTUSOU replied that professionally she didn't think nurses
should have legislation that interferes with their professional
decisions. It would impact a nurse's interest in wanting to stay
in the profession.
SENATOR MEYER said he was glad to hear that flexible schedules
make nurses happy, but the ultimate concern is the safety of the
patient.
MS. ARTUSOU explained how after 18 months of consistent 16-hour
shifts 3-days a week her performance was stellar; she was even
asked to become the manager of the Emergency Room in a New York
hospital. She said as a professional, you have to recognize your
own limitations.
2:31:25 PM
LORRIE HERMAN, Regional Director, Government Affairs, Providence
Health and Services, said they are in negotiations with their
nursing union and hope to conclude those by June. If the
overtime issue hasn't been settled by then, she was committed to
working with nurses, other hospitals in the state and tribal
organizations to come up with a compromise so legislation
wouldn't be needed.
2:32:53 PM
SENATOR MEYER asked if negotiations had started.
MS. HERMAN replied yes.
SENATOR MEYER asked how long have they had been going on.
MS. HERMAN replied that she is not a member of the negotiating
team, but knew of two meetings. At the first meeting, Providence
submitted its list of issues, and she was sure that mandatory
overtime was on it. The nurses union presented its list of
issues at the second meeting. The third meeting is scheduled for
Monday, April 13 is when negotiations would begin.
2:34:14 PM
DEBBIE THOMPSON, RN, Executive Director, Alaska Nurses
Association, supported SB 12. She impressed on them that this is
a patient and nursing safety bill. She pointed out that 50
percent of nurses are not represented by unions nor do they have
the option to negotiate overtime with their employer. Mandatory
overtime was brought up in one facility in her hospital and the
negotiating team was told it would be settled in Juneau as a
legislative matter; so it has not come up in negotiations at
Providence, yet. She reminded them that the Baylor Plan was
never intended to be two 16-hour shifts. It was intended to be
two 12-hour shifts and pay the nurses for 40 hours to have
coverage on the weekends.
2:35:53 PM
KATHLEEN GEDES, RN, Providence Alaska Medical Center, said she
is the Union President. She feels compelled to set the record
straight. She submitted a Providence job description for the
record and said in the description they are held accountable for
medical mistakes. She referenced a book called "Wall of Silence"
written by Rosemary Gibson. It's the untold story of the medical
mistakes that kill and injure millions of Americans daily.
MS. GEDES related that her mother when she was 41 years old
because of a misdiagnosis. She then had to drop out of school to
take care of her three siblings; but she ended up graduating
with a social work degree. So, instead of going over all the
error rates, she wanted them to see her, an error rate.
She did not want this to be a Providence issue, but rather an
Alaskan consumer safety issue. Mandatory overtime was not
brought forward by Providence on the first day of negotiations,
nor on the second day, contrary to what the previous speaker
said. She is the one who brought it up. Further, Ms. Gedes,
corrected that there are actually 15 states, not 13, that have
developed laws and 14 other states are lining up. National
legislation is also pending to ban the use of mandatory
overtime, and Representative Young actually signed on to that
bill.
MS. GEDES said that 73 percent of Providence nurses fill vacancy
holes by working voluntary overtime. The problem is that all the
studies look at mandatory overtime; they don't look at the error
rates for voluntary overtime. With the nursing shortage they
have employee travelers; the adult critical care unit alone has
21 travelers. They have no investment in the community nor is
there continuity of care when their 6 or 11 weeks is finished.
She also remarked that she graduated from high school in 1983
when Ms. Artusou bought her first house. She was a spry 18 years
old and didn't have a grey hair, but she couldn't be confident
that at 16 hours of work she provided safe care. How do you
know? There are errors of omission and errors of commission, the
ones you don't even know happened because you were too fatigued.
MS. GEDES closed saying that the Alaskan public has a right to
expect when they walk into a health care facility that the
nurses taking care of them are alert and properly rested. Every
family member should ask their bedside nurse how many days they
have worked in a row and how many hours they had worked in the
last few days, how many hours they had worked today, and if they
had received any meals or breaks today. Get the facts. She said
eliminating mandatory overtime is common sense; it will protect
the patient and the nurses; it will help retain and recruit
nurses.
2:41:06 PM
BARBARA HUFF-TUCKNESS, Director, Governmental and Legislative
Affairs, Teamsters Local 959, said she supported the concept of
SB 12. She represents nurses and actually the entire health care
work force at South Peninsula Hospital and at Kodiak Island.
They they have a somewhat semi-private facility as well as a
Providence Kodiak Island facility. Collective bargaining
agreements have been in place at South Peninsula Hospital since
1989. Their agreement has language that addresses mandatory
versus voluntary hours, and nurses are allowed to work
voluntarily up to 16 hours. She said they are concerned about
some of the flexibility, but agreed with some of the points made
today.
On-call is a much bigger issue at their facility. They are also
looking at the number of patients per nurse. She is currently in
negotiations with South Peninsula facility and next month will
be going into negotiations for Providence Kodiak.
She remarked that a large number of nurses are unorganized. So
if they don't pass this legislation, it would be an opportunity
to continue organizing or there would be protection for those
unorganized workers. She the concept embodied in SB 12 is an
issue that needs to be addressed.
2:43:37 PM
SENATOR MEYER asked if overtime can be negotiated.
MS. HUFF-TUCKNESS replied yes; it has been in their contracts
for eight years. She said organization as an option for nurses
outside of the union would not be guaranteed if this doesn't
pass.
SENATOR MEYER reasoned that if unorganized nurses see organized
nurses getting something they are not, they will either ask it
and management will grant it or they may become organized.
MS. HUFF-TUCKNESS said she has dealt with employers, herself,
and she wouldn't guarantee that would be the case.
2:45:27 PM
CHAIR PASKVAN closed public testimony.
SENATOR BUNDE asked if people in federal facilities wouldn't be
affected by SB 12, why would they be concerned about it one way
or the other.
SENATOR DAVIS responded that she was confused also. This bill
was before the committee last year and an amendment was
negotiated that they said was okay. Now they are saying that was
not their only issue.
2:47:50 PM
CHAIR PASKVAN held SB 12 until Tuesday.
SB 61-MANDATORY UNIVERSAL HEALTH INSURANCE
2:48:56 PM
CHAIR PASKVAN announced SB 61 to be up for consideration.
SENATOR FRENCH, sponsor of SB 61, said 115,000 Alaskans don't
have a health insurance policy. A majority of them work at jobs
that don't provide it. The idea behind this bill is to make
insurance affordable so their health needs can be addressed in a
fashion that allows early action to be taken instead of waiting
to go to the emergency room and all that entails. The bill is
modeled loosely after the Massachusetts plan that was crafted
with the help of the Heritage Think Tank. It leaves the current
insurance landscape in place; it does not affect anyone that has
insurance coverage they wish to keep. It only makes new private
insurance affordable for those who can't afford it.
2:50:46 PM
SENATOR BUNDE asked if he had an age demographic breakdown of
people who don't have insurance.
SENATOR FRENCH said it is skewed toward the ages 18-30
demographic. Anyone who is 65 years or older has access to
Medicare and the very poor have access to Medicaid. The health
concerns of these young people will get treated in the event of
an emergency or a catastrophe, but those costs are passed off to
everyone else in the state. He believes that a health insurance
plan can be crafted that will allow them to pitch in to the
pool. Obviously, the more people in an insurance pool the
farther and better the risks are spread.
2:52:40 PM
ANDY MODEROW, staff to Senator French, flipped through the
sections of the bill. The findings are on pages 1 and 2; on page
2, line 24, language establishes what the bill tries to
accomplish. Language on page 3, line 9, establishes the Health
Care Board that will implement the plan; page 4, line 5, starts
the section on the board's powers and duties. It will oversee
the health care fund, which pays for this reform and a health
care clearing house that gives them some oversight into
recommending how health care plans can better serve Alaskans and
in other publicly funded program.
The Massachusetts uses an electronic Expedia-style format for
its clearing house where people can compare health plans side-
by-side. The site works with public/private partnerships and
other formats to get information out that connects people to
health care plans.
The next section deals with essential health care services and
this is the most controversial part of the plan; it requires
that individuals in the state have access to some kind of health
care. Being enrolled in a health care plan already would count
as being an IHS beneficiary.
2:55:05 PM
Once everyone is in the pool there is the opportunity to
continue to make other health care reforms. One of those is that
a health care plan be offered to any individual regardless of
preexisting conditions or other health issues they have that
might prevent them from getting coverage today.
Page 7 lists some essential health care services that should be
included in any health care plan. The bill does not set out
financial criteria, and the goal is to increase consumer choice
that includes high deductible health care plans so long as they
protect people in times when they need health care. The board
must help ensure this provision.
2:55:53 PM
Page 8 deals with the employer provisions. Depending on an
employer's payroll size, there are different levies that can be
assessed to help pay for this plan. This bill would not affect
employers with a payroll below $500,000/yr. whether they provide
health coverage or not. Employers with a payroll from $500,000 -
$1,000,000 are levied 1 percent of their payroll if they don't
provide health insurance. If the bar for providing health
insurance is relatively low, either the employer must offer to
pay 33 percent of a health care plan for premium or they must
successfully enroll 25 percent of their employees in the plan
that they do offer regardless of how much they offer to pay.
Employers with a payroll of $1,000,000 or more have to pay 2
percent of payroll. Since that is a chunk of money, there is a
big opt out clause. If an employer merely establishes a Section
125 account, which allows an employee to purchase health
coverage with pre-federal tax dollars, they are exempt from the
levy. The cost of establishing those accounts is several hundred
dollars for an entire employer for all employees for one year.
Page 9 deals with provisions that don't allow denying anyone
coverage who seeks it through the clearing house framework; it
allows different financial criteria, but does not allow a
preexisting condition limitation to extend for more than one
year. If there is a preexisting condition limitation, a plan is
required to give credit for prior coverage. So if you are
leaving a great state job and don't want to buy COBRA, you can
buy a new plan and have it be continuous.
Page 10 deals with the health care fund with funds coming from a
variety of sources. Page 11 under disputes and appeals allows
the right to a hearing. It also provides a variety of different
things the board must come to the legislature with
recommendations. Regulations can be implemented to establish
this.
CHAIR PASKVAN noted that the committee had written testimony
from Beverly Smith.
2:58:41 PM
BEVERLY SMITH said she would be available to answer questions at
the next meeting.
2:59:14 PM
CHAIR PASKVAN said he would hold SB 61 for another hearing.
There being no further business to come before the committee,
Chair Paskvan adjourned the meeting at 2:59 p.m.
| Document Name | Date/Time | Subjects |
|---|