CSHB 109(FIN)-SCREENING NEWBORN FOR HEARING/AUDIOLOGIST  1:35:29 PM CHAIR DYSON announced CSHB 109(FIN) to be up for consideration. REPRESENTATIVE JAY RAMRAS, sponsor of HB 109, informed the committee that every year 30 to 40 children are born with congenital hearing impairment in Alaska. The impairments are often not detected until the affected children are two to three years old and have experienced significant delays in cognitive and speech development as a result of the condition. While the cost of administering a hearing exam at birth is almost negligible, the state's education system incurs great expenses while accommodating a student with a speech or cognitive deficiency. 1:40:14 PM JANE PIERSON, staff to Representative Jay Ramras, offered to answer questions. SENATOR LYDA GREEN remarked that the hearing test is only a small part of the bill and asked the reason for requiring the state to assume the responsibility of defining, tracking, and treating cases of hearing impairment. MS. PIERSON responded that the bill would create a standardized procedure to track the progress of a child diagnosed with a hearing impairment and it would direct the parents to resources available within their community. SENATOR GREEN asked whether participation in the program would be terminated once the child reaches three years of age. MS. PIERSON replied yes. She added that many parents of children with hearing impairments do not have a system to guide them through the various treatment programs that are available. SENATOR GREEN expressed concern that the bill would give the state far too much oversight over what should be a family decision. MS. PIERSON responded that the bill allows families to exit the program at any time. SENATOR GARY WILKEN asked how the legislation would enhance the state's existing response to the problem. MS. PIERSON replied it would establish a standardized program to track the progress of children with hearing impairments. It would also establish a procedure to direct the parents of a hearing impaired child to resources available within their community. 1:44:37 PM SENATOR WILKEN asked whether the bill would add another layer of bureaucracy upon a network of programs that is already working effectively. MS. PIERSON answered it would only establish standardized procedures for programs that already exist throughout the state. 1:46:06 PM CHAIR DYSON asked the reason that the fiscal note is so low. MS. PIERSON replied it was due to the fact that the actual hearing test machinery was already in place throughout the state. CHAIR DYSON questioned whether implementing the standards in the bill would only cost the state $64,000 as is stated in the fiscal note. MS. PIERSON responded that the amount is appropriate so long as the state continues to receive the same amount of federal grant funding to address the problem. SENATOR GREEN asked whether the Department of Health and Social Services (DHSS) could send brochures on hearing impairment to the birthing centers and hospitals in the state. 1:49:45 PM STEPHANIE BURCH, Section Chief, Women's, Children's, and Family Health, Division of Public Health, (DHSS), replied that the department currently distributes a series of brochures on hearing impairment and screening to all the hospitals and birthing centers throughout the state. 1:51:33 PM CHAIR DYSON remarked that the director of the Division of Public Health is in favor of extending the screening program to all infants in the state. He asked how the screening of infants was related to other screening tests performed on newborns. 1:53:49 PM MS. BURCH replied that most newborns are screened for a hearing impairment when they are given the newborn metabolic screening test. She added that while the metabolic test is required by statute, the hearing test is not, and some children born at home or in hospitals with high staff turnover are missed. Her organization would like to see statutory requirements for hearing screening and tracking similar to those for the metabolic test. CHAIR DYSON asked whether the bill would simply add one more condition to an existing screening and tracking program. MS. BURCH replied that is correct. She said that the purpose of the legislation was to help affected families enroll hearing impaired children in early intervention programs before they enter the school system. 1:57:29 PM CHAIR DYSON asked whether the passage of the bill would provide additional remedial services to children with hearing impairments. MS. BURCH replied that the fiscal note provides for a possible expansion of the services currently offered by hearing resource consultants. Funding for the expansion would be allocated only if the number of hearing impaired children in the state increases. SENATOR DONNY OLSON asked how rural hospitals have responded to the proposed legislation. MS. BURCH replied they have received an outstanding response from the rural hospitals. SENATOR OLSON asked whether there were penalties for not complying with the mandate. MS. PIERSON replied no. 2:00:37 PM CHAIR DYSON asked what would happen to medical providers that don't comply. MS. BURCH replied that physicians and hospital managers generally comply with recommendations from the American Academy of Pediatrics and nearly 100 percent of physicians comply with the program today. SENATOR GREEN suggested that programs for diagnosis usually generate pressure to establish programs for treatment. She expressed concern that many communities would not be able to provide services for hearing-impaired children and there would almost certainly be requests for travel funding from affected families. She asked the witness whether that was a pertinent concern. 2:05:15 PM MS. BURCH acknowledged Senator Green's concern and informed the committee that there are several pediatric audiologists in the Native health care system who travel to villages to perform screening and follow up. She added that while some travel is necessary within the program, her organization has been fairly successful in keeping travel costs in line. LEENA ONGLEY testified in support of HB 109. She emphasized that early diagnosis of hearing impairment is crucial. While statistical analysis predicts that there will be 30 children born in Alaska with some degree of hearing impairment in a given year, other children develop hearing impairment later in childhood as a result of frequent ear infections. She said that the screening of newborns provides audiologists with an important baseline by which to diagnose the later form of hearing impairment. MS. ONGLEY added that in her experience, about half of the children living in the villages of the North Slope have chronic ear pathology accompanied by moderate hearing loss by the time they turn one year old. Hearing loss is an oft-undiagnosed cause of delayed language acquisition, which is a major problem in North Slope school districts. 2:09:18 PM KERRY PIPPIN, Speech Therapist, testified in support of HB 109. She said the bill was important in that it would maintain the priority of the program throughout the state. She said it is particularly important for rural areas where the program is often overlooked due to the high turnover rate among hospital staff. 2:13:47 PM PAMELA MUELLER-GUY, Anchorage, testified in support of HB 109. SUZANNE RUST, Anchorage, testified in support of HB 109. She said that her daughter benefited tremendously from early treatment for hearing loss. She relayed her difficult experience seeking appropriate treatment due to a lack of information and remarked that the bill would do much to help families in similar situations. She added that hearing impairment is the most common birth defect in the United States and many states have already implemented similar legislation. 2:21:43 PM JODI RUMPH, Juneau, testified in support of HB 109. She said that her son was born with a correctable hearing impairment that was not detected for years because there were no hearing machines available in the communities in which they lived. Her son's first hearing test was inconclusive because the results could not be compared to any baseline from previous tests and his condition was not properly diagnosed until he started showing significant delays in his speech development. She urged the committee to pass HB 109 to prevent similar cases from occurring. 2:23:56 PM SENATOR GREEN asked the witness whether she believed that she would have been covered under HB 109. MS. RUMPH replied that it was her understanding that her son's condition would have been diagnosed earlier if his baseline were established at birth. SENATOR GREEN said she understood the bill to be limited in scope and suggested that it might not apply to home births. MS. RUMPH responded the bill would standardize the requirements for hearing screening. It would require public health nurses who travel to small communities to test children in the communities for hearing impairment. She expressed concerned that the state's excellent hearing program may fall apart as the equipment ages and rural hospital staff changes. 2:25:50 PM SENATOR OLSON commended the witness on her testimony. He asked how much a rural family not covered by Medicaid could expect to spend while seeking therapy for a hearing impaired child. MS. RUMPH replied such families incur enormous traveling expenses while traveling to larger cities for testing and therapy. 2:31:27 PM LISA OWENS, Anchorage resident, testified in support of HB 109. SANDY FRICKY, nurse, Bartlett Regional Hospital, testified in support of HB 109. She said it was not difficult for the staff at Bartlett Regional Hospital to incorporate hearing screening into their standard metabolic tests. 2:34:28 PM CHAIR DYSON asked Ms. Fricky whether HB 109 would change any of the activities that she performs at the hospital. MS. FRICKY replied no. SENATOR ELTON asked whether the hospital performs hearing screening for babies born at home. MS. FRICKY replied that the hospital performs screening on children born at home only if a home birth attendant requests it. MARTIN BEALS, Representative of the Alaskan Chapter of the American Academy of Pediatrics (AAP), testified in support of HB 109. He emphasized that the screening is not a simple positive/negative test and it often yields false-positive results. Establishing standard procedures for follow up and tracking would simplify the administration of the test and increase the efficiency of the treatment of affected children. 2:39:25 PM CATHERINE PRICE-CARTER, nurse, Bartlett Regional Hospital, testified in support of HB 109. She said that the bill would lend greater legitimacy to Bartlett's existing program. MARK BUTLER, Public Information Officer, Department of Health and Human Services, Municipality of Anchorage, testified in support of HB 109. MARIE DARLIN, AARP Coordinator, Capitol City Task Force, testified in support of HB 109. SUSAN WALKER, Anchorage resident, testified in support of HB 109. 2:44:42 PM DEBBIE GOLDEN, Director, Program Services, March of Dimes, Alaska Chapter, testified in support of HB 109. 2:48:24 PM SENATOR OLSON asked Ms. Golden whether hearing tests performed by nurses and audiologists yield different rates of false positive results. MS. GOLDEN replied no. CHAIR DYSON recognized no further witnesses and closed public testimony. 2:52:29 PM SENATOR ELTON moved to report CSHB 109(FIN) from committee with individual recommendations and attached fiscal notes. There being no objection, it was so ordered.