HOUSE BILL NO. 168 "An Act relating to state certification and designation of trauma centers; creating the uncompensated trauma care fund to offset uncompensated trauma care provided at certified and designated trauma centers; and providing for an effective date." 1:40:56 PM Co-Chair Stoltze noted that public testimony had been closed. He solicited amendments to the bill. 1:41:11 PM Co-Chair Stoltze observed the new fiscal note. CO-CHAIR MIKE HAWKER explained that the legislation was ineffective without the associated funding. He relayed that upon first introduction, the bill had be accompanied by request for an appropriation of $5 million. A parallel bill had moved through the Senate, which also had a $5 million fiscal note attached to it. Discussions had concluded that if the bill were to pass, an appropriation would be needed in order to fund the legislation. He thought that the cost associated with the legislation would become a long term operating budget item. The fiscal note reflected a request of $5 million in FY 11 operating budget, all future years were indeterminate. The funding source was 50 percent federal receipts, and 50 percent general funds, based on the understanding that at those levels there would be disproportionate hospital share authority available under Medicaid. Co-Chair Stoltze agreed that the fiscal note reflected significant fiscal impact. 1:46:02 PM Representative Austerman expressed appreciation for the candid discussion concerning increasing the cost of the operating budget. 1:46:58 PM Representative Austerman understood the need for the trauma centers, but he felt that placing an emphasis on trauma prevention would be more beneficial. He thought that adding more troopers along highways to arrest drunk drivers would save lives, preventing the need for increased trauma centers. He thought that trauma prevention should be addressed as well. Representative Foster cited Page 1, Line 14: (b) The fund consists of money appropriated to it by the legislature, including donations, recoveries of or reimbursements for awards made from activities under this chapter. Representative Foster asked if the fund would need to be replenished from year-to-year, and by how much. He said if each year 25 percent of the fund was being spent, the entire appropriation would be spent in four to five years. 1:49:48 PM SENATOR JOHN COGHILL, SPONSOR, answered that he did not know. The general area of cost was known due looking at similar programs in other states. He said that there were federal grants and local programs that could be willing to contribute. He directed attention to Tab 4 of the "Trauma Care in Alaska: Creating a Trauma Care Fund" book. In order for Trauma Level 2 status to be achieved, alcohol screening and brief intervention was necessary. He argued that this would create a system that had an intervention component that would provide for teachable moments in people's lives. He agreed that safety issues on the road should be examined. 1:52:46 PM Co-Chair Hawker reminded the committee that the legislative proposal had been discussed for over two years. He expressed concern that the proposal was expensive to create and maintain, and could force the state back into deficit spending. However, he felt that the proposal was compelling, and believed that the importance of immediate trauma treatment regardless of the location of the accident should be a priority. He agreed that a stronger state trooper presence along the Seward Highway could be helpful. He stated that the goal should be to build the resources within the state to care for the "innocent victims of stupidity". He offered that Alaska was a high risk state, and that simply living here posed a higher risk than living in other states. He announced support for the legislation and acknowledged the fiscal note associated with the bill. He believed that there was a greater good served by moving the bill forward despite continuing fiscal concerns. He felt that the public understood that the programs would continue for only as long as there was money available to fund them. He recognized that passing the bill would inevitably create financial trauma for the state in the future. 1:56:52 PM Representative Kelly expressed concern that the state would be accepting liability for trauma victims, and that the legislation imposed the responsibility of health care on the state. He agreed with the concept of the bill, but harbored deep concern for the financial responsibility. 1:59:47 PM Representative Salmon disagreed. He believed that the state needed to begin improvements in the area of trauma response. He argued that lives in rural Alaska could be saved by establishing trauma centers closer to villages to assist in the "golden hour". In emergency medicine, the "golden hour" refers to the time period lasting from a few minutes to several hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death. 2:01:17 PM Vice-Chair Thomas MOVED to report CS HB 168(FIN) out of Committee with individual recommendations and the accompanying fiscal note. There being NO OBJECTION, it was so ordered. CS HB 168(FIN) was REPORTED out of Committee with no recommendation and with new fiscal note from the Department of Health and Social Services and previously published zero fiscal note: FN2 (REV) 2:01:49 PM AT EASE 2:14:44 PM RECONVENED