SENATE BILL NO. 131(title am) "An Act relating to the presumption of compensability for a disability resulting from certain cancers in firefighters." 4:18:44 PM SENATOR ROGER HOLLAND, SPONSOR, read the sponsor statement (copy on file): Firefighting is an inherently dangerous job, resulting in instances of cancer in firefighters is shown to be higher than the general population. Studies that have evaluated cancer risk among women firefighters suggest women firefighters, like their male coworkers, may be at an elevated risk for overall cancer incidence (Daniels et al., 2014). These studies also suggest women firefighters may be at an elevated incidence risk for breast cancer (Daniels et al., 2014). In addition to studies on cancer risk among firefighters, a small but growing body of research examines firefighters' exposures to toxic chemicals, including carcinogens and hormone disruptors, on the fire ground, in stations, and from their gear. Exposure to carcinogenic chemicals and hormone- disrupting chemicals do not discriminate based on sex or gender. Exposure to these chemicals may be mitigated, but not eliminated, through protective equipment, firehouse design, and structural changes. Firefighters involved in fire suppression, whether it be as a volunteer or career firefighter, are at higher risk of cancer. SB 131 would help recognize this additional risk firefighters take to keep us safe. Thank you for your consideration of the addition of breast cancer to the list of presumed disability coverages for firefighters. 4:20:46 PM CRAIG VALDEZ, STAFF, SENATOR ROGER HOLLAND, reviewed the sectional analysis (copy on file): Amends this Act relating to the presumption of compensability for a disability resulting from certain diseases for firefighters. Sec. 1 AS 23.30.121(b), relating to the list of coverage for firefighters, is amended by: ? Adding the terms "skin cancer, breast cancer, cervical cancer, testicular cancer, mesothelioma, multiple myeloma, colon cancer, thyroid cancer, and ovarian cancer" to list of AS 23.30.121(b). Sec. 2 Adds a section definition of "firefighter." Sec. 3 Clarifies this change applies to claims made on or after the effective date of this Act. 4:22:46 PM Senator Holland introduced a PowerPoint presentation titled "Senate Bill 131: Workers' Compensation Disability for Firefighters" (copy on file). He briefly reviewed slides 2 through 5. Senator Holland turned to slide 2 titled SB 131: Firefighting is an inherently dangerous job. It is important that workers compensation insurance provides coverage for the inherent risks in that job. Currently, there is an oversight in Alaska Statutes regarding that coverage: Breast Cancer. Senator Holland pointed to slide 3 titled Senate Bill 131: SB 131 would add breast cancer to the list of presumed disability coverages for firefighters, so long as the firefighter could establish that the breast cancer was caused by their work as a firefighter. Senator Holland indicated that the coverage was difficult to qualify for. The firefighter had to obtain a zero year exam that demonstrated no evidence of the disease and maintain an examination over the following seven years to qualify. Senator Holland reviewed slide 4 titled Firefighters at Risk: Instances of cancer in firefighters is shown to be higher than the general population. Studies that have evaluated cancer risk among women firefighters suggest women firefighters, like their male coworkers, may be at an elevated risk for overall cancer incidence (Daniels et al, 2014). These studies also suggest women firefighters may be at an elevated incidence of risk for breast cancer (Daniels et al, 2014). Senator Holland briefly moved to slide 5 titled General Statistics: In the general population, less than one percent of males are likely to develop breast cancer in their lifetime. Studies have found strong associations between firefighting and male breast cancer (Ma et al, 2005). Male firefighters are 7.5 times more likely to die from breast cancer than their non-Fire Service counterparts. (Ma et al, 2005) The same mechanism that would cause increases in breast cancer in men is thought to result in proportional increases in risk among women. Senator Holland shared that a Fairbanks fire chief, Fire Chief Warren Cummings died of breast cancer in 2017 after 42 years of service. 4:25:51 PM Senator Holland moved to slide 6 titled General Statistics: In the general population, one in eight women (12 %) will likely contract breast cancer in their lifetime. At only about four percent of the firefighter population, small sample sizes make it difficult to draw conclusions about females and breast cancer in the Fire Service. This bill protects not only women, because exposure to carcinogenic chemicals, which often occurs in the normal course of a firefighter's job, does not discriminate based on sex or gender. Senator Holland reviewed slide 7 titled Presumptive Laws: Presumptive laws are regulations that assume a given disease is linked, by default, to a specific occupation. This means that when someone is diagnosed  with an illness covered under a presumptive law, they are automatically entitled to disability or workers' compensation, medical expense coverage, and medical leave, provided they meet certain criteria. Senator Holland continued to slide 8 titled Presumptive Laws: Without presumptive laws, to get these benefits, firefighters and other workers may have to prove that their line of work caused their disease. This process can be lengthy and expensive at a time when resources should be dedicated toward treatment, wellness, and, sometimes, end-of-life decisions. Senator Holland highlighted slide 9 titled Alaska Statute 23.30.121: Breast Cancer would join the existing list, including: Respiratory Disease, Cardiovascular Events (Limited), Primary Brain Cancer, Malignant Melanoma, Non- Hodgkins Lymphoma, Bladder Cancer, Ureter Cancer, Kidney Cancer, Prostate Cancer. Senator Holland briefly mentioned slide 10 that repeated what presumptive laws were on slide 7 and asked the question, What are those criteria? Senator Holland highlighted slide 11 titled "Alaska Statute 23.30.121: Once added to the list, several standard limitations would apply. The firefighter must: Have been a firefighter for at least seven years, Have had initial and annual medical exams showing no evidence of disease, Be able to demonstrate exposure to a known carcinogen while in the Fire Service, At a minimum, be certified as a Firefighter I. Senator Holland referred to bullet point number 3 and interjected that proving exposure was difficult. There were so many chemicals in structures that were burning. Senator Holland highlighted slide 12 titled "Alaska Statute 23.30.121: Other qualifying criteria would apply, including: 1. Coverage may be denied based on: a. Use of tobacco products, b. Physical fitness and weight, c. Lifestyle decisions, d. Hereditary factors, e. Exposure from other employment/non-employment activities. 2. Some post-employment coverage is available, a. Three months accrued for every year of service, b. Five year maximum. Senator Holland pointed to slide 13 titled enate Bill 131 that listed the 14 states that added breast cancer in presumptive laws. Slide 14 concluded by asking that Alaska be added to the list of states. 4:29:26 PM Representative Rasmussen asked why a five year limit after retirement was set. She asked if it was possible a person could develop cancer seven to ten years after retiring. Senator Holland believed that it was an industry standard. He would follow up with information. Co-Chair Merrick moved to invited testimony. SCOTT RAYGOR, FIRE CHIEF, FAIRBANKS FIRE DEPARTMENT, FAIRBANKS (via teleconference), asked to hear the question repeated. Representative Rasmussen wondered why the limit was set for 5 years considering the states retention problems and that many firefighters were serving their communities for over 20 years. She noted that a firefighter could develop cancer 7 or 10 years after retirement. Mr. Raygor answered that the reason was related to the presumptive law. He explained that after the 5 year period it was not presumed that the cancer was caused by exposure; other things post retirement could be the cause. He added that it did not mean the claim would be denied, work exposure was just not the presumed cause. Co-Chair Merrick asked to hear Mr. Raygor's testimony. Mr. Raygor urged the committee to pass SB 131. He shared that he had worked with former Fire Chief Cummings who had died from breast cancer. At the time, he was not even aware that men could die from breast cancer. He related that firefighters were at a three times higher risk of a cancer diagnosis. He reported that less than seven percent of firefighters were women and currently studies were beginning to determine how the cancer rates affected women firefighters. He expected that the rates for female firefighters would be higher than for male firefighters. He elaborated that most structures were rarely wood based anymore and were full of petroleum based products; almost all fires caused exposure to carcinogens. He reported that research demonstrated that the places where a firefighter sweated tended to be locations where cancers were discovered. He reiterated that every fire was now a carcinogen. In addition, the chemicals used to fight fires were carcinogens. He summarized that firefighters were three times more likely to develop cancer. He requested that the committee pass the bill. 4:35:35 PM Representative Josephson supported the bill. He shared that a good friend and former legislator [and attorney] Eric Croft handled many of the firefighters' legal cases regarding the issue. He referred to the Adams Decision that considered a challenge by a municipality to the assertion of benefits under Workers Compensation. He reported that public employers were often very aggressive about challenging the claims. He looked at page 2, line 27 of the bill and stated the phrase, the firefighter was exposed to a known carcinogen. He wondered how evidence of exposure was collected. Mr. Raygor replied that there were different ways exposure data was collected. Sometimes individual firefighters document every fire they fought. Currently, the National Cancer Institute had a web portal that allowed the firefighter to document the fire. In some cases, the fire department looked back over a firefighters career and documented every fire fought. He concluded that there were many ways fire departments could manage tracking exposure incidents. Representative Josephson asked if it was true that in the Adams Decision the public employer may put up an extensive fight over the cases. Mr. Raygor believed so but was not sure of the outcome of the decision. He opined that insurance companies fought all claims, presumptive or personal. 4:39:29 PM Representative Carpenter asked how exposure was defined by the International Agency for Research on Cancer or the National Toxicology Program. He asked how the organizations determined the exposure. Senator Holland deferred to the testifier Mr. Raygor did not have the answer. Co-Chair Merrick requested they could get the answer prior to the next hearing. Representative Carpenter observed that other cancers in addition to breast cancer were included in the bill. He read the list: (x) cervical cancer; 7 (xi) testicular cancer; 8 (xii) mesothelioma; 9 (xiii) multiple myeloma; 10 (xiv) colon cancer; 11 (xv) thyroid cancer; and 12 (xvi) ovarian cancer. He presumed the other cancers were added in the prior committee [House Labor and Commerce Committee.] Senator Holland answered that the prior committee had added other cancers to the list, and it had been somewhat of a surprise. In addition, the committee dropped malignant melanoma and added the more general skin cancer. He noted that the director of the Division of Insurance was present and could speak to the costs of adding cancers to the list. He indicated that the cost of just adding breast cancer would be almost unrecognizable in terms of cost due to the low instance of claims. He disclosed that he had some cost concerns over the inclusion of the other cancers. 4:42:21 PM LORI WING-HEIER, DIRECTOR, DIVISION OF INSURANCE, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, asked Representative Carpenter if his concerns were over costs. Representative Carpenter replied that one of his concerns was over costs, but he wanted to understand how the other cancers were added. Senator Holland believed the thought in the prior committee was that the other cancers were just as important to add. He would personally have liked to maintain the focus on breast cancer. He confirmed that the original bill only added breast cancer to the list. Ms. Wing-Heier responded that the division did extensive research to determine what other states had done and examined the data base of the National Council on Compensation that tracked other states data. The council set the rates that the other states adopted. The council and the division did not find any evidence that adding breast cancer or other cancers were increasing workers compensation rates in other states. She elaborated that part of the reason was the presumptions were so strong and few claims were made. She indicated that currently, no data existed to support that the rates would increase. Representative Carpenter asked if the rates were not increasing it meant few claims were being submitted. Ms. Wing-Heier agreed with the conclusion. She explained that not all states had adopted the presumption of compensability for certain cancers, and some fire departments were not eligible. She reiterated that currently, there were not enough claims to raise the rates or presume the rate would increase. Representative Carpenter thought part of the issue was about how exposure was defined. He shared from personal experience that there had been a lot of open pit burning in Afghanistan and Iraq, that was impossible to protect oneself from. He believed that the definition of exposure was key to why an increase in claims may not be seen. He guessed that maybe firefighters were not technically exposed to carcinogens due to protective gear like masks. 4:46:39 PM Senator Holland would follow up with the information. He observed that firefighting procedures had changed over the last 20 years. He commented that firefighters remain fully geared up while in the fire and refrain from removing their protective gear until after the fire and separate themselves from the gear. The protocols decreased the risk of exposure, but firefighting was still a very dangerous career. Representative Josephson asked Representative Carpenter to repeat the question he wanted an answer to. Representative Carpenter complied. He stated that the two entities listed in the bill would determine whether the firefighter was exposed to a known carcinogen. He exemplified a firefighter wearing a mask when fighting a fire and wondered whether that was considered an exposure or if something more had to happen. He wanted to understand the definition of exposure. Representative Josephson suggested that the Adams Decision was worth reading. He explained that the presumption meant that even if the cancer did not actually happen because of exposure an individual could still obtain coverage. Representative Josephson asked if there was any testimony regarding other states adding the other recently added cancers to the list. Senator Holland answered that it had not been brought forward in the Senate. Representative Josephson asked if any of the cancers or just ovarian cancer had been added by his office. Senator Holland answered that the original bill only added breast cancer. He recalled that Representative Kaufman added ovarian cancer to the list in the prior committee. Vice-Chair Ortiz asked who would share the burden of additional costs. Senator Holland responded that there was an employee component of the insurance and with the addition of the other cancers he noted some concern over a potential cost increase to the employer. He deferred to Director Wing-Heier or Fire chief Raygnor to respond. 4:52:13 PM Ms. Wing-Heier asked Vice-Chair Ortiz to repeat the question. Vice-Chair Ortiz complied. Ms. Wing-Heier replied that Workers Compensation was paid completely by the employer. Senator Holland appreciated the correction to his prior statement. Representative LeBon noted that the prior committee substitute also expanded the definition of firefighter to include a firefighter employed by a municipal or state fire department. He wondered whether the Alaska Municipal League (AML) had weighed in with a concern. Senator Holland had received a letter of concern from AML. He would follow up with the information. Co-Chair Merrick wondered if he had heard opposition from the Alaska Public Entity Insurance. Senator Holland was unable to answer the question. 4:55:04 PM Representative Josephson deduced that the addition of the state firefighters, which included airport firefighters was minimal and was likely not a concern of the AML. He guessed that AMLs opposition would be to the added cancers. Co-Chair Merrick stated she would try to get the information for the committee. She asked if there had been discussion about naming the bill after the former Fire Chief Cummings. Senator Holland answered in the negative and thought it was an excellent idea. Representative Carpenter referred to Section 1, Subsection (C) on page 2, lines 25 to 26 of the bill and read, (C) with regard to diseases described in (1)(C) of this subsection, demonstrates He ascertained that the individual had to demonstrate exposure during their employment. He wondered how the requirement or burden to prove exposure was defined. Senator Holland deferred to Mr. Raygor. Mr. Raygor answered that the Fairbanks Fire Department procedure was through HAZMAT physicals. He detailed that an initial baseline physical was performed for a new hire and every year of employment after they were required to get a HAZMAT physical. If a firefighter developed cancer, the department examined every fire the individual fought and did backwards detective work to list all the potential exposures. Representative Carpenter thought the answer made it even more important to understand the definition of exposure. Senator Holland asked the fire chief if the reason for logging the firefighters exposure to carcinogens was to differentiate from someone working in the fire service but who did not fight fires. 4:59:54 PM Mr. Raygor answered that it could be an exclusion. He exemplified the EMTs who worked for a fire department but never fought fires. SB 131(title am) was HEARD and HELD in committee for further consideration. Co-Chair Merrick reviewed the schedule for the following day.