HB 168-TRAUMA CARE CENTERS/FUND  4:48:03 PM CO-CHAIR HERRON announced that the final order of business would be 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." SENATOR JOHN COGHILL, Alaska State Legislature, explained that HB 168 created an account for improving trauma care delivery. He explained that the Department of Health and Social Services (DHSS) commissioner would create regulations based on national standards for trauma care, and evaluate each delivery system. He referenced the packet, "Alaska Trauma Center," [Included in the members packets] which the information presented during the prior year. He shared that this was just one incentive suggested by the College of Surgeons to the State of Alaska. He reported that DHSS had created a trauma response systems administrator. He detailed that he had met with the Emergency Medical Services Council, and was encouraged by its focus on response systems, especially in remote areas. He expressed the need to better coordinate emergency response systems. He detailed the desire to create a fund to incentivize hospitals to enhance trauma care. He suggested putting money toward uncompensated care as it would allow hospitals to contract with more doctors for emergency trauma care. He pointed out that Alaska had 24 acute care hospitals, but only 1 Level Two trauma center. He requested a systemic approach to emergency response systems, and opined that creating incentives was a good place to begin. He pointed out that discussions were taking place with military doctors for a licensing structure to allow them to work with the civilian hospitals. He summarized that the two most critical issues were equipping the medical personnel in the remote parts of Alaska, and creating a fund to incentivize the hospitals to enhance the trauma care. 4:55:37 PM CO-CHAIR HERRON opened public testimony. 4:55:52 PM CO-CHAIR HERRON read a statement from Representative Cissna [original punctuation provided]: "Mr. Chair: I have an unavoidable conflict and won't be able to remain in this meeting. Broadening the discussion with all stakeholders would be an improvement. Increasing other incentives also would be beneficial. I am in favor of passage of this bill (as well as strengthening the bill.)" 4:56:15 PM DAVID HULL, Chair, Alaska Council on Emergency Medical Services (ACEMS), testified that he was speaking on behalf of ACEMS. He opined that trauma calls were increasing every year. He defined trauma as any bodily injury from an external source, and that it could be accidental or intentional. He quoted statistics for death and hospitalizations. He shared that a study in 2004 revealed that the hospital stay for trauma patients was more than $73 million, and that 1 in 4 was not compensated care. He defined a trauma system as a "pre-determined, organized, multi- disciplinary response to managing the care and treatment of severely injured people," and that a statewide system provided "a framework for disaster preparedness and response." He emphasized that the most important time frame for survival of a severely injured person was the time between injury and definitive care, "the Golden Hour." He opined that it was necessary for increased hospital participation for the statewide trauma system to function optimally. He shared that the goal of the statewide trauma system was to ensure that every hospital in Alaska was a designated trauma center. He testified in support of funding for the development of trauma centers, incentives for trauma care designation, and uncompensated patient care. He offered support for HB 168. 4:59:31 PM DR. FRANK SACCO, Trauma Director, Alaska Native Medical Center; Chair, Alaska State Trauma Systems Review Committee, explained that trauma was the leading cause of death for Alaskans under 44 years of age, and that Alaska had the second highest rate of trauma in the U.S. He opined that a good trauma system would decrease the mortality by 15-25 percent. He reflected on prior legislation which was only voluntary with no incentives, and consequently, there was only one Level 2 Trauma Center in Alaska. He summarized an American College of Surgeons review that "the achievements to date have been largely unplanned with limited coordination; as the result, incongruity exists with the current trauma system." He commended the Alaska Native health facilities for working toward trauma designation, but he decried the lack of commitment for "achieving nationally recognized standards of trauma care" from most health facilities. He stated that Alaska was the only state without a Level 2 Trauma Center for the majority of the population, and that Anchorage was the largest city in the United States without a designated Level 1 or Level 2 trauma center for the majority of the population. He expressed support for HB 168, and declared that it was not a partisan issue. 5:04:06 PM DR. REGINA CHENNAULT, Chair, American College of Surgeons Committee on Trauma, Alaska Trauma System Review Committee, expressed concern that Alaska did not have a designated trauma hospital for the general public. She reported that Alaska had a lot of trauma, with a lot of domestic violence. She requested that an organized, systems approach to trauma care be implemented as soon as possible. 5:05:30 PM MARK JOHNSON, Alaska Trauma System Review Committee, opined that [trauma] care would be improved if more hospitals met the national standards. He referred to the 2008 American College of Surgeons review of Alaska hospitals which included 70 recommendations, of which 16 were listed as priority. He supported the incentives within HB 168. 5:07:30 PM WARD HURLBURT, Chief Medical Officer; Director, Division of Public Health, Office of the Commissioner, Department of Health and Social Services (DHSS), shared his personal experience as a trauma physician. He shared that trauma was the third highest cause of death in Alaska, and the highest cause for ages up to 44 years. He reflected on the American College of Surgeons trauma system review and noted with concern that the "trauma infrastructure's unplanned, under developed, under resources, and lacks sufficient coordination and integration." He also expressed the administration's concern that Anchorage was the largest city in the U.S. without Level 1 or 2 trauma centers. He shared that the administration encouraged collaboration among the health care systems and the development of a "more mature trauma system." He stated that the administration was neutral on HB 168. 5:11:55 PM CO-CHAIR HERRON noted a proposed amendment for funding. 5:12:23 PM SENATOR COGHILL replied that it was a good amendment, but that the funding would be drawn from the general fund. 5:12:48 PM [HB 168 was held over.]