HB 277-EMERGENCY USE OF EPINEPHRINE  3:29:15 PM CO-CHAIR KELLER announced that the next order of business would be HOUSE BILL NO. 277, "An Act establishing a program in the Department of Health and Social Services to certify certain individuals to be issued a prescription to administer epinephrine and to possess and administer epinephrine in certain situations." The committee took an at-ease from 3:29 p.m. to 3:34 p.m. 3:34:10 PM CO-CHAIR HERRON moved to adopt the proposed committee substitute (CS) for HB 277, Version 26-LS0951\S, Bullard, 3/26/10, as the work draft. There being no objection, Version S was before the committee. 3:34:36 PM MICHAEL DUNNING, Intern to Representative Peggy Wilson, Alaska State Legislature, said that epinephrine was also referred to as adrenaline, and was naturally occurring. He noted the "fight or flight" response. He pointed out that it was used daily to combat asthma and severe reactions. He stated that the bill proposed to establish a training standard for individuals to administer epinephrine with auto injectors, often referred to as epi-pens, as well as with ampules. He explained that epi-pens administered one or two doses, whereas an ampule was a sterile glass storage container from which a dosage could be drawn, and was significantly cheaper than the epi-pen. He gave examples of existing training programs, which included American Heart Association, Red Cross, and Wilderness Medical Associates. MR. DUNNING explained that an individual that successfully completed the training requirements would be authorized to obtain a prescription to purchase epinephrine and to administer it only in the very specific emergency situations outlined in HB 277. He opined that HB 277 would protect Alaskans, increase safety measures, and hopefully save lives. 3:37:35 PM REPRESENTATIVE SEATON directed attention to page 2, line 24, Sec 17.22.030 and asked why the applicability was not for individuals authorized under other laws. 3:38:03 PM MR. DUNNING said that he did not know. CO-CHAIR HERRON referred to the language on the last paragraph of the memorandum from Legislative Legal and Research Services. REPRESENTATIVE T. WILSON offered her interpretation that an individual rendering aid would be held harmless under the Good Samaritan Law, and she asked Mr. Dunning if he agreed. MR. DUNNING replied that the applicability, the liability of the certified individual, and the referenced Good Samaritan Laws did not preclude one another, as an individual may be immune under one aspect, but not under another aspect. He offered that it would protect individuals who had completed the training program. REPRESENTATIVE T. WILSON questioned if the Good Samaritan Law would pertain if there was not a training program. MR. DUNNING replied that this would depend on the individual facts of a particular case. He explained that HB 277 required the following to avoid personal liability: the individual would have to successfully complete the training program; to administer epinephrine in a narrowly defined emergency situation; and to have acted in Good Faith. 3:41:18 PM REPRESENTATIVE T. WILSON expressed concern that the bill would increase the liability. MR. DUNNING replied that HB 277 offered another layer of protection above the Good Samaritan Law for those that had successfully completed the training program. REPRESENTATIVE T. WILSON asked who would conduct the training. MR. DUNNING reiterated that the training programs already existed, and that some had included the epi-pen training along with CPR. He noted that successful completion of the training allowed for a prescription to purchase epinephrine. REPRESENTATIVE T. WILSON asked to clarify that a pharmacist would supply the epinephrine as requested. 3:43:48 PM MR. DUNNING offered his understanding that this would be the case. CO-CHAIR KELLER inquired about any concern for abuse of epinephrine because of HB 277. MR. DUNNING offered his belief that this was not a concern, and that it was a proven life saving medication. CO-CHAIR KELLER shared that his research indicated that epinephrine was not a recreational drug of choice. 3:44:59 PM REPRESENTATIVE LYNN, speaking as one of the joint prime sponsors of HB 277, conveyed a personal story about epinephrine. 3:46:57 PM REPRESENTATIVE HOLMES indicated support for what the bill was attempting to do. She stated that she wanted to limit liability, and referred to the definition of "emergency situation" on page 3, line 4. She suggested to add "or appears to experience" after "experiences" on page 3, line 5. She opined that this would protect an individual who was acting in good faith from their training. She also suggested adding "reasonably" after "not" on page 3, line 7. 3:49:19 PM REPRESENTATIVE HOLMES, in response to Co-Chair Herron, noted that both the Good Samaritan Law and the limited liability section of HB 277 on page 2, line 27, Sec. 17.22.040. "Liability of certified individual" would protect an individual who acted in good faith. She expressed her desire to ensure that an individual was covered regardless. 3:51:06 PM REPRESENTATIVE CISSNA reflected on a personal family incident. 3:52:13 PM REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, offered her understanding that Alaska State law currently stated that only the person with the medication could self medicate, or receive assistance from a properly trained person. The intent of the bill was to provide protection to those who were not currently covered by the law. 3:53:52 PM WARD HURLBURT, Chief Medical Officer; Director, Division of Public Health, Office of the Commissioner, said that the administration was neutral on HB 277. REPRESENTATIVE T. WILSON asked to clarify that a pharmacist would supply epinephrine solely upon the presentation of the card certifying successful completion of the training. DR. HURLBURT offered his understanding that some details were still to be worked out to ensure it. He reiterated that the training programs already existed, and that a physician's prescription could become part of the process. REPRESENTATIVE HOLMES observed that it was not possible to walk in and buy epinephrine without a prescription. DR. HURLBURT concurred that this was consistent with the current process. 3:56:18 PM REPRESENTATIVE T. WILSON expressed her confusion of why a doctor would write a prescription solely based on successful completion of a course. REPRESENTATIVE P. WILSON referred to page 1, lines 10-12, of the bill, and explained that there was situational justification. REPRESENTATIVE T. WILSON asked if this was acceptable to the medical profession. REPRESENTATIVE P. WILSON replied that one doctor even taught 5 year old children how to self administer the epi-pen. REPRESENTATIVE HOLMES asked Dr. Hurlburt for any concerns. 3:58:21 PM DR. HURLBURT replied that epinephrine was a natural substance and that it was safe, although that did not mean that there was not any risk. He pointed out that sufficient quantities could present a risk, but that it was safer than many other over the counter items found in drug stores. CO-CHAIR KELLER clarified that the training mitigated the risk. He opined that it was appropriate to keep the strict language in the bill. 3:59:53 PM DR. HURLBURT explained that part of the training was for the administration of epinephrine, as most people were not trained to give injections. 4:00:44 PM REPRESENTATIVE HOLMES referred to her earlier suggestion of amending page 3, line 5 to add "or appears to experience" after "experiences," and asked Dr. Hurlburt if it was possible to mistake the signs of anaphylactic shock. DR. HURLBURT replied that, as a physician, her amendment was excellent, as it could not be known with 100 percent certainty. 4:02:14 PM KEN ZAFREN, Medical Director, Alaska Emergency Medical Services Program, expressed his agreement with the comments and with Representative Holmes' amendment to change the wording. CO-CHAIR KELLER asked how the prescription process would work. DR. ZAFREN offered that, although it was not addressed in HB 277, most doctors would be comfortable with writing a prescription for someone who had successfully completed the training. 4:03:55 PM CO-CHAIR KELLER closed public testimony on HB 277. 4:04:04 PM REPRESENTATIVE HOLMES moved to adopt Conceptual Amendment 1, which would read: Page 3, line 5, following "experiences" Insert "or appears to experience" Page 3, line 7, following "not" Insert "reasonably" CO-CHAIR KELLER objected for discussion. There being no other objections, he removed his objection and Conceptual Amendment 1 was adopted. REPRESENTATIVE P. WILSON suggested a conforming amendment to delete "and" between "for" and "purchase" on page 1, line 11. [Before the committee was a motion to adopt Conceptual Amendment 2, which would read: Page 1, line 11, following "prescription for" Delete "and" ] CO-CHAIR KELLER objected for discussion. REPRESENTATIVE HOLMES clarified that line 11 would now read "obtain a prescription for purchase." CO-CHAIR KELLER removed his objection. There being no further objection, Conceptual Amendment 2 was adopted. 4:06:08 PM REPRESENTATIVE T. WILSON moved to report the proposed committee substitute (CS) for HB 277, 26-LS0951\S, Bullard, 3/26/10, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 277(HSS) was reported from the House Health and Social Services Standing Committee.