HB 61-ADVANCE HEALTH CARE DIRECTIVES REGISTRY  3:40:19 PM CHAIR KELLER announced that the next order of business would be HOUSE BILL NO. 61, "An Act relating to a registry for advance health care directives." 3:41:07 PM REPRESENTATIVE LINDSEY HOLMES, Alaska State Legislature, explained that HB 61 dealt with advance health care directives, or living wills, which detailed end of life and health care wishes, as well as designating a decision maker if the individual was not able. She offered an example for the difficulties encountered when a living will was not accessible. She explained that HB 61 created a secure, voluntary, 24 hour, on line registry for living wills, housed in the Department of Health and Social Services (DHSS), which was accessible by other hospitals and health care facilities. She pointed out that out of state access would also be available during business hours. 3:44:02 PM CHAIR KELLER asked how many states had implemented this. REPRESENTATIVE HOLMES replied that Legislative Research had researched a company to set this up more efficiently and less costly than DHSS. REPRESENTATIVE HOLMES, in response to Chair Keller, said that the initial set up cost would be $194,800; in subsequent years, the cost would be $82,400 for a part time employee and the cost of the on line registry. 3:45:33 PM JAMES WALDO, Staff, Representative Lindsey Holmes, Alaska State Legislature, shared that Legislative Research did prepare a report on the advanced health care directives and registries of various states. He reported that seven states already participated or had central state registries. 3:46:53 PM MR. WALDO, directing attention to Section 1 of HB 61, said that it protected health care facilities against liability for accessing or not accessing the registry. He moved on to Section 2, which dictated into statute how the registry would work. He reported that each subsection explained a piece of the bill: (a) created the authorization for the registry within DHSS; (b) established that it was voluntary; (c) reiterated the confidentiality to the hospitals in the state; (d) discussed its availability on line within the state; (e) clarified the legal parameters; (f) addressed the removal of a directive from the registry; whereas (h) stated that a fee could be charged for filing a directive, but not for removing it; (g) clarified that filing the directive or not filing it, did not affect the validity of a directive; (i) authorized DHSS to write regulations to protect the cyber-security of the registry; (j) identified who could access a directive: (k) exempted DHSS from liability; and (l) contained definitions for terms used within the bill. 3:52:04 PM CHAIR KELLER asked for clarification to page 2, lines 3-4. MR. WALDO replied that this referred to one individual, not two. He pointed to lines 12-13, which defined someone other than the individual. 3:54:03 PM CHAIR KELLER, referring to page 2, lines 14 and 15, asked if this should be more specific. 3:55:24 PM MR. WALDO replied that it required that the request must come from the facility where the individual was a patient, and most likely, the patient's doctor would request the directive. 3:56:04 PM CHAIR KELLER, referring to subsection (c) on page 2, lines 5-8, asked for clarity to the word "use." 3:57:32 PM REPRESENTATIVE SEATON, directing attention to page 3, lines 7-8, asked to clarify that the fee would not be any greater than its cost to the department. 3:58:00 PM REPRESENTATIVE HOLMES replied that the department was not required to charge a fee but that it was allowed. The fee could not exceed the actual administrative cost, as the intent was to keep the cost low. 3:58:47 PM REPRESENTATIVE SEATON asked about the costs incurred by other states. 3:59:05 PM MR. WALDO replied that three of the seven states participated in a national data base, which was significantly more expensive, and that the Arizona centralized registry was more comprehensive than the one proposed in HB 61. 4:00:26 PM REPRESENTATIVE SEATON, noting that the information form would be scanned into the registry, asked to verify that DHSS was not responsible for checking the validity of the information. MR. WALDO agreed. 4:01:36 PM MARIE DARLIN, Coordinator, AARP Capital City Task Force, testified in support of HB 61. She stated that this was the next necessary step for the access to advance directives. She pointed out that some hospitals had joined a registry group, as a way for other hospitals to access your records. She opined that HB 61 had covered all the points for concern. 4:04:53 PM REPRESENTATIVE KERTTULA asked to clarify that Bartlett Hospital could release the advance directive to any hospital in the nation. MS. DARLIN offered her belief that Bartlett Hospital would place your advance directive on this national registry. 4:06:00 PM CHAIR KELLER asked how many national registers there were, and if AARP sponsored a registry. 4:06:53 PM MS. DARLIN, in response to Representative Herron, said that AARP had worked hard to get the advanced directives into statute. 4:07:34 PM MS. NENON testified in support of HB 61. She shared a personal story of her father and his problems of advance directives without registries. 4:10:58 PM DR. WARD HURLBURT, Chief Medical Officer/Director, Division of Public Health, Central Office, Department of Health and Social Services, said that the administration did not have a position on the bill. He opined, as a Public Health clinician, that everyone should have a living will. 4:11:49 PM REPRESENTATIVE SEATON asked how many hospitals inquired whether a patient had a living will on file. DR. HURLBURT replied that he did not know that specific for Alaska. He offered his belief that every hospital should ask that question, but that even with this legislation the question might not be asked. He pointed to this as a failing of the health care system. 4:13:24 PM CHAIR KELLER remarked that all the necessary forms were available in the statute. DR. HURLBURT reminded the committee that the ethical default was to keep people alive, although the result of that could sometimes be tragic. 4:14:55 PM REPRESENTATIVE SEATON asked the bill sponsor to survey for the default position of the individual hospitals regarding living wills. 4:15:47 PM REPRESENTATIVE MILLETT reflected that end of life issues were very difficult and emotional decisions. She opined that the registry offered support for these decisions. [HB 61 was held over.]