HB 269-IMMUNITY FOR TEMP. HEALTH CARE PROVIDER  3:06:40 PM CHAIR HIGGINS announced that the first order of business would be HOUSE BILL NO. 269, "An Act providing immunity for certain licensed temporary health care providers who provide free health care services." REPRESENTATIVE KELLER moved to adopt the proposed committee substitute (CS) for HB 269, labeled 28-LS1251\U, Martin\Wallace, 2/4/14, as the working draft. There being no objection, it was so ordered. REPRESENTATIVE STEVE THOMPSON, Alaska State Legislature, reading from a prepared statement: An act providing immunity for certain licensed temporary health care providers who provide free health care services. HB 269 was drafted due to liability concerns surrounding an inaugural Alaska Mission of Mercy (AKMOM) event organized by the Alaska Dental Society, and scheduled in Anchorage this coming April. The Mission of Mercy program was started by a group of dentists thirteen years ago in Virginia. The MOM programs provide free dental care to local residents who would not otherwise have access to affordable dental care. To date, the Mission of Mercy Program in Alaska has 187 dentist volunteers, 7 are from out of state. The AKMOM program will provide extractions, fillings and cleanings as well as other procedures that can be appropriately performed in a mission setting. Out-of-State dental professionals will be licensed to provide pro bono service under courtesy licenses issued by the Alaska Board of Dental Examiners. A courtesy license is a medical professional license issued by the Board for the purposes of providing free services and enforcing state disciplinary provisions. The issue is that there is no clear answer as to whether an out-of-state dentist professional issued a courtesy license is covered under Alaska Statute 09.65.300. AS 09.65.300 provides statutory immunity against civil damages resulting from an act or omission of a health care provider who provides free health care service, within the scope of their license. Under AS 09.65.300 a patient must receive written notice of this immunity as well as give informed consent before any medical service is provided. Under AS 09.65.300 patients still have the right to sue the medical provider for civil damages resulting from the provider's gross negligence, or reckless or intentional misconduct. Unfortunately, an attorney general's opinion indicated that it would take a court case to definitively decide if courtesy licenses have protections. The original intent of the statute was to allow retired Alaska physicians to volunteer their services. The Department of Law opines that the meaning of the law as to out of state providers will ultimately have to be interpreted by the court. HB 269 will clarify AS 09.65.300, ensuring that civil immunity is extended to these out-of-state medical professionals who are licensed to provide dental services in Alaska during the Mission of Mercy Event, without having the issue come before a lengthy proceeding before the Court. REPRESENTATIVE THOMPSON urged the support of the committee. 3:10:18 PM CHAIR HIGGINS asked whether military dentists, when volunteering their time, had immunity coverage. He shared that the legal opinion from the Department of Law was for immunity status, unless the courts stated otherwise. He noted that he was a dentist. 3:11:54 PM DAVID LOGAN, Legislative Committee and DAPAC Chair, Alaska Dental Society, in response to Chair Higgins, explained that, as a general rule, military dentists did not carry malpractice insurance policies, unless they worked away from the military base. CHAIR HIGGINS relayed a concern from Timothy M. Lynch [Included in members' packets] whether a temporary courtesy provider license would be in conjunction with the requirements for a temporary permit under AS 08.64.270. Mr. Lynch asked, if the proposed bill removed the requirement for state licensing, would someone other than a State Medical Board have the authority to license physicians under this approach, which, he opined, would create an ambiguous situation regarding licensing. He questioned whether this would prompt a conflict between the State Medical Board and the Alaska State Medical Association. 3:14:27 PM DR. LOGAN replied that the proposed bill would extend AS 09.65.300, which defined that a health care provider could hold a temporary courtesy license under AS 08.01.62. He pointed out that courtesy licenses were very different from temporary licenses, which were issued under AS 08.064.270, and allowed work and remuneration in any capacity. He noted that courtesy licenses were reserved for unique situations, and specified under various professions. He shared that a courtesy license was issued for short term pro bono work. He pointed out that there could not be any earnings with a courtesy license, other than reimbursement for travel. REPRESENTATIVE TARR asked for information about any necessary follow-up procedures for patients after the AKMOM event. DR. LOGAN deferred the question to Dr. Julie Robinson, as she could speak more specifically to the procedures and any follow up care. He surmised that many of the procedures would be limited, as this was not the setting for more complicated needs. 3:18:08 PM REPRESENTATIVE SEATON asked why the proposed bill did not cover military courtesy licensing for these voluntary services. DR. LOGAN explained that the Alaska Board of Dental Examiners allowed military dental courtesy licenses. He opined that most of the other medical boards had provisions in place for military courtesy licensing. 3:19:56 PM CHAIR HIGGINS opened public testimony. JULIE ROBINSON, Alaska Dental Society, Alaska Mission of Mercy, in response to Chair Higgins, explained that the Alaska Mission of Mercy program had 1058 volunteers, and 202 dentists. She declared that Alaska was the 27th state to offer this program, and that there was a follow up care protocol. She pointed out that, in this type of setting, the scope of practice was limited. She stated that the main goal was to eliminate pain and infection, and to restore smiles. She relayed that patients were informed that the dentists may be from out-of-town or out- of-state. The registration, which must be signed, has an immunity clause printed on the back of the form. After treatment, there was post-operative care during which the treatment was reviewed and written instructions for care were provided, which included an emergency phone number that was monitored by a dentist for the following two weeks. She reported that the Anchorage Neighborhood Health Center had also agreed to see ten people for no charge, following the Alaska Mission of Mercy program. Other dentists had also offered to see post-operative patients. She reported that these programs in other states with similar numbers of participants would usually have fewer than six post-operative calls. DR. ROBINSON explained that dentists not able to see post- operative patients had so indicated on their registration. She reported that of the 202 participating dentists, 8 were military or federal service dentists, and 9 were previous volunteers, with dental licenses from many other states. She expressed the goal to serve 2000 Alaskans in two days, and that the long term goal was for this to be an annual event throughout Alaska. She noted the greater challenges for a program in Alaska than for the contiguous states. She asked that immunity protection for the courtesy license be extended. 3:26:31 PM DR. ROBINSON, in response to Chair Higgins, said that the treatment dates were April 11 and 12, with service beginning at 4:30 a.m. CHAIR HIGGINS declared his desire for the program to focus on the working class who could not afford to go to the dentist and did not have insurance, stating that people covered by Medicaid already had coverage. He offered his services if he was granted time off from the legislative session. He declared his support for the program. REPRESENTATIVE TARR asked how to promote the event in the future. 3:29:06 PM RANDI SWEET, Director, Health Impact, United Way of Anchorage, reported that the United Way was a partner in the event. She spoke in support of HB 269, declaring that the current volunteer health care provider immunity act provided protection to Alaska health care providers who volunteered their time to help Alaskans. She reported that Alaskans were among the least insured in the nation, with a recent study showing that 20.6 percent of the state did not have insurance. She noted that only five other states had a higher percentage of un-insured. She read appreciative comments from individuals participating in the earlier free clinics offered by University of Alaska Anchorage and the Anchorage Project Access. She asked for support for proposed HB 269. 3:33:05 PM REPRESENTATIVE KELLER moved to report CSHB 269, Version 28- LS1251\U, Martin\Wallace, 2/4/14, out of committee with individual recommendations and the accompanying fiscal notes. There being no objections, CSHB 269(HSS) was moved from the House Health and Social Services Standing Committee.