HB 52-NO PATIENT LEFT ALONE ACT  3:03:06 PM CHAIR PRAX announced that the first order of business would be HOUSE BILL NO. 52, "An Act relating to the right of patients and residents to have a support person in person during treatment and during stays at certain facilities; and relating to a requirement that health care facilities make certain information available to the public." 3:04:28 PM REPRESENTATIVE SARAH VANCE, Alaska State Legislature, as prime sponsor, introduced HB 52. She paraphrased from the sponsor statement [copy included in the committee packet], which read as follows [original punctuation provided]: HB 52 seeks to safeguard a patient's right to a support person receiving emergency medical services, or staying at hospital, nursing facility, assisted living home, or hospice care. This bill ensures no patient is left alone when they feel most medically vulnerable and may not be withheld a support person based on a state or federal declaration of disaster, allows for civil penalties and requires healthcare facilities to make visitation policies available to the public. The pandemic has caused great uncertainty and anxiety across Alaska and has significantly affected the medical community. Many unintended consequences have happened to patients because of visitation policies that have prohibited them from having any visitors, including a spouse, parent, close family member, guardian, health care agent, chaplain, or caregiver; and as a result, many have been forced to be alone during their treatment for serious conditions, traumas, illnesses, heart attacks, and routine and emergency surgeries. Some of these patients have been forced to be alone for the entire course of their treatment and in some cases have died alone; and many families have been unable to be physically present with their loved ones while in a hospital, nursing home, hospice care, adult care home, special care unit, or residential treatment setting for mental illness, developmental or intellectual disability, or substance use disorder. Alaskans have been limited to electronic video communications, if any, with the patient; and the patients who have been affected have included adults, minors, and individuals with intellectual or developmental disabilities; however it is my belief that it is our moral obligation that these patients be allowed at least one support person of their choice to be physically present at reasonable times throughout the period of hospitalization or residential treatment. 3:07:19 PM REPRESENTATIVE VANCE shared a recent story which related that a father had resorted to camping on the lawn of a hospital in order to be near his daughter who had been admitted to the hospital with a severe asthma attack. She stated that the father offered to test for COVID-19 and wear protective gear at the hospital, as he believed his presence would improve his daughter's health. She stated that the hospital had refused access to the father. She related a story concerning a constituent's experience after he was admitted to the hospital with COVID-19. His wife was not allowed to be with him in the hospital, and this had been mentally and physically challenging for him. She said he had told her that he had not considered the importance of having a loved one present during recovery. She related that he had realized that this presence would improve the patient as much as drugs and treatment. She maintained that this is an issue of human dignity. 3:11:20 PM REPRESENTATIVE VANCE presented a PowerPoint on HB 52, titled "No Patient Left Alone Act." As listed on slide 2, she addressed the main components of the bill: provide patients with a right to a support person; allow for civil liability; not allow for the rights of patients to be suspended; provide that facilities have written policies; and allow for an investigation by the Department of Health (DOH). REPRESENTATIVE VANCE continued to slide 3, which addressed a patient's right to a support person. She stated that the proposed legislation would require health care facilities to allow a support person to be present at all times during the patient's stay. To eliminate the possibility of any loopholes, she stated that the proposed legislation specifies "in person" in reference to this. She continued that the support person's privileges would not be limited to the visitation hours of the facility, and the right to a support person could not be withheld based on a declaration of disaster. She addressed civil liability, as seen on slide 4. She explained this provision would allow a patient or the support person to bring a civil complaint against a health care facility or health care professional. 3:13:36 PM REPRESENTATIVE VANCE, continuing to slide 5, stated that the proposed legislation would prohibit a state or federal declaration of disaster to change a patient's rights. She continued that the proposed legislation would also require health care facilities to inform patients of the right to equal treatment concerning a support person. Connected to this is the requirement that the current version of a health care facility's visitation policies and procedures be made widely available to the public, as seen on slide 6. She moved to slide 7, stating that this would include investigations by DOH, and individuals would be able to file a complaint with DOH concerning any violation. Moving to slide 8, she stated that, unless required by federal law or regulation, a state agency may not take action against a health care facility for prohibiting a visitor from entering an operating room, isolation room, isolation unit, behavioral health setting, or other typically restricted areas. 3:17:33 PM CHAIR PRAX announced the committee would hear invited testimony on HB 52. 3:18:09 PM JANET OGAN, representing self, began her invited testimony in support for HB 52. She shared the story that in July 2022 her sister-in-law had been admitted to the Mat-Su Regional Medical Center for pneumonia and tested positive for COVID-19. She stated this became a nightmare for her family because the sister-in-law was terrified at being alone and put on a ventilator. Family members were unable to visit her, including her husband, until she died nine days later. She expressed the understanding that the hospital did not welcome the husband. She stressed that sickness can be frightening, and the process can be made easier by having a loved one present for comfort and as an advocate. She described the distressed situation as "helpless." The family had been notified that the sister-in-law was dying but were not allowed in the room until after she had passed away. She questioned, "What logic justified this deprivation of human dignity?" She added that her family had traditions around the death of family members, and that tradition was robbed when they were unable to comfort her sister-in-law or grieve her death. She stated that others have suffered similar actions by health care institutions, emphasizing that a society is judged by its treatment toward the elderly, unborn, and sick. She stated that the COVID-19 pandemic had ushered in a "dark time" for the country, as patients were denied the right to have loved ones make decisions concerning care, and treatment protocols had been forced without allowing alternatives. She stated that HB 52 would be a step in the right direction. 3:25:08 PM NATALIE BEYELER, DO, Internal Medicine Specialist, Dr. Natalie Beyeler and Associates, provided invited testimony in support of HB 52. She shared that she currently runs her own clinic, but for 16 years she had been the director of critical care and intensive care at Mat-Su Regional Medical Center, and for 25 years she had been the director of pulmonary care. She said that after the hospital began employing its own physicians, privately employed physicians, like herself, were relegated to "backseat drivers." She explained that this is why her testimony is important. She expressed the opinion that not recognizing the importance of family members for a patient's recovery process is "absolutely insane." She referenced a recovery-unit study which indicated patients recuperated 80 percent better when they had a view of a tree; however, she argued that a study is not needed to know that the presence of a familiar face or squeeze of a hand improves medical outcomes for patients. She stated that many times patients can be confused, over medicated, sedated, or experiencing intensive-care psychosis. She continued that, whether it is a tooth extraction or a brain surgery, there is no substitute for having a support person present. She voiced the opinion that this could improve medical outcomes for the patient. 3:29:26 PM DR. BEYELER continued that not being able to take care of a family member in the hospital leaves those remaining with regret, remorse, long-lasting grief, anxiety, depression, and guilt. She stated that this is a terrible testimony on health care facilities and expressed shame over being a doctor. She pointed out that hospitals are currently overrun, and the nurse- to-patient ratio is "high," so having the presence of a loved one to rely on is important. She referenced the medical condition of "cryptic shock," which has no outward signs for nurses or other providers to notice, especially with understaffing. She expressed the opinion that a loved one at the bedside would more readily notice this condition, and this could save the patient's life. 3:32:41 PM DR. BEYELER stated there are many stories of patients who had improved outcomes because they were surrounded by loved ones. She shared a recent account of a husband who had contracted a very serious illness and was taken to the hospital. The wife had learned that his outcome would worsen if he were intubated. The wife was not allowed into the hospital room, but she could hear talk through the door concerning intubation. She described the wife as "banging on the intensive care doors" and "screaming" to stop her husband's intubation. She stated that the husband had relied on his wife to be his spokesperson, and when he heard her screaming, whether it was the adrenaline pump or her voice, he was shocked into survivor mode and his oxygen levels went up. 3:35:14 PM DR. BEYELER stated she has researched hospital admissions, discharges, readmissions, and post-hospitalization mortality; however, she has not found one study addressing the presence of a support person. She expressed the opinion that depriving a parent from being present with a minor patient defies civility and should be "punishable by incarceration." She argued that individuals in the hospital would not have the capacity to answer for themselves, so someone must be present to stand in for them. She offered to follow up with any needed materials in support of the proposed legislation. 3:38:33 PM REPRESENTATIVE SUMNER, concerning health care facility liability, pointed out language that would be added to statute as Section 18.20.630 [under Section 1 of HB 52, on page 4, beginning on line 24], which would preclude any state agency from taking any action against a facility. He expressed the understanding that most of the testimony concerned hospitalizations in COVID-19 isolation wards. He questioned whether the legislation would actually address this situation. 3:39:31 PM REPRESENTATIVE VANCE expressed the understanding that not all patients during the pandemic were in isolation wards. She expressed appreciation for the comment; however, many constituents have informed her of situations in regular hospital rooms where they were not allowed a support person. She referred to seniors in assisted living homes who were not allowed to see loved ones. She referenced an example where a doctor prescribed anti-depressants to an individual who was quickly failing in a senior care facility because of the inability to see family. She commented that a variety of facilities limited the rights of patients. 3:41:18 PM REPRESENTATIVE SUMNER expressed the understanding that isolation rooms would be needed in the case of extremely contagious outbreaks. He expressed agreement that in the case of COVID-19, [family support] should not have been restricted; however, he advised that there could be a potential need for isolating patients. 3:42:42 PM REPRESENTATIVE SADDLER questioned Dr. Beyeler on the Mat-Su Medical Center's policies prior to the COVID-19 pandemic. DR. BEYELER responded that there have always been visiting hours, and at least one family member could be with the patient in the critical care unit. She stated that every single room in the hospital has a bed available for a family member, and rarely does a patient explicitly ask to not have a support person. She stated that having a support person present makes providers' jobs easier in regard to bathing, feeding, monitoring medication, and more. 3:44:49 PM REPRESENTATIVE SADDLER, with a follow-up question for clarification, asked whether hospitals currently have no limits on the presence of a support person, even in the emergency room, recovery room, or operating room. DR. BEYELER responded that operating rooms are restricted because of distractions and the need for a sterile environment. In situations with the critically ill, she said, there may be limited space in the room for a support person. She stated that patients in the recovery room would always have at least one support person, but not more than two in a post-operation area. She expressed the importance of having a support person present when a patient is given instructions or a diagnosis. 3:47:10 PM REPRESENTATIVE MINA thanked the bill sponsor. She pointed out that the examples presented had been during the COVID-19 pandemic. She directed attention to the language on page 2, lines 2-3, which concerns a provider's ability to restrict access to patients during emergency-medical services. She continued that the language is repeated within the bill in relation to hospitals, mental health facilities, long-term care facilities, and hospice. She questioned whether the provider's ability to restrict access would apply to COVID-19 concerns. REPRESENTATIVE VANCE, in regard to the intent of the legislation, responded that health care facilities would not restrict access to the patient, regardless of a pandemic or declared disaster, and medical center policies should reflect this intent. She stated that the term "reasonable" would apply, and this would mean detriment to the care of the patient. She expressed the opinion that it had been learned during the COVID- 19 pandemic that withholding a support person is not "reasonable." She stated that health care facilities would need some flexibility to care for patients in a medically appropriate way, while clarifying the right of an individual to have a support person. 3:50:36 PM REPRESENTATIVE MINA provided the example of a highly infectious pneumonic plague and questioned whether the proposed legislation would allow hospitals to apply restrictions, or whether the hospital would be sued based on the civil liability section. REPRESENTATIVE VANCE expressed the belief that she would not be the best person to answer the question. She stated that, in regard to the intent of the legislation, the health care facility would have the ability to make the decision, as long as it is "reasonable" and every individual is treated equally. She suggested that this was not the case during the pandemic. 3:52:40 PM REPRESENTATIVE RUFFRIDGE voiced the opinion that few people would dispute the necessity of having a loved one present in a critical care situation; however, he concurred with Representative Mina. He expressed the concern that the current version of the proposed legislation may not accomplish its intent. He surmised that it does not clearly define a "reasonable restriction". He expressed the opinion that throughout the COVID-19 pandemic most of these issues came to light, and most health care facilities would have "driven pretty hard" on the "clinically necessary" component of the bill. He suggested that the language be clarified. He stated that the provisions in Section 18.20.610 and Section 18.26.620 already exist through DOH. He said that if HB 52 were to become law, then both of these would be redundant. REPRESENTATIVE VANCE responded that she was not aware of the redundancy. She expressed the willingness to work with the committee on clarifying the language. 3:55:33 PM REPRESENTATIVE MINA stated that emergency room physicians have brought forward situations where providers have had to separate the patient, who is a victim, from an abuser. She pointed out that the provision on page 4, line 3 of the proposed legislation would prohibit a health care facility from separating a minor from a support person, except in a case of suspected abuse. She questioned the reasoning for not including this language in other sections related to facilities and providers of emergency medical services. REPRESENTATIVE VANCE responded that the section on page 5, line 7 addresses this, with the intent to make sure patients are safeguarded. 3:57:41 PM REPRESENTATIVE MINA pointed out the provision on page 5, line 7, wherein restricted access could be requested by a patient, law enforcement agency, or court order. In other words, in the case of a dangerous situation, restricted access would have to be requested by the patient, agency, or court before the facility could restrict access. Referring back to page 4, line 3, she pointed out that this provision would not require a court order or a request from the patient before access could be restricted. She expressed the opinion that the language on page 4 should be mirrored fully in the other sections. REPRESENTATIVE VANCE stated that this could be easily accommodated. 3:59:19 PM CHAIR PRAX announced that HB 52 was held over.