HJUD - 2/10/95 HB 39 - AUTHORITY TO PRONOUNCE DEATH Number 020 REPRESENTATIVE GENE THERRIAULT, bill sponsor, introduced CSHB 39. He said the intent was in certain circumstances, to grant the power to those who do not normally have that authority, to declare someone deceased. In rural Alaska there are many instances where there is no doctor, so an emergency medical technician (EMT) or medical assistant has responded to an accident. Once they start cardiopulmonary resuscitation (CPR), they have a legal obligation to continue until somebody relieves them of that duty by either taking over for them, taking the patient to the emergency room, or by declaring death. He worked closely with Emergency Medical Services (EMS) providers to craft language that is fairly tight, so this power is only extended to EMTs and physician assistants in certain circumstances. Another consideration here in Alaska is that there are bodies of water so cold that you have hypothermia conditions, or cold water drowning. Special care needs to be taken in those instances. Two proposed amendments were included in the committee packets, which Representative Therriault supported. REPRESENTATIVE CYNTHIA TOOHEY made a motion to adopt the committee substitute, version F for HB 39. Number 095 REPRESENTATIVE DAVID FINKELSTEIN wanted to know the difference between the committee substitute and the original bill. ANNE CARPENETI, House Judiciary Committee Council, said the only change she found was on page 3, line 13. This version of the committee substitute removes the material that was in the original bill, "by emergency medical technician." Number 110 REPRESENTATIVE THERRIAULT explained why that was done. What he wanted the committee to consider, also removes the same language from section (b) on page 3, lines 15 - 21. He said we are allowing individuals to make a declaration of death, if they have properly administered resuscitation efforts according to these two requirements. That power would be extended to EMTs and to physician assistants. The bill started out only providing this authority to EMTs. Now it includes physician assistants, along with other people already allowed by law. The intent of this language is to make the law consistent. Amendment F.2 makes it consistent. REPRESENTATIVE TOOHEY moved that F.2 dated 2/10/95, be adopted as Amendment Number 1. This amendment would delete "by an emergency medical technician" on page 3, lines 16 - 17. Hearing no objection, it was so ordered. Number 190 REPRESENTATIVE TOOHEY moved that F.1 be adopted as Amendment Number 2. This amendment would delete "cardiac arrest accompanied by" from two places: Page 2, line 31, after "means"; and page 3, line 2. There was discussion on the amendment. REPRESENTATIVE THERRIAULT explained there had been concern expressed by the Medical Association about the language on page 3, where it talks about acceptable medical standards. They were concerned over the presence of rigor mortis being enough, by itself to determine the state of death. The EMS providers say they would never just look at the postmortem lividity, discoloration; but they would also check for a pulse, so cardiac arrest would also be present. Section (a) says that cardiac arrest is part of its determining factor. We are trying to make cardiac arrest part of (a), (b), (c), and (d). So cardiac arrest and lividity would be factors in determining death. The EMS providers felt comfortable with that. He added that since the bill passed the Health, Education and Social Services (HESS) Committee, the Interior Fire Chiefs Association informed Representative Therriault they support this bill. Number 290 MARK JOHNSON, Chief, Emergency Medical Services Section, Department of Health and Social Services, testified in support of the bill. He said as Representative Therriault explained, sometimes our EMS providers around the state, especially in rural areas, are expected to continue resuscitative efforts long past the time when there is no hope whatsoever of resuscitating the patient. The attempt here is to give those workers a standard that will allow them to stop efforts when the patient is dead. There is no case where somebody met only one of the criteria in this bill and actually lived, so this is a very tight standard we would be applying. The president of the Alaska State Medical Society expressed concern that the presence of postmortem lividity was not sufficient criteria by itself. After a conference with Dr. Peter Nakamura, Director of Public Health for Alaska and Dr. Michael Probst, Medical Examiner for Alaska, Mr. Johnson concluded that the safe language would be to say that the patient needed to have cardiac arrest accompanied by (a), or (b), or (c), or (d). This would satisfy the criteria. He felt a situation in which a patient could have lividity and not be dead, was rare. The Department of Health and Social Services felt comfortable with the language in this bill, after those concerns were addressed. Number 335 REPRESENTATIVE JOE GREEN asked if there was any potential for someone coming back against the state for deficient training in the situation where someone, other than a doctor makes this judgement call. MR. JOHNSON did not believe they could because they would have to show that there was a chance the patient would have survived. He felt the state training standards were up to national standards. Number 365 REPRESENTATIVE TOOHEY said, having been an EMT for 15 years on the highway, they are very thoroughly trained in knowing death, seeing death, and trying to prevent deaths. You will not find a better, more aggressive group of people to prevent it, when possible. She believed the language covered what was necessary, very well. CHAIRMAN PORTER asked if there was any other discussion on Amendment Number 2, or objection. Seeing none, the amendment was adopted. Number 420 REPRESENTATIVE TOOHEY made a motion to move the bill, with individual recommendations and fiscal notes. Hearing no objection, it was so ordered.