HB 31-WORKERS' COMP: DISEASE PRESUMPTION CHAIR ANDERSON announced that the first order of business would be HOUSE BILL NO. 31, "An Act relating to the presumption of coverage for a workers' compensation claim for disability as a result of certain diseases for certain occupations." CHAIR ANDERSON pointed out that there was a sponsor substitute for HB 31. JON BITTNER, Staff to Representative Anderson, Alaska State Legislature, noted that two changes had been made to HB 31 [by the sponsor substitute]. The first change was the addition of the words "notwithstanding AS 23.30.100(a)" which were added to page 2, line 13. He explained that this language was included to address a concern that current statutes might conflict with the coverage for retired fire fighters. The second change was on page 2, subsection (c), which was rewritten to narrow the coverage for presumption regarding blood borne pathogens to peace officers, emergency medical personnel, and rescue personnel. He explained, "This change was made to address the concern that the coverage for blood borne pathogens was too broad." REPRESENTATIVE CRAWFORD referred to his testimony on this bill at the previous committee meeting in which he spoke about his wife contracting hepatitis while working in an operating room. He commented to Chair Anderson: I was very happy to see that [in HB 31], you had the presumption for nurses because I think that ... the first responders that you're talking about, they're going to hand those same people with the same blood- borne pathogens over to the medical personnel. So I liked your first bill much better than I like your substitute. CHAIR ANDERSON responded that he recognized the need to add [medical personnel], but the problem was that soon every other personnel in the hospital would want the same treatment. He voiced concern that if the bill covered all medical personnel the bill wouldn't pass. REPRESENTATIVE CRAWFORD reiterated that he would like all the emergency room nurses to be covered as well. 3:33:58 PM REPRESENTATIVE GUTTENBERG asked for clarification of the difference between a first responder and a nurse. 3:35:08 PM MR. BITTNER replied that a first responder is defined as a paid employee of a first responder service, a rescue service, an ambulance service, or a fire department. CHAIR ANDERSON explained further that the intent on page 2, line 22-29 is to "encapsulate personnel who are first responders in an emergency outside of a hospital setting." 3:35:49 PM REPRESENTATIVE GUTTENBERG wondered whether the bill would accomplish the intended goals in the "real world." REPRESENTATIVE LEDOUX asked, regarding page 2, line 23-29, if volunteer fire fighters are generally included under workers' compensation. MR. BITTNER answered that under HB 31, volunteer fire fighters would be covered in the bill as denoted on page 2, lines 22-23, "applies to fire fighters covered under AS 23.30.243." REBECCA BOLLING, R.N., President, Alaska Nurses Association (AaNA), commented: The original version of [HB 31] provides an important protection of health care employees infected with a blood-borne pathogen during the course of their employment. What I'm here to talk to you today about is the sponsor substitute to this bill, which limits the coverage of workers' [compensation] benefits for blood-borne pathogens to only fire fighters, peace officers, and emergency responders. It deletes this same coverage for all health workers. ... It is as if the care of the patient stopped at the emergency room door. I can assure you that the ... care of patients with blood-borne pathogens continues on through the emergency room door for many hours, days, and ... sometimes for many weeks. The reason the presumption of coverage is needed is that nurses have had the experience of being stuck with a contaminated needle for HIV-positive patients, subsequently converting from being HIV-negative to HIV-positive, and then have their employers turn around and hire private investigators to try and prove that it is their lifestyle that caused the infection, not their work. And this is not an isolated [incident]. MS. BOLLING continued: This week, HB 31 was announced at a national nurses meeting for the American Nurses Association. It drew the attention of the American Nurses Association national delegates as well as our president, Barbara Blakeney, who responded by stating that the sponsor substitute had the appearance of being discriminatory, given that health care workers are predominantly female. If the committee is concerned about potential impacts to workers' compensation premiums as a result of this bill, we ask you to research how similar legislation has impacted other states. For example, Nevada passed a law in 2001 that provides the presumption of blood-borne pathogens for all health care workers. In a preliminary investigation of the [workers' compensation] rates in Nevada, we found that the rates had not gone up in the three years since this law was passed. HB 31, in its original version, is good legislation and good policy for Alaska. The ... presumptions offered should be afforded to all health care workers who face accident exposure to blood-born pathogens and not just those on one side of the emergency room door or the other. 3:42:32 PM DAVID KESTER, Commercial Insurance Broker, Ribelin Lowell Alaska, USA; board member, Workers' Compensation Committee of Alaska (WCCA) commented: My opposition to [HB 31] stems around the fact that there already exists in the Alaska Workers' Compensation Act adequate presumption of compensability in workers' compensation once a preliminary link has been established between work and the condition. And thus this legislation is redundant and duplicative. Redundancy only creates confusion within the [compensation] system, and that confusion in turn will only increase costs, and therefore this bill is not needed. In addition, this bill could be construed to support a claim for compensation for disability regardless of whether there was a clear connection based on medical evidence to employment. With this in mind, this bill has the potential to place a very heavy financial burden on municipalities, boroughs, towns, villages, and the citizens of Alaska who pay property taxes to support the cities, boroughs, and towns. REPRESENTATIVE CRAWFORD asked Mr. Kester to explain the phrase, "once a preliminary link has been established between work and the condition" and referred to his wife's case of contracting hepatitis as an example. MR. KESTER responded that such a case would be presumed compensable until the employer proved otherwise; the burden of proof lies on the employer. REPRESENTATIVE ROKEBERG commented that there was an analysis by the National Council on Compensation Insurance, Inc (NCCI) in the committee packet that said, "Due to the retroactive coverage provided by this proposal, the overall cost could be significant. Since coverage for such claims may not have been contemplated in previous loss cost filings, such retroactive costs would be unfunded." He asked Mr. Kester to comment on the "issue about the retrospectivity and then the effect on the loss cost underwriting." MR. KESTER replied that he was not familiar with the analysis but said: If I understand it correctly, the National Council has determined that because there is going to be an increase cost which is not currently contemplated in the workers' compensation rates, that that will in itself create a burden upon the system ... and that one be able to get corrected until ... these costs start entering into the rate-making formula. 3:48:26 PM REPRESENTATIVE GUTTENBERG asked Mr. Kester, "Is your cost savings based upon the ability to more easily and more successfully challenge claims?" MR. KESTER answered, "I don't believe so." REPRESENTATIVE GUTTENBERG expressed his concern for "people whose claims have been denied and they simply don't have the ability to aggressively pursue them." MR. KESTER replied that, under the existing act, if a person can establish a connection between his/her condition and the workplace, the person has met the presumption. REPRESENTATIVE ROKEBERG asked Mr. Kester to explain what the appeal rights are under a workers' compensation claim. MR. KESTER responded that if a person's claim has been denied, the person can go before the Alaska Workers' Compensation Board for a hearing. He explained that the hearing panel would consist of a hearing officer, a representative from management, and a representative from labor. The panel would hear the case and make a decision. If the person is not satisfied with the panel's decision, the person may appeal to the superior court, and continue to the supreme court if needed. 3:52:25 PM ERIC TUOTT, Alaska Professional Fire Fighters Association (APFFA) stated that APFFA has about 500 members in Anchorage, Fairbanks, and Juneau, but the bill would represent fire fighters throughout the state, including volunteer fire fighters. He said, On a day-to-day basis we are asked to go into situations where we do not have any idea what kind of things we're going into, whether it's toxins in the air, or if we're going in to help a patient, we have no idea of their previous medical history.... We don't have the luxury of knowing what ... we're going into. ... If we [were] to contract one of these diseases or one of these heart conditions or cancers down the road, [the presumptive disability] gives us an avenue to go back and ask the [Worker's Compensation Board] to presume that we got it as a direct result of our occupation. Presently ... you can still go through the hoops of workers' comp but the sad fact is, in a lot of our cases, these diseases are terminal, and we don't have a whole lot of time to jump through these hoops, asking for workers' comp. One example we have [at the] Anchorage Fire Department right now is one of our long time veteran fire fighters has contracted Hepatitis C. He's not exactly sure where he got this, but in the course of 30 years on the line, it's almost certain that he got it as a result of his occupation. However, his insurance is asking at which point in [his] career ... did [he] get this ..., and the sad fact is, we don't know. Because he's not sure, ... his personal insurance company refuses to cover him, saying it's a workers' comp issue; workers' comp on the other hand is saying [that he needs to prove exactly when he contracted it.] So we're kind of in a catch-22. MR. TUOTT commented that there have been cases in the Lower 48 and in Canada in which employees have cancer and the workers' compensation boards ask the employee at which fire he/she contracted the disease. He pointed out that after 30 years of exposure [to toxins], the fire fighters cannot determine the particular incident that caused their diseases. He continued: I've heard a lot of commentary on the amount of claims that we might see [if HB 31 was passed] ... but our associates in Washington state, the Washington State Council of Fire Fighters, told us that in the two years since they enacted this legislation in Washington, they've had six total claims with about 7,000 fire fighters being covered. I'm assuming that the number of claims that we will have, because of the number of fire fighters and the number of personnel that's covered by this, will be much less than six claims. 3:57:35 PM MR. TUOTT explained that the Hepatitis C cases are the ones that seem to last the longest because most of the cancer, respiratory, and lung diseases are terminal within months or a few years. He noted, "We don't have a whole lot of information about the cost of the cancer because the guys die just as quickly as they get it. I guess that's why this is so important to us." REPRESENTATIVE ROKEBERG stated concern that the basic health care should be taken care of by a health insurance policy. He asked Mr. Tuott if the health care costs are the primary concern of the fire fighters. He mentioned that another benefit of workers' compensation includes retraining. MR. TUOTT replied that most of the workers' compensation cases he was familiar with involved retirees. He noted that he hadn't seen retraining become an issue. REPRESENTATIVE GUTTENBERG asked, "When your members are caught in a turf war between medical carrier and the workers' comp, who has to pay the bill?" MR. TUOTT replied that the employee pays the bill. He explained that the man with Hepatitis C has exhausted his personal savings, and he can't work every day because he is sick, so the department might terminate him. CHAIR ANDERSON closed public testimony. 4:03:07 PM REPRESENTATIVE CRAWFORD commented that he preferred the original version of the bill. REPRESENTATIVE ROKEBERG noted that he had some concerns about the NCCI analysis regarding the "affectability issue." 4:06:21 PM REPRESENTATIVE LYNN moved to report SSHB 31, labeled 24- LS0225\F, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, SSHB 31 was reported from the House Labor and Commerce Standing Committee.