SB 119-ATHLETIC TRAINERS  3:25:54 PM CHAIR OLSON announced that the first order of business would be CS FOR SENATE BILL NO. 119(L&C), "An Act relating to athletic trainers." 3:26:01 PM CHRISTINE MARASIGAN, Staff, Senator Kevin Meyer, Alaska State Legislature, on behalf of the sponsor of SB 119, Senator Kevin Meyer, stated that this bill relates to athletic trainers. 3:28:15 PM REPRESENTATIVE JOHNSON moved to adopt the proposed House committee substitute (CS) to CSSB 119(L&C), labeled 27-LS0732\X, Kirsch, 4/10/12. CHAIR OLSON objected for the purpose of discussion. 3:28:42 PM MS. MARASIGAN reviewed the proposed committee substitute, Version X. She referred to page 2, lines 1-2, which reads, "relating to student participation in interscholastic activities; and providing for an effective date." She also referred to page 2, line 12, which reads, "(2) meets the requirements established by the department in regulation;". She indicated that this provision relates to the requirements set out in regulations under proposed AS 08.07.030 on page 2, lines 20-27. She explained this language was removed by prior committees for cost savings; however, on further reflection and discussions with the Department of Law, it was decided that having the regulations establishing state standards would be appropriate. 3:30:04 PM MS. MARASIGAN referred to the definition section, under proposed AS 08.07.040 has been changed. She related that on page 3, Sections 3 and 4 remain the same and the provisions outline that an athletic trainer is recognized as a health care provider. MS. MARASIGAN referred to Section 4, which relates to potential concussions and traumatic brain injury and clarifies a student may not return for "participation in practice or game" until the student has been evaluated and is cleared for participation in writing. She explained that athletic trainers are trained to treat concussions and traumatic brain injuries. She explained that the language on page 3, lines 28-31 and page 4, of Section 5 outlines the different ways in which those in alternative educational programs can participate in interscholastic school activities. She related that this bill was previously heard in the Health, Education, and Social Services Committee. She offered that Sections 6 and 7 refer to the effective dates. 3:31:44 PM REPRESENTATIVE JOHNSON asked whether the bill excludes ninth grade level students from needing an athletic trainer. He referred to the definition of interscholastic activities or eligibility, noting that it does not seem to cover younger students. MS. MARASIGAN explained this language basically refers to students enrolled in alternative education programs. In other words students who are homeschooled or attend an academy school or any school listed on page 4 of the bill can participate in interscholastic activities if they live in the district. 3:33:11 PM REPRESENTATIVE JOHNSON asked what about "pee wee" football and if an athletic trainer can be used. MS. MARASIGAN answered that the two issues are related, but this bill related to interscholastic athletics does not require an athletic trainer to be present. Students who want to participate in interscholastic athletics don't necessarily need to participate with the blessing of an athletic trainer. REPRESENTATIVE JOHNSON said he would contemplate this. 3:34:18 PM REPRESENTATIVE SADDLER said he attended a small school without athletic trainers. He asked for an informal definition of athletic trainer and whether there are various levels of trainers. MS. MARASIGAN answered that the issue of smaller schools and athletic trainers in general has arisen previously. She explained that athletic training is federally defined as an occupation. These athletic trainers have an undergraduate degree in kinesiology and sports medicine. She explained the trainers adhere to a nationally certified process to become an athletic trainer. In terms of smaller schools, she related her understanding that Fairbanks has an athletic trainer. She stated that currently athletic trainers are unregulated and unlicensed in Alaska. Many of them volunteer for sports activities and are able to recognize concussions and other sports injuries, but there is not any requirement in the bill or otherwise that requires one to be present on site. 3:36:07 PM REPRESENTATIVE SADDLER commented that he thinks of trainers with ice bags or ammonia when he thinks of athletic trainers. He asked whether people who participate in football and have an injury that may require a back board are treated by athletic trainers. He further asked who is liable when a trainer encounters someone with a broken spinal column. He asked whether athletic trainers are held liable. MS. MARASIGAN deferred to the athletic trainers; however; she assumed athletic trainers, just like other medical professionals would be covered under Good Samaritan Law and can provide assistance. 3:38:08 PM BRENDA SHELDON, Athletic Trainer; President, Alaska Athletic Trainers Association (AATA), stated she is an athletic trainer. She explained that athletic trainers are allied health care professionals who graduate from an accredited college or university athletic training program. Nearly 70 percent of athletic trainers hold a master's degree or higher advanced college degree. They take classes, including classes in human anatomy, biology, human physiology, statistics, exercise physiology, kinesiology chemistry, physics, medical conditions and disabilities, and therapeutic modalities. She offered to provide a list to the committee. An independent board of certification nationally certifies athletic trainers, who must pass an examination and obtain 75 hours of medically related continuing education every three years, adhere to the standards of professional practice, and the code of ethics. MS. SHELDON detailed that to be a licensed athletic trainer in Alaska, the trainer must be in good standing with the board of certification, and the Division of Business and Professional Licensing can obtain primary source verification from the board of certification. In Alaska, athletic trainers are found in the university system, in physician offices, on military bases, at high school sporting events, and working with semi-professional teams. This bill does not limit other professionals from standing alongside to provide care. This bill specifically does not prohibit any professional from working within their scope of practice to perform duties. She highlighted that athletic trainers who volunteer at youth or community functions are not currently covered or included in the Alaska Good Samaritan law, but SB 119 will ensure that athletic trainers are covered under the Good Samaritan law. 3:40:38 PM MS. SHELDON referred to page 2 to the definition of athletic trainer, which she characterized as limiting. She respectfully asked for input. She suggested the definition should read, "athletic training" means the prevention, recognition, evaluation, treatment, and rehabilitation of injury or illness and engaging in the organization and administration of athletic training programs under the direction of a physician under AS 08.64." She offered her support for SB 119 with the revised definition of athletic training. She offered her belief that SB 119 would help to ensure that qualified, licensed, athletic trainers are caring for Alaskans. 3:41:41 PM CHAIR OLSON asked about the Good Samaritan Act. He asked whether there are other professions are covered by the act. He related his understanding that the Good Samaritan Act protects a doctor, nurse, practitioner or anyone driving by an accident or on a plane to allow them to provide aid. MS. SHELDON explained the Good Samaritan Act states the person must be licensed to be covered. She referred to page [3], line 3, which lists the professions covered under the Good Samaritan law. She explained that SB 119 would add athletic trainer. 3:43:33 PM REPRESENTATIVE SADDLER asked for a copy of the proposed definition. CHAIR OLSON advised the committee will have the proposed definition distributed. 3:43:59 PM REPRESENTATIVE MILLER indicated the title relates to athletic trainers participating in interscholastic activities. He asked if the definition is too broad for athletic trainers. He was also uncertain whether the host of activities listed in the definition fall under the interscholastic activities. MS. MARASIGAN referred members to Version X, pages 1, 2, and through page 3, line 14. She explained that the original bill solely addresses licensure of athletic trainers. She explained that the bill was amended and the additional language in the bill relates to interscholastic activities. 3:45:52 PM REPRESENTATIVE MILLER referred to the semicolon in the bill title after athletic trainer. MS. MARASIGAN reiterated her understanding that SB 119 relates to athletic trainers, and everything added from page 3, lines 15 through page 5 is another related to the issue scholastic activities previously in HB 369 sponsored by Representatives Thomas and Stolz, which was rolled into this bill since it is related. REPRESENTATIVE MILLER commented he would accept that but it was still unclear. 3:47:47 PM CHAIR OLSON asked if replacing the ";" with an "and" would clarify the title. REPRESENTATIVE MILLER agreed. He commented that he was a swimmer in college and the athletic trainers were available to oversee the football team. REPRESENTATIVE SADDLER asked for the number of athletic trainers in the state and whether they are used at the college, high school, or semi-professional level. MS. SHELDON offered that there are approximately 41 athletic trainers in Alaska, in communities including Fairbanks, Matanuska-Susitna, Juneau, Sitka, and Anchorage. The roles are diverse including the university system, physician offices, and military bases. She related that their professional and allied professional background covers all areas within their scope of practice. 3:49:26 PM REPRESENTATIVE SADDLER asked whether the universities have any undergraduate training programs. MS. SHELDON related her understanding the programs are in the planning phase. 3:49:54 PM REPRESENTATIVE SADDLER inquired as to level of pay for athletic trainers. MS. SHELDON answered it varies in the setting, whether the job is at the university or at a physician's office. She characterized the pay as in the mid-range scale ranging from $40,000 to $55,000, but not in the high-end pay ranges. REPRESENTATIVE SADDLER asked whether the athletic trainers are typically athletes or medical school students. MS. SHELDON responded that it varies in Alaska since athletic trainers are a diverse group. She explained that there are dual-credentialed athletic trainers in Alaska who work in dual capacities, such as athletic trainers that work as a registered nurses, physical therapists, medical doctors (MD), physician assistants, and physical therapy assistants. She explained that athletic trainers typically fall in the medical background arena. 3:51:53 PM LYNNE-MARIE YOUNG, Certified Athletic Trainer; Secretary/Treasurer, Alaska Athletic Trainers' Association, stated she just received a copy of SB 119. She agreed with Ms. Sheldon's testimony and fully supports SB 119 with the revision of the definition. She shared concerns over the definition of an athletic trainer since she is current employed as an athletic trainer. She stated the current definition in the bill will change the scope of practice and some athletic trainers may actually lose their jobs. Under their scope of practice and national board certification, athletic trainers can treat patients in physicians' offices as physician extenders. Additionally, athletic trainers can work in military and industrial settings. She suggested that the language leads people to believe that only athletes and those with athletic injuries can benefit from an athletic trainer's care. She reiterated that the Alaska Athletic Trainers' Association fully supports SB 119 with the definition change for athletic trainers. 3:53:52 PM REPRESENTATIVE SADDLER referred to the definition for athletic trainer and asked how someone practices under the direction of a physician. MS. YOUNG answered that the athletic trainers through education are trained to deal with injuries and illnesses as they occur. She explained that athletic trainers use physicians as their guides. In the event that athletic trainers have questions they consult with a physician to obtain direction. She pointed out that while athletic trainers take many of the same courses, they are not at same level as a physician; however athletic trainers can discuss certain cases. She described the treatment they offer as treating people for injury and illness. She pointed out that one ankle sprain may take two to three weeks to heal and athletic trainers will communicate to see how injury or illness is responding according to the protocol. 3:55:33 PM REPRESENTATIVE SADDLER asked whether a patient must first be seen by a physician and then the athletic trainer takes over or if there is a standard set of orders for conditions. MS. YOUNG answered that there is a standard set of treatments, such that if an athlete or individual slips on ice or on a basketball court, the athletic trainer is trained to do an assessment. Through the assessment and education the athletic trainer knows whether the person would benefit from a basic protocol. She referred to PRICE, which means protection rights, ice, compression, and elevation as is typically taught in first aid courses is used; however, certain tests and evaluation procedures will lead the athletic trainers to determine whether the injured person needs to be splinted and transported to a hospital or to a physician's office for an X-ray. She recapped that based on education an athletic trainer's evaluation will deem whether the athletic trainer will recommend an individual needs an immediate trip to a physician or within a day or two of the injury. REPRESENTATIVE SADDLER related his understanding the standard protocol would apply to someone who slipped on ice, which would still as being under the "direction of a physician." MS. YOUNG offered her belief that the athletic trainers are trained to treat injuries and illnesses. She agreed a person slipping on ice would be treated similarly to someone slipping on a basketball court. 3:57:13 PM CHAIR OLSON assumed the athletic trainers are paid by schools or insurance from the injured party. MS. YOUNG responded that payment depends on the source of employment. She answered that athletic trainers who work at the university are paid by the university; those that work for physicians are paid by the physician or hospital; and those employed by the military are paid by the military. She related her personal circumstances, such that she is employed by a physician's office and she volunteers her service to the high schools, but the schools do not pay for the services. The schools display a banner or thank the physician and athletic trainer by placing an ad in their programs specifically thanking them for caring for their athletes. 3:58:27 PM CHAIR OLSON answered if anyone bills insurance for services. MS. YOUNG answered no. [SB 119 was held over, with Chair Olson's objection to adoption of Version X pending.]