SB 131-WORKERS' COMP DISABILITY FOR FIREFIGHTER  5:23:15 PM CHAIR SPOHNHOLZ announced that first order of business would be SENATE BILL NO. 131(TITLE AM), "An Act relating to the presumption of compensability for a disability resulting from certain cancers in firefighters." CO-CHAIR SPOHNHOLZ reminded members that SB 131(TITLE AM) is similar to Representative Kaufman's bill [HB 204, which was reported from the committee on 5/17/21]. 5:24:09 PM SENATOR ROGER HOLLAND, Alaska State Legislature, as prime sponsor of SB 131(TITLE AM), stated that the subject of breast cancer coverage for fire service members initially struck him as a complicated topic, but the more he looked at the subject the simpler the argument became. He said he hopes to convey what a clear and justified request this is. 5:25:03 PM NIKKI ROSE, Chief of Staff, Senator Roger Holland, Alaska State Legislature, on behalf of Senator Holland, prime sponsor of SB 131(TITLE AM), provided the sponsor statement and a sectional analysis of the bill. She paraphrased from the sponsor statement, which read [original punctuation provided with some formatting changes]: Firefighting is an inherently dangerous job. It is important that workers compensation insurance provides coverage for the inherent risks in that job, but right now there is a hole in that coverage: breast cancer. This bill would add breast cancer to the list of presumed disability coverages for firefighters, so long as the firefighter could establish medically that the breast cancer was caused by work as a firefighter. Instances of cancer in firefighters is shown to be higher than the general population. Studies that have evaluated cancer risk among women firefighters suggest women firefighters, like their male coworkers, may be at an elevated risk for overall cancer incidence (Daniels et al., 2014). These studies also suggest women firefighters may be at an elevated incidence risk for breast cancer (Daniels et al., 2014). This bill protects not only women, because exposure to carcinogenic chemicals, which is sometimes necessary in the course of a firefighter's job, does not discriminate based on sex or gender. Exposure to these chemicals may be mitigated, but not eliminated, through protective equipment. Firefighters are at a higher risk of cancer, and this risk should be covered. Thank you for your consideration of the addition of breast cancer to the list of presumed disability coverages for firefighters. 5:26:36 PM CO-CHAIR SPOHNHOLZ noted that men can get breast cancer as well as women. 5:26:48 PM MS. ROSE provided the sectional analysis of SB 131(TITLE AM). She said the bill relates to the presumption of compensability for disabilities resulting from certain diseases for firefighters. She explained that Section 1 of the bill amends AS 23.30.121(b) by adding the term "breast cancer" to the list of cancers. Section 2 of the bill clarifies this change applies to claims made on or after the effective date of this Act. 5:27:45 PM SENATOR HOLLAND thanked the co-chair for reminding members that breast cancer is not limited to women, which is what makes this an easy argument. He pointed out that women make up about 4 percent of the fire service workforce in Alaska, so it is hard to make a statistical decision on whether breast cancer coverage would be justified. But, he continued, male firefighters are 7.5 times more likely to die of breast cancer than their male counterparts not in the fire service. SENATOR HOLLAND began a PowerPoint presentation, "Senate Bill 131 WORKERS' COMPENSATION DISABILITY FOR FIREFIGHTERS." He displayed slide 2, "SB 131," and stated that firefighting is an inherently dangerous job and currently there is an oversight [in Alaska statutes] regarding [workers compensation insurance coverage] for breast cancer. He moved to slide 3, "Senate Bill 131," and said the bill would add breast cancer to the list of presumed disability coverages. He turned to slide 4 and related that instances of cancer in firefighters are higher than that of the general public, which is why there is a list of presumed disability coverages. Studies suggest women firefighters may also be at an elevated incidence of risk for breast cancer. SENATOR HOLLAND addressed slides 5 and 6, "General Statistics." Paraphrasing from slide 5, he specified that in the general population, less than one percent of males are likely to develop breast cancer in their lifetime, yet male firefighters are 7.5 times more likely to die from breast cancer than their non-fire service counterparts. The same mechanism that would cause increases in breast cancer in men is thought to result in proportional increases in risk among women. Paraphrasing from slide 6, he further specified that in the general population, one in eight women (12 percent) will likely contract breast cancer in their lifetime. The bill protects not only women, because exposure to carcinogenic chemicals, which often occurs in the normal course of a firefighter's job, does not discriminate based on gender. SENATOR HOLLAND continued to slides 7 and 8, "Presumptive Laws." Speaking from slide 7, he explained that presumptive laws are regulations that assume a given disease is linked, by default, to a specific occupation. This means that when someone is diagnosed with an illness covered under a presumptive law, he or she is automatically entitled to disability or workers' compensation, medical expense coverage, and medical leave, provided certain criteria are met. Speaking from slide 8, he further explained that without presumptive laws, to get these benefits firefighters and other workers may have to prove that their line of work caused their disease. SENATOR HOLLAND reviewed slide 9, "Alaska Statute 23.30.121." He pointed out that under SB 131(TITLE AM), breast cancer would join the current list of presumptive diseases for firefighting in Alaska, which includes: respiratory disease, cardiovascular events, primary brain cancer, malignant melanoma, non-Hodgkin's lymphoma, bladder cancer, ureter cancer, kidney cancer, and prostate cancer. SENATOR HOLLAND displayed slide 10, "Presumptive Laws." He continued to slides 11 and 12, "Alaska Statute 23.30.121," and said more work may need to be done in this area. Speaking to slide 11, he explained that once breast cancer is added to the list of presumptive diseases, several criteria [standard limitations] would apply. The firefighter must: 1) have been a firefighter for at least seven years; 2) have had initial and annual medical exams showing no evidence of disease for those seven years; 3) be able to demonstrate exposure to a known carcinogen while in the fire service; and 4) at a minimum, be certified as a Firefighter I. Speaking to slide 12, he outlined the other qualifying criteria or conflicts that would apply. He said coverage may be denied based on use of tobacco products; physical fitness and weight, lifestyle decisions, hereditary factors, [and exposure from other employment/non-employment activities]. Some post-employment coverage is available where a firefighter accrues three months of coverage for every year of service up to a five-year maximum. SENATOR HOLLAND showed slide 13, "Senate Bill 131," and noted that 14 states include breast cancer in presumptive laws: Arizona, Arkansas, Colorado, Idaho, Iowa, Maine, Maryland, Missouri, Montana, New Mexico, New York, Oregon, Virginia, and Wisconsin. He said he would appreciate the committee adding Alaska as the fifteenth state. 5:32:01 PM CO-CHAIR FIELDS thanked the sponsors of the companion bills. He said it is a reality that cancer is more likely for firefighters, and it should be recognized given their service. 5:32:40 PM REPRESENTATIVE NELSON noted that the bill has a zero fiscal note because this is workers' compensative coverage that firefighters pay for themselves. 5:33:20 PM CO-CHAIR SPOHNHOLZ opened invited testimony. 5:33:43 PM JUSTIN MACK, Southcentral Vice President, Alaska Professional Firefighters Association, provided invited testimony in support of SB 131(TITLE AM). He noted that the Alaska Professional Firefighters Association represents about 500 fire and emergency medical service (EMS) professionals. He said he has worked for the Anchorage Fire Department for 10 years and currently serves as a captain and as state director for the firefighter cancer support network, a peer-to-peer cancer support program. MR. MACK stated that a firefighter's job is routine until it isn't. The tones go off at 2:00 a.m. and minutes later firefighters find themselves in a building they've never been in with heavy smoke, fire, and zero visibility. The calls are routine until the report of multiple victims trapped in a multi- family structure, and the firefighters are the difference in whether the victims will see another day. While these calls are anything but routine, it is the career a firefighter has chosen and loves to do. All firefighters know that this career can be dangerous, it simply isn't safe to walk into a burning building. MR. MACK related that early in his career he learned that good training and tactics can help keep a firefighter safe. What he failed to understand, however, is that no matter how careful he is as a firefighter, even if he follows every standard operating guideline, decontaminates himself and his equipment, and wears the most up-to-date personal protection equipment (PPE), he will be exposed to some of the worst chemicals on earth. These chemicals permeate a firefighter's gear, make their way into the firefighter's pores, and then linger. This is the reason that after a significant structure fire firefighters will for days smell it on themselves after a shower as their pores open up and start to release some of those chemicals. MR. MACK explained that Alaska's workers' compensation usually requires that a specific injury be tied to a specific event. In a case of cancer, it's very hard to say which structure fire may have caused the cancer, but study after study shows that firefighters have a significant increase in cancer rates when compared to the general public. An unusual phenomenon occurs in the fire service firefighters come there as some of the healthiest amongst the population but often retire as some of the unhealthiest. Twenty to thirty years at this job takes a toll and for some that's a life changing cancer diagnosis. MR. MACK said SB 131(TITLE AM) is a step in the right direction in advocating for public safety members who, while knowing the risk, continue to respond at 2:00 a.m. He urged the committee to support the bill. 5:36:42 PM REPRESENTATIVE MCCARTY asked whether Mr. Mack believes that language should be included in the bill about a documentation procedure for verifying exposure to a carcinogen. That way, he continued, documentation about carcinogen exposure would already be in place should a firefighter be diagnosed with cancer. MR. MACK replied that reporting is done for every run done by a firefighter. Specifically for structure fires, he said, there is an inherent understanding of a long list of chemicals that a firefighter could reasonably expect to have been exposed. The issue that states often run into with workers' compensation is this language of tying it to one specific event, he advised. Presumptive takes a firefighter's career and his or her reporting documentation so a reasonable assumption can be made that this person got cancer at a younger age or a very rare type of cancer. This is a personal issue, Mr. Mack continued, as his mother-in-law developed a rare blood cancer after 25 years of being a firefighter. She was one of the first people to go through some of this presumptive fight and the documentation of the call volume that she had over 25 years was helpful. The presumptive legislation and just making the assumption is what was especially beneficial in getting her covered through workers' compensation. 5:39:39 PM CO-CHAIR SPOHNHOLZ inquired about the types of carcinogens that are commonly known to be present in a typical structure fire. MR. MACK said he would send the committee a comprehensive list of the [chemicals] that firefighters are reasonably expected to be exposed to, as well as the ones it is thought that firefighters are exposed to. For each chemical the list will also state the household items that the chemical is found in and the type(s) of cancers specifically that those relate to. 5:40:27 PM REPRESENTATIVE NELSON, regarding documentation, asked whether it is assumed that when responding to a house or other structure fire a firefighter is going to be exposed to certain chemicals or whether a test is done afterwards to determine exposure. MR. MACK replied it is assumed and that testing is not typically done. However, he continued, several studies have been done. One study, which he said he would provide to the committee, put a firefighter through a structure fire while using all the up- to-date PPE and decontamination procedures. Urinary testing was then done for the week following that structure fire and significant amounts of carcinogens were found in decreasing amounts over five to seven days. As well, carcinogens were found on the skin for a couple days. REPRESENTATIVE NELSON asked whether contamination on the skin is a problem that is related to the equipment or decontamination, or that over 25 years a firefighter is going to have it. MR. MACK replied that some of these carcinogens permeate through the multiple layers of gear, plus for every one degree increase in body temperature there is a 400 percent increase in pore size and absorption. When operating in a structure fire of 500-1000 degrees, a firefighter's body temperature gets elevated and skin pores open, and this is when these carcinogens are in the air and going directly through the firefighter's gear and directly into his or her pores. Firefighters are aware that this exists and that even with significant improvements in PPE it is still a risk. But if there is a fire in a house or a rescue that needs to be done, firefighters are going to go in and do it. 5:44:04 PM CO-CHAIR SPOHNHOLZ remarked that there are limits to modern technology's ability to protect a person from smoke and chemicals. The evidence on this matter is substantial, she continued, as male firefighters are 7.5 times more likely and female firefighters 4 times more likely to get breast cancer than males and females in the general population. She offered her appreciation to the sponsor for bringing forth the bill. CO-CHAIR SPOHNHOLZ announced that SB 131 was held over.