SB 47-VEHICLE REGISTRATION/PERSONS W/DISABILITY  3:04:51 PM CHAIR KREISS-TOMKINS announced that the first order of business would be SENATE BILL NO. 47, "An Act relating to special registration plates for vehicles owned by persons with disabilities." 3:05:13 PM SENATOR ELVI GRAY-JACKSON, Alaska State Legislature, prime sponsor, introduced SB 47. She spoke from the sponsor statement, which read [original punctuation provided]: SB47 amends AS 28.10.18(d) to allow speech-language pathologists, physical therapists, and occupational therapists to provide proof of disability to their clients. Currently, only chiropractors, physicians, physicians' assistants, or advanced practice registered nurses can provide proof of disability to their clients. By expanding the ability for medical professionals in different fields to provide proof of disability to individuals, the opportunity to obtain special registration plates for vehicles is expanded for people with different kinds of disabilities. Oftentimes, individuals with disabilities are in more constant contact with their physical or occupational therapists than with physicians because their issues require more specialized care. It can be cumbersome for these people, who are already suffering with disabilities, to make an additional visit to the physician purely for the purpose of acquiring their plaques. To provide ease and accessibility for these disabled people, it would be more efficient and effective to allow these additional types of professionals to provide proof of disability. 3:06:53 PM BESSE ODOM, Staff, Senator Elvi Gray-Jackson, Alaska State Legislature, presented a sectional analysis of SB 47 on behalf of Senator Gray-Jackson, prime sponsor. She stated that Section 1 would amend AS 28.10.181(d) to include a person licensed as a speech-language pathologist or as a physical therapist or occupational therapist under AS 08.84 3:07:33 PM REPRESENTATIVE EASTMAN drew attention to page 1, lines [7-8], of the bill which refer to a person with a disability that limits or impairs the ability to walk. He offered his understanding that speech-language pathologists would be added to those who can provide proof of a person being limited in their ability to walk. He inquired about why dentists and other providers would not also be added. SENATOR GRAY-JACKSON replied that that question hadn't been given any thought. 3:08:31 PM REPRESENTATIVE TARR said she supports SB 47 because she believes in having providers take full advantage of their training, especially given the current shortage of providers and the difficulty in getting appointments with them. She explained that in relation to speech-language pathologists, the structures of the inner ear are related to balance and equilibrium and people who have that kind of disorder might have issues related to mobility and go to other health care providers. REPRESENTATIVE STORY offered her appreciation for the detailed letters of support for SB 47 provided in the committee packet, which painted the picture of why this bill is needed. She said the bill is very timely. 3:10:31 PM REPRESENTATIVE KAUFMAN asked whether, if the bill became law, the speech-language therapist would use some sort of grading system to determine the extent of disability. SENATOR GRAY-JACKSON responded that she assumes the process will work exactly as it does today when a person goes to a doctor or chiropractor. REPRESENTATIVE KAUFMAN stated he is asking because he assumes a doctor would have a profound ability to diagnose a structural disability and the range of mobility. He surmised that if a speech-language pathologist was assessing someone for a physical disability that wasn't related to balance, the pathologist may need the tools to be able to do so accurately, and he is interested in any background information. MS. ODOM answered that a person experiencing a mobility issue or a disability impacting their mobility is usually referred to a speech-language pathologist and others as part of their care plan. 3:12:23 PM REPRESENTATIVE EASTMAN observed that the current structure of this statute limits disabilities to those who are impaired in walking. He inquired about opening this type of license plate to those who are disabled in other ways. SENATOR GRAY-JACKSON replied that she believes changing this statute to include occupational therapists and speech therapists would take care of handling folks who have disabilities in other ways. REPRESENTATIVE EASTMAN asked whether the sponsor would be supportive of an amendment that adjusts page 1, line 7, because the way he reads the language is that currently the only person who can request this type of license plate is one who has a limit with the ability to walk. He posited that someone with other kinds of disabilities would not be able to make that initial request and apply for the plate. SENATOR GRAY-JACKSON deferred to [Ms. Alfonsi, an invited witness] to provide an answer. 3:14:27 PM ANNETTE ALFONSI provided invited testimony in support of SB 47. She noted she is speaking on behalf of herself and that she is the Alaska volunteer partner for the Unmasking Brain Injury Project. She related that she has a college degree and used to work full-time until 2012 when she was a passenger in a rollover car accident that resulted in internal injuries and persistent concussion symptoms. She spent her savings on medical care by people who did not understand her injuries nor the right treatment for them. She now works part-time in food service while doing volunteer advocacy. Since 2015 she has planned and implemented annual brain injury education with continuing education credits for chiropractic, physical therapy, occupational therapy, and physician continuing medical education (CME). Getting credits approved requires an understanding of each field's scope of practice. She has been a patient in offices of every field listed in SB 47 and has worked in medical and dental offices. MS. ALFONSI provided examples of why the bill is valid for the scopes of practice. She referred to numbered qualifications listed on the application for a special disability parking permit to obtain a disability placard. She noted that numbers 1 and 2 on the form reference walking distance and walking with assistance. She stated that physical therapists usually assess walking more extensively than do physicians who look for neurological ability to walk but don't physically assess the distance, stamina, or assistive technology. It is in the scope of practice for an occupational therapist to do a driving test, and these results are officially accepted by workman's compensation, but occupational therapists don't have the ability to provide [a signature on an application for special disability parking permit]. The sixth qualification is if the applicant is "severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition." Speech therapists can provide cognitive assessments and cognitive re-training regarding that neurological factor. Cognitive fatigue, full response time, or problems juggling multiple variables can make driving unsafe and can increase the chances for an accident. Currently, when a physical therapist, occupational therapist, or [speech-language pathologist] does an assessment, the patient must then make another appointment to get that [disability] parking placard. This takes additional time, expense, and medical appointments in a state with a health care shortage, as well as put more obstacles on rural residents. Cumulatively, the bill will save money, re-injuries, and time, and increase independence, healing, and economic vitality. MS. Alfonsi urged the committee to pass SB 47. 3:18:16 PM MS. ALFONSI addressed the previous questions from committee members. She said speech-language pathologists and all these fields routinely do various kinds of assessments that are accepted nationally; these are accreditations, certifications, and licensures that are accepted nationally. Of the assessments done by a speech-language pathologist, some are the very same assessments done by a neuropsychologist, so those are approved nationally. Plus, rather than just a test result spit out by a neuropsychologist's computer, a speech-language pathologist can catch if someone is giving themselves an assistive factor, such as someone with vision impairment using auditory assistance while taking the test that they otherwise would have failed. Regarding Representative Eastman's question about an amendment [for those who are disabled in ways other than walking], she suggested that after the phrase "to walk" the words "or drive" be added, so if somebody can't walk or drive without this placard it would be an easy way to adjust for various kinds of disability. She reiterated her support for SB 47. 3:21:22 PM REPRESENTATIVE EASTMAN asked whether it would be in the state's interest to assess someone's vulnerability to cognitive fatigue as part of the application for driving and receiving a license. MS. ALFONSI related her understanding that some states have this requirement and others don't. She said she thinks the states that have this requirement have much better incorporated infrastructure for brain injury assessment and treatment. In Alaska, for example, the Monday following her car accident she saw her primary care provider who wrote in her chart that she had brain fog and trouble with expressing herself. This was with receiving one day off work with obviously active concussion symptoms, and even with the information available at that time, it was not appropriate. The idea of SB 47 is to increase the capability of these different therapists, who typically have a greater amount of patient interaction, to be able to provide each patient with what they need in a timely manner. Cognitive difficulties can change quickly, and people can heal quickly if they get what they need in a timely manner. She would feel better about a system that allows people to try to heal as soon as possible instead of a system with a medical shortage that punishes people for not being able to heal. 3:24:01 PM REPRESENTATIVE VANCE inquired whether a stroke is considered a disability. SENATOR GRAY-JACKSON responded that it is a disability in her opinion. MS. ALFONSI replied that a stroke is considered a type of brain injury. 3:24:38 PM REPRESENTATIVE VANCE shared the experience of a constituent who had had a stroke and was trying to get his driver license reinstated, but due to liability concerns his physician would not sign off for him to continue driving. The constituent reported that the physician did not provide any measures to work toward for showing improvement [and ability to drive]. However, the constituent heard that if he went out of state and paid a few thousand dollars, a physician would sign off, something the constituent felt was unfair and illegal. She asked whether the sponsor had researched instances concerning physician liability and the providers that would be added through SB 47. CHAIR KREISS-TOMKINS suggested the question might be outside of the bill's scope as written, although he understands that there is an adjacent issue. SENATOR GRAY-JACKSON agreed the question is out of the bill's scope. She added that she has been working on this bill since 2019 and did her homework before introducing the bill, which was vetted through meetings where doctors, chiropractors, physical therapists, and speech therapist were present. 3:26:51 PM REPRESENTATIVE EASTMAN, if the bill became law, asked whether a speech-language pathologist could be held liable for harm in court if he or she signs off for this disability, a [disability parking placard] is received, and then the person has an accident. 3:27:42 PM JEFFREY SCHMITZ, Director, Division of Motor Vehicles (DMV), Department of Administration, replied he would not have any comment in terms of liability. He said DMV would maintain the exact procedures and processes that it does now when issuing placards. This bill would simply expand the amount of people who can sign such a certificate. There would be no change from DMV's perspective. CHAIR KREISS-TOMKINS, independent that there would be no change in liability from DMV's perspective, asked whether there is currently a liability relationship between the agency and an accident scenario as described by Representative Eastman. MR. SCHMITZ responded that he is not aware of any liability that DMV or the state would have with respect to this. 3:28:52 PM REPRESENTATIVE KAUFMAN stated it would be good to know what the typical liability insurance profile is for this new group of people who would be able to assess this versus the typical liability insurance levels that a physician carries. There may be a difference and a distinction, he added, that could prevent heartbreak in the future. SENATOR GRAY-JACKSON answered that she thinks the liability would be the same as it currently is for chiropractors, doctors, and nurses, but she will investigate it. 3:29:46 PM CHAIR KREISS-TOMKINS announced that SB 47 was held over.