CS FOR HOUSE BILL NO. 229(FIN) "An Act relating to special medical parole and to prisoners who are severely medically or cognitively disabled." This was the first hearing for this bill in the Senate Finance Committee. Co-chair Wilken stated that this legislation would provide the Alaska Board of Parole the flexibility to deny or approve medical parole. TOM WRIGHT, Staff to Representative John Harris, Co-Chair of the House Finance Committee, stated that Senator Lyda Green's staff would present testimony on the behalf of the House Finance Committee, the bill's sponsor. JACQUELINE TUPOU, Staff to Senator Lyda Green, commented that this bill would allow the Parole Board to grant parole to severely disabled or ill prisoners. As a testament to the Parole Board's "proven track record" regarding discretionary parole decisions, she informed that prisoners who are released on mandatory parole have a 77-percent recidivism rate as compared to a one-percent recidivism rate for those prisoners awarded discretionary parole by the Parole Board. Ms. Tupou stated that the State's inmate population is comprised of 430 individuals 50 years of age or older and that 23 percent of the 430 are more than 60 years of age. She expressed that the aging prison population is incurring great medical expense to the State, as she informed that people in State custody are exempt from Medicaid or Medicare programs and Veterans or Native American benefits. Therefore, she communicated that this legislation would enable the Department to formulate a release plan for qualifying, critically ill prisoners provided that such things as where they would live and who their caregivers would be are addressed. She assured the Committee that the release plan must be developed before a prisoner's name would be advanced to the Parole Board. Ms. Tupou stated that even though some of these prisoners are currently in a hospital or other care facility, because they are in State custody, the State is required to post a guard with them 24- hours a day, regardless of the patient's physical situation. Were these prisoners granted a medical parole, she stated that the cost of the individual's care would be provided by federal matching monies or by family resources. She reiterated that, under current conditions, these funding options are not available. Ms. Tupou declared that, were the medical parole option being considered, the prisoner's victim would be notified and allowed to comment. She further attested that were the action "to diminish the seriousness of the crime," the medical parole would not be granted. Ms. Tupou reiterated that this legislation would grant the Parole Board the flexibility to make these discretionary parole decisions. Senator Bunde asked whether a prisoner must be diagnosed with a terminal medical condition before being considered for medical parole. Ms. Tupou replied yes, the prisoner should be experiencing a life- threatening illness from which recovery is not expected. Senator Bunde asked whether the illness must have "a time certain" death element. DR. JOHN ROBERTSON, Medical Director, Department of Corrections, testified via teleconference from an offnet site to explain that the general guidelines of this legislation specify that "the vast majority" of people who would be considered for medical parole status would have three to six months to live "with a year at the outside." He expressed that this bill addresses the lack of flexibility the Parole Board currently experiences regarding medical paroles. Senator Bunde voiced support for the bill. Dr. Robertson commented that safeguards, based on other states' experiences, are incorporated into the process, and that he is confident that the Parole Board would take all factors such as the crime, the medical condition, the prognosis, and the release plan into consideration during its medical parole determination. He stated that one of the prime considerations in the release plan is that an appropriate care environment would be in available for the person. Amendment #1: This amendment changes the bill's title by inserting new language on page 1, line 2, following the word "disabled" to read as follows. "An Act relating to special medical parole and to prisoners who are severely medically or cognitively disabled; relating to a severe acute respiratory syndrome control program; and providing for an effective date." Additionally, two new sections are inserted on page 1, following line 3. The new sections read as follow. Section 1. The uncodified law of the State of Alaska is amended by adding a new section to read: PURPOSE. (a) The purposed of sec. 2 of this Act is to clarify the law and expressly establish a comprehensive program for health care decisions to control severe acute respiratory syndrome (SARS) in this state, including reporting, examinations, orders, and detention to protect the public health. (b) The purpose of secs. 3 7 of this Act is to clarify standards for special medical parole and to address prisoners who are severely medically or cognitively disabled. Sec. 2 AS 18.15 is amended by adding a new section to read: Article 1A. Severe Acute Respiratory Syndrome (SARS). Sec. 18.15.112. SARS control program authorization. (a) A severe acute respiratory syndrome (SARS) control program is authorized in the department. The SARS control program shall be administered in the same manner and has the same powers, authority, obligations, and limited immunities as does the program for the control of tuberculosis under AS 18.15.120 18.15.149, except for the following: (1) the provisions of the control program described in AS 18.15.120(1) and (7); (2) reports to state medical officers under AS 18.15.131; (3) examinations of persons under AS 18.15.133; (4) title to and inventory of equipment allotted to private institutions under AS 18.15.140; (5) the screening of school employees under AS 18.15.145. (b) In this section, "SARS" or "severe acute respiratory syndrome" means the infectious disease caused by the SARS-CoV or the SARS coronavirus and the mutations of that disease." Furthermore, a new bill section is inserted on page 4, line 12 that reads as follows. Sec. 8. Sections 1 and 2 of this Act take effect immediately under AS 01.10.070(c). Senator Bunde moved for adoption of Amendment #1. Co-Chair Wilken objected to discuss the status of the amendment with Co-chair Green, the Chair of the Committee's subcommittees for the Department of Health and Social Services and the Department of Corrections. Co-chair Green asked that the motion be temporarily tabled. Co-Chair Wilken requested that the motion be withdrawn. Senator Bunde WITHDREW the motion to adopt Amendment #2; however, he asked that the amendment be discussed. DOUGLAS BRUCE, Director, Division of Public Health, Department of Health and Social Services stated that this amendment would allow the Department to develop a program, similar to its tuberculosis program, to address a possible outbreak of Sudden Acute Respiratory Syndrome (SARS) or other issues that might require quarantines. He stated that the amendment would additionally provide the Department with the authority to address the particulars of the disease as they differ from those of tuberculosis. Co-Chair Wilken clarified that this amendment would affect a different section of the bill than the medical parole issue does, and in addition, he stated, it would require a title change. Senator Hoffman asked the potential for a SARS outbreak in the State. DR. BETH FUNK, Epidemiology Section, Division of Public Health, Department of Health and Social Services, testified via teleconference from an offnet site in Anchorage and specified that this amendment would provide the State with the ability to develop a program to specifically address the particulars of SARS. She noted that the State has observed the various international reactions to SARS outbreaks and has determined that the regions that moved quickly to test and quarantine suspected outbreaks have been the most successful in disease control. She stated that while most people voluntarily comply with quarantine requests, the State's lack of enforcement capability might hinder disease control. Dr. Funk informed that the incubation period for SARS is approximately two to ten days. She stated that this timeframe could provide the opportunity for SARS to be introduced to the State due to the fact that Alaskans travel so much and that national and international travel is so "rapid." Senator Taylor questioned why one specific infectious illness is addressed in this amendment, as he suggested that a more generic approach should be presented to allow the Department to address infectious illnesses as deemed necessary. Dr. Bruce agreed "that more general powers" would be welcome; however, he stated that this is the initial step of a long process. Senator Taylor voiced support for the overall Department objective. However; he stated that previous legislative attempts to change regulations to address a medical outbreak, specifically acquired immunodeficiency syndrome (AIDS), were unsuccessful; partly he noted, due to a lack of cooperation from the medical field. He avowed that he has "no problem with this amendment," but he voiced "strong concern ? with the inability of the Department to react" to medical emergencies because of "political sensibilities," rather than "the appropriate medical response." Co-Chair Green questioned whether this concern could be addressed in current Public Health regulations, as specified on page 267 of the Alaska Statutes, Year 2002, Volume 5, that read as follow. Section 18.05.040 Regulations (a) The commissioner shall adopt regulations consistent with existing law for (1) the definition, reporting, and control of diseases of public health significance" should provide the Commissioner with the authority to address major health issues. Mr. Bruce responded that this amendment would address the concern that this regulation does not provide the Department with sufficient ability to quarantine individuals. Co-chair Green suggested that the language could be amended to include SARS under the tuberculosis program authority. Mr. Bruce voiced support for the establishment of a separate SARS program, similar to that specified for tuberculosis, as he stressed that the program must contain language and procedures specific to SARS. Mr. Bruce asserted that this amendment would provide an interim approach to providing the more generic authority that would be required. Co-Chair Green asked whether existing State statutes, specifically Title 26. Military Affairs and Veterans. would provide the State with the authority to make decisions regarding State disasters such as an epidemic situation. Mr. Bruce commented that "the Department of Law has indicated that they would be much more comfortable" were this clarification provided. Co-Chair Green agreed with Senator Taylor's comment that the amendment's language should be generic as opposed to being crafted to address one specific virus. She stated that she would revisit the language of the amendment to provide a more generic approach. Co-chair Wilken commented that the amendment would be further revised. The bill was HELD in Committee.