SB 75-PUBLIC HEALTH DISASTERS/EMERGENCIES    CHAIR FRED DYSON announced SB 75 to be up for consideration. DR. RICHARD MANDSAGER, Director, Division of Public Health, Department of Health & Social Services (DHSS), proceeded with a 20-minute slide presentation focusing on the public health system. He relayed a quote from "The Institute of Medicine," which says, "Public health is what we as a society do collectively to assure that the conditions in which people live can be healthy." He said there are many partners in public health and SB 75 focuses on the governmental part of the public health system - sewage removal and treatment, safe water, clean air, removal of lead from gasoline. DR. MANDSAGER emphasized that public health is not health care, but rather it focuses on populations and prevention, not treatment. It focuses on testing kids for TB in schools and injury prevention projects like on how to prevent logging accidents. He gave another example from last year, when the department addressed cruise ship sickness, which turned out to be caused by oysters from Kachemak Bay. Public health work is involved in places you don't expect it and problems can't be predicted from year to year. He said that SB 75 supports the work the Division of Public Health does and addresses its underpinning statutory weaknesses. He said the department is very dependent on federal funds for preparedness work, which started being redirected last summer and he thought it would probably continue going that way. 2:43:25 PM DR. MANDSAGER said that tuberculosis still exists in Alaska and work will always have to be done to minimize outbreaks. The public health world is now worried about SARS mutating into human-to-human transmission as three cases have been documented. It attacks young adults and healthy people. For the last two years the mortality rate has been 70 percent. Traditional disease control generally involves isolation and the state would have to quarantine people if that were to happen in the next few years. Bringing current law that is based on 1949 statues containing the basic public health framework up to date in SB 75 would allow the division to address current issues like what different cultures expect in terms of health care and present-day chronic disease outbreaks. Further he said that current law contains nothing about due process. He said: In my view this bill is all about trying to find the right balance between the mission of protecting public health and an individual's right to due process in the case they think government has overreached.... 2:46:41 PM DR. MANDSAGER explained that the definition of "essential public health services" is based on the nationally accepted definitions from the U.S. Public Health Functions Task Force and is further based on two reports published in the last 15 years by the Institute of Medicine. He related an example of blood surveys for lead dust the department did 10 years ago in the communities around the Red Dog Mine. When the department went back this fall and tested people again, it found no evidence of lead absorption. He also noted on-going concerns about asbestos in the gravel at Ambler. 2:49:39 PM DR. MANDSAGER continued reviewing his slide presentation. The meat of the bill is in section 8, the quarantine, isolation and medical treatment section. Only one state in country doesn't have adequate statutory authority to quarantine in response to a bio-terrorism attack scenario and that is Alaska. Because the department has authority for two diseases only, if small pox showed up, he would have to persuade a judge that their general governmental authorities are broad enough for them to immediately isolate that patient. 2:52:39 PM SENATOR ELTON asked why section 3 deletes annual TB screening in public schools because he just mentioned that TB is still an issue in Alaska. DR. MANDSAGER replied that the cost benefit analysis of screening rules doesn't justify annual testing of every schoolteacher and child in the State of Alaska. He said the department has been working on this issue on a regulatory basis and this section updates the statute to reflect that. 2:54:28 PM SENATOR ELTON asked if it reduces the cost to districts. DR. MANDSAGER replied yes. CHAIR DYSON asked if he could still do what was necessary by regulation. DR. MANDSAGER replied yes. SENATOR OLSON asked him to describe the interaction between the Center for Disease Control (CDC) and the Public Health Department in the case of a disease outbreak. DR. MANDSAGER replied that the arrangement is complicated, but works well because Alaska has a small population. The CDC has authority on cruise ships until they dock. His division takes over on land. He said the federal government is going to establish a special quarantine office in Washington, D.C. to deal with quarantine authority for disease outbreaks. Because the communications between involved people are good in Alaska, dealing with the cruise ship industry has worked well so far. 2:56:36 PM SENATOR OLSON asked if it is possible to quarantine a cruise ship without it docking. DR. MANDSAGER replied yes and in that case the CDC has authority. SENATOR OLSON asked if the CDC has any problems working within the Alaskan constitution. DR. MANDSAGER replied that he didn't see any. SENATOR OLSON asked if it would be more advantageous for a new lab to be built in a more central location than Fairbanks since most aircraft heads toward Anchorage. DR. MANDSAGER replied that that question gets to the core of the next bill up for consideration [SB 73] and the debate about sample processing is important. Some testing for human viruses can get to Fairbanks fast enough to diagnose quickly. That could be a problem if there weren't many flights between Anchorage and Fairbanks daily. SENATOR OLSON said that time is of the essence in a rabies case in Dutch Harbor. DR. MANDSAGER replied that the biggest risk from Dutch Harbor is getting to Anchorage, not to Fairbanks. The biggest issue is getting the sample from anywhere in rural Alaska to a hub in the first place. He said the Governor's office had prepared an amendment that the Department of Law and the Office of Public Advocacy had agreeable on. SENATOR WILKEN moved to adopt Amendment 1 that was prepared by Dr. Mandsager as follows: AMENDMENT 1 TO: SB 75 Page 13, line 28: Delete all material following "g" through page 13, line 31 Page 14, line 1: Delete "the office of public advocacy to provide a guardian ad litem for the individual." Page 17, following line 14: Insert: "Sec. 18.15.389. Representation; guardian ad litem. An individual who is the respondent in proceedings under AS 18.,15.375(e) or 18.15.385 has the right to be represented by counsel in the proceedings. If the individual cannot afford an attorney, the court shall direct the public defender agency to provide an attorney. The court may, on its own motion or upon request of the individual's attorney or a party, direct the office of public advocacy to provide a guardian ad litem for the individual." There were no objections and Amendment 1 was adopted. 3:02:32 PM SENATOR ELTON moved to adopt Amendment 2. AMENDMENT 2 TO: SB 75 Page 6, line 17: After (4) the transportation of dead bodies, insert "except that the commissioner may not require that a dead body be embalmed unless the body is known to carry a communicable disease or embalmment is otherwise required for the protection of the public health or for compliance with federal law;" SENATOR GREEN objected for discussion purposes. SENATOR ELTON explained that Amendment 2 was prepared due to another bill he co-sponsored with the chairman that provides that transportation of dead bodies doesn't require a waiver process. Families of members of some faiths don't believe in embalming and want bodies buried in the Holy Land or next to relatives in other states that require embalming before they can be shipped out. Currently waivers have been issued in these circumstances, but that is not in statute. The amendment provides that the bodies can be transferred unembalmed unless there is a public health risk. Adopting this amendment means they would not have to take up the separate bill. 3:04:44 PM DR. MANDSAGER said he had no objection to Senator Elton's amendment. CHAIR DYSON said he understood that bodies are sealed and there are no public health issues by not embalming them. DR. MANDSAGER added that dry ice is available today in a way that it wasn't when the statute was written several decades ago. SENATOR GREEN remarked that a member of the other body ran into problems in transporting a body across state lines and asked how transportation could be assured. DR. MANDSAGER replied that federal law covers jurisdiction across state lines and this clause would be okay. He had not done a thorough study of how this would interact with all other states' statutes, however. SENATOR GREEN noted that there was no fiscal note. 3:06:55 PM SENATOR ELTON added that SB 39 on this same issue had no fiscal note either. SENATOR OLSON asked if any disease had ever been spread by an unembalmed body. DR. MANDSAGER replied that he was not aware of any. CHAIR DYSON noted there were no further objections and Amendment 2 was adopted. 3:08:29 PM NATHAN JOHNSON, Division Manager, Anchorage Municipal Department of Health and Social Services, supported SB 75. He said the state statutes are antiquated and it is imperative to update them for bioterrorism, avian flu and the entire scope of present-day public health concerns. 3:10:34 PM ROD BEATTY, President, Alaska State Hospital Nursing Home Association (ASHNHA) supported SB 75 and the fact that it takes care of public health before anything serious happens. He especially praised spelling out privacy issues surrounding a public health emergency. 3:12:00 PM CHAIR DYSON asked Dr. Mandsager to explain the religious treatment of tuberculosis that is repealed in section 12. DR. MANDSAGER deferred to Dan Branch, Senior Assistant Attorney General Department of Law, who explained that SB 75 upgrades the chapter that currently deals with tuberculosis and it was not the intent to implicate religious beliefs with quarantine isolation testing. SENATOR GREEN moved to pass CSSB 75(HES) from committee with individual recommendations and fiscal note. There were no objections and it was so ordered.