SB 161-AUTOPSIES AND DEATH CERTIFICATES  1:34:49 PM CHAIR STEDMAN announced that the first order of business would be SB 161. 1:35:18 PM DAVID SCOTT, Staff, Senator Donny Olson, Alaska State Legislature, Juneau, Alaska, explained SB 161 on behalf of the sponsor. He said the bill was introduced to try to alleviate some unforeseen difficulties for families in rural Alaska when a loved one dies and the body must be transported to Anchorage for an autopsy. There are misunderstandings created by forms that are used resulting in high costs for funeral home expenses. He noted new sections of the bill which would clarify that not every death that requires an autopsy must be transported to Anchorage. The bill also provides telemedicine options to try to save the state money. The state currently uses general fund dollars to transport remains from rural communities to Anchorage and back. 1:37:34 PM MR. SCOTT explained changes in the bill. In Section 1 on line 13, "may" was deleted and "shall" was inserted. On page 2, line 3, the sponsor requests a discussion of language he is ready to remove. It says "by a policy of the transporting entity", which means an airline could require embalming. The sponsor does not believe the policy of a private company should affect what the state does. He said the sponsor is willing to negotiate that issue. He said Section 2 adds two subsections so autopsies don't all have to be conducted in Anchorage, but could be done by video technology. Section 2 (g) is a new section of law which provides that a person who is responsible for the burial of a body would receive a form from the State Medical Examiner's Office. Section 3 conforms to Section 4, which requires that if there is no funeral director in a community, a person shall be designated by the state registrar to file the death certificate and obtain personal data from the next of kin or best qualified person. Section 5 conforms to Section 6, which requires that the medical examiner shall obtain a burial-transit permit before a body is transported. 1:40:25 PM MR. SCOTT noted a DHSS fiscal note and a draft form from the State Medical Examiner's Office in members' packets. He highlighted the first line of the form which states that there is no legal requirement for the use of a funeral home. He concluded that the bill is an effort to alleviate family suffering during tough times. CHAIR STEDMAN noted a DHSS fiscal note for $115,000 in general funds to implement these changes. He opened public testimony. 1:41:47 PM RAEBELLE WHITCOMB, Director, Workforce Development Center, Bristol Bay Native Association (BBNA), Dillingham, Alaska, testified in support of SB 161. She said she is also testifying on behalf of her family. She explained that from BBNA's perspective, the legal requirement for the use of the State Medical Examiner has caused additional burdens on families. She related that BBNA provides burial assistance along with the state. Many times BBNA has had to deal with costs of embalming and air transportation. Limited funding has an impact on the state and tribal organization. She related that sometimes the requirements go against the family's wishes and values. For example, embalming before transportation is not a customary and traditional practice. She shared a person story on behalf of herself and her family. They were forced to pay for embalming costs at a funeral home in Anchorage and the expense was a significant burden. Also, the need to transport an individual out of state entails an extra charge for a container and embalming. She said another issue is that the body is not released until the bill is paid in full. She concluded that the bill is important to people in rural areas. 1:46:43 PM JACKIE RUSSELL, Social Worker, Bristol Bay Area Health Corporation (BBAHC), Dillingham, Alaska, testified in support of SB 161. She concurred with the previous speaker and emphasized how important the bill is to rural communities. She shared the services available at BBAHC, such as telemedicine, and suggested that they could cooperate with the medical examiner to cut costs. She said she hopes the committee will pass the bill. 1:49:10 PM KERRE SHELTON, Director, Alaska Division of Public Health, Department of Health & Social Services, Safety, Anchorage, Alaska, testified in support of SB 161. She stated that the bill is very important to the Division, and the care of families in Alaska is very critical to the Division and to the State Medical Examiner's Office. She related that the State Medical Examiner's Office is in Anchorage and exists to determine cause and manner of death for cases that are brought under their jurisdiction. There are between 1,600 and 1,700 deaths per year in Alaska and only about half fall under the Medical Examiner's jurisdiction. The criteria for those deaths are set out in current statute. Expected home or hospital deaths do not fall under the jurisdiction of the Medical Examiner's Office. She described what happens at the Medical Examiner's Office in Anchorage. Autopsies can be internal or external or both, based on the circumstances of the case. Various tests can be performed. She said there are three forensic pathologists, one position of which is vacant. There are also autopsy technicians and investigators, making a total of 17 staff. The in-house case load was 857 last year; another 775 cases were not brought in to the office MS. SHELTON reported that the Medical Examiner's Office relies strongly on local law enforcement who collect scene information, consult with the pathologist, and determine if the case should be brought into the jurisdiction of the office. Next, the body must be transported to Anchorage and processed as quickly as possible and returned back to the family. The Medical Examiner's Office recognizes the sensitivity and emotional nature of the cases, especially unanticipated death. 1:53:48 PM She shared policies that are in place regarding transporting the body back to the home city. The office provides the burial- transit permit when the body leaves. It also revised the authorization of release-of-remains form to clarify issues regarding funeral homes. The office attempts to do what is best for the family and has no stake in funeral homes. The office no longer does embalming because the law requiring it was abolished in 2005. Funeral homes do embalming and cosmetology work. 1:56:35 PM She indicated that are no other facilities that can perform a forensic examination except for in Fairbanks and Anchorage. Neither of those offices have telemedicine equipment. The state caseload does not warrant another autopsy facility. An extensive amount of equipment would be required to ensure that the exams are legally defensible, medically appropriate, and meet the standards. She said there are no forensic pathology services in rural communities. Forensic examinations must be legally defensible and provide the same high standard of care for all cases. She questioned the liability if someone else would perform a forensic exam. 1:58:50 PM MARCIA DAVIS, General Council, Senior Vice President, Calista Corporation, Anchorage, Alaska, testified in support of SB 161. She described the function of Calista Heritage Foundation, a non-profit that is responsible primarily for educational scholarships for shareholders. Calista also provides burial assistance, funding some of the costs for transport and burial. She discovered that the problem of high costs has been around for a long time. There have been efforts to correct the problem that have not met with success when dealing with state agencies. MS. DAVIS stated that in order to find a solution, she studied laws and had conversations with the Department of Health and Social Services (DHSS), but got nowhere. She then went to the State Medical Examiner's Office in search of a solution. 2:01:27 PM She said in that meeting, she shared culturally sensitive issues surrounding death in rural areas. She described issues with the form families must fill out and the lack of communication between the Medical Examiner's Office and rural Alaska. By contrast, she shared how villages handle a death. She maintained that the form must be revised; it is currently different from what the law requires. She concluded that too much cost is put on the family, and it is unfair to hold a body hostage until the bills are paid. She said she found a law in North Dakota where it is a crime to hold the body for money. She emphasized that values are different in Bush Alaska. 2:08:29 PM She said Calista would like to see the Medical Examiner's Office have the statutory authority to make changes to procedures and to the form. She said the next step is to translate the form into Yupik. 2:09:34 PM CHAIR STEDMAN held SB 161 in committee.