SB 65-LIABILITY CONSULTING HEALTH CARE PROVIDER  1:51:23 PM VICE CHAIR SHOWER announced the consideration of SENATE BILL NO. 65 "An Act relating to immunity for consulting physicians, podiatrists, osteopaths, advanced practice registered nurses, physician assistants, dentists, optometrists, and pharmacists." [CSSB 65(HSS) was before the committee.] 1:51:45 PM VICE CHAIR SHOWER stated the committee would consider amendments. 1:52:43 PM SENATOR KIEHL, speaking as sponsor, said at the first hearing on SB 65 Senator Myers asked whether there was a reason to exclude federal hospitals from the definition of a health care facility. He said it was an unintentional exclusion, so his office prepared an amendment to include federal hospitals in the definition. He stated it would have a limited application in Alaska since most medical practitioners practicing at federal hospitals are federal employees. The federal tort law that allows a person to sue a federal employee would preempt state law. Still, there may be Alaska licensed health care professionals with privileges to practice in a federal hospital, so including federal hospitals will ensure that these hospitals are covered under the provisions of SB 65. 1:54:20 PM SENATOR HUGHES asked if Alaska has any Native health hospitals and if so, whether "federal" would cover those. SENATOR KIEHL answered that the Alaska Native Medical Center (ANMC) in Anchorage is owned by a nonprofit covered by the bill's private nonprofit language. SENATOR HUGHES asked if the hospital in Bethel, which is run by the Yukon-Kuskokwim Health Corporation (YKHC) is set up in the same way. SENATOR KIEHL responded that the only category that might not be covered by private, municipal, state, or federal would be if someone built a tribal hospital. He stated that there are not any tribe-owned hospitals in the state to date, and he is not aware of any proposals to build one. SENATOR HUGHES asked if the Alaska State Hospital and Nursing Home Association (ASHNHA) has reviewed the bill since that organization would know if any hospitals would be excluded. SENATOR KIEHL replied that ASHNHA had written a letter of support. 1:56:32 PM SENATOR MYERS moved to adopt Amendment 1, [work order 32- LS0002\I.1]: 32-LS0002\I.1 Fisher 3/9/21 AMENDMENT 1 OFFERED IN THE SENATE BY SENATOR KIEHL TO: CSSB 65(HSS) Page 2, line 23: Delete "or" Following "state": Insert ", or federal" 1:56:35 PM VICE CHAIR SHOWER objected for discussion purposes. 1:57:03 PM SENATOR MYERS explained Amendment 1. He directed attention to page 2, line 23, which would add "federal" to the definition of health care. It would read, "private, municipal, state, or federal hospital." 1:57:45 PM SENATOR REINBOLD, testifying via teleconference, said the Senate Health and Social Services Standing Committee heard SB 65. She offered her support for Amendment 1. 1:59:15 PM VICE CHAIR SHOWER removed his objection. There being no further objection, Amendment 1 was adopted. 1:59:47 PM VICE CHAIR SHOWER moved to invited testimony. 2:00:24 PM MELINDA RATHKOPF, Physician; Medical Director, Allergy, Asthma and Immunology Center of Alaska, Anchorage, Alaska, said she is a pediatrician. She also serves on the Board of Trustees for the Alaska State Medical Association. She spoke in support of SB 65. She said she is speaking as a specialist, noting that for the first 10 of 15 years, the Allergy, Asthma, and Immunology Center of Alaska was the only allergy immunology practice in the state outside of the military. She related that this practice has taken, and still takes, phone calls from other providers throughout Alaska about their patients with allergy or immunology needs. In the past several years, their most unique role has been screening newborns for a severe combined immune deficiency (SKID) defect, which can be life-threatening if not diagnosed immediately. She said her group is on call statewide to consult on any newborn with an abnormal screening. These calls are for patients that the doctors in her practice may never meet, but the doctors give their expert advice and guidance for the care of these fragile infants. She indicated that in these instances there is never a doctor to patient relationship formed. However, the clinic may treat the patient later for an in-person visit. Typically, these patients are cared for by their primary care providers. The doctors at her clinic are never reimbursed, she said. 2:02:38 PM DR. RATHKOPF explained that she might get a call from a Bethel resident on how to care for an immune issue or receive a call from a family practice doctor in Fairbanks on a severe asthmatic patient. Her practice receives calls from providers throughout Alaska on how to care for patients, but the doctors often never meet the patients. She informed members that her practice has seven satellite clinics in Alaska, most of which require air travel, including in Ketchikan or Valdez. This bill allows physicians to provide advice without fear of liability for advice given without establishing a doctor-patient relationship or having seen the patient in person. 2:03:46 PM VICE CHAIR SHOWER asked if Alaska needs the protection offered by SB 65 more than other states in the Lower 48 due to Alaska's size and limited road system and isolated communities. DR. RATHKOPF agreed that the need is greater due to geographical issues and since Alaska has fewer specialists, many of whom are concentrated in Anchorage. Further, inclement weather issues may prevent patients from coming to Anchorage. 2:05:37 PM SENATOR HUGHES thanked her and her colleagues because of the time spent assisting patients without receiving any financial reimbursement. She asked if her phone consults are primarily outside the Anchorage Bowl and if primary care physicians are more likely to refer patients to see her in person. She surmised that she likely takes more calls than her counterparts in other states. DR. RATHKOPF agreed that her practice likely takes more calls. Someone is on call 24/7 in the state to assist patients. She added that being physicians and providing expertise is what they love and are passionate about. She said she could not imagine a provider who is unwilling to take these calls. She related that some pressure has come from malpractice carriers on the liability insurance issue. She said it is fulfilling to help patients, many of whom are eventually seen by her practice. 2:07:41 PM SENATOR HUGHES said she applauded her because the initial consults did not result in any financial gain. She said she appreciated the passion she brings to help Alaska residents who face some of the problems she can address. 2:07:57 PM VICE CHAIR SHOWER asked if this is a problem in other states. SENATOR KIEHL responded that this issue arose from a Minnesota Supreme Court Case. A doctor provided an unpaid consultation without forming a doctor-patient relationship or duty of care, which led to a lawsuit. He related that this decision sent shock waves throughout the medical community. He stated that insurers like to limit their risk. In some instances, specialists were advised not to take the calls. However, he offered his view that a better approach was to ensure that those who truly do not have a duty of care are not subject to litigation and liability. SB 65 takes this approach, he said. He mentioned that several other states are considering legislation similar to this. He recalled that this concept has passed in Idaho and several other states are considering this legislation. 2:09:52 PM SENATOR REINBOLD characterized it as a Good Samaritan law. She said she hopes to get this bill to the Senate floor soon. 2:11:55 PM VICE CHAIR SHOWER held SB 65 in committee.