SB 14-EMERGENCY MED. SERVICES; DEFIBRILLATORS  1:33:42 PM CHAIR COSTELLO announced the consideration of SB 14. "An Act relating to the appointment of a mobile intensive care paramedic to the State Medical Board; relating to medical review organizations; relating to immunity pertaining to automated external defibrillators; and providing for an effective date." SENATOR JOHN COGHILL, sponsor of SB 14, stated that this legislation adds a paramedic to the State Medical Board and gives emergency medical service (EMS) agencies protections for peer review activities. He deferred further introduction to his staff. 1:35:23 PM SENATOR GIESSEL joined the committee. JORDAN SHILLING, Staff, Senator John Coghill, stated that SB 14 does three things: 1) it adds a paramedic to the State Medical Board; 2) it add EMS agencies and fire departments to the peer review statutes; and 3) it repeals problematic language in AS 09.65.087, the automated external defibrillator statutes. He reviewed the bill sections and the rationale for the bill. He explained that the State Medical Board regulates five medical professions in Alaska - physicians, osteopathic doctors, physician assistants (PA), podiatrists, and paramedics. The board has five physician seats, one PA seat, and two public seats. Paramedics have been regulated by the board for more than 30 years and the sponsor feels that giving this distinctly different profession a seat is long overdue. Despite the lack of representation, the board plays a significant role in the lives of paramedics by disciplining, levying fines, and making final licensing decisions. Adding an EMS seat will broaden the perspective of the board and add the expertise of prehospital medicine. He reported that there are currently 463 active paramedics in Alaska. These professionals, the State Medical Board, and the five physicians that sit on the board support the legislation. SENATOR COGHILL asked Mr. Shilling to discuss the peer review process. MR. SHILLING explained that peer review is a rigorous evaluation process that healthcare organizations use to monitor and improve patient care. Hospitals generally have a peer review committee to look at patient documentation, review reports and give feedback, all of which is statutorily protected from discovery in a civil trial. This is an important protection that promotes honest, candid feedback. All 50 states provide this protection and many are adding it for EMS agencies because they go through the same rigorous evaluation process. The sponsor feels EMS agencies should be extended the same protection as hospitals. MR. SHILLING read a statement from a national EMS assessment. For EMS systems to be used to their maximum potential with respect to performance improvement, peer review protection is required and should be the goal of every state. He highlighted that a group of EMS experts last year recommended that the legislature provide statutory protection from discovery for quality improvement activities related to EMS care. The bill provides this protection in Sections 2-4. 1:41:24 PM SENATOR STEVENS asked if paramedics would be in a position to make a disciplinary licensing decisions about a physician or PA. MR. SHILLING answered yes. SENATOR STEVENS asked if paramedics would be comfortable being in that position. MR. SHILLING answered yes. SENATOR COGHILL clarified that the paramedic member would have one vote, the physicians would have five votes, the PA one vote and the public member one vote. SENATOR GIESSEL asked if paramedics have been misrepresented or if disciplinary action has been inappropriate. 1:43:55 PM MR. SHILLING replied he has anecdotal evidence that not having a voice has negatively affected the profession and some paramedics personally. SENATOR COGHILL added that the unique circumstance of paramedics isn't addressed to their satisfaction. 1:45:17 PM CHAIR COSTELLO asked if adding a paramedic to the State Medical Board follows a national trend. MR. SHILLING replied he hasn't reviewed what other states have done, but Alaska is somewhat unique in that EMTs are under the purview of the Department of Health and Social Services (DHSS), whereas paramedics and physicians are under the purview of the State Medical Board. CHAIR COSTELLO asked if the physicians on the board have given verbal or written support for the legislation. MR. SHILLING advised that on January 13 the board voted unanimously to support this concept and wrote a letter to that effect. CHAIR COSTELLO asked him to describe the value of making this change, and if he'd heard any arguments for maintaining the status quo. MR. SHILLING said the value is having someone with prehospital expertise being involved in discussions that regulate their profession. The sponsor's office has heard mild opposition from the Alaska State Medical Association, just as they opposed giving PAs a seat a few years ago. Their suggestion is to designate one of the public seats as public or paramedic. CHAIR COSTELLO noted the letter from the Alaska State Medical Association that was just distributed. She asked the sponsor to respond to the suggestion Mr. Shilling described. SENATOR COGHILL said he sees equal value in having people who are not in the industry on a board and those who are regulated by the board. 1:50:38 PM CHAIR COSTELLO opened public testimony on SB 14. 1:51:06 PM THOMAS MEYER, President, Paramedic Association of Alaska, voiced support for adding a paramedic to the State Medical Board because they currently do not have representation. The board's terms of initial licensure requirements, the terms of renewals, and disciplines are among if not the strictest and most punitive in the country. Mobil Intensive Care Paramedics (MICPs) permeate the system in vital areas for emergency care. They are firefighters responding to medical and fire emergencies; they provide emergency services in industrial and remote sites; EMT teachers are almost all paramedics; they are in law enforcement special operations; SWAT and field officers are often EMTs and paramedics; para rescuers working for the Air National Guard are MICPs; the U.S. Coast Guard has MICPs licensed in Alaska; and air medivac services require an MICP on board. CHAIR COSTELLO asked if he could support the statement that the State Medical Board is the most punitive in the country. MR. MEYER replied the national registry of state medical board actions and fines on these licensees shows that Alaska has been in the top five most punitive for many years. 1:55:31 PM DON HUDSEN, MD., Anchorage, Alaska, said he's an ER doctor who has worked as a medivac in remote areas of Alaska, as a medical director, and with several paramedic schools. When he served on the State Medical Board it was disconcerting to see that the members really didn't know what paramedics did for a living. He was pleased when he saw the bill come up because he and others have supported having a paramedic on the board since 1981. 1:57:25 PM MITCH FLYNN, Fire Chief, Steese Volunteer Fire Department, Fairbanks, Alaska, stated support for adding a paramedic to the State Medical Board, but expressed concern that SB 14 doesn't extend peer review protection to volunteer fire departments. ROBERT "MEL" VOSTRY, representing himself, Palmer, Alaska, testified in support of SB 14. He has been a state-licensed paramedic since 1984 and has been involved with EMS since 1979. He explained that the first paramedics chose to be under the purview of the State Medical Board in the hopes of eventually attaining a professional status. The field of medicine has evolved in the last 45 years and being a paramedic is no longer simply serving on an ambulance. They now attend a 1-2 year university-level accredited program. The State Medical Board is made up of physicians and most recently a physician assistant, and those professionals may or may not know anything about what a paramedic does in the field or their level of education. MR. VOSTRY said he values the stringent requirements that paramedics are held to by the Medical Board, but they should have a voice. 2:04:35 PM KATHLEEN MCLERON, representing herself, Anchorage, Alaska, testified in support of SB 14. She relayed that she is a licensed physician assistant (PA) and a licensed paramedic. The State Medical Board regulates the practice of PAs and paramedics and she was pleased when PAs got representation on the board. She expressed strong support for giving paramedics similar representation, describing it as a logical next step for the State Medical Board. 2:05:58 PM CHAIR COSTELLO found no further testifiers and closed public testimony on SB 14. She invited Sara Chambers to explain the fiscal note. 2:06:42 PM At ease from 2:06 p.m. to 2:07 p.m. 2:07:43 PM SARA CHAMBERS, Professional Licensing Operations Manager, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development, explained that the fiscal note reflects the estimated addition cost for travel for the State Medical Board. The board is statutorily required to hold quarterly meetings and has found it benefits from face-to-face meetings so it travels throughout the state. Some of the travel is to remote areas to ensure that the message is clear that the voice in rural Alaska is valued. The estimate, based on past travel expenses, is $7,000 per person per year. SENATOR GIESSEL pointed out that this falls under receipt services, which means the board pays for it. CHAIR COSTELLO asked what the fees are for paramedics and physicians. MS. CHAMBERS explained that the biannual licensing fee for paramedics is $50 and physicians pay $300 biannually. Receipt supported services and any additional costs are borne by licensees of the board. CHAIR COSTELLO asked if the board is operating in the black and if the fees will change. MS. CHAMBERS reported that at the end of FY2014, the State Medical Board had a surplus of over $600,000. CHAIR COSTELLO asked if the licensing fees are expected to go down or remain the same. MS. CHAMBERS replied they will remain the same this year but may go up after the next analysis, depending on whether or not fees from new licensees offset rising costs. CHAIR COSTELLO asked if, in addition to the regularly scheduled meetings, the board meets on an as-needed basis. MS. CHAMBERS confirmed that all the boards in the division meet at the will of the board, while adhering to the Open Meetings Act. When the board deems it appropriate, a mail balloting system can be employed. SENATOR GIESSEL asked about the repeal language in Section 5. 2:11:54 PM MR. SHILLING explained that it repeals an exception to immunity related to automatic external defibrillators (AED) if the use of the device is not preceded by employer-provided training. The sponsor believes that the use of an AED is straightforward and has heard that the training requirement tends to inhibit an employer from having a device on the premises. This concern was brought forward by the chief of the university fire department in Fairbanks who had noticed a decrease in the use of AEDs in public spaces. CHAIR COSTELLO held SB 14 in committee for further consideration.