SB 237-TERRORISM, CIVIL DEFENSE, AND DISASTERS  CHAIRMAN THERRIAULT asked Mr. Rush to explain the technical amendment for the bill. MR. RUSH explained the bill amends AS 26.20 civil defense to authorize the governor to declare a state of emergency and exercise emergency civil defense powers in the event of a terrorist attack or a credible threat of an attack. It also amends AS 26.23, the Alaska Disaster Act, to add terrorist or enemy attack, outbreak of disease or credible threat of such events to the definition of disaster. It also amends AS 26.23 to give the governor the power to allocate or redistribute pharmaceuticals and other medicines or supplies as well as the power to access and inspect medical records as necessary to protect public health and safety. He said these changes are necessary because the current world situation indicates that the governor of Alaska needs greater flexibility to respond to and or prepare for a terrorist attack quickly. AS 26.20, the Civil Defense Act, currently allows the governor to declare a civil defense emergency only in the event of an actual enemy attack. SB 237 changes AS 26.20 to allow the governor to declare a state of emergency in the event of an enemy or terrorist attack or credible threat of such an attack against Alaska. This change is necessary for the state to make adequate preparations for a threatened enemy or terrorist attack and be able to respond just as quickly to an actual terrorist attack as it would to an enemy attack from another country. AS 26.23 currently allows the governor to declare a disaster emergency for a variety of events but not specifically for actual enemy or terrorist attacks or outbreaks of disease or the credible threat of the same. The same reasoning for changing AS 26.20 applies for changing AS 26.23. Because bioterrorism is a potential threat even if the state is not the actual target, the outbreak or threatened outbreak of disease needs to be added to the list of specific disaster emergencies. SB 237 will allow the state to more quickly prepare for threatened enemy and terrorist attacks, to include bioterrorism attacks in statute and to more effectively respond if an attack occurs. CHAIRMAN THERRIAULT asked who determines what constitutes a credible threat of attack and what would go into that determination. MR. RUSH replied a recommendation would probably go to the governor from the Disaster Policy Cabinet. CHAIRMAN THERRIAULT asked what the governor's options would be once the cabinet made its recommendation. MR. RUSH said the governor would first decide whether the threat is credible and then a determination of action would be made. CHAIRMAN THERRIAULT said it takes a specific event to trigger these powers but it's a huge difference between authorizing those powers when something has happened and authorizing them for times when something might happen. Although the people want to empower the governor to act when it's appropriate, there is a question of when it is or is not appropriate. He asked if consideration was given to include wording to spell out the criteria for determining a credible threat. Legislators have a responsibility to be careful and selective in giving the governor such extraordinary powers over individuals and their property. He then asked for the considerations made when the decision was made to add this to the statutes. MR. RUSH said the determination of a credible threat is largely in the hands of the state's intelligence apparatus and then the emergency management apparatus that includes the Disaster Policy Cabinet. That information then goes to the governor. If the governor were to determine there is a credible threat it does not mean he could embrace all the powers, just the ones deemed necessary to prepare for that particular threat. He used the [Korean] airliner that was inbound to Anchorage on September 11 as an example of the difficulty associated with making determinations in a short period of time. For eleven minutes it was not known whether the plane was under enemy control or not. This event offered little time for a determination to be made and in this type of circumstance, the emergency organization is heavily relied upon to determine whether it is or is not a credible threat. CHAIRMAN THERRIAULT asked if there was anyone present to answer questions on access and inspection of health care and medical records. MR. RUSH replied they did have someone present and there are two parts to the bill. One deals with including allocation of pharmaceuticals and medicines and the other with access to health care records. CHAIRMAN THERRIAULT said he is less concerned with the distribution of medicines and more concerned or suspicious of access to citizens' health records. He asked whether the medical association was part of the discussion in developing the legislation. KAREN PEARSON, Director of the Division of Public Health (DPH), Department of Health and Social Services (DHSS), agreed; the privacy of medical records is a significant concern. She said Kristen Bomengen from the Department of Law was part of the deliberations on incorporation and was available for questions. There are situations in which people may need a drug or prophylactic administered and they aren't in a situation to sign a release to give to their provider. This bill addresses this type of situation and would provide for the protection of the individual in danger and public health. CHAIRMAN THERRIAULT responded this says nothing about an individual being incapacitated or unable to give their release. MS. PEARSON said time is of the essence if you need to get a prophylactic drug or immunization to thousands of people and there isn't time to get the signed agreement to medical records and the records back. SENATOR PHILLIPS asked if there is someone on central command at Fort Richardson from Public Health and do they have a direct say in proceedings or do they have to call Juneau for information and authorization to act in case of emergency. MS. PEARSON said the anthrax incident serves as a good example. She commended the legislators for recognizing the need for a 24 hour per day 7 day per week (24/7) command prior to September 11 because this proved to be invaluable during the incident. The epidemiologists for Public Health are located in Anchorage and whenever a call come through about a suspicious powder or package, the call is routed to the coordinating center that contacts Public Health physicians for direction. SENATOR PHILLIPS asked if the individual on duty at the time makes the decision. MS. PEARSON said the individual on duty has the authority to make decisions but there is also an established communication system so advice and additional resources are instantly accessible from the Center for Disease Control and Prevention (CDC) in Atlanta. SENATOR PHILLIPS asked whether the phones ever fail. MS. PEARSON replied it was a solid system prior to September 11 but CDC has since built in additional redundancy. Public Health in Alaska is also looking for support to build more capacity and quicker communication capacity and more redundancy in their system to guard against failures. CHAIRMAN THERRIAULT questioned whether the language, "on an as needed basis" is all Public Health needs for record access and what kind of information they might be able to obtain from his own chart at his family doctor. Would the language restrict when access is available or the type of information in his chart? MS. PEARSON said from the public health standpoint, "as needed" means access is authorized to just that information that is needed to deal with the situation at hand. It does not open the entire medical file. CHAIRMAN THERRIAULT referred to "access, inspect, and… on an as needed basis…" and said the event would trigger access to his chart but the wording doesn't speak to what could be looked at inside his chart. KRISTEN BOMENGEN from the Department of Law responded it is her understanding there is a general disclosure of information that is exchanged between doctors when they call one another regarding a patient. The entire chart isn't discussed, just the "front of the chart." She then said she isn't fully qualified to address what information that would involve. The wording intends to mean just information that physicians are generally accustomed to disclosing. She then pointed out that the Division of Public Health already has reasonable access to medical records throughout the state. This legislation places the option of triggering expedited access to the information in the hands of the governor if the circumstances of the particular disaster call for that in order to get individual information. TAPE 02-2, SIDE B  CHAIRMAN THERRIAULT asked if anyone from the medical community had reviewed that portion of the proposed legislation. MS. BOMENGEN said she had no knowledge of that. SENATOR PHILLIPS said he is most interested in the mechanics of meeting the challenge of a terrorist attack and he wanted to know whether the DPH is confident they can meet these challenges as they may arise. He questioned whether systems are currently in place to handle an anthrax threat and how such a threat would be managed. MS. PEARSON replied they cannot guarantee they are able to handle any threat that arises now or next week. They are making great strides in that direction, but there are problem areas in the system. They are concerned about having adequate personnel in their laboratories to run tests and enough physicians and nurse epidemiologists for handling incoming calls and directing field activity. Public Health also has the responsibility of supporting the local Emergency Medical Service (EMS) by making sure they are adequately trained and have the equipment they need. Public Health has conducted assessments with the Department of Military and Veterans Affairs as well as other departments and they have response plans for current capacity but are aware they need additional capacity. SENATOR PHILLIPS asked for current response specifics. MS. PEARSON said one example is the recent response to the potential cutaneous anthrax case. A physician provider who has seen anthrax called the coordinating center to report a potential case. The epidemiologist, physician, and head of the laboratory all examined the patient and took specimens for analysis. They put the patient on prophylactic antibiotics that evening because there was enough positive evidence they could not rule out anthrax. At that time, "All the major players for the department and executive branch were on the phone." The post office was alerted and everyone knew that if there was a positive in the morning everyone on the team needed to know his or her course of action. They ran through the list of responsibilities and discussed whether they had the capacity to trace the pathway back. The good news was that the confirmation tests began to indicate this was not anthrax. They sent samples to the CDC for confirmation and it took a week and one half before they could positively rule out anthrax. SENATOR PHILLIPS asked why they couldn't confirm locally rather than send specimens to Atlanta. MS. PEARSON replied more sophisticated tests are available in Atlanta. SENATOR PHILLIPS commented CDC "sounds like a centralization system versus a de-centralization system" and he can see situations where CDC could be overwhelmed. MS. PEARSON said the Anchorage laboratory is certified at the highest level next to the reference laboratories like the CDC which will always be there as a higher level backup than any state could ever maintain. CHAIRMAN THERRIAULT called for a discussion of the proposed amendment. MR. MIKE MITCHELL, Department of Law, said this amends AS 26.23.210 in the disaster chapter and draws a distinction between natural disaster covered under AS 26.23 and disaster caused by attack which is covered under the little used, 1950's civil defense statute AS 26.20. All disaster response in the last several decades has been authorized under AS 26.23 and in the event of a terrorist attack or credible attack they want AS 26.23 to apply. CHAIRMAN THERRIAULT asked for questions or further testimony. AL ROTHFUSS testified via teleconference against the bill. In his opinion, this law infringes on individual rights, freedoms and privileges. He said, "It is not Alaska's responsibility to defend me in all cases. It is up to me to defend me. All Alaska has to do is give me the information." SENATOR PHILLIPS asked for an example of how SB 237 infringes on individual rights. MR. ROTHFUSS replied the governor should not have the right to move him wherever he wants to move him and he should not have the right to confiscate properties. "If we give this governor all these powers what are you guys going to do? What do we need you for? We don't. That's what you're down there for is to do these things." SENATOR PHILLIPS asked for a page and line upon which to focus. MR. ROTHFUSS cited from the bottom of page 2 on to the top of page 3. CHAIRMAN THERRIAULT advised Mr. Rothfuss the text on the bill that is not underlined and bolded is current law. Changes on page one give the governor the power to act both after an attack and in the face of a credible attack rather that just afterwards. MR. ROTHFUSS asked whose definition would be used to identify a credible threat. CHAIRMAN THERRIAULT said it is a legitimate question and one he raised himself. He thanked him for his testimony. There being no further questions, the bill was held in committee.