ALASKA STATE LEGISLATURE  HOUSE COMMUNITY AND REGIONAL AFFAIRS STANDING COMMITTEE  February 2, 2006 8:09 a.m. MEMBERS PRESENT Representative Kurt Olson, Co-Chair Representative Bill Thomas, Co-Chair Representative Mark Neuman Representative Sharon Cissna Representative Woodie Salmon MEMBERS ABSENT  Representative Pete Kott Representative Gabrielle LeDoux COMMITTEE CALENDAR CONFIRMATION HEARING(S) Department of Commerce, Community, & Economic Development William C. Noll - Juneau - CONFIRMATION(S) ADVANCED HOUSE CONCURRENT RESOLUTION NO. 5 Relating to support of community water fluoridation. - MOVED HCR 5 OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION BILL: HCR 5 SHORT TITLE: FLUORIDATION SPONSOR(s): REPRESENTATIVE(s) SEATON 03/09/05 (H) READ THE FIRST TIME - REFERRALS 03/09/05 (H) CRA, HES 02/02/06 (H) CRA AT 8:00 AM CAPITOL 124 WITNESS REGISTER WILLIAM C. NOLL, Commissioner Department of Commerce, Community, & Economic Development Juneau, Alaska POSITION STATEMENT: Spoke as appointee to the position of Commissioner of DCCED. REPRESENTATIVE PAUL SEATON Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Spoke as the sponsor of HCR 5. TROY RITTER, Senior Environmental Health Consultant Alaska Native Tribal Health Consortium (ANTHC) Anchorage, Alaska POSITION STATEMENT: Testified in support of HCR 5. ARTHUR HANSEN, retired dentist Fairbanks, Alaska POSITION STATEMENT: Testified in support of HCR 5. WILLIAM MARLEY, retired dentist; Representative, Fluoride Committee American Dental Society Homer, Alaska POSITION STATEMENT: Testified in support of HCR 5. JIM TOWLE, Executive Director Alaska Dental Society Anchorage, Alaska POSITION STATEMENT: Testified in support of HCR 5. SHELLEY HUGHES, Policy Analyst Alaska Primary Care Association (No address provided) POSITION STATEMENT: Testified in support of HCR 5. TOM BORNSTEIN, Director Dental Services Southeast Alaska Regional Health Consortium Juneau, Alaska POSITION STATEMENT: Testified in support of HCR 5. BRAD WHISTLER, Dental Officer Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Testified that the department is supportive of community water fluoridation. ACTION NARRATIVE CO-CHAIR BILL THOMAS called the House Community and Regional Affairs Standing Committee meeting to order at 8:09:49 AM. Representatives Thomas, Olson, Neuman, and Cissna were present at the call to order. Representative Salmon arrived as the meeting was in progress. ^CONFIRMATION HEARING(S): ^Department of Commerce, Community, & Economic Development 8:10:06 AM CO-CHAIR THOMAS announced that the first order of business would be the confirmation hearing for the appointment of William C. Noll as commissioner of the Department of Commerce, Community, & Economic Development (DCCED). 8:10:19 AM WILLIAM C. NOLL, Commissioner, Department of Commerce, Community, & Economic Development (DCCED), provided background information, including that he originally came to Alaska in 1968 with the U.S. Army. Upon discovering that he loved the state, he stayed, he related. He also related that the majority of his private career was involved in developing coal exports. In fact, coal is a possible bridge to the future during this time of high oil and gas prices. Furthermore, he related that he also had a public career when he served on the Seward City Council for a couple of terms and when he was the Mayor of Seward. He characterized the aforementioned time as some of the most enjoyable days of his life and a great way to get in touch with people and their needs. He noted that he has a bit of experience in commercial fishing due to his former minority investment in several boats. He also noted that for six to seven years he owned a small tourism business that has ceased to exist. COMMISSIONER NOLL related that he has enjoyed the time he has spent in the department in terms of what he characterized as a very competent labor force with the state government. Commissioner Noll said that he is looking forward to this assignment and the challenges and opportunities that it holds. He paused to answer any questions. 8:13:40 AM REPRESENTATIVE NEUMAN highlighted the ongoing discussion regarding saving money in the state, and asked if Commissioner Noll intends on hiring more personnel for DCCED. If so, he inquired as to [the positions] that would be filled and the cost of such. COMMISSIONER NOLL related his understanding that the current budget proposes 12 new hires, each of which is funded completely with or the vast majority of which with federal funds. For example, the Alaska Aerospace Development Corporation is proposing eight new hires, which would be completely funded with federal funds. 8:14:39 AM CO-CHAIR THOMAS inquired as to who pays for the retirement of employees whose positions are funded by federal funds. COMMISSIONER NOLL answered that those employees would be included in the Public Employees' Retirement System (PERS), and therefore the state would pay for the retirement. However, he pointed out that those employees would be in Tier 4. 8:15:11 AM COMMISSIONER NOLL, in further response to Co-Chair Thomas, recalled that there are two positions proposed for village safe water programs and the majority of the funds for these positions are federal funds. There are also two other proposed positions one of which is for the Regulatory Commission of Alaska (RCA) and the other for the Alaska Industrial Development and Export Authority (AIDEA), both of which receive federal funds as well. 8:16:16 AM REPRESENTATIVE NEUMAN commended Commissioner Noll for seeking federal funds to help pay for these new positions. 8:16:31 AM REPRESENTATIVE CISSNA related that the health system in Alaska is the number one employer in the state. She opined that Alaska's health system has possibly one of the largest under filled positions, particularly in rural Alaska. Therefore, workforce development to try to fill those positions is important. She then opined that the health system is an economic force. COMMISSIONER NOLL related his view that health care is so untended nationwide. He confirmed that the department is very interested in health care from various perspectives. He recalled that in 2003-2004 the State of Alaska had 8,900 new jobs of which more than half were in the health care sector. Through 2005 there were 13,200 new jobs [in the health care sector], which illustrates the huge growth in health care. How to address health needs in rural Alaska as well as urban Alaska is a huge challenge, in which he said he is interested. Commissioner Noll related that he would be glad to work with the committee and legislators on this matter. He then highlighted the opening of the new Palmer hospital and the possibility of using the old hospital as a training facility. However, he expressed concern that nationally the cost of care hasn't been accounted for. 8:21:40 AM REPRESENTATIVE NEUMAN offered to assist Commissioner Noll with any plans for the [old] Palmer hospital. He then asked if DCCED contracts any services to the State of Washington. COMMISSIONER NOLL answered that about half of the commercial fishing fleet lives in the State of Washington. He noted that the Alaska Seafood Marketing Institute (ASMI) has offices located in the State of Washington as well. REPRESENTATIVE NEUMAN expressed concern with the [contracts and services] provided by those in the State of Washington. He requested that Commissioner Noll review what the state is spending in the State of Washington. He also suggested that [the department] do what it can to keep as much [employment] as possible in Alaska. COMMISSIONER NOLL interjected that the ferry system is also located in the State of Washington. He informed the committee that he has had discussions regarding the Native tribal associations in the State of Washington being a potential business partner [with the State of Alaska]. 8:23:51 AM CO-CHAIR THOMAS discussed the location of a possible new ferry terminal, which he suggested should be located on the Lumbee Reservation that is north of Bellingham. Therefore, the State of Alaska would have no alliance to the State of Washington. 8:24:40 AM CO-CHAIR THOMAS recalled that Commissioner Noll was a member of the four-man "Fish Cabinet" that managed a large segment of the wild fish marketing effort. COMMISSIONER NOLL explained that the "Fish Cabinet" received $50 million from the federal government. The following four individuals were the "Fish Cabinet": Alan Austerman, Senior Fish Advisor; himself, Department of Commerce, Community, & Economic Development; Greg O'Claray, Department of Labor & Workforce Development; and Kevin Duffy and Dave Bedford, Alaska Department of Fish & Game. The group decided to place $15 million into capital marketing; $15 million into capital grants; $5 million to beleaguered fishers through an income tax approach; $7 million to communities impacted by tax receipts; and the remainder went into research and to the university. He explained that the aforementioned required matching funds. Commissioner Noll opined that the "Fish Cabinet" has been one of the most successful programs of the past three years. He recalled that in 2004 exports of seafood products out of Alaska amounted to $1.7 billion and he estimated an increase to $2 million in 2005. He attributed the large increases to applied allocation of funds, better fishing techniques, and luck related to timing of news regarding the health benefits of Alaska wild salmon. He noted that there is money left in this program. In fact, recently $1 million [in matching funds] for small vessel upgrades was offered. All the money has been [distributed] and the group is looking for more funds to offer, he mentioned. 8:30:26 AM CO-CHAIR THOMAS informed the committee that there were 134 applications for this program, which he characterized as a good program. COMMISSIONER NOLL reiterated that the group is trying to find more money for the [small vessel upgrades] program. CO-CHAIR THOMAS informed the committee that a tribal government in Haines tried to obtain a block grant such that the fishermen could apply for funds through it. However, the [small vessel upgrades program] doesn't allow labor to be counted for matching funds if the fisherman does his/her own labor. If a fisherman does the labor, he/she should be allowed a $25 per hour wage [to match], he opined. COMMISSIONER NOLL said he would look into that. CO-CHAIR THOMAS complimented the commissioner on the training program for merchant marines. COMMISSIONER NOLL related the administration's commitment to have opportunities for young people in Alaska. 8:35:55 AM CO-CHAIR THOMAS then turned to the Local Boundary Commission (LBC) and his view that it and other agencies don't move in the direction specified by the legislature. He noted the complaints being received in regard to the LBC. Co-Chair Thomas then related his understanding that the goal was to maximize the boundaries for a municipality. However, it seems that the LBC is shrinking [the size of annexation requests]. The aforementioned, he indicated, led to the introduction of legislation to address the concerns with the LBC. In fact, there is legislation, SB 248, providing incentives to form boroughs, especially in locales where there is no state land available [to annex and organize]. He inquired as to Commissioner Noll's stance on the incentives to organize. COMMISSIONER NOLL stated his support for [SB 248] and incentives. He then related his belief that making land available at the local level is paramount to create opportunities for local people. CO-CHAIR THOMAS related the concept of the administrative borough, noting his preference to include language that would allow communities to dissolve or opt-out of the administrative borough if the LBC denies the [requested] boundaries. He informed the committee that maps were sent to communities with recommendations for the borough boundaries. However, there is no land available in some areas and thus incentives are the only way to go. He related that the Chatham and Glacier Bay Boroughs are considering merging; the total land would be less than 400 acres because most of the available land is federal land since the university already selected from what state land there was. Therefore, the incentive funds would provide municipalities the ability to purchase land. COMMISSIONER NOLL noted his agreement [with Co-Chair Thomas] and said that he would discuss these matters with the LBC. CO-CHAIR THOMAS highlighted that the incentive [included in SB 248] is only available for four years. 8:42:10 AM REPRESENTATIVE NEUMAN inquired as to whether Commissioner Noll has any connection or oversight over the LBC. COMMISSIONER NOLL explained that DCCED provides administrative support to the LBC, which is a separately appointed authority that operates independently. 8:43:27 AM REPRESENTATIVE CISSNA moved that the committee forward the name of William C. Noll to the full body for consideration during joint session. There being no objection, it was so ordered. 8:44:16 AM The committee took an at-ease from 8:44 a.m. to 8:45 a.m. HCR 5-FLUORIDATION 8:45:29 AM CO-CHAIR THOMAS announced that the final order of business would be HOUSE CONCURRENT RESOLUTION NO. 5, Relating to support of community water fluoridation. 8:45:38 AM REPRESENTATIVE PAUL SEATON, Alaska State Legislature, sponsor of HCR 5, related that HCR 5 would support community water fluoridation, which is important to the health of Alaskans. He informed the committee that Alaska cities with a population in excess of 30,000 have fluoridated water. Fluoride, he highlighted, has been identified as an effective tool in addressing dental disease. Therefore, HCR 5 merely illustrates that the legislature recognizes the importance of community fluoridation and that all new village safe water projects should design water systems such that fluoridation can be utilized, if the community chooses to do so. The committee packet, he noted, includes letters of support, including the letters from the Alaska Native Tribal Health Consortium and various dentists. 8:49:08 AM REPRESENTATIVE CISSNA recalled learning that life span is linked to the presence of teeth. She also recalled that the clinics in the Aleutians related to her that the largest reason for Medivacs were related to dental problems. Therefore, she inquired as to whether there are any studies specifying the costs related to not taking care of teeth. REPRESENTATIVE SEATON indicated that the committee packet includes a number of studies, including one that specifies that for every dollar spent on fluoridation, approximately $37 in medical costs would be saved. 8:50:57 AM REPRESENTATIVE SEATON, in response to Co-Chair Olson, said that he has received little opposition and what opposition that was received has been included in the committee packet. 8:52:07 AM TROY RITTER, Senior Environmental Health Consultant, Alaska Native Tribal Health Consortium (ANTHC), informed the committee that his expertise is really in relation to the cost of implementing the fluoride. He related that to implement fluoride it costs approximately $1 per person per year, and therefore most communities can be fluoridated for a year for what filing one cavity would cost. He characterized the aforementioned as a fairly good return, although he acknowledged that there are very few public health interventions that save more money than they cost. 8:53:09 AM REPRESENTATIVE NEUMAN asked if the fluoridation system is a simple injection system. He related his understanding that it requires minimal infrastructure. MR. RITTER replied yes. He noted that the delivery system for fluoride is similar to that used for chlorine. He noted that from an operation and maintenance standpoint, fluoride is easier to deliver than chlorine because fluoride is chemically stable. In further response to Representative Neuman, Mr. Ritter explained that the type of fluoride injected [in Alaska] is a powder form. He related the basic principle of toxicology that the dose makes the poison. Therefore, operators use a respirator that is similar to a dust mask. There haven't been any problems experienced with the operators, he said. 8:55:32 AM REPRESENTATIVE CISSNA returned to her concern with regard to the costs of dental problems, and requested information regarding the total cost of not taking care of dental needs. MR. RITTER, from the best studies available and from his Alaska- specific observations, related his belief that fluoridated communities probably reduce dental disease by about 40 percent. 8:57:13 AM MR. RITTER, turning to his prepared testimony, informed the committee that he has worked within Alaska's tribal health system for the last seven years. He also informed the committee that ANTHC is the largest health organization managed by a tribe in the nation. The ANTHC works with its partners to deliver comprehensive health services. Mr. Ritter specified that he is responsible for ensuring that his division's activities provide maximum health benefits. Therefore, ANTHC strongly supports HCR 5. He highlighted that HCR 5 doesn't require fluoridation and helps to align state, tribal, and federal efforts with regard to this issue. Mr. Ritter opined that fluoridation has sometimes been the subject of misunderstanding and misinformation. However, in the mainstream health and public health communities there is no controversy surrounding fluoridation, he further opined. Therefore, passage of HCR 5 would allow the state to say that it relies on credible, science-based information when making health decisions. Mr. Ritter acknowledged that not everyone agrees on fluoridation, but he expressed hope that those communities that choose to fluoride should receive [the state's] best efforts to keep [the residents] healthy and safe. In conclusion, Mr. Ritter characterized HCR 5 as a win-win situation in which public health professionals are provided a tool to provide safer and healthier communities without negatively impacting another area. 9:00:45 AM ARTHUR HANSEN, retired dentist, noted that he has worked in the villages. He related his support of HCR 5, and indicated that fluoridation is the least expensive way in which to reduce decay and dental problems. 9:01:57 AM WILLIAM MARLEY, retired dentist; Representative, Fluoride Committee, Alaska Dental Society, informed the committee that the American Dental Association (ADA) publishes a booklet with fluoride facts, in which it cites over 358 references to scientific studies supporting the safety and efficacy of fluoridating community water supplies. He related that fluoride is endorsed by the Alaska Dental Society, the ADA, the Center for Disease Control, the American Medical Association, the U.S. Surgeon General, the National Institute of Cranial and Facial Research, and over 100 other national and international associations dealing with water and health. Dr. Marley stated that fluoride has been found to be both safe and effective. With regard to cost effectiveness, he related that for every $1 invested [the state would] receive $18 in return. DR. MARLEY highlighted that fluoride has over 60 years of experience in the U.S. and millions of years of natural existence. In 1992 Alaska had 120 communities fluoridating their water, but that has decreased to 37 communities at this point. He then pointed out that Article 7, Section 4, of the Alaska State Constitution specifies that the legislature shall provide for the promotion and protection of the public health. Therefore, HCR 5 would be consistent with the constitution while providing leadership and reducing the rate of decay and the number of dentists that are needed. 9:08:07 AM REPRESENTATIVE NEUMAN inquired as to why there has been such a decrease in the communities that provide fluoridation. DR. MARLEY said he couldn't answer. 9:08:49 AM JIM TOWLE, Executive Director, Alaska Dental Society, stated that the Alaska Dental Society supports HCR 5. He pointed out that tooth decay is a chronic disease and the most common chronic disease in children. He echoed Dr. Marley's comments regarding the history of fluoride, which is naturally occurring. Mr. Towle emphasized that community water fluoridation is a public health measure that benefits individuals of all ages and socio-economic groups. From the information he has, he related that the average cost to fluoridate a community is around $.50 per person with the annual average per person cost being less than one-third of the cost of an average dental restoration or filling of a cavity. Mr. Towle informed the committee that there are over 225 current peer-reviewed studies that recognize the benefit of community water fluoridation. In 2004 Alaska spent $19.3 million for Medicaid and Denali Kid Care dental care, he mentioned. 9:11:24 AM MR. TOWLE, in response to Representative Cissna, agreed to supply the committee with the overall dental costs of the state. 9:12:41 AM SHELLEY HUGHES, Policy Analyst, Alaska Primary Care Association, related the association's support for HCR 5. She related that the Alaska Primary Care Association, which represents 24 health organizations throughout the state, recognizes that fluoridation does benefit the health of residents. She concluded by emphasizing that HCR 5 would be a positive step for the betterment of the health of Alaskans. 9:13:59 AM TOM BORNSTEIN, Director, Dental Services, Southeast Alaska Regional Health Consortium (SEARHC), related his support of HCR 5 for all the reasons stated earlier. 9:14:27 AM CO-CHAIR THOMAS inquired as to why the decrease in the villages fluoridating their water. MR. BORNSTEIN explained that in 1992 there was an overfeed incident in a fluoride system in Hooper Bay. This tragic event resulted in a review that determined one of the issues was the inadequate monitoring of the village water system. The aforementioned caused the Department of Environmental Conservation (DEC) to promulgate new regulations concerning the use of fluoride. Therefore, some of the communities that were just barely able to comply with the current water fluoridation rules were unable to meet the new standards, which were more stringent. Thus, many of the fluoridation systems were taken off-line. 9:16:17 AM CO-CHAIR THOMAS inquired as to what happens to those who drink water that has too much fluoride. MR. BORNSTEIN confirmed that over fluoridation results in sickness. However, he pointed out that it takes many times, about 50 times the recommended dose over a brief period of time before there is an acute effect. A chronic overfeed would result in mottled teeth. He related his understanding that in the Hooper Bay incident an individual who was sick became dehydrated and was told to drink lots of water. That individual ended up with 100 times the dose of fluoride and the individual ultimately died. He characterized the incident as extremely rare. 9:17:55 AM REPRESENTATIVE CISSNA expressed the need to include in the funding for these systems a training component. MR. BORNSTEIN related that the implementation of these systems require a level of training and monitoring as specified in the regulations. 9:19:57 AM REPRESENTATIVE SALMON inquired as to what causes the spots on the teeth of younger kids in Fort Yukon where the water became fluoridated in the 1970s. MR. BORNSTEIN answered that over exposure to fluoride, that is beyond the proper dose, can result in white spots/decalcification on the teeth. White spots/decalcification can also occur prior to decay. Therefore, he said that one would need to review the specific case to make a determination. 9:22:20 AM BRAD WHISTLER, Dental Officer, Department of Health and Social Services (DHSS), related that DHSS is supportive of community water fluoridation, which has a long-standing history in the U.S. With regard to the white spots, he reiterated that it's not always attributed to over fluoridation. In fact, in terms of fluoride, he attributed the white spots mainly to swallowing toothpaste, particularly with young children. Furthermore, amoxicillin may also discolor teeth. The studies that have reviewed long-term controls infrequently report that water fluoridation results [in white spots]. MR. WHISTLER then turned to the costs related to fluoridation. He informed the committee that Alaska would probably experience savings between $37 and $140. With regard to total dental costs in Alaska, he said he didn't know of a source from which to obtain that figure. He agreed that there is a training and capacity issue in rural areas. He also agreed that at very high doses, fluoride isn't good for individuals and thus it needs to be done in a safe manner and monitored. This resolution recognizes that if fluoride is delivered properly, substantial savings can be reaped in terms of dental costs, he said. 9:27:45 AM REPRESENTATIVE NEUMAN recalled that when he ran a water system monthly samples were sent to an engineer and the content of the water was reported to DEC. Therefore, he assumed that the same would be true for water systems using fluoride and thus over fluoridation would only last for a month. MR. WHISTLER informed the committee that water testing is reported monthly but most of the systems are [tested] daily. Therefore, he didn't believe over fluoridation would even last a month. He opined that immediate action would occur if the fluoride level reached four parts per million or more. 9:29:21 AM REPRESENTATIVE CISSNA related her interest in the costs of dental emergencies, particularly in relation to Medivac situations. MR. WHISTLER suggested that such information was available from the Eastern Aleutian tribes who, upon reviewing their Medivac services, found that adult dental emergencies were the most frequent reasons for Medivacs into Anchorage. REPRESENTATIVE CISSNA recalled that perhaps she heard it from a tribe in Dutch Harbor. 9:30:39 AM CO-CHAIR OLSON moved to report HCR 5 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, it was so ordered. 9:30:52 AM ADJOURNMENT  There being no further business before the committee, the House Community and Regional Affairs Standing Committee meeting was adjourned at 9:30 a.m.