ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 30, 2010
3:09 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative Tammie Wilson, Vice Chair
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 307
"An Act relating to residential shelters for runaway minors."
- MOVED OUT OF COMMITTEE
HOUSE BILL NO. 277
"An Act establishing a program in the Department of Health and
Social Services to certify certain individuals to be issued a
prescription to administer epinephrine and to possess and
administer epinephrine in certain situations."
- MOVED CSHB 277(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 361
"An Act requiring 911 dispatchers to be trained in
cardiopulmonary resuscitation; and providing for an effective
date."
- MOVED OUT OF COMMITTEE
HOUSE BILL NO. 25
"An Act establishing the Alaska Health Reform Policy Commission
in the Department of Health and Social Services, and
establishing the position of the executive director of that
commission in the partially exempt service; and providing for an
effective date."
- BILL HEARING CANCELED
HOUSE BILL NO. 392
"An Act establishing the Alaska Health Reform Policy Commission
in the Department of Health and Social Services, and
establishing the position of the executive director of that
commission in the partially exempt service; and providing for an
effective date."
- HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: SB 307
SHORT TITLE: SHELTERS FOR RUNAWAY MINORS
SPONSOR(s): HEALTH & SOCIAL SERVICES
03/10/10 (S) READ THE FIRST TIME - REFERRALS
03/10/10 (S) HSS, JUD
03/15/10 (S) HSS AT 1:30 PM BUTROVICH 205
03/15/10 (S) Moved SB 307 Out of Committee
03/15/10 (S) MINUTE(HSS)
03/16/10 (S) HSS RPT 5DP
03/16/10 (S) DP: DAVIS, ELLIS, THOMAS, PASKVAN,
DYSON
03/17/10 (S) JUD REFERRAL WAIVED
03/23/10 (S) TRANSMITTED TO (H)
03/23/10 (S) VERSION: SB 307
03/24/10 (H) READ THE FIRST TIME - REFERRALS
03/24/10 (H) HSS
03/30/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 277
SHORT TITLE: EMERGENCY USE OF EPINEPHRINE
SPONSOR(s): P.WILSON, LYNN
01/15/10 (H) PREFILE RELEASED 1/15/10
01/19/10 (H) READ THE FIRST TIME - REFERRALS
01/19/10 (H) HSS
03/30/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 361
SHORT TITLE: CPR TRAINING FOR 911 DISPATCHERS
SPONSOR(s): FAIRCLOUGH
02/23/10 (H) READ THE FIRST TIME - REFERRALS
02/23/10 (H) CRA, HSS
03/09/10 (H) CRA AT 8:00 AM BARNES 124
03/09/10 (H) Moved Out of Committee
03/09/10 (H) MINUTE(CRA)
03/10/10 (H) CRA RPT 5NR
03/10/10 (H) NR: GARDNER, KELLER, HARRIS, MUNOZ,
HERRON
03/10/10 (H) FIN REFERRAL ADDED AFTER HSS
03/25/10 (H) HSS AT 3:00 PM CAPITOL 106
03/25/10 (H) Heard & Held
03/25/10 (H) MINUTE(HSS)
03/30/10 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
CELESTE HODGE, Staff
to Senator Bettye Davis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced SB 307 on behalf of the prime
sponsor, Senator Bettye Davis.
TOM OBERMEYER, Staff
to Senator Bettye Davis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions, on behalf of the prime
sponsor, Senator Bettye Davis, during discussion of SB 307.
WILDA LAUGHLIN, Special Assistant
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of SB 307.
LAUREN RICE, Director of Public Affairs
Covenant House Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of SB 307.
KIMBERLY COLBO, Counsel
for Covenant House Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of SB 307.
MICHAEL DUNNING, Intern
to Representative Peggy Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 277 on behalf of
Representative Peggy Wilson, one of the joint prime sponsors of
the bill.
REPRESENTATIVE PEGGY WILSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as one of the joint prime
sponsors of HB 277.
WARD HURLBURT, Chief Medical Officer;
Director, Division of Public Health
Office of the Commissioner
Department of Health and Social Services
POSITION STATEMENT: Testified during discussion of HB 277.
KEN ZAFREN, Medical Director
Alaska Emergency Medical Services Program
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 277.
REPRESENTATIVE ANNA FAIRCLOUGH
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as the prime sponsor of the bill
during discussion of HB 361.
CRYSTAL KOENEMAN, Staff
to Representative Anna Fairclough
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 361, on
behalf of the prime sponsor of the bill, Representative Anna
Fairclough.
ACTION NARRATIVE
3:09:47 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:09 p.m.
Representatives Keller, Herron, Seaton, Cissna, and T. Wilson
were present at the call to order. Representatives Lynn and
Holmes arrived as the meeting was in progress.
SB 307-SHELTERS FOR RUNAWAY MINORS
3:10:54 PM
CO-CHAIR KELLER announced that the first order of business would
be SENATE BILL NO. 307, "An Act relating to residential shelters
for runaway minors."
3:11:16 PM
CELESTE HODGE, Staff to Senator Bettye Davis, Alaska State
Legislature, read from the sponsor statement [Included in the
committee packet.] [original punctuation provided]:
SB307 allows emergency residential shelters like the
Covenant House Alaska to continue to accept federal
grant funding. Covenant House Alaska has five
programs that include emergency shelter, healthcare,
job and educational assistance and transitional
living. Covenant House Alaska served nearly 3,000
Alaskan youth in Alaska for over 20 years and served
literally tens of thousands of youth.
In 2007, Covenant House Alaska was awarded the federal
Basic Center Grant (BCG) through the Administration
for Children and Families. This competitive, federal
grant supplied Covenant House Alaska with $300,000
phased over three years to operate the Crisis Center
($100,000 per year). The Administration for Children
and Families recently notified Covenant House Alaska
the Crisis Center is technically out of compliance
with federal grant requirements stated in the Homeless
and Runaway Youth Act.
The Act at 42 U.S.C Section 5712(b)(2)(A) states the
shelter can have "a maximum capacity of not more than
20 youth, except where the applicant assures that the
State where the center or locally controlled facility
is located has a State or local law or regulation that
requires a higher maximum to comply with licensure
requirements for child and youth serving facilities."
Established through the Act, federal regulation 45 CFR
1351.18 (d) states the Basic Center Grant (BCG) may be
awarded to facilities with a shelter capacity of 20
beds or less. Covenant House Alaska holds 40 beds.
The Administration for Children and Families (ACF)
concedes that states with statutes requiring them to
operate a facility over 20 beds will meet the federal
requirements. SB307 allows for a simple amendment to
AS 47.10.310 - "Licensing of Programs for Runaway
Minors" by adding a new subsection to read: "(e) A
program for runaway minors that operates a licensed
residential shelter in the state shall provide a
shelter with a capacity designated in the license
issued under AS 47.10.300-47.10.390." This simple
amendment will allow emergency residential shelters
like Covenant House Alaska to continue competing for
the federal Basic Center Grant (BCG).
REPRESENTATIVE SEATON asked how SB 307 would mandate a specific
number of beds in order to comply with license requirements.
3:15:03 PM
TOM OBERMEYER, Staff to Senator Bettye Davis, Alaska State
Legislature, stated that Legislative Legal and Research had
reviewed the federal statute in order to write a bill to bring
Covenant House into compliance with federal law. He offered his
understanding that should a state statute allow this level of
capacity then the federal law would also allow it.
3:17:25 PM
WILDA LAUGHLIN, Special Assistant, Office of the Commissioner,
Department of Health and Social Services (DHSS), stated that
Department of Health and Social Services had no concerns with
the bill. She pointed out that it would help the Division of
Juvenile Justice and Office of Children's Services. She offered
her understanding that the licensing would not have a
programmatic impact on the section of certification and
licensing, as this was a federal regulation.
CO-CHAIR KELLER offered his belief that the federal requirement
for 20 beds was already in the regulations, but that Covenant
House had already licensed for 40 beds. This would be an
authorization for Covenant House Alaska to operate at the state
established capacity.
REPRESENTATIVE SEATON read from the sponsor statement that a
State or local law "requires a higher maximum to comply with
license requirements..." He asked if the language in SB 307,
"the state shall provide a shelter with a capacity designated in
the license" was sufficient to comply with the federal law. He
asked if the state was going to have different capacities on
different licenses.
3:20:54 PM
LAUREN RICE, Director of Public Affairs, Covenant House Alaska,
pointed out that Covenant House was the only homeless shelter
for youth in Alaska. It had programs designed to keep kids off
the streets and to help with the transition to healthy lives.
She pointed out that these youth come from all over Alaska, and
more than 39 percent were Native Alaskan. She stated that 65
percent of the girls had been sexually abused or raped, and 75
percent of the kids came from homes with abuse of alcohol and
drugs. She noted that 70 percent of the $3.7 million budget was
from private donations, with the balance coming from local,
state, and federal grants.
MS. RICE directed attention to the 2004 and 2007 Basic Center
Grants (BCG), which Covenant House Alaska had received
regardless of the 20 bed capacity regulation. She shared that
the current federal administration had requested clarifying
language to apply for this grant. She explained that SB 307
would not impact any new shelters with fewer than the 40 bed
capacity of Covenant House Alaska. She summarized SB 307:
if a youth facility is going to operate in the state
of Alaska they need to be able to provide the beds
they are licensed for. So, if you are licensed for
three, you need to be able to provide three. If, in
the situation with Covenant House, if we are licensed
for forty, we will be required to provide forty beds
to our kids.
MS. RICE offered her hope that SB 307 would continue to keep
Covenant House Alaska competitive. She pointed out that its
daily average was 34 kids, and that Covenant House Alaska needed
a 40 bed capacity to operate in Alaska. She stressed that there
was not intent to limit capacity for other new shelters.
3:26:29 PM
KIMBERLY COLBO, Counsel for Covenant House Alaska, expressed
agreement with Ms. Rice's summation. Reading from SB 307, she
offered her belief that "shall provide a shelter with the
capacity designated in the license" that's been approved by the
state was functionally the same as the original language which
stated "is required to provide a shelter." She opined that this
should allow flexibility while permitting Covenant House to
operate and compete for the BCG.
3:28:30 PM
CO-CHAIR KELLER, after ascertaining that no one else wished to
testify, closed public testimony on SB 307.
3:28:44 PM
REPRESENTATIVE T. WILSON moved to report SB 307 out of committee
with individual recommendations. There being no objection, SB
307 was reported from the House Health and Social Services
Standing Committee.
HB 277-EMERGENCY USE OF EPINEPHRINE
3:29:15 PM
CO-CHAIR KELLER announced that the next order of business would
be HOUSE BILL NO. 277, "An Act establishing a program in the
Department of Health and Social Services to certify certain
individuals to be issued a prescription to administer
epinephrine and to possess and administer epinephrine in certain
situations."
The committee took an at-ease from 3:29 p.m. to 3:34 p.m.
3:34:10 PM
CO-CHAIR HERRON moved to adopt the proposed committee substitute
(CS) for HB 277, Version 26-LS0951\S, Bullard, 3/26/10, as the
work draft. There being no objection, Version S was before the
committee.
3:34:36 PM
MICHAEL DUNNING, Intern to Representative Peggy Wilson, Alaska
State Legislature, said that epinephrine was also referred to as
adrenaline, and was naturally occurring. He noted the "fight or
flight" response. He pointed out that it was used daily to
combat asthma and severe reactions. He stated that the bill
proposed to establish a training standard for individuals to
administer epinephrine with auto injectors, often referred to as
epi-pens, as well as with ampules. He explained that epi-pens
administered one or two doses, whereas an ampule was a sterile
glass storage container from which a dosage could be drawn, and
was significantly cheaper than the epi-pen. He gave examples of
existing training programs, which included American Heart
Association, Red Cross, and Wilderness Medical Associates.
MR. DUNNING explained that an individual that successfully
completed the training requirements would be authorized to
obtain a prescription to purchase epinephrine and to administer
it only in the very specific emergency situations outlined in HB
277. He opined that HB 277 would protect Alaskans, increase
safety measures, and hopefully save lives.
3:37:35 PM
REPRESENTATIVE SEATON directed attention to page 2, line 24, Sec
17.22.030 and asked why the applicability was not for
individuals authorized under other laws.
3:38:03 PM
MR. DUNNING said that he did not know.
CO-CHAIR HERRON referred to the language on the last paragraph
of the memorandum from Legislative Legal and Research Services.
REPRESENTATIVE T. WILSON offered her interpretation that an
individual rendering aid would be held harmless under the Good
Samaritan Law, and she asked Mr. Dunning if he agreed.
MR. DUNNING replied that the applicability, the liability of the
certified individual, and the referenced Good Samaritan Laws did
not preclude one another, as an individual may be immune under
one aspect, but not under another aspect. He offered that it
would protect individuals who had completed the training
program.
REPRESENTATIVE T. WILSON questioned if the Good Samaritan Law
would pertain if there was not a training program.
MR. DUNNING replied that this would depend on the individual
facts of a particular case. He explained that HB 277 required
the following to avoid personal liability: the individual would
have to successfully complete the training program; to
administer epinephrine in a narrowly defined emergency
situation; and to have acted in Good Faith.
3:41:18 PM
REPRESENTATIVE T. WILSON expressed concern that the bill would
increase the liability.
MR. DUNNING replied that HB 277 offered another layer of
protection above the Good Samaritan Law for those that had
successfully completed the training program.
REPRESENTATIVE T. WILSON asked who would conduct the training.
MR. DUNNING reiterated that the training programs already
existed, and that some had included the epi-pen training along
with CPR. He noted that successful completion of the training
allowed for a prescription to purchase epinephrine.
REPRESENTATIVE T. WILSON asked to clarify that a pharmacist
would supply the epinephrine as requested.
3:43:48 PM
MR. DUNNING offered his understanding that this would be the
case.
CO-CHAIR KELLER inquired about any concern for abuse of
epinephrine because of HB 277.
MR. DUNNING offered his belief that this was not a concern, and
that it was a proven life saving medication.
CO-CHAIR KELLER shared that his research indicated that
epinephrine was not a recreational drug of choice.
3:44:59 PM
REPRESENTATIVE LYNN, speaking as one of the joint prime sponsors
of HB 277, conveyed a personal story about epinephrine.
3:46:57 PM
REPRESENTATIVE HOLMES indicated support for what the bill was
attempting to do. She stated that she wanted to limit
liability, and referred to the definition of "emergency
situation" on page 3, line 4. She suggested to add "or appears
to experience" after "experiences" on page 3, line 5. She
opined that this would protect an individual who was acting in
good faith from their training. She also suggested adding
"reasonably" after "not" on page 3, line 7.
3:49:19 PM
REPRESENTATIVE HOLMES, in response to Co-Chair Herron, noted
that both the Good Samaritan Law and the limited liability
section of HB 277 on page 2, line 27, Sec. 17.22.040. "Liability
of certified individual" would protect an individual who acted
in good faith. She expressed her desire to ensure that an
individual was covered regardless.
3:51:06 PM
REPRESENTATIVE CISSNA reflected on a personal family incident.
3:52:13 PM
REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, offered
her understanding that Alaska State law currently stated that
only the person with the medication could self medicate, or
receive assistance from a properly trained person. The intent
of the bill was to provide protection to those who were not
currently covered by the law.
3:53:52 PM
WARD HURLBURT, Chief Medical Officer; Director, Division of
Public Health, Office of the Commissioner, said that the
administration was neutral on HB 277.
REPRESENTATIVE T. WILSON asked to clarify that a pharmacist
would supply epinephrine solely upon the presentation of the
card certifying successful completion of the training.
DR. HURLBURT offered his understanding that some details were
still to be worked out to ensure it. He reiterated that the
training programs already existed, and that a physician's
prescription could become part of the process.
REPRESENTATIVE HOLMES observed that it was not possible to walk
in and buy epinephrine without a prescription.
DR. HURLBURT concurred that this was consistent with the current
process.
3:56:18 PM
REPRESENTATIVE T. WILSON expressed her confusion of why a doctor
would write a prescription solely based on successful completion
of a course.
REPRESENTATIVE P. WILSON referred to page 1, lines 10-12, of the
bill, and explained that there was situational justification.
REPRESENTATIVE T. WILSON asked if this was acceptable to the
medical profession.
REPRESENTATIVE P. WILSON replied that one doctor even taught 5
year old children how to self administer the epi-pen.
REPRESENTATIVE HOLMES asked Dr. Hurlburt for any concerns.
3:58:21 PM
DR. HURLBURT replied that epinephrine was a natural substance
and that it was safe, although that did not mean that there was
not any risk. He pointed out that sufficient quantities could
present a risk, but that it was safer than many other over the
counter items found in drug stores.
CO-CHAIR KELLER clarified that the training mitigated the risk.
He opined that it was appropriate to keep the strict language in
the bill.
3:59:53 PM
DR. HURLBURT explained that part of the training was for the
administration of epinephrine, as most people were not trained
to give injections.
4:00:44 PM
REPRESENTATIVE HOLMES referred to her earlier suggestion of
amending page 3, line 5 to add "or appears to experience" after
"experiences," and asked Dr. Hurlburt if it was possible to
mistake the signs of anaphylactic shock.
DR. HURLBURT replied that, as a physician, her amendment was
excellent, as it could not be known with 100 percent certainty.
4:02:14 PM
KEN ZAFREN, Medical Director, Alaska Emergency Medical Services
Program, expressed his agreement with the comments and with
Representative Holmes' amendment to change the wording.
CO-CHAIR KELLER asked how the prescription process would work.
DR. ZAFREN offered that, although it was not addressed in HB
277, most doctors would be comfortable with writing a
prescription for someone who had successfully completed the
training.
4:03:55 PM
CO-CHAIR KELLER closed public testimony on HB 277.
4:04:04 PM
REPRESENTATIVE HOLMES moved to adopt Conceptual Amendment 1,
which would read:
Page 3, line 5, following "experiences"
Insert "or appears to experience"
Page 3, line 7, following "not"
Insert "reasonably"
CO-CHAIR KELLER objected for discussion. There being no other
objections, he removed his objection and Conceptual Amendment 1
was adopted.
REPRESENTATIVE P. WILSON suggested a conforming amendment to
delete "and" between "for" and "purchase" on page 1, line 11.
[Before the committee was a motion to adopt Conceptual Amendment
2, which would read:
Page 1, line 11, following "prescription for"
Delete "and" ]
CO-CHAIR KELLER objected for discussion.
REPRESENTATIVE HOLMES clarified that line 11 would now read
"obtain a prescription for purchase."
CO-CHAIR KELLER removed his objection. There being no further
objection, Conceptual Amendment 2 was adopted.
4:06:08 PM
REPRESENTATIVE T. WILSON moved to report the proposed committee
substitute (CS) for HB 277, 26-LS0951\S, Bullard, 3/26/10, as
amended, out of committee with individual recommendations and
the accompanying fiscal notes. There being no objection, CSHB
277(HSS) was reported from the House Health and Social Services
Standing Committee.
HB 361-CPR TRAINING FOR 911 DISPATCHERS
4:06:29 PM
CO-CHAIR KELLER announced that the final order of business would
be HOUSE BILL NO. 361, "An Act requiring 911 dispatchers to be
trained in cardiopulmonary resuscitation; and providing for an
effective date." [Before the committee was the proposed
committee substitute (CS) for HB 361, 26-LS1478\R,
Luckhaupt/Mischel, 3/11/10, which had been adopted as the
working draft on 3/25/10.]
4:06:41 PM
REPRESENTATIVE T. WILSON moved that the committee rescind its
action in adopting the proposed committee substitute (CS) for HB
361, 26-LS1478\R, Luckhaupt/Mischel, 3/11/10, as the work draft,
and adopt the original HB 361, 26-LS1478\A as the working draft.
CO-CHAIR KELLER objected for discussion. [Later in the meeting,
although the objection was not withdrawn, the committee treated
the motion as having passed.]
4:07:28 PM
REPRESENTATIVE ANNA FAIRCLOUGH, Alaska State Legislature, as the
prime sponsor of HB 361, explained that the purpose of the bill
was to require 911 dispatchers to have Cardiopulmonary
Resuscitation (CPR) training. She explained the bill history,
and noted that the committee substitute currently in front of
the committee had established that the position be facilitated
by the Department of Public Safety (DPS) instead of its current
position with the Department of Military & Veterans' Affairs
(DMVA). She directed attention to the not yet received fiscal
note from DPS, and questioned the funding source to either
department for the 911 coordinator position. She stated a
position of neutrality for either version of the bill. She
offered her belief that it was "a natural fit that the 911
coordinator should be housed in the DPS," but she questioned the
need for a fiscal note.
4:09:50 PM
CRYSTAL KOENEMAN, Staff to Representative Anna Fairclough,
Alaska State Legislature, said that she spoke with
representatives of both DMVA and DPS to inform them of the
return to the original HB 361, 26-LS1478\A.
CO-CHAIR KELLER agreed to return to the original HB 361, 26-
LS1478\A, as the proposed committee substitute had moved beyond
the intent of the sponsor.
REPRESENTATIVE HOLMES concurred and expressed her neutrality for
which department housed the position. She offered her
understanding that a move to DPS would entail a significant
increase to the program cost. She stated her agreement with the
sponsor's concerns.
4:12:20 PM
REPRESENTATIVE HERRON also concurred. He noted his agreement
with the health policy intent of the bill and he surmised that
the fiscal note would be addressed by the House Finance
Committee. He stated his support to move Version A on to the
next committee.
REPRESENTATIVE T. WILSON offered her belief that the 911
dispatcher position should remain in DMVA. She voiced her
support for Version A.
REPRESENTATIVE SEATON pointed out that the HB 361, 26-LS1478\A
was not referred to the House Finance Committee.
4:14:18 PM
MS. KOENEMAN clarified that there was a fiscal note for $2,000
from DPS attached to Version A, which had resulted in the
referral to the House Finance Committee.
4:14:55 PM
REPRESENTATIVE T. WILSON moved to report HB 361, 26-LS1478\A out
of committee with individual recommendations and the
accompanying fiscal note. There being no objection, HB 361 was
reported from the House Health and Social Services Standing
Committee.
4:15:30 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:15 p.m.