ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 30, 2018
3:04 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
Representative Dan Saddler (alternate)
MEMBERS ABSENT
Representative Matt Claman (alternate)
COMMITTEE CALENDAR
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 54
"An Act providing an end-of-life option for terminally ill
individuals; and providing for an effective date."
- MOVED CSSSHB 54(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 162
"An Act relating to criminal and civil history requirements and
a registry regarding certain licenses, certifications, appeals,
and authorizations by the Department of Health and Social
Services; and providing for an effective date."
- HEARD & HELD
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 268
"An Act relating to the prescription of opioids; relating to the
Department of Health and Social Services; relating to the
practice of dentistry; relating to the practice of medicine;
relating to the practice of podiatry; relating to the practice
of osteopathy; relating to the practice of nursing; and relating
to the practice of optometry."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 54
SHORT TITLE: TERMINALLY ILL: ENDING LIFE OPTION
SPONSOR(s): REPRESENTATIVE(s) DRUMMOND
01/18/17 (H) READ THE FIRST TIME - REFERRALS
01/18/17 (H) HSS, JUD
03/14/17 (H) HSS AT 3:00 PM CAPITOL 106
03/14/17 (H) <Bill Hearing Canceled>
03/27/17 (H) SPONSOR SUBSTITUTE INTRODUCED
03/27/17 (H) READ THE FIRST TIME - REFERRALS
03/27/17 (H) HSS, JUD
03/28/17 (H) HSS AT 3:00 PM CAPITOL 106
03/28/17 (H) Heard & Held
03/28/17 (H) MINUTE(HSS)
04/06/17 (H) HSS AT 3:00 PM CAPITOL 106
04/06/17 (H) Heard & Held
04/06/17 (H) MINUTE(HSS)
01/30/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 162
SHORT TITLE: DHSS CENT. REGISTRY;LICENSE;BCKGROUND CHK
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/08/17 (H) READ THE FIRST TIME - REFERRALS
03/08/17 (H) HSS, JUD
01/23/18 (H) HSS AT 3:00 PM CAPITOL 106
01/23/18 (H) Heard & Held
01/23/18 (H) MINUTE(HSS)
01/30/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 268
SHORT TITLE: OPIOID PRESCRIPTION WARNINGS
SPONSOR(s): GARA
01/12/18 (H) PREFILE RELEASED 1/12/18
01/16/18 (H) READ THE FIRST TIME - REFERRALS
01/16/18 (H) HSS, L&C
01/22/18 (H) SPONSOR SUBSTITUTE INTRODUCED
01/22/18 (H) READ THE FIRST TIME - REFERRALS
01/22/18 (H) HSS, FIN
01/30/18 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE HARRIET DRUMMOND
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 54 as the sponsor of the bill.
STACIE KRALY, Chief Assistant Attorney General
Statewide Section Supervisor
Human Services Section
Civil Division (Juneau)
Department of Law
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 162.
KATE BURKHART, Ombudsman
Juneau Office
Office of the Ombudsman
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 162.
CHARLES McKEE
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 162.
REPRESENTATIVE LES GARA
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 268 as the sponsor of the
bill.
ACTION NARRATIVE
3:04:59 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Spohnholz, Sullivan-Leonard, Johnston, Saddler
(alternate), Eastman, Kito, and Tarr were present at the call to
order. Representative Edgmon arrived as the meeting was in
progress.
HB 54-TERMINALLY ILL: ENDING LIFE OPTION
3:06:37 PM
CHAIR SPOHNHOLZ announced that the first order of business would
be SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 54, "An Act providing
an end-of-life option for terminally ill individuals; and
providing for an effective date."
3:07:00 PM
REPRESENTATIVE HARRIET DRUMMOND, Alaska State Legislature,
paraphrased from the Sponsor Statement [Included in members'
packets, which read in part:
This bill allows patients to have important end-of-
life discussions with the doctors they already know
and trust. Without this discussion, well-meaning
doctors are faced with prescribing painful procedures
even when the patient does not want them and there is
little or no hope for success. People in these
conditions have already lost their health and often
much, much more. This bill at least lets them control
the last and most important decision they have left.
House Bill 54 allows terminally ill patients to ease
their suffering and hasten an inevitable and certain
death. This bill preserves dignity and a person's
right to live, and die, on their own terms according
to they own desires and beliefs.
REPRESENTATIVE DRUMMOND offered an update of the bill since the
last hearing during the spring of 2017. She relayed that a
survey had been conducted of more than 600 Alaskans which showed
that more than 70 percent of voting Alaskans supported an end of
life option, "such that this bill allows." She declared that
community support was also rising, directing attention to a
Kodiak Island Borough assembly resolution in support of the
proposed bill. She encouraged support of the proposed bill.
3:08:52 PM
REPRESENTATIVE SULLIVAN-LEONARD asked for more information about
the survey.
REPRESENTATIVE DRUMMOND explained that this survey by a private
group was offered regularly on a quarterly basis and questions
could be added. In response, she said that the cost, paid by
her office account, was between $1600 - $1800.
CHAIR SPOHNHOLZ pointed out that Representative Saddler,
although present, was a committee alternate, and would not be
needed to participate as a committee member.
3:10:02 PM
CHAIR SPOHNHOLZ moved to adopt Amendment 1, labeled 30-
LS0254\O.1, Laffen/Bannister, 1/29/18, which read:
Page 2, line 21, following "request":
Insert "and a written request"
Page 2, following line 28:
Insert a new subsection to read:
"(c) Notwithstanding (a) of this section, if a
qualified individual is not physically able to sign a
written request, the qualified individual may direct
another individual to sign for the qualified
individual."
Page 2, line 31, following "request":
Insert "and the written request"
Page 3, following line 4:
Insert new sections to read:
"Sec. 13.55.050. Written request requirements.
(a) A written request for medication under this
chapter must be in substantially the form described in
AS 13.55.060, signed and dated by the qualified
individual, and witnessed by at least two other
individuals. The attending physician may not witness
the request. The witnesses shall, in the presence of
the qualified individual, attest that, to the best of
their knowledge and belief, the qualified individual
is capable, acting voluntarily, and not under undue
influence to sign the request.
(b) Only one witness may be
(1) a relative of the qualified individual
by blood, marriage, or adoption;
(2) an individual who, at the time the
qualified individual signs the request, would be
entitled to a portion of the estate of the qualified
individual at death under a will or by operation of
law; or
(3) an owner, operator, or employee of a
health care facility where the qualified individual is
receiving medical treatment or is a resident.
(c) If the qualified individual is an inpatient
in a long-term care facility when the qualified
individual signs the request, one of the witnesses
shall be an individual designated by the facility who
has the qualifications established by the department
by regulation. In this subsection, "long-term care
facility" includes an assisted living home as defined
in AS 47.32.900 and a nursing facility as defined in
AS 47.32.900.
Sec. 13.55.060. Form for written request. A
request for a medication under this chapter must be in
substantially the following form:
REQUEST FOR MEDICATION TO END MY LIFE
I, _________________, am an adult of sound mind.
I am suffering from _______________, which my
attending physician has determined is a terminal
disease and which has been medically confirmed by a
consulting physician.
I have been fully informed of my diagnosis,
prognosis, the nature of the medication to be
prescribed and potential associated risks, the
expected result, and the feasible alternatives,
including comfort care, hospice care, and pain
control.
I request that my attending physician prescribe
medication that will end my life in a humane and
dignified manner.
INITIAL ONE OF THE FOLLOWING:
_____ I have informed my family of my decision
and taken their opinions into consideration.
_____ I have decided not to inform my family of
my decision.
_____ I have no family to inform of my decision.
I understand that I have the right to rescind
this request at any time.
I understand the full import of this request, and
I expect to die when I take the medication to be
prescribed. I further understand that, although most
deaths occur within three hours, my death may take
longer, and my attending physician has counseled me
about this possibility.
I make this request voluntarily and without
reservation, and I accept full moral responsibility
for my actions.
Signed: _____________________
Dated: ______________________
DECLARATION OF WITNESSES
We declare that the person signing this request
(1) is personally known to us or has
provided proof of identity;
(2) in our presence signed or directed
another person to sign this request;
(3) is not an individual for whom either of
us is the attending physician; and
(4) to the best of our knowledge and belief,
(A) has the ability to make and communicate
health care decisions to health care providers; and
(B) is acting voluntarily and not under
undue influence.
_______________________ Witness 1 Date: _____
_______________________ Witness 2 Date: _____
NOTE: One witness may not be a relative (by
blood, marriage, or adoption) of the individual
signing this request, may not be entitled to a portion
of the individual's estate on death, and may not own,
operate, or be employed at a health care facility
where the person is an individual or resident. If the
individual is an inpatient at a health care facility,
one of the witnesses shall be an individual designated
by the facility."
Page 3, line 5:
Delete "Sec. 13.55.050"
Insert "Sec. 13.55.070"
Page 3, line 22:
Delete "AS 13.55.070"
Insert "AS 13.55.090"
Page 4, line 2:
Delete "AS 13.55.110"
Insert "AS 13.55.130"
Page 4, line 20:
Delete "Sec. 13.55.060"
Insert "Sec. 13.55.080"
Page 4, line 26:
Delete "Sec. 13.55.070"
Insert "Sec. 13.55.090"
Page 5, line 2:
Delete "Sec. 13.55.080"
Insert "Sec. 13.55.100"
Page 5, line 7:
Delete "Sec. 13.55.090"
Insert "Sec. 13.55.110"
Page 5, line 10:
Delete "Sec. 13.55.100"
Insert "Sec. 13.55.120"
Page 5, line 13, following "prescription":
Insert "and more than 48 hours have elapsed
between the qualified individual's written request and
the writing of the prescription"
Page 5, line 14:
Delete "Sec. 13.55.110"
Insert "Sec. 13.55.130"
Page 5, following line 18:
Insert a new paragraph to read:
"(2) all written requests by a qualified
individual for medication under this chapter;"
Renumber the following paragraphs accordingly.
Page 6, line 2:
Delete "Sec. 13.55.120"
Insert "Sec. 13.55.140"
Page 6, line 6:
Delete "Sec. 13.55.130"
Insert "Sec. 13.55.150"
Page 6, line 19:
Delete "Sec. 13.55.140"
Insert "Sec. 13.55.160"
Page 6, line 28:
Delete "Sec. 13.55.150"
Insert "Sec. 13.55.170"
Page 7, line 5:
Delete "Sec. 13.55.160"
Insert "Sec. 13.55.180"
Page 7, line 9:
Delete "Sec. 13.55.170"
Insert "Sec. 13.55.190"
Delete "AS 13.55.130"
Insert "AS 13.55.150"
Delete "13.55.140"
Insert "13.55.160"
Page 7, line 10:
Delete "AS 13.55.150"
Insert "AS 13.55.170"
Page 7, line 11:
Delete "AS 13.55.160"
Insert "AS 13.55.180"
Page 7, line 27:
Delete "Sec. 13.55.180"
Insert "Sec. 13.55.200"
Page 8, line 12:
Delete "Sec. 13.55.190"
Insert "Sec. 13.55.210"
Page 8, line 14:
Delete "Sec. 13.55.200"
Insert "Sec. 13.55.220"
Page 8, line 18:
Delete "Sec. 13.55.210"
Insert "Sec. 13.55.230"
Page 9, line 2:
Delete "Sec. 13.55.220"
Insert "Sec. 13.55.240"
Page 9, line 12:
Delete "Sec. 13.55.230"
Insert "Sec. 13.55.250"
Page 9, line 20:
Delete "Sec. 13.55.240"
Insert "Sec. 13.55.260"
Page 9, line 26:
Delete "Sec. 13.55.250"
Insert "Sec. 13.55.270"
Page 10, line 1:
Delete "AS 13.55.220"
Insert "AS 13.55.240"
Page 11, line 11:
Delete "AS 13.55.150"
Insert "AS 13.55.170"
Page 11, line 13:
Delete "AS 13.55.150"
Insert "AS 13.55.170"
3:10:28 PM
REPRESENTATIVE TARR objected for discussion.
CHAIR SPOHNHOLZ explained that proposed Amendment 1 would
include in statute a requirement that a terminally ill
individual's desire for life ending medication be written down
and witnessed by two individuals. Of those two, only one could
be related to an individual entitled to a portion of the estate
of the individual whose life would be ending or be employed by
the health care facility where the individual was living or
receiving treatment. She clarified that two interested parties
could not sign off on this. She shared that there was an
exemption to the written requirement if the individual did not
possess the capacity to physically sign the document. In that
case, the individual could direct another person to sign on
their behalf. She reported that pages 2 and 3 of proposed
Amendment 1 spelled out the form of the written request and the
witnessing aspect. She directed attention to page 5, lines 1 -
2, of proposed Amendment 1, where the written request waiting
period was outlined. On page 5, lines 10 - 11, the
documentation requirement was outlined.
3:11:38 PM
REPRESENTATIVE TARR removed her objection.
3:11:47 PM
REPRESENTATIVE SULLIVAN-LEONARD objected.
REPRESENTATIVE EASTMAN asked about a request for medication by
an individual as an option, as they may be unsure of their
decision. He asked if these witnesses would have to be present
during the administration of the medicine.
CHAIR SPOHNHOLZ said no.
3:12:35 PM
REPRESENTATIVE JOHNSTON directed attention to Page 2, line 7 and
asked if the "by regulation" referenced the facility and not the
person.
CHAIR SPOHNHOLZ replied, "correct."
REPRESENTATIVE EASTMAN acknowledged that the concerns for
coercion had been raised in the last year. He asked if there
were concerns for coercion regarding an individual, and whether
that would prohibit the written request from going through or
would it not have an effect.
CHAIR SPOHNHOLZ offered her belief that the written request was
to document and insure that coercion was not in place.
REPRESENTATIVE EASTMAN asked if a situation of coercion would
prohibit this as a second attempt.
CHAIR SPOHNHOLZ questioned whether the reference of second
attempt was toward an individual choosing to end their life.
She opined that the individual would still have the autonomy for
choice.
3:14:24 PM
REPRESENTATIVE SULLIVAN-LEONARD maintained her objection.
3:14:33 PM
A roll call vote was taken. Representatives Spohnholz,
Johnston, Edgmon, Kito, and Tarr voted in favor of proposed
Amendment 1. Representatives Sullivan-Leonard and Eastman voted
against it. Therefore, Amendment 1 was adopted by a vote of 5
yeas - 2 nays.
3:15:27 PM
REPRESENTATIVE EASTMAN asked what would appear on the death
certificate if someone went through this process.
REPRESENTATIVE DRUMMOND offered her understanding that the
diagnosis on the death certificate would be the terminal illness
which would have killed the person.
REPRESENTATIVE EASTMAN mused that, from a legal perspective, it
would appear that the person had not engaged entirely in this
process, and they had died of natural causes.
REPRESENTATIVE DRUMMOND replied, "I think so."
REPRESENTATIVE SADDLER (alternate) asked to clarify that,
although he was not allowed to vote on the proposed bill, he was
not allowed to debate the issue, as well.
CHAIR SPOHNHOLZ offered her belief that "an alternate is to make
sure that you caucus is properly represented and that you're
here for informational purposes."
3:17:59 PM
REPRESENTATIVE TARR moved to report SSHB 54, Version 30-
LS0254\O, as amended, out of committee with individual
recommendations and the accompanying fiscal notes.
3:18:13 PM
REPRESENTATIVE EASTMAN objected. He shared that his concerns
were "squarely on the side of what happens when what is supposed
to happen doesn't happen." He declared that a chief role of
government was to protect an individual's right to life and he
expressed his concern that within this intention of creating a
path for things to happen, there would be abuse. He stated his
concern that, if there was no requirement for any witnesses to
be present when the drugs were administered, it would be very
difficult for law enforcement to investigate if something
criminal and illegal did take place which resulted in the death.
He declared that this was not a fulfillment of the role to
protect an individual's right to life, or to prosecute someone
who took a life criminally. He expressed his concern that the
age requirement for this process was very young.
3:20:46 PM
REPRESENTATIVE SULLIVAN-LEONARD echoed the comments of
Representative Eastman and stated that she did not support the
proposed bill. She stated that she believed in the sanctity of
life, from beginning to end. She shared a personal anecdote of
death within her family. She declared that this was a very
controversial bill.
3:21:44 PM
REPRESENTATIVE TARR referenced the sad stories shared earlier.
She declared that each individual had the right to make this
decision. She expressed her concern for the more vulnerable
populations, including seniors and those individuals with
disabilities. She directed attention to page 2, line 7, that an
individual did not qualify solely because of age or
disabilities. She noted that many elders did feel themselves a
burden on family, especially as their health deteriorated, they
had more significant needs, and they did not have the resources
or access to good health care. She offered her belief that, as
the language of the proposed bill was restrictive, the issues
had been addressed sufficiently. She stated her support of the
proposed bill. She acknowledged that the witness aspect was "an
interesting component" and she expressed her desire that the
bill sponsor further address this as the bill moved forward.
3:24:11 PM
CHAIR SPOHNHOLZ offered her belief that it was a fundamental
right for an individual to make the decisions for their own
body. She allowed that the proposed bill included numerous
safeguards, including the written requirement. She said that it
was important to document the process. She directed attention
to page 7, line 27, which established AS 13.55.180, a new
section establishing criminal penalties for anyone committing
the crime of abuse of life ending process of a person. She
pointed out that this was equivalent to murder and may be
punished similarly. She declared that this proposed bill was
not legalizing anything other than giving an individual the
right to make their own choices with their bodies. This did not
give anyone else the right to choose to end another's life.
3:26:32 PM
REPRESENTATIVE EASTMAN maintained his objection.
3:26:37 PM
A roll call vote was taken. Representatives Spohnholz,
Johnston, Edgmon, Kito, and Tarr voted in favor of SSHB 54.
Representatives Sullivan-Leonard and Eastman voted against it.
Therefore, CSSSHB 54, Version 30-LS0254\O, was reported out of
the House Health and Social Services Standing Committee by a
vote of 5 yeas - 2 nays.
3:27:19 PM
The committee took an at-ease from 3:27 p.m. to 3:30 p.m.
HB 162-DHSS CENT. REGISTRY;LICENSE;BCKGROUND CHK
3:30:03 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be HOUSE BILL NO. 162, "An Act relating to criminal and civil
history requirements and a registry regarding certain licenses,
certifications, appeals, and authorizations by the Department of
Health and Social Services; and providing for an effective
date."
3:30:15 PM
STACIE KRALY, Chief Assistant Attorney General, Statewide
Section Supervisor, Human Services Section, Civil Division
(Juneau), Department of Law, characterized the proposed bill as
a legislative fix to existing statutes found in AS 47,
specifically the background check found in AS 47.05.300 and the
licensing statutes found in AS 47.32. She declared that HB 162
was a technical fix which arose out of a number of issues over
the past 15 years to identify a number of gaps, overlaps,
redundancies, and "squishy language."
3:31:27 PM
CHAIR SPOHNHOLZ opened public testimony.
3:31:52 PM
KATE BURKHART, Ombudsman, Juneau Office, Office of the
Ombudsman, reported that her office was an independent, non-
partisan, and objective organization which investigated
complaints about state government. When those complaints were
found to be justified, the office would make recommendations for
the improvement of government policies and programs. She
emphasized that this was not an advocacy role and would only
include comment on issues that directly affected work or where
work might provide information that would inform deliberations
with some context. She reported that the Office of the
Ombudsman had developed an understanding of the background check
program based on an extensive investigation which had been
concluded and then reported in 2016. She declared that this
information was relevant to some of the provisions in proposed
HB 162. She offered her comments for use as the bill moved
forward, pointing out that she was not advocating that the
previous recommendations should be taken in lieu of those in the
proposed bill. She pointed out that, as there was not a unique
registry associated with the background check program, the
proposed bill offered an opportunity for clarification in
statute. The bill, as written, referred to a civil registry
which was in fact a program that checked pre-existing registries
held in other places. Prior to 2012, the background check
program used the standard for civil barriers, which included
substantiated reports of child maltreatment and harm to the
Office of Children's Services (OCS). In 2012, the Office of
Children's Services began use of a "more robust standard" which
looked to findings from the court in a "child in need of aid"
proceeding. The recommendations from the Ombudsman's office had
been to use the more robust standard of adjudicated findings
which also provided an opportunity for due process in the court;
whereas the substantiated report of harm did not always offer
this opportunity. She stated that the background check program
was an essential component to the systems which served
vulnerable Alaskans and that proposed HB 162 offered an
opportunity to strengthen the program. She relayed that if
there was a decision to use a substantiated report of harm as a
basis for a civil barrier under the background check program,
which was a policy decision, then the notice to the people about
whom a report had been substantiated needed to be very clear
because this could affect them for up to 10 years. She pointed
out that, currently, this notice was not clear. She stated that
an express provision in the proposed bill, which required that a
person be put on notice for inclusion in the child protection
registry, could have effects on their ability to take a care
giving job, or to become a relative placement for a child in OCS
custody. She opined that this was an important program and that
the proposed bill provided the opportunity to strengthen the
program. She reiterated that these comments were offered to
inform the process moving forward.
3:37:20 PM
CHAIR SPOHNHOLZ stated that the bill would be held.
3:37:46 PM
REPRESENTATIVE SULLIVAN-LEONARD directed attention to the 12
recommendations addressing allegations with the Department of
Health and Social Services listed on page 2 of the letter from
the Office of the Ombudsman, and that there had been agreement
for implementation to 3 of those recommendations. She asked for
a general outline of the 12 recommendations, with more specific
details to those 3 agreed upon recommendations.
MS. BURKHART directed attention to page 35 of the report, which
presented the response by the Department of Health and Social
Services. She explained the Ombudsman process, which began with
a confidential preliminary report to a state agency. The agency
then had a chance to respond before a final report was issued
and an executive summary was published if the issue was of
public interest. She pointed to the Department of Health and
Social Services (DHSS) response on page 35. She explained that
DHSS was in the midst of a regulatory process as well as the
proposal of a bill similar to HB 162. She opined that part of
the intention was to implement recommendations 9 & 10 through
the regulatory process, as noted on page 42.
CHAIR SPOHNHOLZ pointed out that the committee members did not
have this report.
MS. BURKHART explained recommendations 4 & 5 although, she
reported, these were not relevant to HB 162.
3:41:38 PM
REPRESENTATIVE TARR asked about recommendations 9 & 10.
MS. BURKHART explained that recommendation 9 reviewed the need
for another look at whether really old findings in child in need
of aid cases should be a permanent bar to an appointment. She
reported that proposed HB 162 maintained for the current method,
that the only permanent bar related to child protection was
termination of parental rights. She reiterated that this
recommendation was "not necessarily super relevant to [HB] 162."
She directed attention to recommendation 10 which suggested
implementation of a tiered response system, and that regulations
adopted last year included a tiered response system,
particularly with criminal barriers.
3:43:22 PM
MS. KRALY stated that there had been significant and substantial
communication with the Office of the Ombudsman about moving
forward with the proposed bill and improving the process.
CHAIR SPOHNHOLZ pointed out that there would be additional
meetings between Ms. Kraly and Ms. Burkhart to offer
recommendations for possible inclusion in the proposed bill.
3:44:33 PM
CHARLES McKEE shared some personal experiences.
3:47:26 PM
CHAIR SPOHNHOLZ left public testimony open.
[HB 162 was held over.]
HB 268-OPIOID PRESCRIPTION WARNINGS
3:47:40 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 268, "An Act relating
to the prescription of opioids; relating to the Department of
Health and Social Services; relating to the practice of
dentistry; relating to the practice of medicine; relating to the
practice of podiatry; relating to the practice of osteopathy;
relating to the practice of nursing; and relating to the
practice of optometry."
3:48:32 PM
REPRESENTATIVE LES GARA, Alaska State Legislature, paraphrased
from the Sponsor Statement [Include in members' packets], which
read:
House Bill 268 seeks to help address the opioid
addiction crisis in Alaska, by making sure patients
are advised of the potential addictive dangers of
these prescription drugs. Opioid drugs include
oxycodone, hydrocodone, and other pain reducing drugs.
In many cases these drugs are needed to address acute
physical pain, but the facts show that these drugs can
also have powerful addictive effects. Furthermore,
studies show many heroin users started as opioid drug
users. The relatively low cost of heroin as a
substitute drug can lead to the transition by many
Americans and Alaskans to heroin. Obviously, this can
occur when a medical provider will no longer provide
additional prescription medication. A small but
troubling percentage of people who become addicted to
opioid drugs later become heroin addicts.
These addictions can destroy families, destroy a
person's ability to hold employment, and destroy
lives. Addiction treatment is costly for consumers,
who pay indirect insurance costs, as well as for the
state, which often covers and pays for addiction
treatment. In the worst case, overdose deaths also
result from opioid use. According to the Department of
Health and Social Services, 14,000 Americans died from
opioid use in 2014 and 91 Americans die every day.
Alaska's per capita death rate is twice the national
average. According to the Department, between 2009-
2015, 774 Alaskans died from opioid overdose.
This bill recognizes a reality. Since 1999, the number
of opioid prescriptions has tripled. More Americans
and Alaskans have been prescribed these often useful,
but potentially dangerous drugs.
House Bill 268 is a patient information bill. It
requires prescribers to let patients know about the
potentially addictive qualities of these drugs when
they are prescribed, and that they can potentially
lead to opioid abuse and addiction. Providers must
also offer information about opioid use being a
potential risk factor for future heroin addiction.
Patients can then use this knowledge to help
themselves and their family members guard against
overuse and abuse when prescribed these medications.
To keep the requirements flexible, and as non-
burdensome as feasible, while still protecting
patients, medical providers who prescribe these drugs
will be required to provide this information to their
patients in their "own words".
The bill also requires the Department of Health and
Social Services to prepare a very short handout with
some facts on the dangers of opioid addiction, and the
potential association between opioid addiction and
heroin use. To increase the chances that this
information will be presented in a form that is
useful, it is required to be concise, and may include
graphics. The handout is Important because it
recognizes that the patient-provider discussion may
not be long and detailed, and a patient may not
remember what is told to them by a medical provider in
this regard. It also serves to reinforce the
information.
This bill does not create opportunities for new civil
lawsuits against providers, thus protecting the
patient-provider relationship. Instead of imposing
civil liability, and raising the specter of lawsuits,
the enforcement mechanism in the bill allows the
providers' Board to consider sanctions for "habitual"
violations of this statute that occur without "good
cause".
Exceptions to the legislation's requirements, borrowed
from a similar statute passed in New Jersey, include
medical services where opioids may be necessary such
as for opioid addiction treatment and hospice care.
REPRESENTATIVE GARA declared that this was a world-wide problem,
and opined that, as heroin was cheap, it could be substituted if
the prescription opiates were no longer available from a doctor.
He relayed his request that the Department of Health and Social
Services put a link on its website for physicians to use to
download a concise handout. He offered his own experience with
opioid prescriptions, that he had never been told that they were
potentially addictive or any link between opioid use and
eventual heroin use.
3:54:34 PM
REPRESENTATIVE SULLIVAN-LEONARD asked about offering the choice
of another pain relieving, non-narcotic based product. She
shared that pharmaceutical representatives had tried to offer
this to doctors, but the response had been that the patients
wanted quick relief.
REPRESENTATIVE GARA expressed his agreement, and he pointed out
that the proposed bill required that a reasonable alternative to
the opioid must be mentioned to the patient.
3:55:49 PM
REPRESENTATIVE JOHNSTON asked if the proposed bill was just for
written prescriptions as a patient may not be able to read.
REPRESENTATIVE GARA explained that the bill was intended for
written prescriptions. He reported that there was some opioid
use that was not prescription use, and he cited examples of a
hospice care center or a heroin addiction treatment center. He
stated that the proposed bill did not affect these centers. He
explained that the proposed bill was a requirement for any
prescription from an authorized provider.
3:57:36 PM
REPRESENTATIVE JOHNSTON said that she was thinking of trauma
cases in emergency rooms.
REPRESENTATIVE GARA expressed his agreement that it should not
affect emergency rooms and immediate care facilities.
CHAIR SPOHNHOLZ pointed out that there were times when you could
and could not give consent.
3:58:12 PM
REPRESENTATIVE TARR directed attention to page 11, line 6, and
suggested that the mechanism of action with opioid use needed to
be described to a patient to better understand the health
effects, even after the end of the prescription use. She asked
if the Department of Health and Social Services would consider
this, absent legislation, as there would be immediate positive
effect.
REPRESENTATIVE GARA offered his belief that the Department of
Health and Social Services would not require medical
practitioners to read a statement or provide a handout, hence
the need for legislation to make this a mandatory requirement.
He pointed out that should a warning become too long, there
would be resistance from physicians. He acknowledged that any
appropriate additional information could be included in the
written handout.
4:01:18 PM
REPRESENTATIVE TARR asked if the department would put something
on its website more immediately.
REPRESENTATIVE GARA replied that it was already on the DHSS
website.
4:01:53 PM
CHAIR SPOHNHOLZ added that the Office of Substance Misuse and
Addiction Prevention had a lot of information and resources
available to the public and health care practitioners.
4:02:09 PM
REPRESENTATIVE SADDLER (alternate) asked about the extent of
impingement on a professional's judgement and who made the
determination for "without good cause" for failing to provide
information.
REPRESENTATIVE GARA replied that the goal of the proposed bill
was to be non-burdensome on medical practitioners and not to
create a hostile litigation relationship between patient and
provider. He pointed out that the discipline for providers was
very relaxed, noting that there was no lawsuit liability created
by the bill. He explained that the enforcement mechanism was
for habitual violators of the provisions of the bill who did not
have good cause.
REPRESENTATIVE SADDLER asked who defined good cause and what
constituted habitual.
4:03:56 PM
REPRESENTATIVE GARA replied that it was only habitual if the
person was not following the law on a consistent basis.
REPRESENTATIVE KITO asked how a violation was determined and who
would determine these violations.
REPRESENTATIVE GARA explained that the regulatory board for each
profession would determine the violations and the need for
punishment. He stated that the legal standard for habitual was
determined by the dictionary definition.
4:04:54 PM
REPRESENTATIVE KITO asked how the board members were made aware
of the violation.
REPRESENTATIVE GARA replied that "somebody would have to
complain to them" and he opined that it would be rare as medical
practitioners would not want to violate the law.
4:05:37 PM
CHAIR SPOHNHOLZ said the bill would be held over.
4:05:58 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:05 p.m.