ALASKA STATE LEGISLATURE
HOUSE JUDICIARY STANDING COMMITTEE
February 26, 2014
1:14 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Gabrielle LeDoux
Representative Charisse Millett
Representative Lance Pruitt
Representative Max Gruenberg
MEMBERS ABSENT
Representative Bob Lynn, Vice Chair
Representative Neal Foster
COMMITTEE CALENDAR
HOUSE JOINT RESOLUTION NO. 1
Proposing amendments to the Constitution of the State of Alaska
relating to state aid for education.
- MOVED HJR 1 OUT OF COMMITTEE
HOUSE BILL NO. 269
"An Act providing immunity for certain licensed temporary health
care providers who provide free health care services."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HJR 1
SHORT TITLE: CONST. AM: EDUCATION FUNDING
SPONSOR(s): REPRESENTATIVE(s) KELLER
01/16/13 (H) PREFILE RELEASED 1/7/13
01/16/13 (H) READ THE FIRST TIME - REFERRALS
01/16/13 (H) EDC, JUD, FIN
02/22/13 (H) EDC AT 8:00 AM CAPITOL 106
02/22/13 (H) Heard & Held
02/22/13 (H) MINUTE(EDC)
03/01/13 (H) EDC AT 8:00 AM CAPITOL 106
03/01/13 (H) Heard & Held
03/01/13 (H) MINUTE(EDC)
02/07/14 (H) EDC RPT 3DP 3DNP 1NR
02/07/14 (H) DP: REINBOLD, SADDLER, GATTIS
02/07/14 (H) DNP: P.WILSON, DRUMMOND, SEATON
02/07/14 (H) NR: LEDOUX
02/07/14 (H) EDC AT 8:00 AM CAPITOL 106
02/07/14 (H) Moved Out of Committee
02/07/14 (H) MINUTE(EDC)
02/19/14 (H) JUD AT 1:00 PM CAPITOL 120
02/19/14 (H) Heard & Held
02/19/14 (H) MINUTE(JUD)
02/26/14 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 269
SHORT TITLE: IMMUNITY FOR VOL. HEALTH CARE PROVIDER
SPONSOR(s): REPRESENTATIVE(s) THOMPSON
01/21/14 (H) READ THE FIRST TIME - REFERRALS
01/21/14 (H) HSS, JUD
02/13/14 (H) HSS AT 3:00 PM CAPITOL 106
02/13/14 (H) Moved CSHB 269(HSS) Out of Committee
02/13/14 (H) MINUTE(HSS)
02/17/14 (H) HSS RPT CS(HSS) NT 5DP
02/17/14 (H) DP: SEATON, PRUITT, KELLER, TARR,
HIGGINS
02/26/14 (H) JUD AT 1:00 PM CAPITOL 120
WITNESS REGISTER
REPRESENTATIVE STEVE THOMPSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as prime sponsor of HB 269.
JULIE ROBINSON, DDS, Co-Chair
Alaska Mission of Mercy (AKMOM)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 269.
JANA SHOCKMAN, RN, President
Alaska Nurses Association (ANA)
Anchorage, Alaska
POSITION STATEMENT: Testified in regarding HB 269.
DAVID LOGAN, DDS
Alaska Dental Society (ADS)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 269.
JANE PIERSON, Staff
Representative Steve Thompson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding HB 269.
ACTION NARRATIVE
1:14:50 PM
CHAIR WES KELLER called the House Judiciary Standing Committee
meeting to order at 1:14 p.m. Representatives Millett, Pruitt,
Gruenberg, LeDoux, and Keller were present at the call to order.
HJR 1-CONST. AM: EDUCATION FUNDING
1:15:10 PM
CHAIR KELLER announced that the first order of business would be
HOUSE JOINT RESOLUTION NO. 1, Proposing amendments to the
Constitution of the State of Alaska relating to state aid for
education.
1:15:24 PM
CHAIR KELLER, noting that there have been over 24 hours of
testimony and over 135 testifiers on the language in HJR 1,
announced that HJR 1 is before the committee for consideration
and vote.
1:16:46 PM
REPRESENTATIVE GRUENBERG advised he opposes HJR 1 as he believes
it overturns a fundamental provision in the Alaska State
Constitution, which prohibits the use of direct aid for private
education, and urged that the constitution not be amended in
this manner. He noted that a majority of people he has heard
testify and who have contacted him are in opposition to this
change.
1:19:14 PM
REPRESENTATIVE LEDOUX questioned how one reconciles the Blaine
Amendment with performance scholarships that can be used at
private and religious colleges. She recalled that money is
granted under capitol grants for private and sometimes religious
pre-school transportation, as is the case in Fairbanks and in
Kodiak parochial schools.
REPRESENTATIVE GRUENBERG stated he has performed extensive
research on this provision since the 1980s and found that tax
credits for contributions to public and private colleges in
Alaska is not considered direct aid as the taxpayer would make
the contribution. In regard to scholarships, he noted, it is
similar in that it is not a direct aid to the university as it
was to benefit each student receiving a scholarship. With
respect to the transportation issue, he advised that he could
not answer as he is not an expert on school funding. The
question in this matter is should the [Blaine Amendment] be
repealed in order to provide direct aid [to private schools]
which is in opposition to the basic principle of separation [of
church and state], he opined.
1:23:59 PM
REPRESENTATIVE PRUITT moved to report HJR 1 out of committee
with individual recommendations and the accompanying fiscal
note. There being no objection, HJR 1 was reported from the
House Judiciary Standing Committee.
HB 269-IMMUNITY FOR TEMP. HEALTH CARE PROVIDER
1:25:58 PM
CHAIR KELLER announced that the next order of business would be
HOUSE BILL NO. 269, "An Act providing immunity for certain
licensed temporary health care providers who provide free health
care services." [Before the committee was CSHB 269(HSS).]
1:26:18 PM
REPRESENTATIVE STEVE THOMPSON, Alaska State Legislature,
speaking as the prime sponsor, paraphrased from the following
written sponsor statement [original punctuation as provided]:
The problem is that there is no clear answer as to
whether an out-of-state dental professional issued a
courtesy license is covered under Alaska Statute
09.65.300. AS 09.65.300 provides statutory immunity
against civil damages resulting from an act or
omission of a health care provider who provides free
health care services, within the scope of their
license. Under AS 09.65.300 a patient must receive
written notice of this immunity as well as giving
informed consent before any medical service is
provided. Under AS 09.65.300 patients still have the
right to sue the medical provider for civil damages
resulting from the provider's gross negligence, or
reckless or intentional misconduct.
Unfortunately, it is unclear whether these out-of-
state dental professionals, participating in the AKMOM
event qualify under AS 09.65.300, the Volunteer Health
Care Provider Immunity Act of 2004. The original
purpose of the statute was to allow retired Alaska
physicians to volunteer their services. The Department
of Law opines that the meaning of the law will
ultimately have to be interpreted in a court case.
HB 269 will clarify AS 09.65.300, ensuring that civil
immunity is extended to these out-of-state medical
professionals who are licensed to provide dental
services in Alaska during the Mission of Mercy Event,
without having the issue come before a lengthy
proceeding before the Court.
Please join Representative Thompson in supporting this
legislation.
1:29:51 PM
CHAIR KELLER opened public testimony.
1:30:19 PM
JULIE ROBINSON, DDS, Co-Chair, Alaska Mission of Mercy (AKMOM),
informed the committee that the MOM event includes approximately
1,200 total volunteers, 216 dentists, and approximately 45 days
for the AKMOM event. This legislation is important for this
event because many of the dentists participating in the event
apply for courtesy licenses. Eight dentists have applied for
courtesy licenses, including dentists from Joint Base Elmendorf-
Richardson (JBER) and the South Central Foundation as well
dentists from 13 different states. Each dentist's participation
is necessary for the success of this event, she emphasized. The
[April] event is budgeted at approximately $185,000 with a goal
of treating 2,000 people during the course of 2 days. The
projected number of people cannot be treated without the out-of-
state and military dentists' participation, she opined.
1:33:21 PM
JANA SHOCKMAN, RN, President, Alaska Nurses Association (ANA),
advised that ANA is in favor of HB 269, but suggested amending
it such that the providers with a courtesy license are required
to provide their Alaska patients with a local contact person
that these patients may go to for follow-up care. Ms. Shockman
noted that following treatment patients may require follow-up
care due to complications; these patients may not have the
financial resources to have their own local primary care
provider. The Dental Society responded to ANA's concerns
stating that [follow-up] has not been a problem for them since
arrangements have been made for follow-up at the upcoming MOM
event, she noted. The Alaska Nurses Association prefers that
out-of-state providers, for programs yet to come, are required
to do the same. Therefore, she suggested the earlier mentioned
[amendment] to the bill be inserted under AS 09.65.300(a)(5),
which lists providers' responsibilities.
1:35:48 PM
REPRESENTATIVE LEDOUX questioned whether the follow-up care
would be "free" or simply [a dentist] the patients can call.
MS. SHOCKMAN responded that it would be a [dentist] who has
agreed with the program or the provider to provide follow-up
care for the patient. For instance, with the dental clinic the
Dental Society has contacts available for patients with a
problem, after receiving free care.
1:36:48 PM
REPRESENTATIVE PRUITT requested that Ms. Shockman reiterate her
suggested language.
MS. SHOCKMAN specified that on to [page 2], line 6, following
"(5) provider" insert "(C) the provider with the courtesy
temporary license must provide a contact for follow-up care as
needed."
1:39:51 PM
DAVID LOGAN, DDS, Alaska Dental Society, stated he is a dentist
in Juneau and represents the Alaska Dental Society (ADS)
supports HB 269 as written without any alteration. He advised
that ADS supports follow-up care and, in fact, it is part of the
Alaska Mission of Mercy (AKMOM) protocol. He explained that
chiropractors, dentists, physicians and nurses are the four
professions affected by courtesy licensing and their individual
professional requirements are different. Therefore follow-up
care is best addressed within each profession's regulation.
This bill deals with immunity for health care providers'
services and under dentistry the dentist is issued a courtesy
license only if they are performing free care but that is not
the case for all professions. The question is should the state
mandate [follow-up care] only for free care or for all holders
of courtesy licenses, which by nature are transient and not
permanently located in the state, he opined. He reiterated the
belief that [follow-up care] is better addressed under
regulations for each individual health care profession rather
than in statute.
1:43:05 PM
REPRESENTATIVE PRUITT expressed his concern that a [health care
provider] can obtain a temporary courtesy license, come to
Alaska and leave shortly thereafter. In such a situation, he
questioned what recourse the patient would have if [the patient
requires additional care] or if the [health care provider] is
grossly negligent and then leaves the state. While he said he
agrees with the roles regulations play, the legislature must
perform its own due diligence to ensure the patient has
recourse. The Mission of Mercy may be an oddity for many of the
patients as they most likely do not receive assistance on a
regular basis. The state, he opined, should deal with temporary
out-of-state [health care providers] in an appropriate manner as
it appears the legislature is almost creating a second category
of individuals.
DR. LOGAN remarked his concern is that the discussion is
singling out a very narrow spectrum of temporary [health care]
providers who come into the state, are not here on a permanent
basis, and deal strictly with courtesy licenses that offer free
health care. Whereas, he noted, there are chiropractors,
physician, and nurses who temporarily come into the state and
are paid but dentists are unique in that they either have a
license or not, or are issued a short lived courtesy license.
The ADS, he stated, believes follow-up care should be part of
any treatment and as such is part of the MOM events. He opined
that part of being a health care professional is self-regulation
[and taking on things such as follow-up care]. He suggested
that if the issue is approached at a professional level and is
under regulation it will be easier to reach the broad range [of
providers] and the changes can be made in three separate
regulations.
1:47:08 PM
REPRESENTATIVE PRUITT stated that if HB 269 passes as written,
the intent is for there to be regulations that address this
issue [for follow-up care].
1:47:36 PM
CHAIR KELLER related his understanding that in response to
Representative LeDoux's question, Ms. Shockman did not answer
whether [the follow-up care] is intended to be free. Ms.
Shockman's suggested [amendment] language did not specify that
the follow-up care would be free, but simply stated that a
contact number would be provided. However, he said he
understood Dr. Logan's testimony to imply it was free follow-up
care.
DR. LOGAN said he suspected it would vary depending upon whether
the service was free or not. For instance, the MOM events
provide free dental care and free follow-up care in Anchorage
for a period of 30 days afterwards, he explained. Within the
MOM event he fully expects that in treating approximately 2,000
patients someone will require follow-up care after receiving a
lot of dental work in a short period of time. Due to the gap in
health care coverage, he predicted that more events [similar to
MOM] will happen and if a [health care provider] is [providing
services] at a free health care event, the provider has an
obligation to provide free follow-up within reason. On the
other hand, if a patient is treated by a [health care provider]
who holds a temporary permit and is charging for his/her
services, the follow-up care unless included as part of the
service would have a charge.
1:50:05 PM
REPRESENTATIVE LEDOUX referred to the Good Samaritan Law wherein
if a doctor stops at an accident [scene] to offer emergency aid,
that doctor is not required to provide free orthopedic care
forever. Therefore, she was not certain follow-up care should
be legislatively mandated.
DR. LOGAN deferred to the sponsor of HB 269.
1:51:34 PM
JANE PIERSON, Staff, Representative Steve Thompson, Alaska State
Legislature, explained that chiropractors, physicians, nurses
and dentists have different duties and standards within their
professions. The strongest approach, she opined, is for that
the various health care boards and professions that issue
courtesy licenses to be regulated by their own board under their
own section of statute. She offered that MOM performs well in
providing free health care follow-up for 30 days. Upon
requesting HB 269, she was advised by Legislative Legal and
Research Services that the bill was unnecessary as [health care
providers] are already covered. However, the Attorney General's
Office advised that [health care providers] may or may not be
[covered], but that a court case would decide. Therefore, HB
269 attempts to avoid a court case. With regard to regulating
under individual boards, she opined that it is up to each board
to set its own standards as each profession may have different
follow-up practices. Ms. Pierson testified that the sponsor
prefers HB 269 as it is written.
1:54:10 PM
CHAIR KELLER characterized Representative Pruitt's comments as
good, noting that it is very important to register legislative
intent. He extended the invitation to the members of the
committee to also join if they believe the legislative intent
should be in the regulations to ensure there is adequate
information regarding follow-up service.
1:54:39 PM
REPRESENTATIVE GRUENBERG inquired as to the meaning of the last
paragraph of the memorandum from Hilary Martin, Legislative
Counsel to Representative Steve Thompson, dated 1/13/14, which
read:
Finally, please be aware of the temporary permitting
for a locum tenens practice under AS 08.64.27 which
allows a member of the state medical board or its
executive secretary to grant a temporary permit to a
physician or osteopath licensed in another state,
territory, or province to substitute for another
physician in the state. I am not sure how the
temporary licensing and temporary permitting work
together, but you might want to include a reference to
this section in order to clarify whether a locum
tenens is included as a licensed health care provider
under AS 09.65.300.
MS. PIERSON explained that a locum tenens is quite different
than a temporary health care provider in that [the locum tenens
providers] come to Alaska and work a practice for a period of
time. She advised the committee that she spoke with Hilary
Martin after receiving the memorandum, dated 1/13/14, and
thought it was addressed in the 2/13/14 memorandum [from Megan
A. Wallace, Legislative Legal and Research Services] to
Representative Steve Thompson. Ms. Pierson further explained
that a locum tenens would not be covered as it is a paid
position, which is very different from temporary health care
providers who provide free services in Alaska.
MS. PIERSON, in further response to Representative Gruenberg,
advised that temporary [courtesy] licenses are issued for the
duration of the MOM event, which is basically a weekend. She
confirmed the expiration date is listed on the temporary
licenses, which are issued by the board for a limited amount of
time to provide free services for a certain event. She further
confirmed, regarding page 2, line 4, that Representative
Gruenberg is correct in that the services are free services and
not services provided at a reduced rate.
1:58:27 PM
REPRESENTATIVE GRUENBERG, acknowledging this is current law,
pointed out that on page 2, line 7, the language does not
require the informed consent to be in writing, and yet on page
2, line 11, the language requires the notice of immunity to be
in writing. He questioned if there is a good reason informed
consent is not obtained in writing.
MS. PIERSON advised Representative Gruenberg she has worked on
approximately 400 medical malpractice cases and informed consent
is always in writing and is the first thing reviewed.
CHAIR KELLER suggested that if that is the case, then the law
should be clear that written informed consent is required.
MS. PIERSON advised Chair Keller the sponsor would consider it a
friendly amendment.
2:00:24 PM
CHAIR KELLER closed public testimony.
2:00:35 PM
REPRESENTATIVE GRUENBERG moved the committee adopt Conceptual
[Amendment 1], as follows:
Page 2, line 7, following "consent";
Insert "in writing"
There being no objection, [Conceptual Amendment 1] was adopted.
2:01:46 PM
CHAIR KELLER, in response to Representative Gruenberg, advised
that his staff had requested answers from Legislative Legal and
Research Services in response to questions from Dr. Logan in an
email but Legislative Legal and Research Services has not yet
responded. Therefore, Chair Keller held over HB 269.
2:03:37 PM
ADJOURNMENT
There being no further business before the committee, the House
Judiciary Standing Committee meeting was adjourned at 2:03 p.m.