MINUTES SENATE FINANCE COMMITTEE March 15, 1993 8:40 a.m. TAPES SFC-93, #35, Side 2 (425-end) SFC-93, #37, Side 1 (000-end) SFC-93, #37, Side 2 (575-181) CALL TO ORDER Senator Drue Pearce, Co-chair, convened the meeting at approximately 8:40 a.m. PRESENT In addition to Co-chairs Pearce and Frank, Senators Jacko, Kerttula, Rieger, and Sharp were present. Senator Kelly arrived soon after the meeting began. ALSO ATTENDING: Senator Leman; Keith Gerken, Deputy Commissioner, Dept. of Transportation and Public Facilities; Jim Ayers, System Director, Alaska Marine Highway, Dept. of Transportation and Public Facilities; Jon Scribner, Regional Director, Southeast Region, Dept. of Transportation and Public Facilities; Mike McKinnon, Chief of Planning, Southeast Region, Dept. of Transportation and Public Facilities; Steven O'Connor, Assistant Chief, Central Emergency Services, Kenai Peninsula Borough; Mark Johnson, Coordinator, Emergency Medical Services, Division of Public Health, Dept. of Health and Social Services; and aides to committee members and other members of the legislature. SUMMARY INFORMATION SB 50 - FY 94 CAPITAL BUDGET Overview of the Dept. of Transportation and Public Facilities capital budget for the SOUTHEAST REGION and ALASKA MARINE HIGHWAY SYSTEM was presented by department staff. SSSB 71 - Act relating to emergency medical services; and repealing obsolete references to the Statewide Health Coordinating Council and health systems agencies. Discussion was had with Senator Leman, Steve O'Connor, and Mark Johnson. Amendment No. 1 was ADOPTED. The bill was then HELD in committee for further review and resolution of fiscal concerns. SENATE BILL NO. 50 An Act making appropriations for capital projects; and providing for an effective date. (Cross-reference to HCS CSSB 183(Fin) the ultimate vehicle for the FY 94 capital budget.) HOUSE CS FOR CS FOR SENATE BILL NO. 183(FIN) An Act making special appropriations for restoration projects relating to the Exxon Valdez oil spill and for oil spill response projects; making appropriations for capital project matching grant funds; making appropriations for capital projects; making an appropriation to pay judgment, interest, and attorney fees for Frontier Flying Service v. Turpin; and providing for an effective date. Log notes of the capital budget overview presentation by Jon Scribner, Mike McKinnon, and Jim Ayers, on behalf of the Dept. of Transportation and Public Facilities, were taken and are appended to the end of these minutes. Copies of the notes and tape recordings of the meeting are available from the Senate Finance Committee Secretary, Room 520, State Capitol Building, Juneau, Alaska, (phone 465-2618) or through the Legislative Finance Division, P. O. Box 113200, Juneau, Alaska 99811-3200 (phone 465-3795). SPONSOR SUBSTITUTE FOR SENATE BILL NO. 71 An Act relating to emergency medical services; and repealing obsolete references to the Statewide Health Coordinating Council and health systems agencies. Co-chair Pearce directed that SSSB 71 be brought on for discussion and referenced a proposed amendment by Senator Leman. End, SFC-93, #37, Side 1 Begin, SFC-93, #37, Side 2 SENATOR LEMAN, prime sponsor of the legislation, came before committee. He explained that the bill responds to last fall's review of the state EMS program by the technical assistance team of the National Highway Traffic Safety Administration. The report contained a number of recommendations, many of which are incorporated within SSSB 71. Senator Leman explained that secs. 1 through 8 delete the term "physician trained" as applied to paramedics. That change acknowledges that training can be provided by entities and persons other than physicians. The bill also contains a number of deletions of obsolete references. Key features of the legislation are that it will allow the Dept. of Health & Social Services to set standards for mobile intensive care paramedic training programs in Alaska. Currently, paramedics must be trained outside the state. The bill further allows the department to regulate voluntary compliance by trauma centers. A substantial amount of the fiscal impact relates to reviews by "outside reviewers" for establishment of trauma centers in Alaska. A mechanism is also included whereby hospitals would pay a portion of the review cost. The legislation also provides for a "patient care information system" to accumulate data and allow for evaluation of standards and quality of care. Senator Leman next directed attention to Corrected Amendment No. 1 (copy on file in the original SFC file for SSSB 71). He explained that it relates to the composition of the Alaska Council on Emergency Medical Services. The amendment reflects a suggestion from the Southeast Regional EMS Council. It provides that at least one of the three members who are active as prehospital emergency care providers be from a rural area of the state. Senator Leman acknowledged that those engaged in EMS services in rural areas encounter unique obstacles of which the Council should be aware. In response to a question from Senator Jacko, Senator Leman said that the Council would consist of eleven members: 1. Two physicians with emergency medicine or trauma care experience. 2. A registered nurse with experience in emergency nursing. 3. Three active prehospital emergency care providers. 4. An emergency medical services administrator. 5. An administrator of a hospital or Native health organization. 6. Three consumers of emergency medical services. Senator Leman reiterated that under the corrected amendment, one of the three emergency care providers listed in subsection 3, above, would be from a rural area. Co-chair Frank expressed concern regarding the request for two additional positions on the state payroll. He then asked if proposed training could occur at the regional level through nonprofits. Senator Leman said he had raised similar questions. He further explained that, up to this time, training services were provided per a federal grant through the Public Health Service. That grant will expire on October 1, 1993, and may not be renewed thereafter. Further, much data will be flowing to the department from twenty-five hospitals, for the patient care system. The department will also have to coordinate reviews of hospitals that could serve as trauma centers. Co-chairman Frank questioned need for $60.0 for a research analyst. Senator Leman deferred to staff from the department. Senator Kelly advised that he would support the proposed amendment, but he voiced further need to point out "some of the consequences of what we do." He then questioned the wisdom of pulling perhaps the only qualified EMS medic from a rural area to send him or her to a board meeting. STEVEN O'CONNOR, Assistant Chief, Central Emergency Services, Kenai Peninsula Borough, next came before committee. He explained that he also serves as chair of the Governor's Advisory Council on Emergency Medical Services. The current council worked closely with state and regional EMS offices to bring about the technical assistance review team study. It has since moved on to support and enforcement of recommendations from the study. SSSB 71 is viewed as key legislation to bring the EMS system up to date. Speaking to accompanying fiscal notes, Mr. O'Connor termed them "conservative," given systemwide potential for impact on long-term health care costs. He urged support for the legislation. Co-chair Frank made reference to department movement of funding from budgetary grant line items into administrative functions. Mr. O'Connor said that he could not recall such a transfer. Co-chair Frank noted requests from the EMS regional councils for an increase to make up for previous cuts. Mr. O'Connor acknowledged that regional directors have asked for grant increments to support regional activities. He attested to the fact that these councils work hand-in-hand with the state EMS office. In response to a comment by Senator Rieger, Mr. O'Connor voiced his understanding that fiscal note costs relate to: 1. Implementation of the review system 2. Setting up of standards for hospital application to become trauma centers 3. Recruitment of inspection teams for hospital audit 4. Establishment of the patient care information system. MARK JOHNSON, Chief, Emergency Medical Services, Dept. of Health and Social Services, came before committee. Senator Rieger inquired concerning the relative value of the patient care information system when compared to hospital certification. Mr. Johnson explained that the patient care information system "is a way to evaluate what we're doing." He acknowledged programs whereby the state spends substantial sums without knowing whether or not the programs work. The system will also highlight areas where additional training is needed as well as define need for better protocol in the flow and handling of patients. It assists both hospitals and prehospital ambulance services with data that tells them "how good a job they did." It also provides information on the causes and severity of injuries that will hopefully help prevent them in the future. Mr. Johnson said there had been no movement of moneys from regions to the department office. The two positions requested in the fiscal notes are presently on staff and will have to be laid off in the fall if funding is not provided. The grant involved in the effort is four years in duration and will stop at the end of that time. Department staff works diligently to garner federal grants. Most of that funding is passed through to the regions. Mr. Johnson acknowledged need for increased funding at regional levels to train medics for rural Alaska. He then requested that committee members read the division's annual report which summarizes state and regional activities. Department staff has agreed to absorb some of the extra duties under the proposed bill, such as certifying of emergency medical dispatchers, establishment of standards for paramedic training programs, etc. In response to a question from Co-chair Pearce, Mr. Johnston explained that information gathering has been ongoing since 1988. Information flowing to the division is returned to hospitals and ambulance services in monthly or quarterly reports. Injuries, like diseases, are in clusters. The more that is understood about clusters, the better the chance to prevent the injuries. Mr. Johnson pointed to an ongoing study of commercial fishing injuries as an example. Senator Sharp expressed reluctance to add positions, previously funded under federal grants, to the state payroll. He then inquired concerning whether the proposed legislation would qualify as a safety program under ISTEA funding. Senator Rieger advised that he had raised the issue in the Dept. of Public Safety budget subcommittee. The impression at the time was that it would qualify under highway safety planning moneys. Senator Kelly inquired regarding existing staff size. Mr. Johnson explained that the EMS program is authorized 10 positions. There are currently 9 employees. Three are under federal grants and might be gone by fall. Staff supports EMS programs through establishment of standards for training programs. It does all of the certifying and provides technical assistance to regional councils, advisory councils, and volunteer efforts. Staff recently prepared and distributed a new medivac manual and a billing manual for volunteer ambulance services. Division prepared treatment guidelines help doctors keep up with state-of-the- art treatments. Much effort is hands-on training. Senator Jacko MOVED for adoption of Corrected Amendment No. 1. No objection having been raised, Corrected Amendment No. 1 was ADOPTED. Co-chair Pearce then queried members concerning disposition of the bill. Senator Sharp MOVED that CSSSSB 71 (Fin) pass from committee with accompanying fiscal notes. Senator Kelly raised OBJECTION to the fiscal notes. Senator Rieger voiced his understanding that the committee is not obligated to fund any fiscal note and could address the issue at conference committee on the budget. He expressed further skepticism concerning federal grants that lead to state funded positions. Senator Kelly concurred. He suggested that the funding of additional positions in times of tight budgets often means that as money becomes tighter elsewhere, centralized planners draw funds from other areas to maintain the bureaucracy and keep new positions on. He further suggested that portions of the bill requiring additional staff be removed or that those activities be undertaken with existing staff. Senator Rieger noted that federally funded employees have been performing the work up to this time. Senator Leman explained that March 16 has been designated EMS day in the legislature. He voiced his hope to have the bill on the floor in recognition of that designation. Senator Kelly suggested that the bill be amended to make the patient care information system permissive rather than mandatory. The bill could then be moved from committee for floor action, and the fiscal note could be dealt with at a later time. Senator Sharp WITHDREW his motion for passage of CSSSSB 71 (Finance). No objection having been raised, the motion was WITHDRAWN. Senator Kelly directed attention to Page 4, Line 19, and MOVED to change "shall" to "may." That would provide flexibility. If funding is available, the project could proceed. Co-chair Pearce asked what changes the fiscal note would incur as a result of the amendment. Mark Johnson said he would still ask for the fiscal note. The division would do whatever it could with the funding it receives. Co-chair Pearce questioned whether the change from "shall" to "may" would adequately address concerns raised by members. Senator Leman noted that other sections and subsections may require slight revisions as a result of the language change. He specifically noted language requiring hospitals to provide information to the department and questioned need for that if the patient care information system is not to proceed. Co-chair Pearce concurred in need to review all sections prior to movement of the bill. At the request of the Co-chair, Senator Kelly WITHDREW his amendment. Ch-chair Pearce then directed that the bill be HELD until the next meeting and asked that Senator Leman work with Senator Rieger, chairman of the Health, Education, and Social Services subcommittee, on proposed amendments to satisfy fiscal concerns. Prior to conference on the budget, members will also review the possibility of using "helmet safety funds for education." ANNOUNCEMENT Co-chair Pearce advised that the Wednesday meeting would begin at 8:30 a.m. SB 84 will be taken up at that time. ADJOURNMENT The meeting was adjourned at approximately 10:20 a.m.