SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE April 12, 1999 1:32 p.m. MEMBERS PRESENT Senator Mike Miller, Chairman Senator Pete Kelly, Vice-Chairman Senator Gary Wilken Senator Drue Pearce Senator Kim Elton MEMBERS ABSENT All members were present COMMITTEE CALENDAR SENATE BILL NO. 71 "An Act relating to licensure by the State Medical Board." -MOVED CSSB 71(HES) OUT OF COMMITTEE Briefing by the Alaska Food Coalition SENATE BILL NO. 21 "An Act making an appropriation for construction and renovation of the University of Alaska, Anchorage Consortium Library Facility; and providing for an effective date." -MOVED SB 21 OUT OF COMMITTEE PREVIOUS SENATE COMMITTEE ACTION SB 71 - See HESS minutes dated 4/7/99 SB 21 - No previous action to report WITNESS REGISTER Dr. Sarah Isto, Chair State Medical Board 1718 Willow Drive Juneau, AK 99801 POSITION STATEMENT: Supported SB 71 Ms. Catherine Reardon, Director Division of Occupational Licensing Department of Commerce & Economic Development PO Box 110806 Juneau, AK 99811 POSITION STATEMENT: Supported SB 71 Senator Johnny Ellis Alaska State Capitol Juneau, AK 99801-1182 POSITION STATEMENT: Presented SB 21 Chancellor Gorsuch University of Alaska Anchorage 3211 Providence Drive Anchorage, AK 99508-4675 POSITION STATEMENT: Supported SB 21 Mr. Steve Rawlins, Dean UAA Library University of Alaska Anchorage 3211 Providence Drive Anchorage, AK 99508-4675 POSITION STATEMENT: Supported SB 21 Mr. Joshua Hunter, President Union of Students University of Alaska Anchorage 3211 Providence Drive Anchorage, AK 99508-8362 POSITION STATEMENT: Supported SB 21 ACTION NARRATIVE TAPE 99-18, SIDE A Number 001 SB 71-PHYSICIAN LICENSURE CHANGES CHAIRMAN MILLER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:32 p.m. and brought up SB 71. After SB 71, the committee would hear a briefing by the Alaska Food Coalition, followed by SB 21. Number 010 DR. SARAH ISTO, Chairman of the Medical Board, spoke on behalf of the board in support of SB 71, and expressed its appreciation of Senator Miller and the committee for introducing this bill which is important for the board's functioning and for Alaskans who are patients. As background she noted there are about 2,000 licensed physicians in the state, of whom about 400 are osteopaths and the remainder, medical doctors. The board also licenses paramedics and physician assistants, but this bill doesn't include those practitioners who are in an up-to-date statute. SB 71 deals with older provisions in the statute relating to medical doctors. There is no reciprocity for medical licenses in the U.S. which means each state sets its own standards, requiring people to apply in each state they practice. DR. ISTO said Alaska statutes should meet at least the same kind of standards that other states require in order to get competent practitioners in our state. DR. ISTO proceeded to explain the statute changes in SB 71 summarized in her letter to Senator Miller on April 7. She said she grouped items together by subject matter in paragraphs rather than by numerically following the statute. The italicized language in her letter explains the board's reasoning and concerns that led to these requested changes. Paragraph (1) relates to the current situation in Alaska when someone with a felony conviction applies for a medical license. The board can consider the conviction only if it occurred in the course of their practice of medicine or their duties as a physician. The board received an application for a medical license from penitentiary from someone who committed a brutal murder, and the statute did not allow consideration of that part of the applicant's history because it did not involve a patient and was it not committed in the office or the hospital. DR. ISTO stated, "Fortunately, there were other problems with that application and we did not grant that person a license, because we would have been very nervous, not being able to evaluate that part of the license." This change adds language on a felony or misdemeanor substantially related to the licensee's fitness to practice. A felony conviction for tax evasion might not be considered by the board, but a brutal murder should be. Paragraph (2) adds "or its designee," and is a housekeeping measure relating to licensed physicians who, when renewing their license, are required to have 34 hours of continuing medical education. The board sets up a plan, and physicians must wait until the board meets again and even suspend their practice. This language change would avoid having that delay built into a routine matter. Paragraph (3) refers to Section 5 in the bill, another housekeeping item relating to temporary or "locum physicians" replacing doctors on vacation. The temporary physicians cannot renew that permit without the board taking action at the moment the permit expires. The board feels the renewals could be handled by the board's staff. Paragraph (4) refers to Section 4 in the bill regarding physicians in training. The only training program in Alaska is the three-year Alaska Family Practice residency in Anchorage. Current statute allows a permit to practice under the supervision of a training program for only one year. By the time they complete their one year, they must take an exam and get the results before they can get an active license. If SB 71 passes, those who are foreign medical graduates would be required to complete their entire training before obtaining an independent license. This would enable the board to renew those permits. Paragraph (5) refers to Section 5. Currently the statute considers only a suspension or revocation in another state in a new applicant's file. But states also deny or have licenses surrendered while an applicant is under investigation for violations of law, or restrict or condition licenses, or place people on probation. The board wants to be able to consider those actions. This change would expand the language to include the kinds of actions that other boards use. Paragraph (6) refers to Section 1. Alaska is the only state that requires citizenship of an applicant or permanent residence. There are physicians legally here under visas allowing them to practice temporarily, but they are not citizens or permanent residents. A visiting specialist who is excellent couldn't be granted a license by the board. Foreign trained physicians will have already had three years of training according to this bill. Paragraph (7) refers to Section 3. Forty-three states require three years of post-graduate training for physicians who graduated from foreign medical schools. Alaska does not have a way to evaluate foreign education or, as in the case of Burma, even to get the records. To confirm competency, most states require foreign graduates to be trained in the U.S. in an accredited residency program where they will be supervised for three years. The board would like to do the same thing. Paragraph (8) refers to Sections 2 and 6 and relates to applicants who are U.S. and Canada trained and not considered to be from a foreign medical school. Currently Alaska requires one year of post-graduate training. There are few two-year programs, with most programs lasting three to five years. The board wants to recognize that situation and require those graduating after 1995 to have at least 2 years, in order to evaluate competency. On the other hand, if someone graduated in 1978, they have had a long work experience and the board can evaluate that they are competent. DR. ISTO concluded that in Alaska it's extremely important for practitioners to have good skills and judgment, especially in rural Alaska where there aren't a lot of specialists and equipment. Thirty people were licensed at the last board meeting, and only one would not have met these proposed criteria. Number 205 SENATOR PEARCE asked if the Medical Board is notified when a malpractice suit is filed or only if there's an actual judgment against a doctor. DR. ISTO replied a judgment or a settlement is required to be reported to the board. The attorneys are aware of that requirement and the board has sent out newsletters reminding the licensees of it. The malpractice companies are careful to ensure that reporting is done. She believed the board receives most of the reports. SENATOR PEARCE asked if the board requires doctors to have malpractice insurance. DR. ISTO answered "No, the board doesn't get into the insurance business. Someone can be uninsured, but they are still required to report." SENATOR PEARCE asked if there could be a number of reports before the board would evaluate a physician. DR. ISTO replied the board looks at certain types of malpractice issues involving alcohol or negligence. A pattern would concern the board, but there is no computerized system and each report is scanned on arrival. A patient can file a malpractice action and complain to the board. All complaints to the board are evaluated, and the board knows if there have been a number of complaints against a doctor. Number 258 SENATOR ELTON said he appreciated Dr. Isto's concise sectional analysis of the bill. SENATOR PEARCE asked if there is a companion bill in the House. DR. ISTO replied there is not, but the House expressed earlier interest in the issue. SB 71 has a zero fiscal note. SENATOR PEARCE asked if most hospitals require their doctors to carry malpractice insurance. DR. ISTO responded she believed that is true. CHAIRMAN MILLER interjected he believed Ms. Isto is correct, recalling that was an issue in tort reform a couple years ago. He asked for a motion to adopt the Committee Substitute. SENATOR WILKEN moved to adopt CSSB 71 (HES) Version D Lauterbach 4/7/99 in lieu of the original bill. Without objection, it was so ordered. Number 288 MS. CATHERINE REARDON, Director of the Division of Occupational Licensing, Department of Commerce & Economic Development spoke in support of the bill. She stated her division provides staff support to the state Medical Board. The department appreciates the time the committee has put into introducing and crafting the bill. Following up on the previous discussion, MS. REARDON clarified the board doesn't have statutory authority to require malpractice insurance, and it would require legislative action if the committee wanted to do that. CHAIRMAN MILLER asked the wish of the committee. SENATOR WILKEN moved to report CSSB 71 (HES) out with individual recommendations and attached zero fiscal note. Without objection, it was so ordered. Number 315 MS. SAMANTHA CASTLE KIRSTEIN, Executive Director of Fairbanks Community Food Bank (FCFB), thanked the Fairbanks members of the committee as individual donors to the FCFB. She introduced Mr. Wendell Otness, Executive Director of Fairbanks Rescue Mission, and Mr. George Hieronymous, Jr., Executive Director of Bean's Cafe in Anchorage. She said they represent the Alaska Food Coalition, a group of independent grass-roots individuals from city and village networks. There is no statewide advocacy group or state or federal funding for the issue of hunger The coalition asks the committee to abandon HB 161/SB 126 which would reduce payments to individuals under certain benefit programs until the following conditions are met: the effects of the welfare reform process are understood; legislators remove the vague language from the bill; the Department of Law finds the bill constitutional(it currently recommends it is not); and there is good faith and fair dealing with the providers. As people are moved from state welfare rolls, MS. KIRSTEIN said, the safety net of local agencies and the community must gear up. The coalition is worried about nonprofit response, and some communities haven't yet taken the step of caring for their own. She said the real question now is what is happening to the people being removed from the welfare rolls: are they strong healthy self-sufficient contributing members of their communities? Do they need further assistance? Number 402 MR. WENDELL OTNESS stated Fairbanks has been very supportive of the Food Bank and Rescue Mission, and several other organizations. The federal numbers indicate the Welfare to Work program is working. The mission helps people get GEDs, and single mothers who can't survive on the minimum wage with day care costs use the services at the mission. People exist through a combination of welfare, work, and service organizations. MR. OTNESS described "the working poor" as a married couple who both have jobs but live at the mission because they can't afford housing. No one really knows where the welfare people have gone. He'd like to see the numbers before stating the program is a success, and it may take a few years, as Ms. Kirstein said. He told the committee the Rescue Mission would like to see a five-year program before cuts are made or successes are proclaimed. Number 442 MR. GEORGE HIERONYMOUS, Executive Director of Bean's Cafe, stated that Bean's feeds and provides a day shelter for homeless men and women. Last July Bean's took over a small program called Kids Kitchen begun a couple years ago by Eldon Jones. It now includes 4 sites and 220 children a day getting a hot after-school meal. He estimated feeding 600-700 children a day by next year at this time, in about a 4-neighborhood area of Anchorage. The Children in Transition Title I program for homeless children estimates 3,000 kids are eligible for their program. MR. HIERONYMOUS stated he doesn't know if he can feed 3,000 kids every day. With the Welfare to Work rule, he asked what happens to the people when you tell them they've lost their benefits. "Am I seeing them at Bean's or their children at Kid's Kitchen because they don't have food at home?" The parents just aren't there to feed the kids. In making decisions on the budget and on DHSS bills, he encouraged the committee to keep in mind the long-range outcome. The great majority of the children they feed are under 11 years old. Kids Kitchen serves at Fairview Community Center, Mt. View Elementary, Mt. View Boys and Girls Club, and NE Community Center in Muldoon. MR. HIERONYMOUS said they're looking to expand that program to four or five more sites, adding several hundred more kids. CHAIRMAN MILLER asked the speakers to provide written copies of their testimony to the committee. Number 481 SENATOR WILKEN asked Ms. Kirstein how long she's been with the Food Bank. She replied 10 years, and added that it provides 2-5 tons of food each day, and collects 1.5 million pounds of food a year. Prompted by Senator Wilken, she related the story of the $1.5 million building on South Cushman that Dennis Weiss donated to the Food Bank. On February 8 the Food Bank moved into the turnkey building that's mortgage free. Other groups donated manpower and materials. This donated building has allowed the Food Bank to focus on the program. Fifty percent of the people served are children, and MS. KIRSTEIN said " that's just not acceptable." SENATOR WILKEN noted that legislative citations prepared for the building donors will be presented in June. He asked Mr. Otness if the female dormitory at the Rescue Mission is new. MR. OTNESS replied it was built in 1985. Until four years ago, there was low occupancy because of its reputation of being unsafe. The zero tolerance in alcohol has changed it from a flophouse. There's room for 28 women with children, and four are currently in the recovery program for women. SENATOR WILKEN asked how his program differs from WICCA. MR. OTNESS said WICCA handles mostly abused wife and emergency situations. For security reasons, the Rescue Mission doesn't do emergencies, but it coordinates with WICCA. CHAIRMAN MILLER thanked the speakers. There are several successful programs the Fairbanks business community has been involved in, such as Scan Away at Christmas, and CHAIR MILLER felt it should become the statewide direction. The bookkeeping is minimal and it's a way for businesses and the general public to help. SENATOR WILKEN asked if Scan Away was a statewide program. MR. OTNESS said it originated in Syracuse, New York. It brought in $25,000 this year, split between the mission and food bank in Fairbanks. MS. KIRSTEIN explained it is the trademark Rescue Mission program and Carr's is sponsoring it in Anchorage as "Swipe Away." A local program at Carr's will benefit the SE Alaska Food Bank. CHAIRMAN MILLER remarked that it's a program that could expand beyond grocery stores to businesses with a lot of clientele. SB 21-APPROP: UAA CONSORTIUM LIBRARY FACILITY CHAIRMAN MILLER brought up SB 21, and stated that Senator Ellis would present the bill. Number 564 SENATOR JOHNNY ELLIS, sponsor of SB 21 expressed appreciation of the committee for hearing the bill. Last year the legislature passed an amendment by Senator Kelly during deliberations on the capital budget that allowed the University of Alaska Anchorage to take deferred maintenance monies of about $10 million to begin work on this project. This bill proposes to appropriate from the General Fund the balance of monies needed to complete the project. Expansion of the library is essential for continued national accreditation. Support of the project is widespread among students, faculty and staff, and the general public. The UAA Library operates the most active inter-library loan program in Alaska. The project will provide new opportunities to train the future workforce in the state. SENATOR ELLIS said his true purpose is to get this on the agenda of the Finance Committee as a project in the capital construction budget and leave the exact appropriation amount and source of funding to their wisdom and experience. CHANCELLOR GORSUCH, on-line from Anchorage, spoke in support of SB 21. He said the UAA Library is 25 years old, and the student body has doubled in that time. TAPE 99-18, SIDE B Number 588 CHANCELLOR GORSUCH discussed the issues of the expansion of the library and the materials contained in it. ARILS is a collection of 8 previously independent natural resource libraries of both federal and state agencies located in a consolidated facility on C Street. UAA plans to make ARILS an integral part of its expanded library. He said UAA hopes to find other partners to join in the library expansion. He pointed out the resolutions passed by the Municipality, Anchorage Chamber of Commerce that indicate this is a high priority project. Number 556 SENATOR WILKEN asked if society is moving away from libraries. Law offices are now being built without libraries, and instead use the space for computers and offices for more attorneys. He asked, "Do we really need a $30 million library?" Would the money be better spent for a smaller building with greater distributive capacity for access by people with computer terminals? COMMISSIONER GORSUCH replied it's a good question. Steve Rawlins, Dean of the Library, is very familiar with the emergence of the electronic library, and would follow up on his comments. The chief director of the Library of Congress informed the commissioner that it was unlikely within the next 30 to 40 years that more than 30% of the Library of Congress's hard copy holdings would be fully digitized and available in electronic form. In the chief director's estimate, the written book will not die, and we will continue to have many of our historical materials in hard copy, while seeing a continued explosion of information in electronic form. COMMISSIONER GORSUCH said he has been cautioned about digitizing library holdings because with every major computer upgrade, data and information get lost in the conversion process. For archival reasons, there's a strong recommendation for continuing to have hard copy as a backup. COMMISSIONER GORSUCH explained to Senator Wilken that a major portion of the library includes study areas for students. The current reference library facilities are undersized. The $40 million fiscal note would simply bring the library expansion up to the maximum capacity standards at the time the library opens, and would not accommodate needs for the next 20 to 30 years. He said he is banking that some of the electronic holdings will diminish the demands on the library. Number 496 MR. STEVE RAWLINS, Dean of UAA Library, stated he likes to think of the library of the 21st century as a place that holds "collections and connections." Last year 65,000 books were published and very few appeared on the Internet. In planning a library for the 21st century you have to accommodate the people, the instruction occurring in the building, the existing and growing print collections, and the network connections. COMMISSIONER GORSUCH asked Mr. Rawlins to discuss the collaboration with the Municipality, the Rasmussen Library and the state library, and how people outside the Anchorage area will be beneficiaries of this project. MR. RAWLINS explained that electronic connections are being established as well as partnerships with other libraries. UAA teams up with other university libraries to save money by jointly licensing electronic library products. It will develop a joint system with the Anchorage Municipal Library where people can access the holdings from the UAA Consortium Library and all the extended campuses of UAA on one database. It will also develop more electronic access and digital formats through the Internet and Worldwide Web. Number 451 MR. JOSH HUNTER, UAA Student President, spoke from the students' perspective. He said that since the first semester he attended UAA, the students have complained bitterly about the current state of the library. Depending upon the program, there is a lag time in current research and available documents. Research documents for medical and biology students have been cut off, and there have been cuts in journal acquisition over the past four years. When students go on with their education or go to work in their fields, they are several years behind in knowing what's currently going on. Faculty can only spend so much of their own money copying and distributing important journal articles. MR. HUNTER said many students have flown to libraries in Washington and Oregon and paid to become members in order to obtain current research information. He urged the committee to look further ahead and build for tomorrow, not for today. CHAIRMAN MILLER asked the wish of the committee. SENATOR PEARCE moved SB 21 from committee with individual recommendations. Without objection, it was so ordered. The committee adjourned at 2:40 p.m.