ALASKA STATE LEGISLATURE  SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 14, 2024 3:32 p.m. MEMBERS PRESENT Senator David Wilson, Chair Senator James Kaufman, Vice Chair Senator Forrest Dunbar Senator Cathy Giessel MEMBERS ABSENT  Senator Löki Tobin COMMITTEE CALENDAR  CONFIRMATION HEARING(S) State Medical Board David Paulson - Anchorage - CONFIRMATION ADVANCED HOUSE BILL NO. 57 "An Act relating to review organizations and permitting an emergency medical services provider to establish a review organization; and relating to patient records." - HEARD & HELD SENATE BILL NO. 181 "An Act relating to placement of a child in need of aid; relating to adoption; and providing for an effective date." - MOVED CSSB 181(HSS) OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION  BILL: HB 57 SHORT TITLE: EMERGENCY MED. SVCS: REVIEW ORGANIZATIONS SPONSOR(s): REPRESENTATIVE(s) WRIGHT 02/03/23 (H) READ THE FIRST TIME - REFERRALS 02/03/23 (H) L&C, HSS 02/17/23 (H) L&C AT 3:15 PM BARNES 124 02/17/23 (H) Heard & Held 02/17/23 (H) MINUTE(L&C) 03/03/23 (H) L&C AT 3:15 PM BARNES 124 03/03/23 (H) Moved HB 57 Out of Committee 03/03/23 (H) MINUTE(L&C) 03/06/23 (H) L&C RPT 4DP 1NR 03/06/23 (H) DP: SADDLER, PRAX, RUFFRIDGE, SUMNER 03/06/23 (H) NR: CARRICK 03/21/23 (H) HSS AT 3:00 PM DAVIS 106 03/21/23 (H) Heard & Held 03/21/23 (H) MINUTE(HSS) 03/28/23 (H) HSS AT 3:00 PM DAVIS 106 03/28/23 (H) Moved HB 57 Out of Committee 03/28/23 (H) MINUTE(HSS) 03/29/23 (H) HSS RPT 5DP 03/29/23 (H) DP: RUFFRIDGE, SUMNER, FIELDS, MINA, PRAX 05/09/23 (H) TRANSMITTED TO (S) 05/09/23 (H) VERSION: HB 57 05/10/23 (S) READ THE FIRST TIME - REFERRALS 05/10/23 (S) L&C, HSS 02/12/24 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg) 02/12/24 (S) Heard & Held 02/12/24 (S) MINUTE(L&C) 02/21/24 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg) 02/21/24 (S) Moved HB 57 Out of Committee 02/21/24 (S) MINUTE(L&C) 02/23/24 (S) L&C RPT 4DP 02/23/24 (S) DP: BJORKMAN, DUNBAR, GRAY-JACKSON, MERRICK 03/14/24 (S) HSS AT 3:30 PM BUTROVICH 205 BILL: SB 181 SHORT TITLE: CHILD PLACEMENT; DILIGENT SEARCH SPONSOR(s): SENATOR(s) BJORKMAN 01/16/24 (S) READ THE FIRST TIME - REFERRALS 01/16/24 (S) HSS 02/15/24 (S) HSS AT 3:30 PM BUTROVICH 205 02/15/24 (S) Heard & Held 02/15/24 (S) MINUTE(HSS) 02/29/24 (S) HSS AT 3:30 PM BUTROVICH 205 02/29/24 (S) Heard & Held 02/29/24 (S) MINUTE(HSS) 03/14/24 (S) HSS AT 3:30 PM BUTROVICH 205 WITNESS REGISTER REPRESENTATIVE STANLEY WRIGHT, District 22 Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Sponsor of HB 57. RACHEL GUNN, Staff Representative Stanley Wright Alaska State Legislature Juneau, Alaska POSITION STATEMENT: BRIAN WEBB, representing self Anchorage, Alaska POSITION STATEMENT: Invited testimony for HB 57. DAVID PAULSON, M.D., Appointee State Medical Board Anchorage, Alaska POSITION STATEMENT: Testified as the governor's appointee to the State Medical Board. SENATOR JESSE BJORKMAN, District D Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Sponsor of SB 181. LAURA ACHEE, Staff Senator Jesse Bjorkman Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Provided an overview of SB 181 and an explanation of the proposed amendment. ACTION NARRATIVE 3:32:58 PM CHAIR DAVID WILSON called the Senate Health and Social Services Standing Committee meeting to order at 3:32 p.m. Present at the call to order were Senators Giessel, Dunbar, Kaufman, and Chair Wilson HB 57-EMERGENCY MED. SVCS: REVIEW ORGANIZATIONS  3:33:50 PM CHAIR WILSON announced the consideration of HOUSE BILL NO. 57 "An Act relating to review organizations and permitting an emergency medical services provider to establish a review organization; and relating to patient records." 3:34:14 PM REPRESENTATIVE STANLEY WRIGHT, District 22, Alaska State Legislature, Juneau, Alaska, Sponsor of HB 57 stated the bill corrects an inequity affecting emergency medical services (EMS) in Alaska by extending quality assurance program protections to EMS workers, which fixed healthcare facilities have had for years. He noted that several states have already recognized the need for such protections for EMS systems. Alaska's EMS system, especially in rural areas, relies heavily on volunteers, including medical directors who are often physicians ensuring communities have access to state-certified emergency services. He emphasized a discrepancy where these physicians have quality assurance protections in their primary roles at clinics and hospitals but lose those protections when serving as EMS medical directors, threatening the health and safety of Alaskans and the sustainability of rural EMS systems. 3:36:05 PM RACHEL GUNN, Staff, Representative Stanley Wright, Alaska State Legislature, Juneau, Alaska, said EMS represents a vital intersection of transportation, safety, medical, and public health disciplines, with emergency physicians playing a critical role. She explained that these physicians extend their expertise beyond hospital walls, guiding EMTs and paramedics through medical control, issuing treatment orders, and establishing prehospital protocols to direct patient care before hospital arrival. EMS professionals, including Emergency Trauma Technicians (ETTs), Mobile Intensive Care Technicians (TMTs), paramedics, and medical directors, engage in critical self- reflection to assess what went well, what could improve, and factors contributing to poor outcomes. She emphasized that while peer review boards and quality assurance programs encourage continuous evaluation, the legal protections for hospital-based medical directors do not extend to EMS review processes. She argued that HB 57 is necessary to protect peer review discussions from legal exploitation, ensuring that EMS professionals can openly discuss improvements without fear of litigation, which is crucial for continuous EMS advancement and safety. 3:38:13 PM MS. GUNN provided the following sectional analysis for HB 57: [Original punctuation provided.] SECTIONAL ANALYSIS  HB 57  Emergency Medical Services Quality  Assurance Program Protections  SECTIONAL ANALYSIS HB 57 Emergency Medical Services Quality Assurance Program Protections Section I:    Amends AS 18.23.070(1) to Include EMT's, dispatchers, and paramedics in the definition of "health care provider" for the purpose of peer review protection. Section II:    Amends the definition of "healthcare provider" in AS 18.23.070(3) to include EMS agencies and employees who are conducting peer review activities. Section III:    AS 18.23.070(5) is amended to include emergency medical services agencies and employees under the definition of a "review organization" 3:39:17 PM CHAIR WILSON announced invited testimony on HB 57. 3:39:28 PM BRIAN WEBB, representing self, Anchorage, Alaska, stated SB 57 aims to address the omission of EMS in the original statute by extending the same protections that fixed healthcare facilities have to Alaska EMS services. He explained that Alaska EMS requests an amendment to AS 18.23.070 to broaden the definitions of covered entities, as the current wording does not include EMS personnel or activities. He noted that EMS providers are aware that what is discussed or documented in review processes is legally discoverable, leading to hesitation in sharing information, which hinders education and patient care improvements. The lack of protections impacts EMS retention, with valuable volunteers, clinicians, and critical medical directors leaving the system due to the absence of legal safeguards. He emphasized that rural towns in Alaska rely on volunteer medical directors, who have legal protections in their day jobs but not when volunteering, making HB 57 crucial. He cited a tenfold increase in EMS medical director litigation since COVID-19, mostly related to administrative duties, and noted that other states, including California, Arizona, Florida, and Washington, have already enacted similar protections. 3:43:00 PM MS. GUNN stated Dr. Livengood was on a medical emergency but provided a written testimony. 3:43:11 PM CHAIR WILSON opened public testimony on HB 57; finding none, he closed public testimony. 3:43:41 PM SENATOR KAUFMAN opined that HB 57 is sensible as it provides protection and opens communication channels to include EMS personnel in discussions about continuous improvement and quality management. 3:44:22 PM REPRESENTATIVE WRIGHT thanked the committee for hearing HB 57. 3:44:41 PM CHAIR WILSON held HB 57 in committee. ^CONFIRMATION HEARING(S) CONFIRMATION HEARING(S)  STATE MEDICAL BOARD  3:44:48 PM CHAIR WILSON announced the consideration of governor appointee Dr. David Paulson to the State Medical Board. 3:45:23 PM DAVID PAULSON, M.D., Appointee, State Medical Board, Anchorage, Alaska, provided a brief overview of his work on the State Medical Board, including quality control of candidates applying for licenses in Alaska and assisting with investigations. He mentioned his participation in board actions and noted that this was his first experience serving on a board. He expressed his interest in continuing to serve and protect Alaskans. 3:46:29 PM SENATOR GIESSEL asked Dr. Paulson to share his philosophy on pain medication and management. She specifically requested his perspective as a neurosurgeon on the use of opioids, either before and after surgery. DR. PAULSON replied that preoperatively, it is important for him to have patients reduce their pain medication to the lowest possible amount. He collaborates with other medical professionals to assess patients and typically asks them to decrease their pain medication by half. He stated that postoperatively, beyond two weeks, he is not involved in pain management, as it is handled by a pain specialist. SENATOR GIESSEL apologized and clarified that she should have disclosed her background as a board-certified family practice nurse practitioner, which was the reason for her question on pain management. 3:47:46 PM SENATOR DUNBAR asked what the "hot" topics or pressing issues are expected to be in the coming term. DR. PAULSON stated that unless the legislature addresses reforms for physician assistants (PAs) and pharmacy practices, certain issues need to be clarified. Specifically, he mentioned the need to sort out pharmacists' authority to write certain prescriptions and increasing autonomy for PAs. He noted these are important questions for the board to address. 3:48:44 PM CHAIR WILSON asked if he foresees any regulatory difficulty with the board. DR. PAULSON asked for further elaboration on the question. CHAIR WILSON said his question relates to the change in scope of practice for physician assistants (PAs) and other issues that might fall under the board's purview. He mentioned that the Medical Board had a recent change with EMS oversight moving to the Department of Health and inquired if there are any other items the board might be considering in the future, seeking general insights. 3:49:50 PM DR. PAULSON apologized and stated that nothing comes to mind. 3:50:10 PM DR. PAULSON thanked the committee for their consideration. 3:50:25 PM CHAIR WILSON solicited a motion. 3:50:27 PM SENATOR KAUFMAN moved that the consideration of Dr. David Paulson, appointee to the State Medical Board, be forwarded to a Joint Session of the legislature. He reminded members that signing the report(s) regarding appointments to boards and commissions in no way reflects individual members' approval or disapproval of the appointees; the nominations are merely forwarded to the full legislature for confirmation or rejection. 3:50:42 PM CHAIR WILSON found no objection. [In accordance with AS 39.05.080, the Senate Health and Social Services Standing Committee reviewed the following and recommends the appointments be forwarded to a joint session for consideration: State Medical Board David Paulson - Anchorage 3:50:54 PM At ease SB 181-CHILD PLACEMENT; DILIGENT SEARCH  3:52:50 PM CHAIR WILSON reconvened the meeting and announced the consideration of SENATE BILL NO. 181 "An Act relating to placement of a child in need of aid; relating to adoption; and providing for an effective date." CHAIR WILSON stated that at the committee's last hearing CSSB 181, version Y, was adopted. 3:53:52 PM CHAIR WILSON solicited a motion. 3:53:46 PM SENATOR KAUFMAN moved to adopt Amendment 1, work order 33- LS0348\Y.1, to SB 181. 33-LS0348\Y.1 Bergerud 3/5/24   A M E N D M E N T 1 OFFERED IN THE SENATE TO: CSSB 181(HSS), Draft Version "Y" Page 1, line 13: Delete "has the status of an intervenor for purposes  of that hearing" Insert "does not become a party to the case" 3:53:49 PM CHAIR WILSON objected for purposes of discussion. 3:53:59 PM SENATOR JESSE BJORKMAN, District D, Alaska State Legislature, Juneau, Alaska, sponsor of SB 181, explained that the need for Amendment 1 (Y.1) arose due to conflicting opinions between the drafters of the law and the court system, which is responsible for implementing it. He stated that it was decided, for the sake of prudence, that those in charge of implementing and applying the law should have their perspective prevail. 3:54:41 PM CHAIR WILSON asked for a brief overview of SB 181. 3:54:44 PM LAURA ACHEE, Staff, Senator Jesse Bjorkman, Alaska State Legislature, Juneau, Alaska, provided an overview of SB 181 and an explanation of the proposed amendment. She stated that the overall purpose of SB 181 is to amend the state's Child in Need of Aid law to allow foster parents to request a hearing when necessary. It also grants courts and the Department of Family and Community Services more discretion in making placements that serve the best interests of the child. 3:55:21 PM At ease 3:55:39 PM CHAIR WILSON reconvened the meeting. 3:55:42 PM MS. ACHEE said SB 181 establishes clear statutory requirements for the Office of Children's Services to conduct family searches, ensuring timely placement of children with an adult family member or family friend, if available. In SB 181, version Y, Section 1, language was added to address concerns from both the Alaska Court System and the Department of Family and Community Services. It clarifies that while foster parents may request a hearing, they are not a party to the case. An agreement was reached to address the court's concerns, adding clarity without changing the bill's intent. 3:56:54 PM SENATOR GIESSEL asked the meaning of "a party to the case." MS. ACHEE stated her belief that being "a party to the case" gives a person greater precedence in the case and grants complete access to files, including private and confidential information. 3:57:29 PM SENATOR GIESSEL asked Ms. Achee to incorporate that information into the sentence being amended and clarify the full meaning of "a party to the case." 3:57:55 PM SENATOR GIESSEL interjected to clarify that she was not asking how the amendment would look in SB 181 but wanted to understand what the application of being "a party to the case" would mean in practice. MS. ACHEE explained her understanding that under the original statute, a "party" to the case, such as a parent, could request a hearing. The concern arose that allowing a foster parent to request a hearing without clarification might lead courts to interpret this as making foster parents a party to the case, giving them full access rights to information. The change allows foster parents to request a hearing, but it makes clear they do not receive all the rights and access that are given to a party. 3:59:06 PM CHAIR WILSON removed his objection; finding no further objection Amendment 1 (Y.1) was adopted. 3:59:14 PM CHAIR WILSON stated that before the committee is CSSB 181, as amended. 3:59:26 PM SENATOR BJORKMAN thanked the committee for their consideration as SB 181 goes a long way in making sure there are better outcomes for children facing foster care. 3:59:49 PM CHAIR WILSON solicited a motion. 3:59:53 PM SENATOR KAUFMAN moved to report CSSB 181, work order 33- LS0348\Y, as amended, from committee with individual recommendations and attached fiscal note(s). 4:00:09 PM CHAIR WILSON found no further objection and CSSB 181(HSS) was reported from the Senate Health and Social Services Standing Committee. 4:00:32 PM There being no further business to come before the committee, Chair Wilson adjourned the Senate Health and Social Services Standing Committee meeting at 4:00 p.m.