This hearing the Senate Health and Social Services Committee will now come to order.
Today is Thursday, February 5th and the time is 3.32 p.m.
We are in a bunch of its room 205.
Members present are Senator Myers, Senator Tobin, my self-chair Dunbar, the Senator Giesell
is excused and I expect, given his special chair is here, that Senator Clayman will be
with us shortly.
of the record reflect that we have a quorum to conduct business. Before we begin, I would
like to thank Mary Gwen Kawakami, the Senate Health and Social Services recording secretary,
and Susan Quigley from the Juno LAO for staffing the committee today.
Today we are holding an introductory hearing
on House Bill 27, Representative Mina's bill
relating to medical care for major emergencies.
Presenting the bill today,
we have Representative Meena's staff member, Katie Giorgio.
We also have Dr. Bob Lawrence, Chief Medical Officer
online for questions.
We have Wendy Allen, who is a nurse consultant
and she is also on the phone.
Today, Ms. Georgio, would you like to come forward, put yourself on the record and begin your presentation?
Thank you chair Dunbar and members of the Senate Health and Social Services Committee. My name is Katie Georgia
I am chief of staff to representative Genevieve Mina house district 19
Thank You very much for hearing house bill 27
the the goal of house Bill 27 is to modernize our systems of care and how we
How we address people who are experiencing heart attacks and strokes and time sensitive emergencies of that type
And just for a little bit of context why we brought this bill forward, Representative Mina was having a chat with a neurosurgeon from Anchorage, and this neuro surgeon said, hey, I think that we could do a better job in Alaska and how we address stroke care and time sensitive emergencies.
And at the time, Dr. Anne Zank was our Chief Medical Officer, and
she suggested that perhaps a change in statute would be in a good way to move forward.
And this bill, this, what it would do, was empower the Department of Health to replicate systems of care that we already do for
trauma in the state, which we've done since the 90s.
and replicate that trauma system of care
for strokes and heart attacks.
One of the main questions I get,
we get as we are talking about this bill is,
what do you mean we don't already have a system
of caring for heart attack and stroke?
You know, my mother had a heart-attack
and the ambulance came and then she went to this place,
then, she wanted this space,
she got the care she needed and she's fine.
And like, we have lot of success in our medical system.
However, it has become clear that we could do a better job.
And we can replicate the success that
we've had with our trauma care system in heart attacks and stroke.
And so what's the types of things that this bill will enable the Department of Health to do is develop.
training and education that would go out statewide to providers.
That would be based on standardized guidelines from accredited national organizations,
professional organizations best practices, nationally recognized industry standards
is what we would adopt into our own systems of care here.
Advanced communications, obviously what
outcomes for Alaskans at the end of the day.
So if we were able to get someone
who is experiencing one of these time sensitive emergencies
to the right place with the rights provider
in an appropriate amount of time,
could be the difference between that person
going home to their home community
or needing help with basic daily tasks
the rest of their life.
I'm going to pause there.
I do have Dr. Bob Lawrence on the phone,
our chief medical officer.
He's really the expert and can explain the need for this
a lot better than I can.
But I'll pause, there, I also, if you're,
if, to remember if he would like,
I could go through the brief sectional
or field any questions at this point.
Why don't we go though the section?
Sure.
It's not too long, thankfully.
Section one, sub-section, excuse me,
section one sub sections one through three
as major emergencies to the existing EMS system.
Right now we only have trauma care and statute.
This would add the term major emergency
to that part of the statute and again enabling
the Department of Health to include heart attacks and strokes
in the same kind of way that they do for trauma.
Subsection four addresses the trauma center
designation status for hospitals.
I didn't mention this in my opening comments,
but part of this is that providers in this state
can register with the department of health
and basically attest that we have certain equipment
and personnel and expertise within our facility.
Again, this would be based on sort of national standards
of how they represent themselves
and what they're capable of doing.
So that there will be sort
of a clear understanding that certain providers might be able
to deliver that type of, you know, thrombolytics
or whatever the intervention is.
So just so everyone is on the same page
about what are different facilities are able to do.
is about the regulations governing those designations.
This was added, I believe,
in health and social services on the other body,
just again, to reaffirm that we're talking
about nationally-accredited standards,
and we are not just making things up here in Alaska.
These are evidence-based practices.
And then, section three adds a new paragraph,
and again this defines major emergencies,
specifically to be for a heart attacks and stroke.
Thank you, Mr. Roger. I have a question, and I don't know if it's for you or better from Dr. Lawrence.
Defining major emergency is hard tack and stroke. Is that all-inclusive or are there other things like
pulmonary embolism, for example? Does that fit in this category or
are their other
conditions that would be considered a major in emergency or is it just those two?
Sure, and to the chair, I can absolutely have Dr. Lawrence answer this, but I will,
I could tell you that as we were drafting the bill, there was a little bit of debate
over using that term major emergency.
In the profession, they usually will use the term time sensitive emergency,
We're still a little bit, I think everything is good with this major emergency language,
but what we're trying to capture again is the time sensitive nature of specifically
heart attacks and stroke for the purpose of this bill.
So section three, again, has that delineation that we really talk about heart attack and
stroke.
So maybe Dr. Lawrence could expand on your specific question about pulmonary embolisms.
Thank you.
Dr. Lawrence, did you hear the question?
Yes.
Good afternoon.
Thanks, Chairman.
For the record, this is Dr Robert Lawrence from the Chief Medical Officer for Alaska Department
of Health.
And the questions is really a good one because in the statute, there are different terms
that are used.
One of those will be just the general term, emergency medical services, and we're introducing
this new term of major emergencies, but as used in this particular proposed statute
The term major emergencies is intended to include what we call,
as Katie was saying, time-sensitive emergencies.
And we usually will put several things in that category.
One of those would be trauma, the other would
be heart attack, other strokes.
Sometimes others would include.
But what all of the sharing common is that outcomes are
in a timely way of getting a patient from the point of crisis to the
point treatment. So your example is a good one asking about pulmonary
embolus, pulmonary emblus among many other very serious
conditions are absolutely emergencies. But in terms of the time sensitive
emergencies that are spoken to in this statute,
only two broad categories. One of those would be cardiac events.
The other broad category of strokes are included
statute, which is really pointing forward to giving authority to the Department of Health
to build out an entire system or making sure that those particular emergencies are addressed.
Okay.
Just a quick follow-up, Dr. Lawrence.
So I guess I'm not a medical professional, so I am just asking you for your expertise.
outcome, positive outcome hopefully, then aren't there some, you know, significantly
other conditions besides heart attack or stroke that also rely on, I understand that's what
we are doing to, we're singling out heart-attack and stroke, but if the issue is whether it's
Am I mistaken in that or are there other things that are time sensitive that could be included in here?
Yes, to the chair that's actually a great way to ask that question or whatever do is they take us if we could take a step back and
recognize that under the statute
There is already a system built out across the state to address medical emergencies in general
So, basically the statute has already given the authority for the department to build out that system.
And any example that, you know, may come to mind as an emergency,
but absolutely needs to get to the highest level of care available in a given region.
It's some of our rural regions that might be a local health clinic and others that may be an
emergency department.
But the system has built out to take care of most medical emergencies.
There are certain emergencies though that sort of lies to a higher level, meaning that
the system needs to be very well coordinated for getting a person evaluated at the point
of crisis.
And again, that may be in a very rural part of Alaska, but then appropriately getting
individuals to the hospital center where a time sensitive emergency can be treated so
The analogy that I heard that sort of at least worked for me was to imagine walking into a hospital,
you expected every single room in a
hospital is going to be capable of taking care of most patients. There's a bed, there's the
ability to get medications, maybe to check lab work and so forth. But in that hospital you
expected there would be perhaps a room to take care more urgent things like cardiothoracic surgery.
major emergencies, but you wouldn't expect that every single woman in the hospital
without providing that full level of care.
In the same way in Alaska, we have a system in place to think of Alaska as the big hospital,
where every community has access to some level
of emergency care, including things that we would say absolutely are important
But within our state, we also need to build out the coordinated system of care that allowed
us to take care of the specific issues that we've put in this category of time since
there's emergency.
And the example there, of course, is trauma care, which has been built out for 15 years
and two that what this statute does is it has two other conditions.
to build out the system that will allow individuals who are in the state who suffer a heart attack or a stroke to be appropriately evaluated and then connected to the best load of treatment.
And just as important that that information will be captured in a registry of sorts that we'll provide a feedback with to everyone who is a part of that system so that this system continues to get better.
point there at the end is that we think fewer, more outcomes when it comes to heart attacks or strokes in the state.
So if the long answer that I hope that finding is helpful.
I think so.
Thank you.
We have Senator Tobin and then Senator Clayman.
Thank You Mr. Chairman.
Will we have the department provide us an overview of the fiscal note or should I, and should hold my questions regarding the
fiscal notet till that time?
I think I can speak a little bit to the fiscal note if you'd like me to.
Yes, Mr. Chairman.
So I'm looking at the Fiscal Note, and I am reading through the legislation.
I see that in section one, the direction to
the department is to establish the system coordination for major emergencies.
Not only is the the dollar amount, but also the description say that they will need a full-time permanent
person
To create this system
I am curious of why that's not a non-perm non a temporary position
If you're creating a system and it's meant to be lifted up
It seems like an ongoing cost for a person to continue to
Establish something is not necessary. And so I'm curious to understand
What exactly this person will be doing in perpetuity? Sure. Yeah
Thank you for the question through the chair, Senator Tobin.
We also, I think, have Karen Allen on the line.
And I might call on her a little bit to help out with my answer.
She is involved with the current trauma care system.
One of the things that she shared with me the other day was,
in least in terms of trauma care,
as you're aware recently,
we had a lot of very cold temperatures in part of
the state and it as part
of work that they do there,
as that we have this employee there at Department of Health.
And again, in the trauma, does trauma cares?
section, you know, we were seeing a lot of, I guess, of a
lot people with severe frostbite, and that is part of what,
you, know the sort of trauma system responds to. So, as you
when we're getting these trends and we are seeing data in this
data collection is really a critical piece too. The data
collection we see particular trends, like people coming in
with a severe of frost bite, or maybe a certain part
of this state as we benchmarking to other parts of the state,
is something kind of weird might be going on over here.
There's a human being at the Department of Health
who's looking at that information and analyzing it
and thinking, well, maybe we should do a bulletin out
for all of our providers out there.
As a reminder, here are the protocols that we use.
When you see these types of things,
here the interventions, whatever it might
be.
So I think that having that permanent person who
is monitoring the data collection,
The designations for the hospital, someone has to sort of run that program.
That's the reason that we would be adding a position in that department.
Yes, Senator Tobin.
Thank you, Mr. Chairman.
And I think my question around this is related to the idea that, we are in a tight fiscal situation.
And, I thing this very critical piece of legislation.
trying to understand the total cost and how we might be able to bring some of that down.
I understand a person reviewing the relevant data and those pieces.
However, I'm assuming as they talk about the IT systems that they will need to build out,
that some this work and evaluation could be automated at a later date.
And so that might to be built into what I think would be a more reflective and
lower fiscal note to implement this legislation.
Thank you.
Thank You Senator Tobin.
We do have Wendy Allen, nurse consultant online, if we want to address the question to her, but first we'll go to Senator Klayman.
If Ms. Allen has something about the fiscal note, I'm happy to stay on that topic before I go
to mine, because mine is not on the physical note.
Ms Allen can you hear me and did you have any thoughts on
the questions that Senator Tobin asked?
Hi, for the record, this is Wendy Allen,
and through the chair,
and thank you for your question, Senator Tobin.
So I am the Program Manager for The Promises in Alaska,
and my main responsibilities are,
I oversee the designation of the promises throughout Alaska.
So making sure that they have the appropriate equipment,
the inappropriate personnel,
the personnel have appropriate education,
and that there's administrative support
from the various facilities for the coma program.
And besides just, you know, we do have
the data aspect of it, which allows us
to do performance equipment at the immunology
throughout the state.
You know, that can only I guess be automated to a certain degree, you know
they're ultimately as it has to be as you can be
Kind of over seeing the whole system
There could be I think some flexibility as to how much of a full-time equivalent how my step B would be devoted
Does that answer your question?
Senator, thank you, Mr. Chairman
It does, and I know that we are not the finance committee,
and so we will allow them to have the opportunity to evaluate how the department came to this determination,
and the ways that they have built out this request here.
But again, I think it's a very critical piece of legislation,
and i want to ensure that it gets passed,
and recognize that our fiscal situation might prevent that from happening.
Thank you. Thank You, Ms. Allen.
Senator Klayman.
So this is a question for Dr. Lawrence.
Dr. Lawrence, I thought actually the chair's question about pulmonary embolisms highlighted
one of at least as a EMT who doesn't do that much E.M.T. work.
I've always seen understood pulmonary amblism at these in terms of the emergency care tend
Invasive process is kind of more surgical type procedures to deal with it whereas strokes and heart issues oftentimes can be addressed fairly effectively with medication and not so many procedures.
And so one of the questions I had about the chair's question is one is, one the distinctions between something like pulmonary embolism that you actually have a lot fewer medical centers that can treat that without a medevac and getting one to a surgery location whereas
some of the stroke medication and some
of that cardiac medication is something
that can be actually fairly effectively administered
in much less, I'm not right, sure what the,
but facilities that actually have a lot fewer providers
and fewer instruments and other facilities.
And if that question makes sense.
I think that's for the record, this is Dr. Robert Lawrence and through the Chair of
Senator Clayman, it's actually a great example and I appreciate you bringing that up because
it helps highlight that the legislation has proposed, I don't think it is intended in
any way to discount the importance of any medical emergency, but as you point out,
each different medical condition is treated in ways that could be different. So if I can
that there are of course there's a wide variety of ways that that might present in some of those
cases can be taken care of at the point of crisis regardless of where Alaska that occurs.
For strokes there is also a similar range of presentations from strokes that are caused by a
without getting too deep into that in order to find out whether or not a person needs to be
in a facility where they can provide emergency surgery. One of the first things that has to
be done is a CT scan. So imagine being a real part of Alaska, it's like show signs and not
early stroke. The very first step is to get a portion two of facility that had the CT
scan, but that doesn't necessarily mean they need to go all the way to the facility
the final procedure, which may end up being a surgical procedure or a medical type of procedure.
Instead, the question is at close to the point of crisis. The same might be true,
a part of the course occurred. There are different types of part effects
in those occur along a range of presentations, some of which absolutely mean to get to
in a more remote type of study, and so the distinction there, I think, is an important
one, but we're not discounting that there needs to be a system to take care of any major
medical condition.
But there are certain conditions where in order to reach the best outcomes, there need
to a well-coordinated system where, for example, in rural Alaska, a CT scan can be performed
Say AI technologies and so forth before the patient is even out of the scanner.
The neurosurgeon has already been alerted that there may be somebody who's being brought
to Anchorage that the medevac flankers are already alerted, that somebody needs to move
quickly.
But if the opposite is true and the condition is not as concerning, then the property will
Yeah, just recognizing that there's a distinction between these different conditions is important.
Good, thank you Senator Myers.
Thank you Mr. Chair and I may expose my ignorance a little bit on my couple of questions here so.
First of all, I guess my question is to Mr. Oggio,
is why exactly do we need a statute change?
Why does the department of health feel
that they don't already have the authority
to do what we're asking,
put this type of system in place?
Through the chair to Senator Myers,
thank you for the question.
I think that it is possible
that the Department could do this
without a Statute Change.
However, I'm not sure that's totally true,
but obviously doing a statute change will,
I mean, for lack of a better word,
force them to do this, right?
We, it's an intention on our part
as a legislature that we want to this.
So again, when we were first starting to think about
what can we do to improve the care for Alaskans?
And again, Dr. Zink suggested that we go this route
and we thought that this was a great way
to not only bring attention to the matter,
but really take a look at how we are delivering
healthcare in Alaska.
And basically say, hey, we have an aging population,
very rapidly expanding aging populations also in Alaskan.
Maybe we should be looking ahead
and making sure that
we the best system possible to respond
experience by our aging population. So it is a way for us to say, hey this is
how we want to take care of our Alaskans by having a better system of care.
Okay, and then go ahead, Sam. Thank you. A little bit of a follow-up to Senator
Tobin's question. You know as I'm reading through the sponsor statement
I mean, it sounds like a very good practice of what we're attempting to put in place,
but the question is that it seems like most of it is things like coordination among providers.
It sounds, like, continuing education, things of that.
A lot of things that really already happen on their own in a lot ways.
the Department of Health to be centralizing that instead of saying, hey,
Providence, you're the best out quipped hospital in the state.
Can you run some of this continuing education, things like that?
Why is it that we need to centralize it to within the State?
Through the chair to Senator Myers. Thank you again for the question
I might call on dr. Lawrence or miss allen to answer that question because I just think they'll do a better job than I will
That's right. Thanks
But through the chairs and our buyers is just dr large
That it's been answered to the questionnaire
Underlying the term use coordination of care right now
Hospitals in the state are doing the best they can to build up
These conditions like heart attacks,
like strokes, different hospitals are building up
that you need to do that in to some extent
they swap notes and share resources and provide education.
So the statute isn't adding something new
as you point out from that point.
But what the statue does that is important is,
first of all, where I came out and said,
in order to take care of time sensitive emergencies,
it requires all of the facilities across the state
to work in a coordinated fashion.
In other words, we don't need more hospitals.
We're able to do everything.
We need each hospital to be able
to the right thing at the moment,
wherever they're located in the state,
and to so in a coordinated fashion.
So the first thing the statute does is that it gives
the authority to department of health
to stay for this particular condition.
We want the system to build out
to allow for coordination among all participating facilities.
The other thing that I give the Authority to
to build out a registry of all the cases that occur
and to allow that information and that data to loop back
to everyone involved in taking care of a case.
So for example, right now in the state,
if there's a car accident, there is any kind of trauma
that results in a hospitalization or even a death.
All the data from that particular case
is kept in registry which then an aggregate is reviewed
registry review committee which then comes out with recommendation and anyone who has participated
in the chain of events leading to that person's hospitalization has access to see what were the
outcomes of the particular condition. That is not true if somebody has a heart attack or a stroke
people who are identified as having a stroke in a one particular hospital were identified
by that at the hospital, but that was unknown to the EMS personnel who brought them in.
And that information was never circled back to EMS agency.
And so the EMS personnel were not able to learn from those cases that come back.
With the trauma system, what we found is that the ability to take that data.
And look it back to everyone involved in the process, make the system better, but also
each individual involved with the processes better over time, and that's what I think
that leads to better outcomes.
And so the statute, what it adds, is the ability again for all facilities to be able to coordinate
together and for there to being this collective circling back of data to help in a looping
Go ahead, Senator. Thank you. So just to kind of clarify on my own mind a little bit
So the analogy I'm kind coming up with is effectively we're
We're kind-of creating another 911 system almost with the difference being that this isn't a system accessible to the public
This is a System between providers to make sure that that information gets dispatched out
promptly and accurately is that sound accurate
Senator Myers, I think that's a good analogy, you like to do any analogy we have to be careful
how far that we take it, but there are parts of the system, if you imagine when it's built
out, it would very much look like a 911 system for hospital facilities and clinics, and even
down to community clinics across Alaska. And that right now, yes, a kind of sense of emergency
occurs in some parts in Alaska and I am the receiving provider. You may be unclear to me
call where am I going to transfer the patient to and how do I need to manage the
patient while we're waiting for transfer. And so that can create delays in care.
But imagine a system like 911, which I like your analogy there, where I, even as
a provider, can call and it's a centralized system that's well coordinated and given
the patients who's in front of me, what's given symptoms I can receive a
telemedicine consult with a specialist, but then also make sure that my patient
to transfer to the profit level of care.
Okay, thank you.
Thank you, Senator Meyer.
Any further questions?
Not seeing any.
Ms. Georgio, before we set this bill aside,
do you have any closing comments today?
Thank You, Chair Dunbar.
No, I don't have any closing comments.
Thank you very much for hearing our bill today.
Very good.
We will of course have this bill back before us
at some point in the near future.
We're gonna set it aside for further consideration.
Thank to Ms. Georgio, thank you to Dr. Lawrence
and Ms Allen for being here today
The next meeting the Senate Health and Social Services Committee will be Tuesday, February 10th.
We will have Guide House here to discuss their Medicaid rate review, as well as an introductory hearing on Senator Tobin's bill SB 206.
An act relating to school suicide policies and establishing the firearm safe storage grant fund.
With that, it is 4.03 PM and this meeting is adjourned.