Legislature(2009 - 2010)HOUSE FINANCE 519

04/06/2010 09:00 AM House FINANCE

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HOUSE BILL NO. 168                                                                                                            
     "An   Act   relating   to   state   certification   and                                                                    
     designation   of    trauma   centers;    creating   the                                                                    
     uncompensated trauma care  fund to offset uncompensated                                                                    
     trauma  care  provided   at  certified  and  designated                                                                    
     trauma centers; and providing for an effective date."                                                                      
9:09:38 AM                                                                                                                    
REPRESENTATIVE  BOB  HERRON,  SPONSOR,  explained  that  the                                                                    
legislation  would set  up  a trauma  care  fund that  could                                                                    
reimburse    trauma    centers    for    uncompensated    or                                                                    
undercompensated services and  create incentives for forming                                                                    
trauma  centers. The  measure  could  help Alaska  establish                                                                    
have more trauma  centers and balance services  to people in                                                                    
Vice-Chair Thomas  MOVED to ADOPT  Work Draft  CSHB 168(FIN)                                                                    
(26-LS0437\P, Mischel,  3/24/10, copy on file)  as a working                                                                    
document before the committee. Co-Chair Stoltze OBJECTED.                                                                       
SENATOR JOHN  COGHILL, SPONSOR, explained that  the CS would                                                                    
remove the  alcohol tax  as a funding  source. The  CS would                                                                    
establish compensation  standards to encourage  hospitals to                                                                    
incentivize  doctors.  Section  1  would  remain  the  same.                                                                    
Section 2 discusses how to manage the funding sources.                                                                          
9:13:40 AM                                                                                                                    
Vice-Chair Thomas  asked whether  the Alaska  Native Medical                                                                    
Center  (ANMC)  was the  only  trauma  center in  Anchorage.                                                                    
Senator Coghill  replied there were 24  hospitals in Alaska,                                                                    
one Level II hospital (ANMC  in Anchorage) and four Level IV                                                                    
trauma  centers. The  Alaska Native  Medical  Center is  the                                                                    
only major qualified trauma  center in Anchorage; generally,                                                                    
it did not  serve the wider population. He  pointed out that                                                                    
there  were   two  hospitals  in  Anchorage   (Regional  and                                                                    
Providence  Hospitals)  and   one  in  Fairbanks  (Fairbanks                                                                    
Memorial Hospital) that could  reach higher levels; the fund                                                                    
was intended to incentivize that process.                                                                                       
Senator Coghill reported that  Providence Hospital wanted to                                                                    
be certified  under national standards. The  doctors at ANMC                                                                    
are on  contract and work  under the conditions  required of                                                                    
Level II  centers (doctors have  to be  on call and  able to                                                                    
arrive  within  15  minutes or  present  at  the  facility).                                                                    
Doctors  at  Providence  and Regional  Hospitals  work  with                                                                    
hospital privileges and are on  a rotational call, but there                                                                    
is no guarantee that doctors  will arrive at the hospital at                                                                    
a  certain  time.  The  protocols   and  the  equipment  are                                                                    
different as well.                                                                                                              
Senator   Coghill   stated   that  the   legislation   would                                                                    
incentivize  for  uncompensated and  undercompensated  care.                                                                    
The  fund would  incentivize organizations  to organize  and                                                                    
make agreements  about handling  emergency responses  at the                                                                    
trauma  center. He  referred  to  backup materials  ("Trauma                                                                    
Care  in Alaska  2010"  copy  on file)  and  pointed to  the                                                                    
American College  of Surgeons report (November  2008), which                                                                    
informs  the bill.  He noted  the advantages  and assets  of                                                                    
trauma care referenced in the report:                                                                                           
   · Committed individuals who use their time and expertise                                                                     
     every day to serve Alaska citizens.                                                                                        
   · Extensive networks for transport.                                                                                          
   · 3 large medical centers with extensive subspecialty                                                                        
     expertise within the state.                                                                                                
   · Large Level I trauma center in Seattle which freely                                                                        
     accepts adult and pediatric trauma patients.                                                                               
   · One center maintains ACS Level II verification                                                                             
     standards and others have obtained consultations and                                                                       
     are working toward verification.                                                                                           
   · Alaska Trauma Registry - all 24 acute care hospitals                                                                       
     provide data.                                                                                                              
   · Injury prevention activities are well established.                                                                         
   · Initial efforts at legislative change.                                                                                     
Senator Coghill listed challenges and vulnerabilities:                                                                          
   · No trauma system plan.                                                                                                     
   · Geography/Weather/Remote and isolated communities.                                                                         
   · No standards or scene trauma triage or trauma inter-                                                                       
     facility transfers.                                                                                                        
   · Trauma system issues have limited visibility within                                                                        
     state government.                                                                                                          
   · Public not aware of trauma system issues.                                                                                  
   · Limited human resources.                                                                                                   
   · Few incentives for hospitals to participate.                                                                               
   · No statewide evaluation of system performance.                                                                             
9:18:29 AM                                                                                                                    
Senator  Coghill  noted  that the  legislation  intended  to                                                                    
address the  item on  the list  of challenges  regarding few                                                                    
incentives.  He added  that the  College of  Surgeons report                                                                    
recommended that  the bill  mandate [that  hospitals achieve                                                                    
trauma care system standards] as  some states do. He thought                                                                    
having a fund with incentives  was a better approach. The CS                                                                    
included  the requirements  for  getting into  the fund  and                                                                    
incentives  for using  it properly.  He  commended ANMC  and                                                                    
urged the rest of Alaskan facilities to follow suit.                                                                            
Vice-Chair Thomas  asked whether  the bill would  allow non-                                                                    
Native  people to  use ANMC  for trauma  situations. Senator                                                                    
Coghill responded that the bill  does not address the issue,                                                                    
but  there are  protocols  at the  medical  center to  allow                                                                    
trauma cases.  He thought hospitals outside  the Native care                                                                    
system needed to step up.                                                                                                       
Representative Austerman  asked how many hospitals  have the                                                                    
ability  to  take advantage  of  the  fund. Senator  Coghill                                                                    
replied that every hospital had  the ability. Some hospitals                                                                    
have already gone through the  process and gotten a Level IV                                                                    
designation. Of  the 24 hospitals  in the Alaska,  only five                                                                    
have actual designations and nine  are under review, leaving                                                                    
quite  a few  hospitals  that could  take  advantage of  the                                                                    
9:22:42 AM                                                                                                                    
Representative Austerman  asked what steps have  to be taken                                                                    
to   achieve  appropriate   status  and   queried  financial                                                                    
barriers.   Senator   Coghill   answered  that   there   are                                                                    
requirements. There are national  standard for Levels I, II,                                                                    
III,  and   IV  with  different  requirements   and  various                                                                    
reviews,  including  staff,  equipment,  and  timeliness  of                                                                    
response. He  stated that  the fund  was meant  to encourage                                                                    
hospitals  to  begin  the  process  and  to  work  with  the                                                                    
Representative  Austerman wanted  to  discern the  practical                                                                    
and  financial steps  necessary  to  meet the  requirements,                                                                    
especially outside  major population  centers that  are able                                                                    
to  support expensive  equipment. Senator  Coghill responded                                                                    
that  in  most outlying  areas,  personnel  such as  Village                                                                    
Public  Safety Officers,  Emergency  Medical Services  (EMS)                                                                    
personnel,  public health  officials, and  medical transport                                                                    
personnel would work  to stabilize patients in  order to get                                                                    
them  to the  next level  of  care needed.  A hospital  will                                                                    
perform  at  the  level  it  can.  The  fund  would  provide                                                                    
incentives to  get hospitals to the  highest level possible.                                                                    
The reality is that there will  not be a Level I hospital in                                                                    
Alaska,  as a  facility at  that  level must  be a  teaching                                                                    
hospital.  Alaska can  have level  II  facilities, like  the                                                                    
ANMC. He thought Fairbanks could  rise to a Level III, which                                                                    
would  enable them  to stabilize  and  prepare patients  for                                                                    
9:26:37 AM                                                                                                                    
Representative  Austerman queried  the cost  factors of  the                                                                    
fund. Senator Coghill responded that  they had looked at the                                                                    
trauma  mandates and  requirements throughout  the U.S.  and                                                                    
calculated for  Alaska's population base and  geography. The                                                                    
sponsors  thought that  having $5  million in  a fund  would                                                                    
adequately  provide  the  ability to  give  incentives.  The                                                                    
money could  be divided several  ways. Some of  the Medicaid                                                                    
money  could be  matched  by state  money.  Hospitals get  a                                                                    
certain amount  for Medicaid that  they are able to  use for                                                                    
match  money. Services  with billing  must  be performed  in                                                                    
order to access the money.  He thought there were other ways                                                                    
to  enhance Alaskan  dollars.  Research  on funding  sources                                                                    
resulted in  a preliminary  list, including  funding private                                                                    
sources and  grants, but  he believed  the state  should put                                                                    
some money in to get the fund in place.                                                                                         
Representative  Austerman  pointed  to   page  2,  line  11,                                                                    
regarding  spending up  to 25  percent of  the fund  for one                                                                    
facility  and queried  how to  replenish  the fund.  Senator                                                                    
Coghill responded that  he did not want any  one hospital to                                                                    
dominate the fund. He thought  it would be unwise to deplete                                                                    
the fund. He was open  to discussion; the provision was just                                                                    
a way to limit one entity from getting all the assets.                                                                          
9:30:35 AM                                                                                                                    
Representative  Austerman  commented   that  up-front  money                                                                    
would be needed  to get started, plus there  would be annual                                                                    
needs. He  was not optimistic  about pulling funds  from the                                                                    
sources referenced on the list.                                                                                                 
Representative  Foster queried  the total  need relative  to                                                                    
the $5  million. Senator Coghill  responded that  the number                                                                    
was  a judgment  call. He  reported that  other states  have                                                                    
mandated  meeting the  standards  and put  the  cost on  the                                                                    
facilities. He  thought that factors unique  to Alaska would                                                                    
affect the  situation. He viewed the  fund as a way  for the                                                                    
state  to contribute  to  the process.  He  agreed that  the                                                                    
total need  was unknown.  He pointed  out that  the hospital                                                                    
association and the insurance people would have numbers.                                                                        
Representative  Foster  referenced  a fact  sheet  from  the                                                                    
Alaska  Statewide Trauma  Center  saying that  in 2004,  the                                                                    
economic cost  of hospital stays  alone for  trauma patients                                                                    
in Alaska  was estimated  at over $73  million; one  in four                                                                    
hospital  admissions were  uncompensated.  He asked  whether                                                                    
there  were updated  numbers. Senator  Coghill replied  that                                                                    
much of  the uncompensated  care would be  picked up  by the                                                                    
state or Medicaid, requiring  matching funds. He recommended                                                                    
taking Medicaid (disproportionate  share) money and matching                                                                    
it to get  more money. He thought the window  in which to do                                                                    
that  from the  federal  government might  be  two or  three                                                                    
Senator Coghill argued that people  would not get served and                                                                    
would die if the state  did not incentivize trauma care. The                                                                    
state was already spending money for trauma care.                                                                               
9:34:35 AM                                                                                                                    
Vice-Chair Thomas  queried using alcohol and  tobacco tax as                                                                    
other states  do. Representative  Herron responded  that the                                                                    
House Health,  Education and  Social Services  Committee had                                                                    
discussed  the major  causes of  the kinds  of trauma  cases                                                                    
coming  to   hospitals  and  determined  that   alcohol  was                                                                    
related. There  was discussion as  to why the  alcohol money                                                                    
would not work.                                                                                                                 
Senator Coghill explained that both  the tobacco and alcohol                                                                    
taxes  were  considered, but  they  are  general funds.  The                                                                    
proposed fund would  have the option of  drawing other money                                                                    
as well. Some states use  vehicle registration funds, as the                                                                    
vast majority of trauma cases  result from using alcohol and                                                                    
vehicles together.  He emphasized that there  are other ways                                                                    
to collect the funds, including increasing alcohol taxes.                                                                       
Vice-Chair Thomas  referred to previous  legislation related                                                                    
to tobacco tax and questioned  why the tobacco tax could not                                                                    
be used.                                                                                                                        
9:38:15 AM                                                                                                                    
REGINA  CHENNAULT, GENERAL  SURGEON,  ALASKA NATIVE  MEDICAL                                                                    
CENTER and  MEMBER, VIOLENT  CRIMES COMPENSATION  BOARD (via                                                                    
teleconference), spoke  in support  of the  legislation. She                                                                    
informed the  committee that she  also served on  the Alaska                                                                    
Trauma System Review Committee and  was the American College                                                                    
of  Surgeon's chair  for Alaska's  Committee on  Trauma. She                                                                    
pointed out that  trauma was a public safety  threat for all                                                                    
citizens. She  had seen  people die because  of the  lack of                                                                    
standards. She  emphasized that the state  is paying through                                                                    
Medicaid dollars  for some of  the care, but the  quality of                                                                    
care  that the  rest of  the nation  receives was  not being                                                                    
Representative  Joule asked  for  elaboration regarding  the                                                                    
level of  care in Alaska.  Dr. Chennault described  a recent                                                                    
experience  in an  Anchorage hospital  related to  a violent                                                                    
act. She had received a  complaint because a person had been                                                                    
picked  up  with  life-threatening injuries;  the  emergency                                                                    
personnel had tried  to take her to one  hospital (she would                                                                    
not  name the  hospital)  but the  patient  was turned  back                                                                    
because no  surgeon was available.  The patient  was brought                                                                    
to ANMC  with good results,  but she could have  easily bled                                                                    
to  death  without  timely  care. She  was  aware  of  other                                                                    
similar cases during her tenure in Alaska.                                                                                      
Representative Joule asked how  the legislation would change                                                                    
the situation. Dr. Chennault referred  to the review done by                                                                    
the  College of  Surgeons (copy  on file)  listing 70  major                                                                    
problems with  Alaska's response system. She  described care                                                                    
that was automatically given in  other parts of the country.                                                                    
The important  issue is timely  care. Some hospitals  do not                                                                    
want to  put up the money  to train doctors and  nurses. She                                                                    
added that  in the private  sectors, doctors do not  want to                                                                    
be  required to  arrive  at a  hospital  within 15  minutes,                                                                    
which could mean  the difference between life  and death for                                                                    
a trauma patient.                                                                                                               
Representative  Joule   asked  whether   the  goal   of  the                                                                    
legislation   was  to   change  the   behavior  of   service                                                                    
providers.  Dr.   Chennault  replied  yes,  to   change  the                                                                    
behavior of both providers  and hospitals, because sometimes                                                                    
it   comes  down   to  training,   equipment,  or   response                                                                    
protocols. She  pointed out that the  same capabilities were                                                                    
the backbone of preparedness  response for natural disasters                                                                    
like earthquakes.                                                                                                               
9:43:21 AM                                                                                                                    
FRANK SACCO, TRAUMA DIRECTOR,  ALASKA NATIVE MEDICAL CENTER,                                                                    
ANCHORAGE (via teleconference), testified  in support of the                                                                    
legislation. He  noted that  the issue  was a  public safety                                                                    
issue  that applied  to everyone,  because  a trauma  system                                                                    
decreases mortality by 15 to 25 percent.                                                                                        
Dr. Sacco informed  the committee that he had  been chair of                                                                    
the  Trauma  System  Review Committee  and  was  the  Trauma                                                                    
Director  at ANMC.  He  has been  involved  in developing  a                                                                    
trauma  system   in  Alaska  for  15   years.  The  original                                                                    
legislation set  up the  framework for  a trauma  system but                                                                    
did not  provide incentives  or disincentives  for hospitals                                                                    
to participate, and little progress  was made. He pointed to                                                                    
recommendations by the College of Surgeons' review.                                                                             
Dr.  Sacco  explained  that  ANMC  takes  seriously  injured                                                                    
patients and would never turn  a patient away. However, ANMC                                                                    
has limited capacity  and is often 100 percent  full. It has                                                                    
served as  a safety  net for the  broader community,  but at                                                                    
times has been  the only hospital available to  take care of                                                                    
critically injured  children for  several months at  a time.                                                                    
He  wanted all  the hospitals  to  be at  Level II  response                                                                    
capability;  the fund  in HB  168 would  allow hospitals  to                                                                    
help  doctors be  available on  short notice.  The costs  to                                                                    
smaller hospitals without surgeons  would not be very large,                                                                    
which  is why  there are  four hospitals  in rural  areas at                                                                    
Level  IV   capability,  including  Norton   Sound  Regional                                                                    
Hospital  (Nome),  Yukon-Kuskokwim Delta  Regional  Hospital                                                                    
(Bethel),  Sitka   Community  Hospital  (the   only  private                                                                    
hospital), and Mt. Edgecumbe Hospital (Sitka).                                                                                  
Dr. Sacco  emphasized that  the most  important part  of the                                                                    
system  was continuous  re-evaluation  of  care and  outside                                                                    
review  of care,  which results  in  steady improvement.  He                                                                    
believed HB  168 was  a good start  and that  the incentives                                                                    
were important. He  thought if the incentives  did not work,                                                                    
then more would  be needed. He pointed out that  the size of                                                                    
the  $5  million fund  amount  was  taken from  states  with                                                                    
similar population.                                                                                                             
9:48:20 AM                                                                                                                    
Representative  Joule referred  to  the  fact sheet  stating                                                                    
that more  than 400 Alaskans  die from trauma each  year and                                                                    
that  more than  800  Alaskans are  hospitalized because  of                                                                    
trauma. He asked  whether the numbers would  have been lower                                                                    
if  there  had  been  trauma centers  in  place.  Dr.  Sacco                                                                    
responded that other  states have been able  to decrease the                                                                    
mortality rate  related to  trauma by 15  to 25  percent. He                                                                    
believed that saving even 10  percent of the lives of trauma                                                                    
victims,  or one  person each  week,  would have  tremendous                                                                    
impact.  He reminded  the committee  that for  every patient                                                                    
that   dies,   three   people  are   left   with   permanent                                                                    
disabilities.  Those people  will  never work  at the  level                                                                    
they once  had worked  and the state  would have  to provide                                                                    
additional  resources. He  underlined  that the  legislation                                                                    
would save lives  and emphasized that Alaska  has the second                                                                    
highest death rate from trauma in the country.                                                                                  
WARD HURLBURT,  CHIEF MEDICAL OFFICER/DIRECTOR,  DIVISION OF                                                                    
PUBLIC  HEALTH, DEPARTMENT  OF HEALTH  AND SOCIAL  SERVICES,                                                                    
spoke in support of the  bill. He remarked that his clinical                                                                    
background was as a general  surgeon, and that he had worked                                                                    
many  years in  Alaska's  Native healthcare  system. He  was                                                                    
very  involved  with  trauma  systems   and  had  served  as                                                                    
Director  of ANMC.  He  emphasized  that the  administration                                                                    
supported the  concept of HB  168 and was  neutral regarding                                                                    
the fiscal note.                                                                                                                
Dr.  Hurlburt  informed  the committee  that  the  U.S.  had                                                                    
adopted the  kind of system  that has been described  as the                                                                    
way to  deal with  trauma. He  noted that  studies conducted                                                                    
nationally  and  reported  in the  New  England  Journal  of                                                                    
Medicine  have documented  that trauma  victims who  receive                                                                    
care in  certified and designated  facilities have  a better                                                                    
survival rate.                                                                                                                  
Dr. Hurlburt  described the process  of setting up  a trauma                                                                    
system.  The  American  College  of  Surgeons  Committee  on                                                                    
Trauma  comes to  a  hospital, uses  criteria  to develop  a                                                                    
report,  and   certifies  whether   a  hospital   meets  the                                                                    
criteria. The state  then designates the hospital  as far as                                                                    
levels. He did  not believe there would be a  Level I trauma                                                                    
center in Alaska; Harborview Hospital  serves as the Level I                                                                    
trauma center  for Alaska, Washington,  and Idaho,  and much                                                                    
of Montana. However,  ANMC is a Level II  trauma center that                                                                    
meets the  necessary criteria; it  does care  for non-Native                                                                    
people, but does  not have the capacity to take  care of the                                                                    
other 85  percent of the  population of Alaska on  a regular                                                                    
basis. As a  result, Alaska is the only state  where most of                                                                    
the  population does  not have  access to  a Level  I or  II                                                                    
trauma facility. Anchorage  is the largest city  in the U.S.                                                                    
without a  Level II trauma  center. He declared  that Alaska                                                                    
is not participating in a system documented to save lives.                                                                      
Dr. Hurlburt  stated that the  department would like  to see                                                                    
every hospital  reach its appropriate designation.  He noted                                                                    
Sitka  Community Hospital,  a small  hospital that  took the                                                                    
issue  seriously  and was  able  to  meet the  criteria.  He                                                                    
thought Level  III would make  the most sense  for Fairbanks                                                                    
Memorial  Hospital. To  achieve Level  II, surgeons  must be                                                                    
available within 15 minutes. The  surgeons at ANMC generally                                                                    
stay in  the hospital at night  when they are on  call; part                                                                    
of the reason  is that the facility  has become increasingly                                                                    
busy. The 15-minute  availability is a major  issue in other                                                                    
Anchorage hospitals.                                                                                                            
Dr. Hurlburt reported talking with  the administrator of the                                                                    
hospital  in Soldotna,  which  would look  at  a Level  III.                                                                    
Ketchikan  had  recently  looked  at becoming  a  Level  III                                                                    
hospital,  but   did  not  meet  the   criteria  because  of                                                                    
9:56:28 AM                                                                                                                    
Representative Austerman asked  whether the amount available                                                                    
in the  $5 million fund  could get Anchorage hospitals  to a                                                                    
Level  II  designation.  Dr.  Hurlburt  replied  that  as  a                                                                    
surgeon,  he had  expected to  be on  call. Younger  doctors                                                                    
expect to  be paid  more to  be on  call. The  Alaska Health                                                                    
Commission (which  he chairs) calculates  that approximately                                                                    
$6 billion  is spent in  Alaska per  year on health  care, a                                                                    
huge part  of the state's  economy. Physicians expect  to be                                                                    
compensated. He  estimated that  the $5  million was  a good                                                                    
amount, although only  time would tell if it  was enough. He                                                                    
provided the example  of two hospitals in  Tacoma and Pierce                                                                    
County in the  state of Washington that  had developed joint                                                                    
compensation  for  an  on-call  system.  Other  states  have                                                                    
simply mandated that hospitals meet the standards.                                                                              
Representative  Joule noted  that ANMC  was designated  as a                                                                    
Level II facility,  but that its certification  had been due                                                                    
in   2009.  He   asked   whether  the   facility  had   been                                                                    
recertified.   Dr.  Hurlburt   responded   that  they   were                                                                    
recertified    and    have   maintained    the    three-year                                                                    
10:00:31 AM                                                                                                                   
MARK   JOHNSON,   MEMBER,   ALASKA  TRAUMA   SYSTEM   REVIEW                                                                    
COMMITTEE,  JUNEAU,  spoke in  support  of  the measure.  He                                                                    
described his  experience as the chief  of emergency medical                                                                    
services for  the state.  He had been  involved in  the 1993                                                                    
legislation and  the subsequent development  of regulations.                                                                    
The  American   College  of  Surgeons  standards   had  been                                                                    
adopted;  the same  standards were  part of  HB 168.  He had                                                                    
taken part  in reviews  of eight  hospitals in  Alaska. They                                                                    
had  had a  federal grant  but it  expired and  momentum was                                                                    
lost. Many studies have been  done showing the difference in                                                                    
outcome when standards  are being met. He  noted that trauma                                                                    
was the  number one cause  of death for ages  1 to 44  and a                                                                    
major cause of death and disability for all ages.                                                                               
Mr. Johnson  believed that  HB 168 would  move the  state in                                                                    
the direction  of getting hospitals to  meet national trauma                                                                    
system standards.  He described  the process used  in Alaska                                                                    
and  noted  lesser expense  for  small  rural hospitals.  He                                                                    
pointed out  that the  American College  of Surgeons  had 16                                                                    
major recommendations.  He commended work done  to implement                                                                    
some of the recommendations.                                                                                                    
Mr.  Johnson  stated that  undocumented  care  has cost  $20                                                                    
million; he  was hopeful the  $5 million fund was  enough to                                                                    
move forward.                                                                                                                   
Mr. Johnson  emphasized that a certain  percentage of people                                                                    
who get  definitive care within  the first six to  ten hours                                                                    
would  result  in  a  better  outcome  and  that  the  rural                                                                    
hospitals could make the difference.  He thought there could                                                                    
be more prevention as well.                                                                                                     
10:06:07 AM                                                                                                                   
Representative  Austerman  referenced the  six-to-eight-hour                                                                    
time period and asked  about level designations. Mr. Johnson                                                                    
answered that Level  IV is the most  basic level identified.                                                                    
He pointed out  that rural health clinics in  Alaska have to                                                                    
be considered.  They would not  be covered by the  bill, but                                                                    
their personnel also need the right kind of training.                                                                           
Representative Austerman queried the  number of hospitals in                                                                    
the  state  with the  potential  to  get  to Level  IV.  Mr.                                                                    
Johnson  replied that  every hospital  in the  state besides                                                                    
Fairbanks,  Mat-Su, Anchorage,  Kenai Peninsula,  Juneau, or                                                                    
Ketchikan could  be at  Level IV.  He listed  hospitals that                                                                    
could be various  other levels. He emphasized  that it could                                                                    
be done.                                                                                                                        
Co-Chair Stoltze closed public testimony.                                                                                       
HB  168  was  HEARD  and   HELD  in  Committee  for  further                                                                    

Document Name Date/Time Subjects
HB168pkt.PDF HFIN 4/6/2010 9:00:00 AM
HB 168
HB168pkt Pkt.#1.PDF HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - 02.26.09 KTVA CBS News 11 - More Funding Needed for FIght Brain Injuries in Alaska.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - 03.10.09 ADN - Attracting doctors - Legislature can raise Alaska's stake in competition for docs.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - 03.24.09 ADN Compass - Emergency trauma care needs improvement in Alaska.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - ADN Compass - Alaska needs a better trauma system.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - Alaska Statewide Trauma System Fact Sheet.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - Alaska Trauma Hospital designations as of April 2009.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - Anchorage Hospital Trauma Mortality Rates.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - NCSL - Preparing for the worst - states address trauma center troubles.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - Trauma Care in Alaska slideshow by Dr. Frank Sacco.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - Trauma Legislation sticks from other states.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - TraumaEMS System in Alaska.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - TraumaEMS System in Alaska.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 backup - uncompensated trauma care by state.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
HB 168 CS WORKDRAFT VERSION 26-LS0437 Pwith SECTIONAL.pdf HFIN 4/6/2010 9:00:00 AM
HB 168
2.sponsor statment HB413.docx HFIN 4/6/2010 9:00:00 AM
HB 413
4.back up AMYA.pdf HFIN 4/6/2010 9:00:00 AM
HB 168 CS WORKDRAFT VERSION 26-LS0437 Pwith SECTIONAL.pdf HFIN 4/6/2010 9:00:00 AM
HB 168