Legislature(2009 - 2010)CAPITOL 106

04/09/2009 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Heard & Held
Heard & Held
<Bill Hearing Rescheduled from 04/07/09>
HB 168-TRAUMA CARE CENTERS/FUND                                                                                               
3:19:35 PM                                                                                                                    
CO-CHAIR KELLER  announced that the  next order of  business would                                                              
be 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."                                                                                                                
3:20:19 PM                                                                                                                    
REPRESENTATIVE COGHILL  stressed that it  was a high  priority for                                                              
Alaska  to  have   an  emergency  trauma  delivery   system.    He                                                              
explained that  he would like  to incentivize hospitals  to attain                                                              
trauma  center  designation,  and  to direct  funding  for  trauma                                                              
uses.    He noted  that  two  central issues  were  for  uninsured                                                              
patients, and for  payment to the hospitals for  the new programs.                                                              
He  suggested   that  hospitals   which  increased   their  trauma                                                              
designation  would  receive  repayment   for  the  expenses.    He                                                              
referred  to the  "Trauma  System  Consultation"  report from  its                                                              
November 2-5,  2008, meeting in  Anchorage, Alaska.   [Included in                                                              
the  members'  packets]    He  noted  that  the  report  contained                                                              
suggestions of ways  for Alaska to improve its trauma  system.  He                                                              
opined that hospitals  would be reluctant, but  would support this                                                              
program.  He summarized  that there was an important  need to take                                                              
care of  Alaskans who were  hurt, and that  there should not  be a                                                              
question of where the payment would come from.                                                                                  
3:27:48 PM                                                                                                                    
DR. FRANK  SACCO, Chair, Alaska  Trauma Systems Review  Committee,                                                              
said that  his report  would demonstrate  why this was  important,                                                              
what had been done  so far, and what was still  needed.  He quoted                                                              
the former  U.S. Surgeon General,  C. Everett Koop, "If  a disease                                                              
were  killing our  children  at  the rate  unintentional  injuries                                                              
are, the public  would be outraged and demand that  this killer be                                                              
stopped."   He opined  that a  public health  system approach  was                                                              
the  only proven  way  to make  an  impact.   He  stated that  the                                                              
leading cause of  death for individuals up to 44  years of age was                                                              
trauma, and yet it was still not recognized.                                                                                    
3:31:15 PM                                                                                                                    
DR. SACCO  referred to slide 5,  "Trauma in Alaska,"  and detailed                                                              
the annual impact to Alaskans.                                                                                                  
3:31:45 PM                                                                                                                    
DR. SACCO directed  attention to the comparative  deaths by trauma                                                              
in  the  U.S.  and  Alaska  on slide  6,  "Death  from  Trauma  in                                                              
Alaska."  He pointed  out the high rate for Alaskans  and the much                                                              
higher  rate for  Alaska natives,  and  he noted  that the  Alaska                                                              
trauma death rate was second only to New Mexico.                                                                                
3:32:21 PM                                                                                                                    
DR. SACCO  explained that  the leading  causes of traumatic  death                                                              
in Alaska  were motor vehicles and  firearms, slide 7,  "Trauma in                                                              
Alaska."   He disclosed that  25 percent  of the $73  million cost                                                              
for trauma care in Alaska was not compensated.                                                                                  
3:32:53 PM                                                                                                                    
DR.  SACCO compared  the time  from injury  to death  on slide  8,                                                              
"Death  from Trauma."   He  pointed out  that intervention  during                                                              
the golden hours would improve survival.                                                                                        
3:33:27 PM                                                                                                                    
DR.  SACCO  indicated  slide  9, "Trauma  Systems,"  and  read  "A                                                              
trauma  system  consists  of  hospitals,   personnel,  and  public                                                              
service  agencies with  a preplanned  response to  caring for  the                                                              
injured patient."                                                                                                               
3:33:51 PM                                                                                                                    
DR. SACCO  considered slide  10, "Trauma  Systems," and  described                                                              
the  facilities, the  personnel training,  the patient  transport,                                                              
the  triage.   He said  "a  trauma system  was  getting the  right                                                              
patient to the right place in the right amount of time."                                                                        
3:34:20 PM                                                                                                                    
DR. SACCO  looked at  slide 11,  "Facilities-Trauma Centers,"  and                                                              
reviewed the definitions for Levels I-IV of trauma centers.                                                                     
3:35:28 PM                                                                                                                    
DR. SACCO  spoke about the  various trauma related  courses, which                                                              
included ATLC, TNCC, RTTDC, and ETT, on slide 12, "Personnel."                                                                  
3:36:07 PM                                                                                                                    
DR.  SACCO  directed   attention  to  slide  13,   "Transport  and                                                              
triage," and  spoke about  the guidelines  that take into  account                                                              
local resources and capabilities.                                                                                               
3:36:35 PM                                                                                                                    
DR. SACCO referred  to "Trauma Systems" on slide  14, and declared                                                              
that trauma  systems improved  survival of  the seriously  injured                                                              
by 15  -25 percent,  increased the  productive working  years, and                                                              
enhanced the statewide disaster preparedness.                                                                                   
3:37:25 PM                                                                                                                    
DR. SACCO  spoke to  slide 15 "Preventable  Deaths: the  impact of                                                              
trauma systems,"  and he compared  the decrease to  percentages of                                                              
preventable deaths for three major metropolitan areas.                                                                          
3:37:47 PM                                                                                                                    
DR.  SACCO continued  on  to slide  16,  "Trauma  Systems &  crash                                                              
mortality," which  depicted a state to state  comparison for crash                                                              
mortality before and after the introduction of trauma systems.                                                                  
3:37:59 PM                                                                                                                    
DR.  SACCO  explained  that  slide 17,  "Trauma  systems  &  crash                                                              
mortality"  revealed the  impact  on mortality  rates with  trauma                                                              
systems,  seat belt restraint  laws, lower  allowable blood  level                                                              
alcohol, and increases to the speed limit.                                                                                      
3:38:21 PM                                                                                                                    
DR. SACCO  spoke about slide  18, "Anchorage Mortality  Rate 2005-                                                              
2007" which depicted  the lower mortality rate  for designated, as                                                              
opposed  to  non-designated,  trauma  centers in  Anchorage.    He                                                              
explained   that  the   next  slide   reflected  the   significant                                                              
differences for  age group mortality rates between  the designated                                                              
and non-designated  trauma centers.   He reviewed the  next slide,                                                              
"Trauma  Center  and  Disaster Preparedness,"  and  noted  that  a                                                              
trauma  center  maintained  its  readiness, was  staffed  for  all                                                              
types of  injuries, had  a broad  communications network,  and had                                                              
the resources to facilitate the patient's recovery.                                                                             
3:39:21 PM                                                                                                                    
DR. SACCO  stated that slide 21  "Trauma Systems and  the Public,"                                                              
showed that  83 percent of  the people  wanted a trauma  system in                                                              
their area.                                                                                                                     
3:39:47 PM                                                                                                                    
DR. SACCO  said that  slide 22,  also titled  "Trauma Systems  and                                                              
the  Public,"  affirmed  that 75  percent  of  people  interviewed                                                              
thought there  was a trauma center  system in their state,  but in                                                              
actuality only  15 percent of the  people lived in a state  with a                                                              
comprehensive system.                                                                                                           
3:40:17 PM                                                                                                                    
DR. SACCO  explained slide 23,  "Alaska Trauma System,"  and noted                                                              
that  a  1993  Alaska  statute   created  the  EMS  authority  for                                                              
designating  trauma centers,  set  national  standards for  trauma                                                              
centers,  and made  hospital participation  in  the trauma  system                                                              
voluntary.   He said that  in the 15  years since, there  was only                                                              
one Level  II trauma center and  four Level IV centers  in Alaska,                                                              
which were all listed on slide 25, "Current Status."                                                                            
3:41:54 PM                                                                                                                    
DR.  SACCO introduced  the Site  Visit Team  on slide  26, and  he                                                              
described the  "Objective," slide 27,  which was "To  help promote                                                              
a  sustainable   effort  in  the   graduated  development   of  an                                                              
inclusive trauma system for Alaska."                                                                                            
3:42:20 PM                                                                                                                    
DR. SACCO  continued on  to slide 28,  "Advantages &  Assets," and                                                              
emphasized that  Alaska had very committed individuals  who served                                                              
Alaska,  that  there  was an  extensive  transport  network,  that                                                              
there were  three large medical  centers with extensive  expertise                                                              
in the  state, and that  there was a  very good relationship  with                                                              
Harborview   Medical  Center   in  Seattle   for  sending   trauma                                                              
patients.   He  also  listed the  Level  II facility,  with  other                                                              
small  hospitals working  toward  verification of  Level  IV.   He                                                              
said the  Alaska Trauma Registry  received data from all  24 acute                                                              
care hospitals.                                                                                                                 
3:43:27 PM                                                                                                                    
DR.   SACCO    moved   on   to    slide   30,   "Challenges    and                                                              
Vulnerabilities."   He declared that Alaska did not  have a trauma                                                              
system plan,  there were no  trauma standards, there  were limited                                                              
human   resources,  there   were  few   incentives  for   hospital                                                              
participation,   and  there  was   not  a  statewide   performance                                                              
3:44:24 PM                                                                                                                    
DR. SACCO directed  attention to slide 31, "Trauma  Care in Alaska                                                              
2009,"  and  concluded:  "There  are two  healthcare  systems  for                                                              
injured  patients.    One  for  Alaska  natives  that  adheres  to                                                              
national   standards  and   another  for   the  majority   of  the                                                              
population." [original punctuation provided]                                                                                    
3:44:32 PM                                                                                                                    
DR.  SACCO   referred  to   the  recommendations   on  slide   32,                                                              
"Definitive  Care Facilities,"  and said  that a  second Level  II                                                              
Trauma  Center  had  to be  established  in  Anchorage,  and  that                                                              
participation  by  all acute  care  hospitals should  be  mandated                                                              
within  two years  for trauma  center  designation appropriate  to                                                              
their  capabilities.   He continued  with slide  33, and  declared                                                              
that there  was a need for  pediatric trauma care capability.   He                                                              
concluded  that  it  was  necessary   to  determine  a  method  of                                                              
financial support to trauma centers for uncompensated care.                                                                     
3:45:30 PM                                                                                                                    
DR.  SACCO noted  that  slide 36,  "Alaska  Trauma Systems  Review                                                              
Committee,"  reflected that  the committee  met twice  a year  and                                                              
that  its role  was  to  review the  Level  IV hospitals  and  the                                                              
interfacility  transfer  guidelines,   and  make  suggestions  for                                                              
trauma system improvement.                                                                                                      
3:45:57 PM                                                                                                                    
DR. SACCO  explained that  "Head Injury  Guidelines for  Rural and                                                              
Remote Alaska,"  were implemented  primarily by the  tribal health                                                              
system and it  decreased unnecessary medevacs by  75 percent, with                                                              
no adverse consequences.                                                                                                        
3:47:10 PM                                                                                                                    
DR.  SACCO  commented on  slide  38,  "Current Activity  US,"  and                                                              
compared that  both Georgia and  Arkansas put millions  of dollars                                                              
into  the  trauma  system,  whereas  Alaska  was  the  only  state                                                              
without  a designated  Level 1  or  Level 2  trauma center,  other                                                              
than the  Native Health Service  facility.  He added  that federal                                                              
legislation  was currently  being  considered for  help to  trauma                                                              
3:48:24 PM                                                                                                                    
DR. SACCO concluded  with slide 39, "Alaska Trauma  System: "Where                                                              
do  we  go now?"  and  said  that  it was  necessary  to  increase                                                              
facility participation for development of an inclusive system.                                                                  
3:49:08 PM                                                                                                                    
REPRESENTATIVE  CISSNA asked  about  community emergency  response                                                              
DR. SACCO,  in response to  Representative Cissna,  explained that                                                              
the  difference between  designated  and non-designated  hospitals                                                              
was determined  by the ability to  maintain a minimum  care level.                                                              
He  endorsed the  need  to organize  providers  and facilities  to                                                              
ensure that this care level was always available.                                                                               
DR. SACCO,  in response to  Representative Cissna,  explained that                                                              
the mortality  rates were  adjusted per  100,000 people,  and that                                                              
Alaskans had the second highest rate.                                                                                           
3:52:30 PM                                                                                                                    
REPRESENTATIVE  CISSNA  referred  to  the need  for  funding,  and                                                              
asked what could be done that was not funding related.                                                                          
DR. SACCO  said that  there were  over 70  recommendations  in the                                                              
American  College of  Surgeons report  [Included  in the  members'                                                              
packets],  many of which  did not  require any  funding.   He gave                                                              
two  examples:  mal-practice  caps  on  damages  at  a  designated                                                              
trauma  center and  Medicare  and  Medicaid allowable  billing  by                                                              
designated trauma  centers for the Emergency Room  activation of a                                                              
trauma team.                                                                                                                    
3:55:37 PM                                                                                                                    
CO-CHAIR KELLER opened public testimony.                                                                                        
3:55:55 PM                                                                                                                    
DR.  REGINA   CHENNAULT,  Chair,   Alaska  Committee   on  Trauma,                                                              
American College  of Surgeons, Alaska Native Medical  Center, said                                                              
that  she agreed  with Dr.  Sacco, and  that a  trauma system  was                                                              
also the best design  for handling any disaster.   She stated that                                                              
appropriate trauma care did reduce mortality.                                                                                   
3:58:26 PM                                                                                                                    
DR. DANNY  ROBINETTE, Northern  Alaska Medical Surgical,  observed                                                              
that  there  was  an  increasing  manpower  shortage  for  general                                                              
surgery.  He  noted that trauma patients were  often under insured                                                              
and he suggested  that there be  incentives for doctors.   He said                                                              
that it  became necessary  to medevac  a patient  to Seattle  when                                                              
the Anchorage medical system did not have the availability.                                                                     
4:01:45 PM                                                                                                                    
GERAD GODFREY,  Chair, Alaska  Violent Crimes Compensation  Board,                                                              
related a personal  story which reflected the flaws  in the trauma                                                              
response time.   He said  that the ad  hoc committee  had realized                                                              
that  there  was   not  a  standardized  procedure   for  all  the                                                              
potential  variables.   He  opined  that there  was  unwillingness                                                              
from the hospitals  to go along with the training,  the protocols,                                                              
and the start  up cost.  He  supported the pro active  approach of                                                              
the American College of Surgeons.                                                                                               
4:08:00 PM                                                                                                                    
DAVID  HULL,   Chairman,  Alaska  Council  on   Emergency  Medical                                                              
Services,  said that  trauma  care  needed to  be  addressed.   He                                                              
offered examples  of emergency  medical systems  that had  treated                                                              
trauma  patients,  and he  advocated  for  an entire  trauma  care                                                              
4:12:30 PM                                                                                                                    
ROD  BETIT, President  & CEO,  Alaska State  Hospital and  Nursing                                                              
Home  Association  (ASHNHA), said  that  ASHNHA agreed  that  work                                                              
needed  to be  done on  the  trauma care  system,  and that  there                                                              
should be  incentives for initiating  the system.  He  opined that                                                              
DHSS needed to agree  on its importance before any  talks would be                                                              
effective.   He observed  that that there  was a significant  cost                                                              
to guarantee  the availability  of physicians  and nurses  for the                                                              
required time  response.   He remarked that  it was  different for                                                              
staff  model  hospitals,   as  the  physicians  worked   for  that                                                              
hospital,  than for private  hospitals, where  the physicians  did                                                              
not work  for the  hospital.   He agreed  that HB  168 was  a good                                                              
4:16:45 PM                                                                                                                    
MR. BETIT,  in response to  Representative Coghill, said  that the                                                              
Medicaid  disproportionate share  funds were  available, as  these                                                              
were often left unused.                                                                                                         
4:17:22 PM                                                                                                                    
REPRESENTATIVE  COGHILL  agreed that  having  an already  existing                                                              
funding stream was optimal.                                                                                                     
4:17:27 PM                                                                                                                    
MARK  JOHNSON,  Chief  (ret.),   Community  Health  and  Emergency                                                              
Medical Services,  referred to the  initial legislation  passed in                                                              
1993, which  had set up the  aforementioned voluntary system.   He                                                              
explained  that  DHSS had  co-sponsored  the American  College  of                                                              
Surgeons review of  eight different hospitals in Alaska.   He said                                                              
that  he participated  in the  reviews, and  that many  facilities                                                              
were  close  to  designation.   He  opined  that  incentives  were                                                              
necessary  for  enthusiasm  for   the  designation  process.    He                                                              
stressed that the trauma system would save lives.                                                                               
4:19:38 PM                                                                                                                    
DR.   JAY  BUTLER,   Chief   Medical   Officer,   Office  of   the                                                              
Commissioner,  Department of  Health and  Social Services  (DHSS),                                                              
said that  injury deaths could not  be controlled like  a disease.                                                              
He  reported that  a systematic  approach to  improve trauma  care                                                              
had become  a DHSS priority.   He shared that an  American College                                                              
of Surgeons  recommendation was  for each  acute care  hospital to                                                              
seek  trauma  center designation,  appropriate  to  its  capacity,                                                              
within  the next  two years.   He affirmed  that  the goal was  to                                                              
improve the  quality of care for  trauma victims.  He  stated that                                                              
HB  168 provided  an  incentive to  become  a trauma  center.   He                                                              
cited  potential funding  sources for  reimbursement to  hospitals                                                              
for underinsured  trauma patients.  He noted  that DHSS recognized                                                              
the  importance of  trauma care,  but that  there was  uncertainty                                                              
for  fiscal support.    He observed  that  the administration  had                                                              
taken a neutral stance.                                                                                                         
4:22:37 PM                                                                                                                    
REPRESENTATIVE SEATON  asked how  many trauma deaths  were alcohol                                                              
related, and  if it  was necessary to  address the larger  problem                                                              
of alcoholism.                                                                                                                  
DR.  BUTLER, in  response to  Representative  Seaton, agreed  that                                                              
alcohol  was a  component  and that  the  reduction  to the  legal                                                              
limit for blood alcohol was a part of the larger solution.                                                                      
REPRESENTATIVE  COGHILL,  in response  to  Representative  Seaton,                                                              
said  that he  was open  to  the inclusion  of  other aspects  for                                                              
prevention, as these also had an impact on the system.                                                                          
4:25:53 PM                                                                                                                    
DR.  BUTLER spoke  about  teachable moments,  and  he shared  that                                                              
non-fatal  incidences  of  trauma,  specifically  alcohol  related                                                              
events, were excellent teachable moments.                                                                                       
4:26:42 PM                                                                                                                    
DR. SACCO  agreed with the use  of teachable moments, and  he gave                                                              
examples to the  success with alcohol intervention  and education.                                                              
He suggested  that a requirement  for trauma centers was  to teach                                                              
injury prevention to high risk populations.                                                                                     
4:29:17 PM                                                                                                                    
REPRESENTATIVE COGHILL,  in reference to the bill,  reflected that                                                              
it was  important to  "be quick  but don't  get in  a hurry."   He                                                              
agreed  that  there were  complexities  to  the issues,  but  that                                                              
people's lives were involved.                                                                                                   
4:30:34 PM                                                                                                                    
CO-CHAIR KELLER closed public testimony.                                                                                        
[HB 168 was held over.]                                                                                                         

Document Name Date/Time Subjects
CSHB 188 Sponsor Summary version N.doc HHSS 4/9/2009 3:00:00 PM
HB 188
CSHB 188 Version N.PDF HHSS 4/9/2009 3:00:00 PM
HB 188
HSS188pkt.PDF HHSS 3/26/2009 3:00:00 PM
HHSS 4/9/2009 3:00:00 PM
HB223pkt.PDF HHSS 4/9/2009 3:00:00 PM
HB 223
HB168pkt.PDF HHSS 4/9/2009 3:00:00 PM
HB 168
HB 188 Sectional Version N.PDF HHSS 4/9/2009 3:00:00 PM
HB 188