Legislature(2017 - 2018)CAPITOL 106

02/28/2017 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:04:05 PM Start
03:05:44 PM HB25
03:32:40 PM HB43
04:20:00 PM Presentation: Reducing Use of Emergency Department Services
04:47:03 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 25 INSURANCE COVERAGE FOR CONTRACEPTIVES TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
*+ HB 43 NEW DRUGS FOR THE TERMINALLY ILL TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Presentation: Reducing Use of Emergency Dept. TELECONFERENCED
Services - Follow Up on a Component of SB 74
Medicaid Reform (29th Legislature) by Anne Zink,
MD, AK ACEP President; Ben Zaniello, MD, VP
Collective Medical Technologies & Connie Beemer,
MBA, AK State Hospital & Nursing Home Assoc.
(ASHNHA)
+ Bills Previously Heard/Scheduled TELECONFERENCED
             HB 43-NEW DRUGS FOR THE TERMINALLY ILL                                                                         
                                                                                                                                
3:32:40 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  announced that the  next order of  business would                                                              
be  HOUSE   BILL  NO.  43,   "An  Act  relating   to  prescribing,                                                              
dispensing,   and    administering   an   investigational    drug,                                                              
biological product,  or device by physicians for  patients who are                                                              
terminally  ill;  providing  immunity  related  to  manufacturing,                                                              
distributing,  or  providing  investigational   drugs,  biological                                                              
products,  or  devices;  and  relating  to  licensed  health  care                                                              
facility requirements."                                                                                                         
                                                                                                                                
3:32:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JASON  GRENN,  Alaska  State  Legislature,  shared                                                              
that the proposed  bill was often referenced nationally  as "Right                                                              
to Try"  legislation.   He stated  that the  goal of the  proposed                                                              
bill was:                                                                                                                       
                                                                                                                                
     to  create  a  legal climate  in  which  terminally  ill                                                                   
     patients  who  have exhausted  all  FDA (U.S.  Food  and                                                                   
     Drug  Administration)  approved  treatment  options  may                                                                   
     work  with  their  doctors  and  drug  manufacturers  to                                                                   
     access  investigational and  safe  treatments that  have                                                                   
     passed Phase I  of the FDA approval process  but are not                                                                   
     yet widely available.                                                                                                      
                                                                                                                                
REPRESENTATIVE GRENN  reported that "Right  to Try" laws  had been                                                              
passed in  33 states,  with this  legislation being considered  in                                                              
another 15  states, now including  Alaska.  Paraphrasing  from the                                                              
Sponsor  Statement  [included  in  members'  packets],  he  stated                                                              
that,  each  year, it  was  estimated  that  more than  1  million                                                              
Americans  died  from  terminal  illness.   "For  those  who  have                                                              
exhausted  all FDA approved  options, clinical  trials become  the                                                              
next step.  However,  of those patients who attempt  to gain entry                                                              
into a clinical  trial, it is found that fewer than  3 percent are                                                              
accepted."    He  declared  that,  although the  FDA  did  have  a                                                              
program in  place for accessing  investigational drugs  outside of                                                              
clinical  trials,  which  was  known  as  the  "Compassionate  Use                                                              
Program," it  was estimated  that only about  1200 people  made it                                                              
through the long,  arduous federal process annually.   He declared                                                              
that  the goal  of  the  proposed bill  was  to provide  the  same                                                              
access as  the existing  program but  on a  shorter timeline.   He                                                              
said  that  by assuring  that  terminally  ill patients  had  more                                                              
timely   access   to   safe,   though   experimental   drugs,   in                                                              
consultation  with their  doctor,  the proposed  bill would  offer                                                              
new hope after all FDA approved options had been exhausted.                                                                     
                                                                                                                                
3:35:02 PM                                                                                                                    
                                                                                                                                
BROOKE  IVY,  Staff,  Representative  Jason  Grenn,  Alaska  State                                                              
Legislature,  presented a  PowerPoint titled  "House Bill  43: The                                                              
Right to Try."   She directed attention to the  sectional analysis                                                              
[included in  members' packets] and  to slide 2, "House  Bill 43."                                                              
She addressed  Section  1 of the  proposed bill,  and stated  that                                                              
this section prohibited  disciplinary action by the  State Medical                                                              
Board  against  physicians  for prescribing  or  administering  an                                                              
investigational drug  to a terminally ill patient  who met certain                                                              
criteria.   She reported  that patients  had  to be ineligible  or                                                              
unable  to   participate  in  an   ongoing  clinical   trial,  had                                                              
considered all  available treatment  options in consultation  with                                                              
their doctor, and  had provided written consent.  She  moved on to                                                              
Section   2  of  the   proposed  bill,   which  established   that                                                              
physicians,  medical team members,  manufacturers, importers,  and                                                              
distributors acting  in good faith and with reasonable  care would                                                              
not  be  held  liable  in  the  case  of  injury  or  death  of  a                                                              
terminally ill  patient from the  use of an investigational  drug,                                                              
provided that the  informed consent was obtained  from the patient                                                              
and notice of immunity  was also given to the patient  in advance.                                                              
She  added  that   the  section  also  established   immunity  for                                                              
physicians and manufacturers  who chose not to  participate in the                                                              
distribution of  investigational drugs.   She addressed  Section 3                                                              
which  amended  AS  17.20.110,   and  would  allow  physicians  to                                                              
prescribe   or   administer  investigational   drugs   under   the                                                              
conditions established  in Section  1 of the  proposed bill.   She                                                              
spoke about  Section 4, which  prevented the Department  of Health                                                              
and  Social  Services  from  requiring   a  licensed  health  care                                                              
facility  to   increase  its   services,  solely  to   accommodate                                                              
physicians who  were prescribing or administering  investigational                                                              
drugs to a patient.                                                                                                             
                                                                                                                                
3:37:37 PM                                                                                                                    
                                                                                                                                
MS.  IVY  directed   attention  to  slide  3,   "FDA  Drug  Review                                                              
Process," and  explained this process.   She reported  that, prior                                                              
to Phase  1, the  sponsors of a  drug were  required to  submit an                                                              
"Investigation  New  Drug"  (IND) application,  and  through  this                                                              
application,  the   FDA  reviewed  the  applicant's   pre-clinical                                                              
testing  results,  and  then  determined   whether  the  drug  was                                                              
reasonably safe for testing in humans.                                                                                          
                                                                                                                                
MS. IVY spoke  about slide 4, "FDA Drug Review  Process (cont'd),"                                                              
and  explained  that  in  Phase 1,  the  studies  occurring  after                                                              
approval of  the IND application,  the studies could  be conducted                                                              
on   healthy  volunteers   dependent   on  the   purpose  of   the                                                              
medication, or on  individuals with specific diseases  or terminal                                                              
illness.    She stated  that  safety  to determine  possible  side                                                              
effects  and  toxicity  levels was  the  goal  of  Phase 1.    She                                                              
addressed slide 5,  "FDA Drug Review Process (cont'd),"  and spoke                                                              
about  the  Phase   2  studies,  which  began  when   a  drug  was                                                              
determined to  be safe,  and was focused  on the effectiveness  of                                                              
the drug.   She  stated that, if  there was  evidence that  a drug                                                              
was effective, it  moved on to Phase 3, slide 6,  "FDA Drug Review                                                              
Process (cont'd)."   In  Phase 3, more  information was  gained on                                                              
safety  and  effectiveness, particularly  in  varying  populations                                                              
and in  different dosages.   After Phase  3, sponsors of  the drug                                                              
have  a  review meeting  with  the  FDA,  and  submit a  new  drug                                                              
application requesting  approval to market the drug  in the United                                                              
States, slide 7,  "FDA Drug Review Process (cont'd)."   After this                                                              
application,  the FDA had  60 days  to decide  whether to  file an                                                              
application  for  review  and  then  applications  were  generally                                                              
processed within 10 months.                                                                                                     
                                                                                                                                
3:39:26 PM                                                                                                                    
                                                                                                                                
MS.  IVY reviewed  slide  8,  and explained  that  investigational                                                              
drugs  had  passed  the  safety  testing  in  Phase  1,  and  were                                                              
currently in  ongoing clinical  trials in Phase  2 and Phase  3 of                                                              
the FDA process.                                                                                                                
                                                                                                                                
3:39:43 PM                                                                                                                    
                                                                                                                                
MS.  IVY directed  attention to  slide 9,  "FDA's Expanded  Access                                                              
Program," and spoke  about the "Compassionate Use"  program, which                                                              
was  designed  for  terminally  ill  patients  without  access  to                                                              
clinical  trials so  they could  apply  for these  investigational                                                              
treatments.   She  explained that  the  patient had  to work  with                                                              
their  doctor to  apply  directly to  the  FDA.   She noted  that,                                                              
until recently,  this application took  more than 100 hours  for a                                                              
doctor  to  complete,  but  it   had  now  been  shortened.    She                                                              
acknowledged  that  this was  still  just the  first  step in  the                                                              
approval  process.   She  added  that  manufacturers also  had  to                                                              
submit lengthy  documentation before the application  went through                                                              
the  internal   FDA  approval  process   and  on  to   a  separate                                                              
institutional review  board, often a lengthy  multi-month process.                                                              
She reported  that approximately  1200 applicants made  it through                                                              
the process annually.   She addressed slide 10, "The  Right to Try                                                              
- A  Nationwide  Effort," and  pointed out  that this  legislation                                                              
had been passed or was under consideration in all but one state.                                                                
                                                                                                                                
3:41:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD, referencing  slide 9,  asked how                                                              
many applicants did not make it through the process.                                                                            
                                                                                                                                
MS. IVY said that she did not have that number.                                                                                 
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD offered  her belief  that it  was                                                              
an important component to the proposed bill.                                                                                    
                                                                                                                                
3:42:05 PM                                                                                                                    
                                                                                                                                
MS.  IVY pointed  to  the Clinical  Trials  document [included  in                                                              
members'  packets]  which  included  stories  of  Alaskans  facing                                                              
terminal illness  and the benefit  of having access to  the drugs.                                                              
She stated  that, additionally,  there was  a Goldwater  Institute                                                              
policy report  [included  in members' packets]  which delved  into                                                              
greater  detail  for  the  challenges  of  the  Compassionate  Use                                                              
program.                                                                                                                        
                                                                                                                                
REPRESENTATIVE TARR  asked for an  update to the policy  signed by                                                              
President Obama prior  to leaving office, which  had included some                                                              
provisions to expand  drug trials for non-approved  drugs, and for                                                              
its interaction to the proposed bill.                                                                                           
                                                                                                                                
MS. IVY said that she would research the specifics.                                                                             
                                                                                                                                
3:44:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked  why  the legislation  was  vetoed  in                                                              
Hawaii.                                                                                                                         
                                                                                                                                
MS.  IVY  replied  that,  although   the  legislation  had  passed                                                              
unanimously  from  the legislature  in  Hawaii, the  governor  had                                                              
vetoed  it.   She shared  that Governor  Brown  in California  had                                                              
also  vetoed the  legislation,  but had  since  changed his  mind,                                                              
purportedly  because  of  instances  of benefits  to  patients  in                                                              
Texas.                                                                                                                          
                                                                                                                                
3:46:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  referenced   the  statement  from  the  bill                                                              
sponsor  that this  was an  opportunity for  individuals who  have                                                              
terminal  illnesses  to try  something  that  was not  a  standard                                                              
procedure.     He  offered   his  belief   that  there   might  be                                                              
opportunities  for treatment  benefits  prior to  waiting until  a                                                              
diagnosis of terminal  illness.  He asked why it  was necessary to                                                              
wait to prescribe a potential remedy until a terminal diagnosis.                                                                
                                                                                                                                
MS. IVY  replied that  the national  advisors on this  legislation                                                              
had  suggested to  keep  a narrow  focus,  as  this was  something                                                              
already available  through the FDA.   She pointed out  that taking                                                              
on  preventative care  with all  medications that  go through  the                                                              
FDA approval process  was a much larger federal  policy discussion                                                              
regarding the approval of drugs in the U.S.                                                                                     
                                                                                                                                
3:47:59 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  added that, as  medications had side  effects, an                                                              
important  part of  the FDA approval  process  was to ensure  that                                                              
the medication  was safe,  did what it  claimed, and  its benefits                                                              
outweighed  the costs.   The FDA  approval process  was set  up to                                                              
protect  consumers.   She  offered  an  example of  aspirin  being                                                              
taken to  prevent heart  problems, whereas  it actually  increased                                                              
gastric  problems  as  a  side  effect.    She  pointed  out  that                                                              
experimental drugs  needed to be proven  safe.  She asked  for the                                                              
definition of terminally ill in the proposed bill.                                                                              
                                                                                                                                
MS. IVY  directed attention  to page  2, line  12 of the  proposed                                                              
bill, and she read:                                                                                                             
                                                                                                                                
     "terminal illness"  means a disease that,  without life-                                                                   
     sustaining  procedures,  will  result  in death  in  the                                                                   
     near  future or  a  state of  permanent  unconsciousness                                                                   
     from which recovery is unlikely.                                                                                           
                                                                                                                                
3:50:43 PM                                                                                                                    
                                                                                                                                
LINDA  BRUCE,  Attorney, Legislative  Legal  Counsel,  Legislative                                                              
Legal Services,  stated that this  was a new definition  which had                                                              
been drafted for this bill.                                                                                                     
                                                                                                                                
MS. IVY  offered her  belief that the  definition came  from model                                                              
legislation in other states.                                                                                                    
                                                                                                                                
3:51:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  whether  the  information                                                              
collected from  terminally ill  patients could  be used  for other                                                              
patients.                                                                                                                       
                                                                                                                                
MS. IVY  replied that  the data  from investigational  drugs, used                                                              
outside a  clinical trial,  was being  collected and that  federal                                                              
law   dictated  that   manufacturers   needed   to  provide   this                                                              
information  to the  FDA.   She  offered her  belief  that it  was                                                              
required that the data be collected.                                                                                            
                                                                                                                                
3:53:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   commented  that  this  was   Rare  Diseases                                                              
Awareness Day.   She shared that, as there was not  a large enough                                                              
population   to  have  statistically   relevant  information   for                                                              
appropriate interventions,  it was often a fight to  get access to                                                              
medication.                                                                                                                     
                                                                                                                                
3:54:50 PM                                                                                                                    
                                                                                                                                
STARLEE   COLEMAN,  Vice   President,  Communications,   Goldwater                                                              
Institute,  reported   that  her  organization  had   crafted  the                                                              
language  on  which  proposed  HB  43  was  based,  although,  she                                                              
acknowledged,  there had  been some  Alaska specific  adjustments.                                                              
She  relayed  that  diagnosis for  a  terminal  illness  currently                                                              
offered  three  paths  of  approved  options  for  the  access  to                                                              
promising  investigational treatments:    the first  path was  for                                                              
the  clinical trials;  the second  path  was for  those who  could                                                              
afford  to  travel overseas  to  access  drugs that  were  already                                                              
available  in countries  other than  the U.S;  the third path  was                                                              
for  the  connected,  the  aforementioned  FDA  "Expanded  Access"                                                              
program.  For  the remainder of  the public, there was  no path to                                                              
access  investigational  treatments,  hence  the  "Right  to  Try"                                                              
program.   She stated  that it  was important  to understand  that                                                              
this  program was  the  opposite  of the  right  to die  movement,                                                              
which was  for people ready  to end their  own lives.   The "Right                                                              
to Try"  program allows patients  with terminal illnesses  who had                                                              
tried existing  treatments with no  success, and could  not enroll                                                              
with  a  clinical  trial, to  access  promising  treatments  being                                                              
safely used in  government approved clinical trials.   She pointed                                                              
out  that it  was not  a question  for  whether or  not trying  an                                                              
investigational treatment  was too risky,  as the risk  from these                                                              
treatments  was  exactly  the  same  as  for  those  entered  into                                                              
government clinical  trials.  She  emphasized that it was  hard to                                                              
be  selected for  a clinical  trial.   She offered  an example  of                                                              
clinical  trials  for  children  diagnosed  with  spinal  muscular                                                              
atrophy (SMA).   She reported that  97 percent of  cancer patients                                                              
had to rely  on drugs already on  the market, even if a  drug in a                                                              
clinical  trial was being  developed specifically  for their  type                                                              
of  cancer, and  had  already been  approved  in other  countries.                                                              
She reiterated that,  although about 1200 people  annually made it                                                              
through  the  application  process,  it  was not  known  how  many                                                              
people were  declined as FDA did  not keep records.   She reported                                                              
that, although the  FDA declared that its approval  rate was about                                                              
99  percent,  she  had  questioned  this rate.    She  offered  an                                                              
example of  a cancer trial center  in Houston, the largest  in the                                                              
world,  which claimed  that  it  had only  been  able  to get  one                                                              
person through  the FDA "Expanded  Access" process annually.   She                                                              
surmised that many  doctors spoke to the FDA in  advance and would                                                              
not  apply   if  the  FDA  stated   they  would  not   accept  the                                                              
application.    She pointed  out  the  difficulty for  doctors  in                                                              
Alaska who  were not familiar with  the FDA process  or hierarchy.                                                              
She compared  the FDA  program with  a similar  program in  France                                                              
which  treated 25,000  people annually,  and  declared that  there                                                              
was a problem with the FDA program.                                                                                             
                                                                                                                                
4:04:00 PM                                                                                                                    
                                                                                                                                
MS.  COLEMAN stated  that, although  no one  expected a  guarantee                                                              
that  an  investigational  drug  would offer  a  cure,  they  just                                                              
wanted an  opportunity to try  the medications already  being used                                                              
in clinical  trials.   She declared  that dying  people and  their                                                              
families were  owed that opportunity.   She stated that  "Right to                                                              
Try"  was  already working  and  saving  lives.   She  offered  an                                                              
example of  terminal pancreatic  cancer patients.   She emphasized                                                              
that states  were able to do  this to complement the  federal drug                                                              
approval  process, and  not compete  with it.   She declared  that                                                              
the right  to save your  own life was a  human right, and  that it                                                              
should not be necessary to also fight government red tape.                                                                      
                                                                                                                                
4:05:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JOHNSTON  asked   for   clarification  that   the                                                              
proposed  bill  was for  the  right to  try  drugs  that had  gone                                                              
through the first, second, and third steps toward FDA approval.                                                                 
                                                                                                                                
MS. IVY  replied that all  of these drugs  had passed Phase  1 for                                                              
safety testing and were currently in Phase 2 or Phase 3.                                                                        
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked if  drugs  allowed  in Europe  had                                                              
already passed  Phase 1 by  the FDA, and were  also in Phase  2 or                                                              
Phase 3.                                                                                                                        
                                                                                                                                
MS.  IVY replied  that  was  correct.   She  stated  that in  some                                                              
countries  medications  or treatments  were  in general  use,  and                                                              
considered  safe  and effective,  but  had  not yet  gone  through                                                              
Phase  1 of the  FDA process  in order  to be  eligible under  the                                                              
"Right  to Try"  program.   She pointed  out that  a person  could                                                              
travel to  that country and utilize  the medication, but  that was                                                              
outside this process.                                                                                                           
                                                                                                                                
MS.  COLEMAN  offered  an example  for  five  FDA  investigational                                                              
treatment  drugs for  breast  cancer which  had  been approved  in                                                              
other  countries.   She stated  that  "Right to  Try" would  allow                                                              
those treatments  already in use  to become available  to American                                                              
women.                                                                                                                          
                                                                                                                                
4:07:59 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked  how many people had taken  advantage of the                                                              
access to "Right to Try."                                                                                                       
                                                                                                                                
MS.  COLEMAN replied  that there  was  not a  complete record  for                                                              
that  information, as  there was  not a  state specific  reporting                                                              
requirement  for the  use of  drugs in  a state with  a "Right  to                                                              
Try"  law.   She noted  that  this would  be  duplicative of  drug                                                              
company  reports to  the FDA,  adding that  the FDA  did not  make                                                              
this information available under public records laws.                                                                           
                                                                                                                                
4:09:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked if a  drug would qualify if  it was                                                              
used  for  one   treatment,  even  though  its   purpose  was  for                                                              
something  else.    She  pointed  out that  it  had  already  gone                                                              
through  the  Phase  1  safety test,  but  not  through  the  next                                                              
phases.                                                                                                                         
                                                                                                                                
MS. COLEMAN  said that  she would  need more  specifics about  the                                                              
drug's placement  in the trial process.   She reiterated  that the                                                              
goal  of  "Right  to  Try" was  to  provide  access  for  terminal                                                              
patients to  any drug which had  passed the initial  safety trial,                                                              
and was  in on-going trials and  under active investigation.   She                                                              
said that it was  legal for drugs to be used  for another purpose,                                                              
which she termed "off label use."                                                                                               
                                                                                                                                
4:11:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  expressed   concern  for  the  provision  of                                                              
immunity, noting  that medical  malpractice provisions  were still                                                              
in  place, and  asked  if this  had  been an  issue  in any  other                                                              
states.  She asked  if there was protection for  an individual who                                                              
felt pressured or coerced into taking a drug.                                                                                   
                                                                                                                                
MS.  COLEMAN shared  this  concern  that patients  were  protected                                                              
from  any undue  pressure to  try  something they  were not  fully                                                              
comfortable  with and to  protect them  from medical  malpractice.                                                              
She shared  that the  proposed bill  had two patient  protections:                                                              
(1)  that  a  patient  must  voluntarily   sign  a  comprehensive,                                                              
informed  consent   document,  and  (2)  that  this   was  totally                                                              
voluntary  with no  incentive for  the  pharmaceutical company  to                                                              
participate.   She  said that  medical malpractice  laws were  not                                                              
impacted  by the proposed  bill,  and these laws  would remain  in                                                              
place.  She declared  that a point of the liability  shield was to                                                              
ensure  that  doctors,  hospitals,  and  pharmaceutical  companies                                                              
understand  that should  a  patient in  a  terminal situation  die                                                              
while  taking  an  investigational  treatment,  that,  in  and  of                                                              
itself, was not a reason to be sued.                                                                                            
                                                                                                                                
4:15:05 PM                                                                                                                    
                                                                                                                                
MS. IVY  added that there were  other protections in  the proposed                                                              
bill, as  it included  investigational drugs  in on-going  trials.                                                              
She  offered her  belief that,  under  federal law,  manufacturers                                                              
cannot engage in  the marketing and sale of unapproved  drugs, and                                                              
were  not legally  permitted  to  sell investigational  drugs  for                                                              
more than the production  cost.  She stated that  this removed the                                                              
cost benefit for manufacturers to participate.                                                                                  
                                                                                                                                
CHAIR SPOHNHOLZ  asked whether the  informed consent  described in                                                              
the proposed bill  included a verbal discussion for  the risks and                                                              
benefits.                                                                                                                       
                                                                                                                                
MS. IVY, in  response to Chair Spohnholz, expressed  her agreement                                                              
and added  that discussion would  include all available  treatment                                                              
options currently approved by the FDA.                                                                                          
                                                                                                                                
CHAIR SPOHNHOLZ  directed attention to  page 2, lines 26  - 27, as                                                              
the guarantee of  a verbal conversation with the  doctor regarding                                                              
the  risks  and  benefits  of  a  potential  treatment,  and  that                                                              
writing was a codification of that consent.                                                                                     
                                                                                                                                
MS. IVY expressed  her agreement that  this was the intent  of the                                                              
proposed  bill,  and  expressed   her  support  of  any  necessary                                                              
amendment to clarify the requirement for a verbal conversation.                                                                 
                                                                                                                                
4:18:24 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  said that  HB 43  would be  held over  and public                                                              
testimony would be opened at that time.                                                                                         

Document Name Date/Time Subjects
HB025 ver A 2.16.17.PDF HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Sponsor Statement 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Sectional Analysis ver A 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Cost Savings Study 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-ADN Commentary 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Guttmacher Alaska Statistics 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Guttmacher Public Costs from Unintended Pregnancies 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Kachemak Bay Family Planning Clinic 2.23.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter League of Women Voters Alaska 2.24.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Unintended Pregnancies Study 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Planned Parenthood Votes Northwest & Hawaii 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-UCSF Study Newspaper Article 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Dr. Tina Tomsen 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Support Emails 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Opposing Document-America's Health Insurance Plans 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Opposing Document-Letter NFIB 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DHSS-Medicaid Services 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DHSS-DHCS 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DCCED-DIO 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB043 ver D 2.22.17.PDF HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Sponsor Statement 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Sectional Analysis ver D 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Legislative Map 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - FDA Drug Review Process 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Clinical Trials in Alaska.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Goldwater Institute Fact Sheet 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Goldwater Institute Patient Stories 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Goldwater Institute Policy Report Summary 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB43 Supporting Document - Letters of Support 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Fiscal Note DCCED--DCBPL 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB 43 Powerpoint Presentation.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
AK ED Coordination Project from SB 74 to H HSS.pdf HHSS 2/28/2017 3:00:00 PM