Legislature(2009 - 2010)CAPITOL 106
04/01/2010 08:00 AM STATE AFFAIRS
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
SB 215-PIONEERS HOME RX DRUG BENEFIT [Contains mentioned of HB 284.] 9:48:46 AM CHAIR LYNN announced that the next order of business was SENATE BILL NO. 215, "An Act requiring the Department of Health and Social Services to accept federal prescription drug benefits or to provide comparable benefits for residents of the Alaska Pioneers' Home." 9:49:40 AM SENATOR WIELECHOWSKI, Alaska State Legislature, as co-prime sponsor, noted that HB 284 is a companion bill. He offered a history of the problem, which SB 215 proposes to address. He noted that in April 2009, veterans living in the Alaska Pioneer Homes, who were not able to administer their own medications, stopped receiving the free or low-cost medications they earned through the Veterans Administration and were forced to purchase their medication through the Alaska Pioneer Homes' pharmacies. The problem, Senator Wielechowski explained, is that the Alaska Pioneer Homes' pharmacies prepare medication in blister packs, and the Veterans' Administration does not have the equipment to do so. The staff at the Alaska Pioneer Homes refused to administer drugs from bottles, and was not able to put the medication in blister packs. SENATOR WIELECHOWSKI said the Department of Health & Social Services, the Alaska Pioneer Homes, the Veterans Administration, veterans' advocates, and several members of the legislature worked together for several months to solve the problem. The Alaska Pioneer Homes were cooperative, and the chief pharmacist of the Alaska Veterans Association and chief of staff conducted in-service visits to the Alaska Pioneer Homes to ensure that the nurses were properly administering medications directly from the original bottles from the Veterans Association. SENATOR WIELECHOWSKI stated that SB 215 seeks to ensure that this problem does not surface in the future. He stated his understanding that "this isn't the first time that this has happened." He said the change of administrations could be a time when this happens, and that is why "we're seeking to codify this." Senator Wielechowski related that the bill has a zero fiscal note and no known opposition. The proposed legislation is supported by the Office of Veteran Affairs and is a top legislative priority for the Vietnam Veterans of America. He offered to answer questions from the committee. 9:53:10 AM REPRESENTATIVE JOHNSON stated his understanding that the reason for using blister packs is to eliminate the possibility of dosing error. He asked if the state would be subjecting itself to liability by saying it's okay to use bottles. 9:55:00 AM SENATOR WIELECHOWSKI responded that those who administer medications at the Alaska Pioneer Homes were concerned about the possibility of error, but after consideration have decided that they can administer medication safely from bottles, which is why they are "supportive of this compromise." He noted that there are only about a dozen people to which the proposed the legislation would apply. 9:56:26 AM REPRESENTATIVE SEATON said when the committee heard the companion bill, HB 284, he had relayed that he has a relative who "was in this situation." He expressed concern that the proposed legislation would be "putting things in statute that are already taken care of." He said one issue that has not been addressed is the waste resulting in using blister packs. He explained that blister packs are made for 31 days, and those medications not used during months with fewer days are thrown out, and the value of those discarded medications is not reimbursed to the person in whose name the prescription is written. 9:57:20 AM REPRESENTATIVE P. WILSON said as a nurse, she has "dispensed drugs like this." She said veterans deserve the free drugs from the Veterans Association; they should not have to pay for the same drug because it's in a blister pack. She said she thinks SB 215 is a good bill. 9:58:38 AM REPRESENTATIVE GRUENBERG echoed Representative Johnson's concern about possible liability to the state under SB 215. 9:59:22 AM SENATOR WIELECHOWSKI responded that "anyone can sue for any reason at all." He stated, "At some point you have to put some … confidence in the professionals that are working at the [Alaska Pioneer] Homes - the nurses that are working there." Regarding whether or not there would be increased liability, he said, "I guess someone could administer the wrong blister pack." 9:59:54 AM REPRESENTATIVE GRUENBERG asked the bill sponsor if he thinks the legal aspect of the bill had been sufficiently addressed. 10:00:03 AM SENATOR WIELECHOWSKI responded: Personally, … as an attorney myself, I don't see it as burdensome. I don't see it as an additional, potential liability. You have a professional nurse in a professional organization who's been working with the [Alaska Pioneer] Homes, whose working with the Department of Health & Social Services to figure out a method to do this. It really is just a matter of taking a pill out of a bottle and giving it to the person. And so, obviously if a nurse doesn't do that correctly, there's potential liability there. I don't think there's any way you can get around that. If … they give the person the wrong medicine from a blister pack, there's potential liability there. REPRESENTATIVE GRUENBERG expressed satisfaction with Senator Wielechowski's answer. 10:01:09 AM VERDIE BOWEN, Director, Office of Veteran Affairs, Department of Military & Veterans' Affairs (DMVA), testified in support of SB 215. He said several times last year patients had to stop receiving their medication from the VA. He stated, "Each time a solution was brought forward, then something new would creep up from some administrative order or something that would not allow the patient to receive the medication." Mr. Bowen said what made the situation worse was that many of the patients involved could not speak up for themselves because they had Alzheimer's and dementia, and so their families had to go to their defense. He affirmed that Senator Wielechowski was correct that the number of patients affected last year was about a dozen. Mr. Bowen stated that the intent of the bill is to prevent this situation from happening again years from now. He credited Commissioner Hogan as the person who "stood up" and "put forth the fixes in place." Regarding bottled medicine, Mr. Bowen explained that the pills are taken out of the bottle and placed into "ready packs," which he said look like blister packs, but are packaged for Monday through Sunday. He said he does not know what liability there would be to the state, but does know that "this is something that those people have earned and should continue to receive." 10:03:16 AM CHAIR LYNN closed public testimony. 10:03:24 AM REPRESENTATIVE PETERSEN said he thinks it is unfortunate that some veterans were denied their medication last year, and he stated his support of SB 215. 10:04:02 AM CHAIR LYNN reopened public testimony. 10:04:15 AM DAVE COTE, Director, Central Office, Division of Alaska Pioneer Homes, stated that the department is neutral regarding SB 215, because "we are basically already doing this anyway." Regarding safety, he relayed that while certified nurses' aides are allowed to dispense from the blister packs, the department has asked that only nurses dispense the VA and Indian Health Services medications. Mr. Cote stated that those people who were charged for the period of May through November were all refunded and credited back all the money that they were charged. Mr. Cote, in response to Representative Johnson, said blister packs increase the amount of money and time required for dispensing medication and "the VA doesn't do that." In response to a follow-up question, he said the state uses the blister packs for safety reasons. 10:07:12 AM MR. CODY, regarding Representative Seaton's concern about the wasted medication in a 31-day blister pack, indicated that there are rules related to whether or not medications can be returned to pharmacies. He indicated that important factors are whether, since its release from the pharmacy, the medication stayed at the proper temperature and was not damaged or tampered with in any way. He said the department and the pharmacies believe "this is the right way to go with this." 10:08:11 AM REPRESENTATIVE GRUENBERG moved to report SB 215 out of committee with individual recommendations and the accompanying zero fiscal notes. There being no objection, SB 215 was reported out of the House State Affairs Standing Committee.