Alaska

Stomping through stubborn, crunchy January snow, Dr. Jennifer Pierce made her way recently to a new Anchorage Fire Department vehicle. It might look like a simple SUV, but it’s equipped as a new mobile unit that – for the first time – will allow emergency responders to administer buprenorphine on-site, which can help get patients on the road to recovery.

“We want people to see us as a beacon of help,” Pierce said.

Pierce is on a mission: to treat Anchorage residents who overdose and connect them with care afterwards. After being treated for an overdose, many patients don’t agree to further treatment at the hospital or emergency room. Working out of mobile units allows the team to meet those Alaskans where they are.

“We don’t want people to fall through the cracks,” she said.

Narcan, or naloxone, is used to reverse overdoses. But it puts people into immediate and uncomfortable withdrawal. Research shows that in similar mobile programs, offering that second medication, buprenorphine, makes it more likely patients will enter long-term recovery. Even if people don’t continue treatment, Pierce said, the medication can help them make it through a critical window when overdose survivors are at high risk of dying.

“Even if it’s just one life,” she said. “We’re saving lives out there and preventing individuals, maybe from overdosing the next day or overdosing again later and dying.”

Pierce visited successful programs in Texas and Washington state for ideas and best practices to replicate in Alaska.

The Anchorage team can get dispatched by 9-1-1 when someone is experiencing an overdose. During slower parts of their shift, they’ll be able to do treatment outreach with people who are at higher risk of overdose, Pierce said.

Offering patients buprenorphine has several benefits, said Seth Workentine, an addiction medicine specialist in Juneau who consulted for the pilot program there.

Buprenorphine lasts much longer than Narcan, at least 24 hours, protecting people from re-entering overdose. It also reduces withdrawal symptoms, which can push people back to opioid use, Workentine said.

“Withdrawal is an extremely uncomfortable experience hated by almost everyone who’s ever experienced it and is often a barrier to people seeking treatment,” he said. “Now they just feel normal and have a much bigger leg up into entering recovery.”

But buprenorphine is an opioid, and Workentine said he’s heard critics of similar programs argue that it’s just swapping one drug for another. That’s not the case, he said, because buprenorphine is different and, over time, it actually helps reverse the brain changes that happen with addiction.

“So it’s not replacing one for the other, even though they’re in the same category,” Workentine said. “It is actually part of healing you.”

And that, he said, is integral to the recovery process.

Dr. Quigley Peterson, an emergency room physician heading Juneau’s pilot program, said he’s also seen the healing benefits of buprenorphine. He’s confident the pilot will do well partly because he’s seen how helpful the medication can be in a different setting: the emergency room.

“We have something that can help engage people, that’s super safe and it’s cheap, and it works,” Peterson said.

The pilot programs will collect data over the year to see what happens to patients after they’re given buprenorphine for an overdose, Peterson said. His hope is that it reduces emergency room visits and calls for emergency medical care. That would be good for the mental health of emergency responders, too, who get burnt out responding to the same patients over and over, he said.

If you can get patients into long-term care, Peterson said, “you won’t need to see them in the future. You won’t have these recurrent EMS calls.”

If the pilot programs are successful, Peterson’s goal is to inspire similar programs in more communities across Alaska.

Landslides, storm-driven floods, infrastructure-damaging permafrost thaw and intensifying wildfires are among the expensive disasters that scientists link to Alaska’s rapidly changing climate.

Now a state legislator is proposing to levy a 20-cent surcharge on every barrel of Alaska-produced oil to fund programs that respond to and prepare for disasters related to climate change.

Rep. Andy Josephson, D-Anchorage, introduced the measure, House Bill 247, in advance of the legislative session scheduled to start on Jan. 20.

To explain why the state needs such a fund, Josephson ticked off a list of recent disasters in Alaska that imposed heavy costs — and, in some cases, killed people. Those events, which include deadly landslides in Southeast Alaska, landslides that have blocked roads, severe flooding in Western Alaska last October from the remnants of Typhoon Halong and similar damage in 2022 from the remnants of Typhoon Merbok, all had some links to climate change that is caused by greenhouse gas emissions from fossil fuel burning, he said.

“It’s a true statement that a lot of the disaster dollars we need right now are related to climate change. That, in my opinion, is sort of inarguable,” he said.

Disasters like those that have occurred in recent years are expected to continue in the future, he said: “We’re in a new normal.”

The bill is logical from a fiscal standpoint, Josephson said.

As of now, the state’s disaster relief fund is “basically a sub-fund of the general fund,” and it gets whatever lawmakers are able to appropriate, he said. But if there is a new stream of money as proposed by his bill, “we would free up those dollars we’re otherwise spending in the disaster relief fund.”

At 20 cents per barrel, the proposed surcharge would raise about $30 million a year, he said.

In comparison, Gov. Mike Dunleavy in December proposed that lawmakers approve a $40 million appropriation for the state’s existing disaster relief fund. The need could increase from that total if the Trump administration fails to reimburse 100% of the costs for Typhoon Halong relief rather than the normal 75%. The Biden administration in 2022 approved 100% reimbursement for Merbok-related costs.

As introduced by Josephson, the bill would give the Alaska Department of Environmental Conservation oversight over the money generated by the surcharge. It would distribute fund money in the form of grants to local governments and other entities for purposes like disaster response, disaster preparation and upgrades that make infrastructure better protected against climate change.

The surcharge idea has precedent in Alaska. The Department of Environmental Conservation already administers another fund with money coming from a per-barrel fee on oil produced in the state.

After the 1989 Exxon Valdez oil spill, the state began levying a 5-cent-per-barrel surcharge on oil that goes into the state’s Oil and Hazardous Substance Release Prevention and Response Fund. The fund itself was created by the legislature in 1986, with the surcharge established after the disastrous Prince William Sound spill.

That surcharge and rules concerning the fund’s operations have been modified over the years, broadening the purposes for which the fund can be used and boosting DEC’s reporting requirements, according to the department.

In its current configuration, each 5-cent-per-barrel surcharge sends 1 cent into a spill response account, to be used for spills that have been officially declared disasters. The other 4 cents goes into a spill prevention account, which can be used to address spills that have not been declared disasters, among other functions.

In 2015, refined petroleum products were added to the program. The state added a small surcharge, 0.95 cents per gallon, on refined fuel projects sold, transferred or used at the wholesale level, according to the DEC.

The idea of a similar levy to raise money for climate change preparedness and response is not new.

Rick Steiner, a retired University of Alaska marine conservation professor who founded and leads an environmental organization called Oasis Earth, has been advocating for the approach for several years.

“The legislature has so far seemed unable or unwilling to connect the dots between the many climate-related disasters we are experiencing — typhoon Merbok, wildfires, landslides, floods, coastal erosion, permafrost thaw, storm damage, infrastructure damage, subsistence impacts, commercial fishing impacts, etc..– to see the larger picture of the threat and costs these interrelated climate disasters pose,” he said in a letter to lawmakers sent last September. “The money to address these issues will have to come from government.”

In advocating for what he called an Alaska Climate Resilience Fund, Steiner said funding issues have become more pressing because of federal cutbacks.

The climate-response surcharge idea is not unique to Alaska, either.

Hawaii has put its version of a climate surcharge into law, a measure that seeks to raise money for responses to future disasters like the deadly 2023 Lahaina wildfire on the island of Maui.

In May, Hawaii Gov. Josh Green, a Democrat, signed a bill that increases the state’s hotel and lodging tax by less than a percentage point. The increase is applied to the state’s Transient Accommodations Tax, known at TAT. The governor said the increase would amount to an additional charge of about $3 on a $400-a-night hotel room fee. It is expected to generate about $100 million a year, according to state officials.

Alaska’s capital city will soon have a new fire chief. 

The City and Borough of Juneau named Thomas Hatley as Capital City Fire/Rescue’s new fire chief on Friday afternoon. His first day will be Feb. 9. 

He was one of the two finalists for the position to replace longtime fire chief Rich Etheridge, who retired at the end of December after more than 15 years leading the department. 

Hatley served as the deputy chief for the Spokane Valley Fire Department in Washington until April of this year, when he left due to a family medical reason. He has more than three decades of experience in fire service, holding positions like fire chief, assistant chief and fire marshal at multiple agencies in the Northwest. 

During a public candidate presentation in Juneau in December, Hatley said he was drawn to the position because of the complexities of Juneau’s fire and emergency medical services needs. He pointed to its lack of outside support, large service area and seasonal population surges. 

Hatley said he wanted to see the department focus on resolving its staffing issues, especially by retaining the department’s employees. The Juneau Career Firefighters Union is currently at an impasse in its negotiations over a new contract with the city. Union representatives say uncompetitive wages and staffing shortages are driving people away from the department.

The annual salary listed on the city’s website for the position is between $125,944 and $161,761.

Cindy Carte, the city’s human resources manager, is currently serving as acting chief.

The Juneau School Board held off on returning $1.05 million in funding earmarked for child care to the City and Borough of Juneau this week amid questions about the current privately-run program and the possibility of an additional operator in the future.

Board Vice President Elizabeth Siddon said at a meeting Tuesday she still has questions around how things are going with Auke Lake Preschool, like the status of its state licensing. Auke Lake Preschool started running an after-school program at the beginning of this school year after the district stopped operating its own.

“I just think we’re not ready, especially in a final reading, to make this decision,” Siddon said. “We don’t have all the information about the programs and what options we have for kids at all of our sites.”

Siddon said there is also a possibility for YMCA Alaska to expand its child care program to Juneau, and that the city funding might be able to be used for that.

Nate Root is the CEO of YMCA Alaska. The organization currently runs after-school child care in Anchorage, the Mat-Su Borough and Kodiak.

In an interview with KTOO, Root said YMCA is looking into how feasible it would be to expand its after-school program to Juneau. He toured three schools last year and said the organization is working on surveys to see how many families are interested in the program.

He said running a program depends on how financially sustainable it will be. And it will still take a while to get licensed by the state if they move forward with starting a program in Juneau.

“To be completely transparent, it would look like the soonest we would open a program would be the beginning of the 26-27 school year,” he said.

Derik Swanson is the co-owner of Auke Lake Preschool, which runs the current after-school child care program out of Harborview Elementary, Auke Bay Elementary and Sít’ Eetí Shaanáx̱ – Glacier Valley Elementary.

He said in an interview Friday that the program is still currently unlicensed. Swanson said staffing issues have delayed the process, but with those now resolved, he plans to keep working on getting licensed.

“It’s been pretty successful overall,” Swanson said. “It was kind of a rush to get the program started and up and running, but now it seems to be running fairly smoothly.”

Swanson was unaware of the potential for YMCA to expand to Juneau, but said child care providers in the city generally work together to meet the high demand.

The school board unanimously agreed to discuss the state of the after-school child care program and the remaining city funding at its facilities committee meeting on Feb. 3.

Hundreds of health care workers and government officials descended on Anchorage this week for the kickoff of a five-year, $1.3 billion program aimed at reimagining medical care across Alaska.

The money comes from the Rural Health Transformation Program created by President Trump’s signature tax- and spending-cut legislation passed last summer — the same legislation that pares back Medicaid.

The problem the funding seeks to solve is no secret, the state’s former chief medical officer, Dr. Anne Zink, said on a call with reporters and state officials. Zink is working with the state Department of Health on the program, she said.

“We consistently see that people who live in rural areas — Alaska and beyond — have worse health outcomes with increased cost,” she said. “This is an opportunity to rethink the way that care is delivered to make sure, no matter where you live, you have access to quality, timely, effective care.”

States across the country are racing to develop plans to spend the influx of cash. They have until October to obligate the first tranche of cash and another year to spend it.

Alaska is building its version of the program around six goals, from improving maternal health, preventive care and access to healthcare to strengthening the workforce and rethinking how doctors and hospitals charge for care.

That last point — what the state is calling “pay for value” — is a big one. Most medical care is what’s known as “fee for service,” for example, when a patient goes to a doctor and pays the doctor for their time, whether they get healthy or not.

With pay for value, the idea is to pay for results.

But given the fragmented nature of health care in Alaska, where many patients have to travel hundreds of miles from home for care, “the realities of making that transition take time,” said Deputy Health Commissioner Emily Ricci.

“It’s very challenging, and it will look different for every community and every provider and the provider types,” Ricci said.

Another example: Say you have a rash. You go to the doctor. The doctor sends you to the dermatologist, who sends you to the pharmacy for a medicated lotion.

Does your primary care provider know what your dermatologist prescribed? Does your dermatologist know your regular doctor tried that same medication with the hard-to-pronounce name six months ago?

And does anyone know if you eventually get better?

Maybe not. And that’s an issue standing in the way of a transition to value-based care that the state would like to address, Ricci said.

“How can we use this funding to begin now, over the next five years, building out the infrastructure, the concepts, the protocols, the data that providers need in order to kind of make that transition?” Ricci said.

So technology is one focus for the first of what the Department of Health said will be a series of workshops in Anchorage.

The meetings — known as “convenings” — are an effort to get as many stakeholders involved as possible, from cities and tribes to hospitals, medical providers and vendors, Health Commissioner Heidi Hedberg said.

“This funding is really to support what the community and region need,” Hedberg said. “Every community, and every region, needs something different.”

Alaska will receive roughly $273 million per year for five years as part of the $50 billion nationwide program. Hedberg calls it “generational.”

But the elephant in the room, of course, is that the same tax cut legislation that created the program could also push many Alaskans away from the health care system, said Alaska Hospital and Healthcare Association head Jared Kosin.

“I see the bright side and the good things looking ahead,” Kosin said. “I talk about coverage disruptions with these enhanced premium tax credits expiring. We talk about coverage disruptions with the tightening of Medicaid eligibility right around the corner.”

State officials have downplayed the spending law’s impact on Alaskans on Medicaid. But Kosin is worried the changes will push health care costs up, he said, because when people can’t pay, hospitals have no choice but to shift those costs onto those who can.

Kosin said he’s also concerned that the transition to a new administration after Gov. Mike Dunleavy’s term ends in December could throw a wrench in the state’s plans.

State officials, though, say they’re building sustainability into their plans. Ricci, the deputy health commissioner, said that the state Health Department was “acutely aware” of the challenges involved in standing up a program that will span at least two governors’ administrations over half a decade.

“The key to that, I think, is bringing in the communities and the partners and the healthcare entities into the discussion from the beginning and into that structure,” Ricci said.

Put more simply, “this is a project for Alaskans by Alaskans,” said Zink, the state’s former chief medical officer.

“The sustainability will be dependent on Alaskans,” she said.

Alaska Public Media’s Rachel Cassandra contributed reporting.

Martin Luther King Jr. Day is coming up on Monday.

It’s a day to remember the legacy of the famous civil rights leader and a national day of service, and local organizations and volunteers will host events to mark the occasion. 

The Black Awareness Association of Juneau will also host a virtual MLK Day event on Monday from 1 to 2 p.m. It’s advertised as a family-friendly service featuring soulful music and accounts from people whose lives were impacted by Dr. King. 

More information is available at baajuneau.org, where participants can also register for the event. 

The Alaska Bar Association, in partnership with the Alaska Court System, Alaska Legal Services Corporation, ACLU of Alaska, will host a free legal clinic at Ḵunéix̱ Hídi Northern Light United Church in the Flats neighborhood from 10 a.m. to 1 p.m. and at St. Paul’s Catholic Church in the Mendenhall Valley from 9 a.m. to 2 p.m. 

Local lawyers, judges and legal professionals volunteer their time to help advise people on legal matters. Kevin Higgins from the Alaska Bar Association shared information about the clinic on Juneau Afternoon Wednesday. 

“Really anything can bring you in the door,” he said. “And a lot of times what we’re able to do at the clinic, you know, it’s a very limited representation. I’s not like we’re going to be coming into court with you over the life of a potential case, but we can really kind of help you figure out how to orient yourself with the court system and what steps you can take next.”

Higgins said they can help with any stage of a legal situation, including how to potentially avoid one. No appointments are required. You can find more information at alaskabar.org/MLK. Similar clinics are also happening Monday in Anchorage, Bethel and Fairbanks.