Legislature(2007 - 2008)BELTZ 211
04/19/2007 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB102 | |
| SB107 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 107 | TELECONFERENCED | |
| *+ | SB 140 | TELECONFERENCED | |
| += | SB 102 | TELECONFERENCED | |
| += | HB 118 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
April 19, 2007
1:34 p.m.
MEMBERS PRESENT
Senator Johnny Ellis, Chair
Senator Gary Stevens, Vice Chair
Senator Bettye Davis
Senator Con Bunde
MEMBERS ABSENT
Senator Lyman Hoffman
COMMITTEE CALENDAR
SENATE BILL NO. 102
"An Act relating to mortgage lenders, mortgage brokers, mortgage
originators, state agents who collect program administration
fees, and other persons who engage in activities relating to
mortgage lending; relating to mortgage loan activities; relating
to an originator fund; relating to fees for mortgage loan
transactions; and providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 107
"An Act relating to naturopaths and to naturopathic practice;
establishing a Naturopathic Advisory Committee and an Alaska
Naturopathic Formulary Council; amending the duties of the State
Medical Board and the Board of Pharmacy relating to naturopathic
practice; and providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 140
"An Act requiring paid leave from employment for bone marrow
donation."
SCHEDULED BUT NOT HEARD
CS FOR HOUSE BILL NO. 118(RLS)
"An Act relating to underage possession of alcoholic beverages
in a dwelling."
SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 102
SHORT TITLE: MORTGAGE LENDING
SPONSOR(s): SENATOR(s) HUGGINS BY REQUEST
03/02/07 (S) READ THE FIRST TIME - REFERRALS
03/02/07 (S) L&C, FIN
04/17/07 (S) L&C AT 1:30 PM BELTZ 211
04/17/07 (S) Scheduled But Not Heard
04/19/07 (S) L&C AT 1:30 PM BELTZ 211
BILL: SB 107
SHORT TITLE: NATUROPATHS
SPONSOR(s): SENATOR(s) DAVIS BY REQUEST
03/07/07 (S) READ THE FIRST TIME - REFERRALS
03/07/07 (S) L&C, HES, FIN
04/19/07 (S) L&C AT 1:30 PM BELTZ 211
WITNESS REGISTER
DANA OWEN
Staff to Senator Ellis
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Commented on SB 102.
MARK DAVIS, Director
Division of Banking and Securities
Department of Commerce Community & Economic Development
Juneau AK 99801
POSITION STATEMENT: Commented on SB 102.
MARIE DARLIN, Volunteer Coordinator
AARP Capital City Task Force
Juneau AK
POSITION STATEMENT: Commented on SB 102.
DANIELLE FAGRE ARLO, Senior Vice President
State Government Affairs
American Financial Services Association (AFSA)
POSITION STATEMENT: Supported SB 102.
JOHN CARMAN, Chairman
Legislative Affairs
Alaska Mortgage Bankers Association
POSITION STATEMENT: Supported the concept of SB 102.
JOHN MARTIN, Member
Predatory Lending Task Force
Alaska Association of Mortgage Brokers (AAMB)
Anchorage AK
POSITION STATEMENT: Supported the new CS to SB 102.
JOE BRAMMER, Chairman
Legislative Committee
Alaska Association of Mortgage Brokers
POSITION STATEMENT: Supported the new CS to SB 102.
TOM OBERMEYER
Staff to Senator Davis
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Commented on SB 107 for the sponsor.
GARY FERGUSON, N.D.
Eastern Aleutians
State of Alaska
POSITION STATEMENT: Supported SB 107.
EMILY KANE, N.D.
Juneau AK
POSITION STATEMENT: Supported SB 107.
SCOTT LOOPER, N.D.
Fairbanks AK
POSITION STATEMENT: Supported SB 107.
PATRICIA ANDERSON
Anchorage AK
POSITION STATEMENT: Supported SB 107.
ACTION NARRATIVE
CHAIR JOHNNY ELLIS called the Senate Labor and Commerce Standing
Committee meeting to order at 1:34:54 PM. Present at the call to
order were Senators Davis, Stevens, Bunde and Ellis. The chair
announced that HB 118 would not be heard today and that this
would be the first public hearing for the other three.
SB 102-MORTGAGE LENDING
1:36:11 PM
CHAIR ELLIS announced SB 102 to be up for consideration and that
there was a committee substitute labeled 25-LS0691\C).
DANA OWEN, staff to Senator Ellis, stated that he had just
received the CS from the sponsor to SB 102 and said that Mark
Davis would explain it in greater detail. It is identical to the
current House version that passed out of House Labor and
Commerce yesterday. The sponsor asked this committee to take up
that version of the bill.
1:37:43 PM
MARK DAVIS, Director, Division of Banking and Securities,
Department of Commerce, Community & Economic Development, said
he would first go over the structure of the bill and then the
changes in the CS. He explained that this bill proposes to
license all components of the industry - mortgage bankers,
mortgage brokers and mortgage originators. It states that an
originator must work for one of the other licensees and that the
mortgage banker and the mortgage broker must work through an
originator.
The originator is the person in this industry who meets with the
consumer, sits down with them and goes over their proposal to
get a mortgage. An important component then is continuing
education under AS O6.61.060, which hasn't changed in either
version, to require originators to be aware of both Alaska law
and federal law.
The bill has a series of prohibitions in it. For example, AS
06.60.320 prohibits false advertising; it also requires
compliance with federal mortgage law. Presently 10 federal
statutes apply to mortgages, but there is limited enforcement by
the federal agency. Recently, states have been adopting federal
standards and then examining for compliance with them. The ones
people are more familiar with are the Truth in Lending Act and
the Real Estate Settlement Procedures Act of 1974.
MR. DAVIS noted on December 8, 2006, the State of Maine
commissioned a Predatory Lending Task Force and after several
months of investigation, one of its major conclusions was that
Maine should enforce or examine for respite the Real Estate
Settlement Act. That is also in this bill.
1:40:25 PM
He said the idea is that they would examine mortgage brokers,
mortgage licensees and originators for compliance not only with
the provisions of this statute, but with the federal statutes.
CSSB 102, version C, also has certain refinancing prohibitions
in section 350. However, it clearly doesn't affect the remedies
that are already available to the Attorney General under the
Alaska Consumer Protection Act.
MR. DAVIS said he had been working with the Department of Law on
this bill and the CS reflects changes that it wanted.
1:41:21 PM
Essentially the bill says there is a private right of action
under the Consumer Protection Act or to the Attorney General
which provides for either treble damages or restitution. The
consumer protection section of law has done mortgage cases
already under that act.
MR. DAVIS explained that the CS inserts an exemption for anyone
who is already licensed under Alaska's Small Loan Act. The idea
is that they are not trying to double up on regulation and if
one regulates under another licensing scheme, that is fine.
However, he said the federal exemption was modified and he
explained that some of the exemptions were designed to allow
non-profit housing organizations to help people with their
mortgages without being licensed, but also an exemption exists
for certain federal subsidiaries of federal banks or the banks
themselves or state banks.
1:42:48 PM
With regard to state banks, Mr. Davis said his division already
examines them and their mortgage activities. The federal
government has taken the position that it should examine any
federal bank and any subsidiary of a federal bank that does
mortgage lending. The U.S. Supreme Court ruled on Tuesday that
any subsidiary or operating subsidiary of a federal bank engaged
in mortgage lending would not be subject to any state
regulation. He said CSSB 102, version C, tracks that decision in
that the bill was drafted using the rule of law established in
the Ninth Circuit that was essentially affirmed by the U.S.
Supreme Court.
The only issue open under that case is that the Supreme Court
said under the Gramm-Leach-Blighly Act an affiliate of a bank
that is engaged in insurance and securities will be subject to
state regulation. What it didn't say is whether an affiliate of
a bank that engages in banking and other banking activities
would be subject to preemption.
MR. DAVIS said the bill was changed to deny an originator's
license if he previously violated a chapter even if it happened
in another state. This situation has already occurred in Alaska.
CHAIR ELLIS asked how this bill protects consumers in that
respect.
MR. DAVIS replied that it allows for a background check of
licensees along with their licensing status. This bill brings
the state more in line with securities law. The CS also says
that the mortgage bankers would be responsible for things they
know or should know about the conduct of the originators - like
appraisals that are way above what the property is worth or
statements of income of the potential borrower, which are more
than they make.
He said a criminal provision was inserted making certain
violations Class A misdemeanors, which give the statute teeth.
"Escrowed" is defined as having written instructions. He said
there over 100 mainly technical changes - mainly lawyers using
different drafting styles.
CHAIR ELLIS asked Mr. Owen if the sectional analysis relates to
the CS. He answered yes.
1:46:02 PM
SENATOR BUNDE said he has heard some complaints, specifically
about mortgage originators with substantial criminal records and
he asked if anyone opposed tightening up these regulations.
MR. DAVIS replied the American Financial Services Association
(AFSA) wants a partial exemption for their originators, which
are companies that either operated in Alaska or through call
centers like Countrywide and Primera. In this case the parent
company would get a license and be responsible for the
originators. Since this is not an administration bill, but an
industry bill, he deferred to industry for their ideas.
He related that he had been told that AARP also has concerns
about restitution, but those provisions are already in the bill.
He explained that the surety fund is not an exclusive remedy and
that one can still sue with private counsel. He believed it
would be much like real estate. If it's a major case and the
person you are suing has money, you'd pursue your remedies. If
it's not, you might go to the realty surety fund to do the best
you could. The surety fund is designed to be a stop-gap thing to
make sure somebody gets some money out of a bad situation.
Making mortgage brokers and mortgage bankers liable for conduct
of their originators provides people with a deep pocket which
didn't exist before, a good reform. It's like a lawyer being
responsible for the conduct of his paralegal.
MR. DAVIS reported the other issue AARP had was wondering why
the bill included a referral to the attorney general. And the
reason he wanted to adopt that is based on Minnesota law that
says if it didn't have the right of referral, his division would
be stuck with only the remedies in the law. He wanted the
ability if someone was not a standard case to refer it to the
attorney general who has the full powers of the Consumer
Protection Act and/or restitution.
1:49:05 PM
SENATOR STEVENS asked what escrow language they were tightening.
MR. DAVIS replied there were questions on whether there are
written instructions in every escrow agreement that will say how
the money is given to a third party who would disperse it when
certain events occur. He wanted to make sure a consumer had
written instructions to refer to.
SENATOR STEVENS asked if this would impact Internet mortgages
and out-of-state lenders.
1:50:16 PM
MR. DAVIS replied this bill proposes covering those. Two years
ago an act was passed that regulates payday loans or deferred
deposit companies. It had a provision for licensing interstate
companies, which has been done successfully. He has been able to
collect $700,000 in restitution from many Internet lenders for
some of Alaska's poorest consumers through the provisions in
that act. This bill is patterned on that law and follows the
same language.
CHAIR ELLIS asked his position on partial licensing of state
mortgagers like Countrywide.
MR. DAVIS said he would have to think about that, but he would
focus on making sure consumers are protected.
1:52:20 PM
MARIE DARLIN, Volunteer Coordinator, AARP Capital City Task
Force, reference its letter with several concerns in it
regarding the original bill. She had not seen the CS, but it
sounded like some of their concerns were addressed in it. AARP
has the consumer's point of view and she was concerned with
pointing out omissions related to consumer protection. Only a
two-year statute of limitations was one concern.
CHAIR ELLIS said he would consider reasonable ways to improve
consumer protection and asked her to look over the CS and
comment at a later date.
MR. DAVIS added that his division and AARP are conducting
seminars around the state. He explained that he looked at CSSB
102, version C, as a licensing law, but AARP is looking at it as
a predatory lending law. He thought predatory lending should be
dealt with in another bill. He mentioned that reverse mortgages
are also questionable.
CHAIR ELLIS said if there are reasonable pro-consumer changes he
would like to see them and would consider putting them in this
bill.
1:57:55 PM
MR. DAVIS said he had agreed with the Department of Law to put a
restitution order provision in Section 870. That is one way he
would respond to AARP.
SENATOR STEVENS asked if this is the proper place to cap civil
penalties.
MR. DAVIS replied these are licensing violations and the $10,000
fine is very similar to what is in the Uniform Securities Act.
The idea in this bill is if something is more than a licensing
issue, like the one that is currently under federal
investigation, it would be referred to the attorney general.
CHAIR ELLIS asked if things come out of this discussion that
aren't appropriate to be included in this bill, would he bring
them up to the committee along with suggestions on how to "tune
up" other state statutes.
MR. DAVIS replied that he would be very happy to do that and
related that two years ago he set up the Predatory Lending Task
Force and hotline and his division had developed a database
about what the current scams and problems are.
2:00:01 PM
DANIELLE FAGRE ARLO, Senior Vice President, State Government
Affairs, American Financial Services Association (AFSA),
supported the CS to CSSB 102, version C, and thanked everyone
for helping them work on the language, especially Mr. Davis and
his division. They still have concerns, but hope to continue
work on resolving them. She said AFSA is a national trade
association based in Washington, D.C. Its members come from
financial services firms that provide credit for consumers in
small businesses; it has 350 members.
Her primary concern related to licensing individual employees
and exclusive agents of large multi-state mortgage companies.
This language will significantly increase the burden on lenders,
regulators and consumers. Their cost will be passed on to the
borrowers in the form of fees. In the case of regulators, it
could have a negative effect on compliance activities. Covering
collections personnel, call center employees, loan processors,
underwriters and others who speak to customers in the process of
completing a loan is unnecessary, she said. Regulators can also
be negatively affected by the administrative burden.
MS. ARLO said that large mortgage lenders and licensed entities
already have programs and policies in place for pre employment
screening, background checks, in-house training, education and
compliance to meet state requirements for their employees and
exclusive representatives. These programs and policies help
prevent fraud or other criminal activity and facilitate
enforcement capability by the department. She explained:
Large mortgage lenders do not oppose licensing for
loan originators who work on behalf of independent
mortgage brokers to find and negotiate loans for
borrowers. A mortgage broker is generally considered
to be an independent person or specialty company who
shops loans to different lenders for the borrower. A
mortgage lender underwrites and/or funds the loan and
is responsible for the credit risk of the loans.
Large mortgage lenders are very different from
independent mortgage brokers in various ways. For
example, they typically operate as licensed entities
in multiple states, have large numbers of employees
who interact with customers from many states on a
daily basis. They are very well capitalized; they
carry huge reputational risks associated with employee
misconduct and they may be affiliated with or a
subsidiary of an entity regulated by the Federal
Reserve Board.
Sensible state licensing of lending companies
themselves render the need to license individual
employees unnecessary and it is our proposed solution
in the substitution language we have prepared and will
continue to work with the department on until they are
satisfied.
2:04:39 PM
JOHN CARMAN, Chairman, Legislative Affairs, Alaska Mortgage
Bankers Association, said CSSB 102, version C, is not perfect in
anyone's mind. Last year it went through 27 revisions before it
passed in the Senate 19 to 1 and died at the last minute in the
House. Last year's bill only called for company licensing
without a provision for individual licensing, but it was always
their intention to pursue individual licensing this year and add
it to the bill. Since the bill was delayed, they are now adding
it at the request of their members. He thought the Division of
Banking and Securities would like the provision and the fact
that they have gotten as far as they have with all the diverse
groups in Alaska from small mortgage brokers to major mortgage
lenders is significant.
MR. CARMAN said he thought the people who were still "working
on" on the bill were really trying to kill it. They fall into
one of two categories - the well-intentioned people that are
late to the process and do not realize how many times every word
in this bill has been debated and that adding more words just
adds more arguing and debate over exactly what the provision
means. He said there are only three weeks left in the session
and currently the state has zero regulation. They need to get a
bill in place that would fund the division so it could hire more
people to enforce existing laws.
The other group is people who are bad-intentioned and that might
have a criminal record or for some other reason find it
difficult to do business under this new bill.
The purchase of a home is huge and everyone else is licensed, he
said, but today a number of convicted felons are doing
mortgages. He knew of a realtor who lost her license for life
for falsifying a tax return for a customer who was applying for
a loan. She is now a lender because there is no restriction on
her activities in lending. Recently an individual was working
for a large bank and was convicted in the federal courts for
banking fraud. This person had already had his license pulled in
another state. If this law would have been in place, this person
would not have been able to practice in Alaska.
There is no doubt, he said, that this bill gives the Division of
Banking and Securities enforcement ability in an area in which
it currently has none. Enforcement of the act will be self-
funded with fees paid by licensees and a $10 loan fee for each
residential transaction borrower. It will be applicable to out-
of-state lenders that have been a major source of complaints to
the division as well as Internet lenders; it will not be onerous
to implement.
2:10:00 PM
JOHN MARTIN, Anchorage, said he has been a resident of Alaska
since 1959. Since 1977 he has been involved in the real estate
industry as broker, investor and developer. For the last 20
years he has been in the mortgage loan business - as a mortgage
loan originator, manager in charge of production of one of
Alaska's largest lenders as well as the manager in charge of all
their branch offices. He is a member of the Predatory Lending
Task Force in Anchorage representing the Alaska Association of
Mortgage Brokers (AAMB). Presently he is the owner of a small
mortgage company and has two originators working with him. He is
the founding member and past president of the AAMB and presently
is a member of the Legislative Committee. He is president-elect
of the Western Regional Mortgage Broker Lenders' Conference, an
organization of 14 western states that puts on an educational
program each year for people in the mortgage loan industry who
receive education, get up-to-date information from national
leading experts and have a face-to-face expo with the nation's
top mortgage lenders.
MR. MARTIN said Alaska is the last state to license mortgage
operations and recent news stories illustrate that our state is
not exempt from unscrupulous operators. Licensure would put
everyone on an even playing field, he said, and "background
checks, competency testing, continuing education will go a long
way towards serving the public." Because these would be
administered by the state, they would be equal and not subject
to a company-wide interpretation of what is a good background
check and what isn't.
CSSB 102, version C, would give the state the ability to revoke
a license if necessary and that's true accountability. It's
important to realize they are only licensing originators. This
has nothing to do with underwriters, shippers, processors,
clerks or anyone else. It's important to license originators
because if they get fired from one company and try to go to
another, the state will know and have a hammer. He said the Mat-
Su Homebuilders Association, Home Inspectors of Alaska,
Independent Brokers Association of Real Estate Brokers in
Alaska, and the American Land Title Association, Alaska Chapter,
all support this legislation. He recommended adopting the new
CS.
2:16:07 PM
JOE BRAMMER, Chairman, Legislative Committee, Alaska Association
of Mortgage Brokers, said he is a mortgage loan originator and
had a three-fold purpose before them today. First he wanted to
relate a brief history of this legislation, second he wanted to
address competency testing and finally, he wanted to speak about
continuing education requirements.
He related that the mortgage industry currently has no
regulations. This lack of regulation has contributed to
unscrupulous operators preying on the consumers of Alaska and
nothing can be done currently to stop them. CSSB 102, version C,
was drafted in conjunction with industry representatives from
the Alaska Association of Mortgage Brokers and the Alaska
Mortgage Bankers Association along with various state
departments. It provides safeguards for the public and
enforceable penalties for violators. It requires the licensing
of mortgage companies and, more importantly, mortgage loan
originators. Right now a person could pedal used cars one day
and be a mortgage loan originator the next - with no training or
education.
Before a loan originator can be eligible for licensing under
CSSB 102, version C,, on page 5, line 24, he will be required to
pass a competency test prior to dealing with the public. In
addition, he will be required to attend and complete continuing
education requirements as outlined on page 15, line 19. This is
important for consumer protection because the industry is
constantly changing. He pointed out that state regulations exist
for pre-licensing testing and continuing education prior to
license renewal for insurance agents, real estate brokers and
others. He concluded saying that CSSB 102, version C, is a
consumer protection bill designed to level the playing field in
the industry that provides enforcement mechanisms and penalties
for violators.
2:21:23 PM
CHAIR ELLIS said the committee had responded to the request of
the sponsor to schedule and delay this bill and would take the
time to do a good job on it. He said there is plenty of time for
it to pass this legislature. He said CS for SB 102, version C,
would be back before the committee on Tuesday.
SB 107-NATUROPATHS
2:21:49 PM
CHAIR ELLIS announced SB 107 to be up for consideration.
TOM OBERMEYER, staff to Senator Davis, sponsor of SB 107,
explained the bill relates to establishing a Naturopathic
Advisory Committee and a Naturopathic Formulary Council. It
amends the duties of the State Medical Board and the Board of
Pharmacy relating to the naturopathic practice and provides an
effective date. He said the three-member advisory committee is
to be comprised of three licensed naturopaths appointed by the
commissioner of the Department of Commerce, Community & Economic
Development. It is responsible for selecting the Formulary
Council and reviewing allegations of member misconduct. The
Counsel will include three naturopaths, one medical doctor or
osteopath and one pharmacist appointed by the respective boards
to approve certain drugs to be prescribed by naturopaths and to
authorized prescription endorsements to qualified naturopaths.
While the State Medical Board licenses osteopaths, podiatrists,
physician assistants, intensive care and paramedics, and foreign
medical graduates, the Department of Commerce, Community &
Economic Development licenses naturopathic applicants who have
graduated from one of the four accredited schools of naturopathy
in the U.S. and one of the two schools in Canada. Applicants
must also have passed the Naturopathic Physician's Licensing
Examination.
New naturopathic procedures under SB 107 allow minor surgery,
including operative electrical and other methods of repair to
superficial lacerations and abrasion or lesions, and removal of
foreign bodies in superficial tissues. The bill also allows
naturopaths to use antiseptics and local anesthetics in
connection with allowed procedures. The law prohibits
naturopaths from performing major surgery and spinal and general
anesthetics.
Thirteen states license naturopaths and nine have instituted
formulary laws. The states are Alaska, Arizona, Connecticut,
Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon,
Utah, Vermont and Washington. Currently, Alaska has 40
practicing naturopaths, Washington has 802, Oregon has 715,
Arizona has 375, Connecticut has 210, Vermont has 117, Hawaii
has 85, Montana has 67, New Hampshire has 67, Maine has 27, Utah
has 18, and Kansas has 11. Nine states allow naturopaths to
prescribe without any M.D. supervision or protocol, but they
usually are allowed to prescribe only designated drugs.
Arizona has the broadest formulary in the nation allowing
naturopaths to prescribe all but I.V. medications, controlled
substances except morphine, cancer chemo-therapeutics, and anti
psychotic drugs. Kansas requires M.D. supervision and Maine
requires collaboration with a physician for one year prior to
independent prescribing.
MR. OBERMEYER said that naturopathic doctors focus on
preventative care and in keeping patients healthy and they
usually rely much less than M.D.s on the use of drugs. Patients
often turn to naturopathic doctors when traditional medicine has
failed. One of the reasons naturopaths require formulary or
prescribing law is to reduce the amount of combinations of drugs
patients are taking.
2:26:37 PM
He said SB 107 is designed to reasonably expand the services of
naturopathic doctors only to areas collateral to the needs of
their daily practice without infringing on the duties and
responsibilities of medical doctors licensed by the State
Medical Board. This type of bill has been before the Senate in
SB 306 in the last legislature; it went through several
revisions and the result was a task force that was to address
it. The Alaska State Medical Board indicated it didn't think the
process was complete.
2:27:08 PM
MARY MINER, N.D., said she is currently practicing in Anchorage,
and that she would address the educational requirements for
naturopaths and how they compare to other licensed health care
professionals in the State of Alaska.
She referenced Appendix E that compared the curricula of
National College, Bastyr University, Southwest (all naturopathic
colleges) and John Hopkins, Yale and Stanford. The basic
clinical education is similar across the board, she observed.
There are differences in the allopathic and the naturopathic
strength in the clinical applications. Naturopaths do a lot more
with botanical medicine, naturopathic philosophy, and oriental
medicine which are not included in the allopathic schools. The
total number of hours of education is similar.
2:29:36 PM
She also handed out a comparison of medical background education
of licensed professionals who are able to use prescription
medications at this time based on a UW study from two years ago
- including nurse practitioners, physician assistants, medical
doctors, and other states that license naturopaths. The
prerequisites to get in to college are fairly similar; the
education once they are in school is also quite similar.
Naturopaths have a different focus on being more wellness
oriented.
MS. MINER said it is within the scope of the practice of most
licensed M.D.s to use prescription medications, particularly
legend drugs, which are not controlled substances and
naturopaths just want to expand their licensing to fit their
training and have it available for their patients.
2:31:07 PM
GARY FERGUSON, N.D., said he practices in the Eastern Aleutians
and represents the Alaska Association of Naturopathic Physicians
as its Alaska Native liaison. His primary work is with the
Alaska Native population although he works for Eastern Aleutian
Tribes community health centers. He serves mainly the
underserved population that has huge health disparities. His
focus in the last five years has been in diabetes and diabetes
management.
One challenge to his practice in the Aleutians is that the nine
communities are remote and have a limited practitioner base. He
sometimes teams up with nurse practitioners and others, but it
still is often not enough. Medications often need to be changed
as health improves. Since he cannot prescribe changes, patients
needs separate appointments and sometimes they get the lost in
the shuffle. He has been trained in pharmacology and pharmaco-
kinetics of drugs and this bill would allow him to practice the
way he was trained. He supported the bill.
2:35:58 PM
EMILY KANE, N.D., said she graduated from an accredited
naturopathic school in 1992 and has been practicing in Juneau
for nearly 15 years. She has had hospital privileges with
Bartlett Regional Hospital for over a decade. So far the ideas
of comparable education have been presented along with expanding
of primary health care providers, which naturopaths are, in the
state of Alaska, which is underserved.
DR. KANE said she wanted to address consumer safety. Appendix K
covered states and disciplinary actions. In the years 2000 to
2003 in various states there were twice as many disciplinary
actions for medical doctors as for naturopaths. However, in
those years Arizona naturopaths had access to prescription drug
writing. However, she noted that it's feasible that Alaska's
zero disciplinary actions for the years surveyed relates to
naturopaths not having access to prescription medication. She
argued that prescription drugs have a much higher side effect
profile, which is why N.D.s get this training. She also noted
that one of the aspects of the bill insures continuing education
and staying abreast of pharmaceutical practices. Dr. Kane said
naturopaths want to provide the best care for their patients
within the scope of their practice.
SENATOR STEVENS asked if the disciplinary actions she mentioned
were for prescription misuse.
DR. KANE replied no; they covered any kind of disciplinary
action that would have been registered through the Division of
Occupational Licensing.
CHAIR ELLIS said the bill was referred to the Labor and Commerce
Committee because of scope of practice issues and workforce
development. He said the Alaska Medical Association opposed this
bill saying the legislature should spend its time expanding the
WWAMI slots and training programs because many M.D.s are
retiring. However, the legislature has doubled the WWAMI slots
this year and he supposed Dr. Kane would argue that N.D.s do
fill that need every day in our state and they are a class of
medical providers that could expand as well. He asked her if she
could comment on that point.
2:42:08 PM
DR. KANE responded that it's fantastic that the legislature has
expanded the WWAMI slots. She said she and Dr. Miner have been
practicing as family doctors for over 20 years. They are already
established in their communities and practicing as primary care
family doctors. She has 4,000 charts. She would be more useful
to her large patient base immediately. The new WWAMI doctors
will be needed, but it's not an either/or situation.
2:42:55 PM
SENATOR STEVENS said he understood Dr. Ferguson's remote
argument, but that's not the case here in Juneau where lots of
people can prescribe medications. He asked what is the rationale
is for providing her that opportunity in town.
DR. KANE replied that she makes referrals frequently saying she
is "well-embedded" in the medical community here. However,
sometimes it takes a long time to get in and the patient needs
the antibiotic immediately. Or they are just not going to go the
medical doctor. It's a freedom of choice in health care issue -
in part. There are plenty of medical doctors here, but on the
whole Alaskans are underserved and naturopaths are submitting
they are trained and available, established and providing
patient care already, and that they have more training than
nurse practitioners who already have prescriptive rights. This
would bring Alaska in line with all the other western states
that license naturopaths and provide prescriptive rights to
them.
2:44:45 PM
SCOTT LOOPER, N.D., Fairbanks, supported SB 107 and wanted to
add that the main reason naturopaths are doing this is to
provide the best quality care to their patients they can.
Sometimes it is in the patient's best interest to receive an
antibiotic, a diuretic or something like that. The fact is that
naturopathic physicians are trained to prescribe when needed
within the context of the practice of naturopathic medicine.
They want to provide quality care with the tools they are
trained to use.
2:46:40 PM
DR. LOOPER described how the right to prescribe is earned. You
attend classes where you learn how to use prescription
medications, then you move on to a clinic situation where under
the supervision of practicing licensed doctors, you practice
using them. After that, you take a national board exam; if you
pass that exam, you earn the right to get licensed.
In Alaska, they do every step of that process with the exception
of the licensing piece. It is often inconvenient for patients to
go to another doctor when their naturopathic doctor is trained
in the use of those medications. It's also more expensive, more
difficult and time consuming. He has a license in Oregon and
Arizona and is used to being able to use these tools on
occasion.
2:48:16 PM
CHAIR ELLIS asked if the lack of prescriptive powers keeps
naturopaths from locating to Alaska.
DR. LOOPER replied that he didn't know. He said the fact is that
naturopathic doctors don't prescribe much. When he had the right
to prescribe in Oregon and Arizona, he only wrote a script once
a week or two and most times he would be taking people off of
things. Not having prescriptive rights doesn't limit his ability
to help people, but it creates a certain frustration knowing
that you're going to be moving to a state that you can't do some
basic things, like writing for thyroid hormone replacement,
which is a normal thing to do in someone whose thyroid isn't
working right.
2:49:11 PM
PATRICIA ANDERSON, Anchorage resident, said she had been a
patient of an N.D. there and has been for over seven years. She
related how she is on her third bout of breast cancer and how
her naturopathic doctor worked with her oncologist to make her
chemotherapy less uncomfortable for her. Her naturopath has
extensive experience with cancer care. After she finished with
chemotherapy, she ended up on a bone loss type medicine and he
has helped her get the exact right kind of calcium to keep the
bone loss minimal. She also recognizes her naturopathic doctor
as her primary physician. She supported SB 107 even though she
has no need of regular prescriptions. She wanted to know that he
would be able to give them to her if she needed them.
2:51:26 PM
RICK URION, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community &
Economic Development (DCCED), disclosed that in a previous life
he lobbied for the State Medical Society and was instrumental in
writing the first law allowing for licensing of naturopaths in
the State of Alaska. Today he represents the administration on
this issue and has a neutral position on it, but he had an
opinion on the two committees the bill forms.
MR. URION said it appears that the advisory committee is really
a board, but it is being formed without being called a board. A
committee is appointed by the commissioner of DCCED and he
thought they might want to change that as well as add a member
of the public - as other boards have. The advisory committee
talks about disciplinary actions and that's what boards do.
Also, the Formulary Counsel consists of three members in the
bill, but it should consist of five members, three of which are
naturopaths and one physician. He also pointed out that existing
law makes it illegal for naturopaths to call themselves
physicians.
CHAIR ELLIS asked if he was suggesting that the committee
consider making the language more conventional to comport with
the way boards are set up for other professions.
MR. URION replied yes. It appears that they are forming a board
whether or not they are calling it that. All the other boards
consist of members of the profession and a member of the public.
The governor does the appointing, not the associations. They can
make recommendations.
2:54:50 PM
CHAIR ELLIS asked Mr. Obermeyer if there is a reason the bill
was drafted differently than all the other boards.
MR. OBERMEYER answered there was an initial question of whether
this type of practice would be regulated by the DCCED or the
State Medical Board. Basically, the naturopaths felt they were
criticized harshly in the last legislature and they wanted to
have some type of control. Documentation indicates that even in
California that the few physicians willing and trained for N.D.
supervision have difficulty getting malpractice coverage. There
are many issues and he didn't have the answers for everything.
He said the 40 naturopaths in Alaska are looking for a way to be
recognized in their profession and expand their practice to
minor procedures and to have an opportunity to be regulated
within their own group. Presumably they would want to keep
malpractice out of their profession.
CHAIR ELLIS requested the sponsor talk with Mr. Urion and draft
the bill with standard operating procedure and bring it back to
the committee next week.
2:57:53 PM
SENATOR DAVIS said she would do what is necessary to move the
bill along.
2:58:17 PM
CHAIR ELLIS asked if there was any work product from Senator
Seekins' Naturopathic Task Force.
MR. OBERMEYER replied there were no recommendations. He said the
State Medical Board said it was concerned that naturopaths are
not as well trained or educated. There is no residency program
for instance. He said this group is willing to address those
issues as necessary in order to have some type of regulation
that everyone agrees with.
CHAIR ELLIS said they would have another meeting as soon as
those things could get resolved in the committee substitute for
SB 107.
There being no further business to come before the committee,
Chair Ellis adjourned the meeting at 3:00:07 PM.
| Document Name | Date/Time | Subjects |
|---|