Legislature(2011 - 2012)BELTZ 105 (TSBldg)
02/09/2012 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB146 | |
| SB175 | |
| SB125 | |
| SB149 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 125 | TELECONFERENCED | |
| *+ | SB 149 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 175 | TELECONFERENCED | |
| = | SB 146 | ||
SB 175-PRACTICE OF NATUROPATHY
1:39:25 PM
CHAIR EGAN announced consideration of SB 175 [version 27-
LS1230\M]. He said that public testimony was still open.
SENATOR GIESSEL moved to adopt Amendment 1.
27-LS1230\M.4
AMENDMENT 1
OFFERED IN THE SENATE SENATOR GIESSEL
TO: SB 175
Page 1, line 13, through page 2, line 2:
Delete all material and insert:
"* Sec. 2. AS 08.45.050 is amended by adding new
subsections to read:
(b) Notwithstanding (a)(1)(A) of this section, a
person who practices naturopathy may give, prescribe,
or recommend in the practice a device or, in a form
that is not a controlled substance, an herbal or
homeopathic remedy, a dietetic remedy, or
hydrotherapy.
(c) In this section,
(1) "dietetic remedy" means nutritional
therapy, nutritional counseling, a nutritional
substance, vitamins, minerals, or supplements to
promote health and to diagnose, treat, or prevent
disease, illness, or conditions;
(2) "herbal remedy" means a substance
derived from or a concentrate or extract of a plant,
tree, root, moss, or fungus;
(3) "homeopathic remedy" means a remedy
defined in the current version of Homeopathic
Pharmacopoeia of the United States;
(4) "hydrotherapy" means the use of water
in all forms and temperatures to promote health and to
diagnose, treat, and prevent disease, illness, and
conditions."
SENATOR GIESSEL explained that this amendment would replace
Section 2 of the bill.
1:40:30 PM
SENATOR PASKVAN objected for purposes of discussion.
1:41:25 PM
MARY MINER, Naturopathic Doctor (N.D.), Fairbanks, Alaska, said
Valentine's Day is the 28th anniversary of her being licensed in
Washington State. She supported SB 175 as amended. She has been
well trained and does not want to limit the services she is able
to deliver to her patients and has a sense of urgency because
these services wouldn't be available to them otherwise. They
would have to go to their other provider who wouldn't have a
clue what they are.
1:44:18 PM
MADELEINE MORRISON, Alaska Association of Naturopathic Doctors,
Anchorage, said she had practiced in Alaska since 1996 and
agreed with Ms. Miner's testimony. She added that she works with
M.D.s on a regular basis together with patients for the best
possible outcome.
1:45:27 PM
WARD HURLBURT, Chief Medical Officer, Department of Health and
Social Services (DHSS), Anchorage, said the administration has
concerns with SB 175 because it could either potentially or in
reality expand the scope of naturopathic practice. Dr. Jackson,
who testified at an earlier meeting, said that he ran into a
problem with a prescription being required for capsicum. Their
Chief Pharmacist did some research and talked with the company
that manufactures it and found that it was their decision to put
on the box that a prescription be required, not something the
FDA did.
He said the state has in the past considered that naturopathic
doctors do not have prescribing authority and believes that the
bill would expand it, which would incur a cost. Dr. Jackson said
his understanding is that authorizing prescriptions for
substances derived from plant, trees, roots, moss and fungus
would include substances like penicillin. Fifteen to twenty
percent of drugs used by allopathic and osteopathic physicians
are originally derived from natural substances.
Some confusion may be because of different training and
vocabulary used for the disciplines. Dr. Jackson testified that
in his training drugs and medicines are different; the drugs are
synthetic chemical substances whereas the medicines more broadly
include natural substances. Mr. Hurlburt said in his training
those terms are interchangeable.
SENATOR MENARD clarified that vitamins are from natural sources
and are sometimes put into 11 percent of prescription-type drugs
to enhance them.
MR. HURLBURT answered they are not talking about vitamins.
Examples of other kinds of pharmaceuticals that are derived from
plants would be digitalis, used for heart failure, and quinine,
originally an anti-malaria drug, some anti-cancer drugs and
penicillin.
SENATOR GIESSEL said the current definition in regulation for
naturopath says herbal remedies include "medicines derived". The
amended form of the bill says herbal remedy means "a substance",
the effort there being to separate digitalis from an herbal
preparation. Did he not think that was clear enough that it's
not a prescription, pharmaceutical agent?
MR. HURLBURT replied his initial take is that it would clarify
it, but their Chief Pharmacist felt the language in the
amendment was broad enough to lead to some confusion in saying
they are derived from natural substances and opened the
possibility of prescribing things like digitalis and anti-cancer
drugs.
SENATOR GIESSEL asked if a clearer statement would have a
semicolon and another phrase that says, "these substances do not
include pharmaceutical agents."
MR. HURLBURT answered yes.
1:53:03 PM
MARY DESMETT, representing herself, Juneau, said she is a
consumer and patient of both naturopathic and allopathic care.
Her life had been profoundly affected in a positive way by being
able to choose when to see a naturopathic doctor or a western
doctor. She was well on her way to type 2 diabetes and now her
labs are all good and she is off every medication including an
anti-depressant.
1:54:32 PM
C.W. JASPER, N.D., said he supported SB 175 and the amendments.
He enjoyed meeting with Dr. Hurlburt, but the concerns about
anti-cancer drugs that may come from an herb or digitalis
forgets an important issue - that every health care provider is
limited by his training and education. And even though this
definition in the regulations might have allowed the use of
those anti-cancer drugs in the last 18 years, the fact of the
matter is that nobody has used them for the last 18 years,
because that is not what their training is. That is the safety
factor. Digitalis is always mentioned because it's a famous
herbal medicine, but nobody uses it anymore. Penicillin was
brought up, and the definition would allow it, but after
speaking to many colleagues on the phone he found that no one
knows of any naturopath who has used it in the last 18 years,
just that the definition would allow it. But again, he said they
practice what they are trained to do. He just didn't think it
was an issued because it's not part of naturopathic practice
based on their training.
1:56:36 PM
SENATOR PASKVAN asked what notice he received of any change from
the department or division.
DR. JASPER replied none. He had a nice meeting with Mr. Habegar
this morning who wasn't aware of putting out any notice to that
effect and didn't know where it came from; he was checking into
it.
1:58:07 PM
SENATOR PASKVAN asked how long naturopaths have used
pharmacists.
MR. JASPER answered for the past 18 years pharmacists have
honored their prescriptions, but for just very few things,
because there aren't a lot of prescription drugs.
SENATOR PASKVAN asked for 18 years consistent with the statutes
and administrative codes of Alaska.
MR. JASPER responded that was correct.
SENATOR GIESSEL asked what he would think if she amended item 2
in Section 2 to say "herbal remedy means a substance derived
from; substance does not mean pharmaceutical agent."
MR. JASPER said he thought it would be confusing because it
would add an undefined word to the definition.
2:01:02 PM
MARY ALICE MCKEEN, representing herself, Juneau, said she is a
consumer of naturopathic care and an administrative judge for
the federal government. She supported SB 175 and appreciated all
the efforts to solve this problem, because people want access to
this type of care. In 1986 the legislature made a policy
decision that people in Alaska should have access to it and
severely restricting the scope of practice [for naturopaths]
really undermines that decision.
Referencing the department's letter that said patients could use
substances in their natural form, she remarked the legislature
did not intend for naturopaths to recommend that patients grind
up their own red pepper but that they could obtain a capsicum
tincture by prescription. She said the regulation answers that
squarely because it says in 12 AAC 42.990(a) that a prescription
drug does not include a device or herbal or homeopathic remedy
or dietetic substance in a form that is not a controlled
substance. It doesn't say it has to be in its natural form; it
really answers the form question by saying the prescription drug
cannot be in a form that is not a controlled substance.
MS. MCKEEN said this new interpretation didn't have any notice
or comment period but the regulations have all gone through a
notice and comment procedure and the public got a chance to
weigh in. If there was a proposed regulation that said
"prescription drug" means everything you need a prescription to
get, people would come out and testify against it and she mused
that in a way, this is the comment period for this new
interpretation.
2:05:07 PM
MARTIN NEIMI, representing himself, Juneau, said he is a 69
year-old patient of a naturopathic doctor and old enough to
choose which kind doctor to see first. The way he views his
choices is that the naturopathic doctor guides him to a better
and healthier life style and when it gets to the point of
needing drugs or surgery, he will go to a medical doctor. He
summarized that he was a P.E. and health teacher before he
retired and knows a little bit about health care and has had a
wonderful experience with naturopathic doctors.
2:06:12 PM
DON HABEGAR, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), came forward to answer questions.
SENATOR PASKVAN asked if he agreed that naturopaths didn't have
any notice of this change.
MR. HABEGAR replied that his staff hadn't released any kind of
formal information to pharmacists or naturopaths, but he was
still looking into it.
SENATOR PASKVAN said that answer seems to infer that no process
was followed, so there was no foundation for his position in the
last meeting.
MR. HABEGAR said in the last meeting he referred to recent
licensure action and he also referred to what appears to be a
consistent no prescriptive authority position based on the
division's history.
SENATOR PASKVAN asked if he agreed that whatever the source,
there had been a material restriction in the naturopath's
ability to access pharmacies as part of their practice from what
has occurred over the last 18 years.
MR. HABEGAR replied he agreed that that is the issue before
everyone and that is what they are saying, but he personally
didn't have any evidence of it.
SENATOR PASKVAN said everything he is hearing says that there
are statutes going back to 1986 and administrative regulations
that go back to 1994 and it appears that they have solid
practices going back 18 years. No notice was given to the
naturopaths, and that implies there was no opportunity for them
to be heard. Therefore, something has occurred that appears to
be arbitrary and capricious. Whatever the source, he was pretty
troubled.
2:10:14 PM
ANDY HARRINGTON, Assistant Attorney General, Civil Division,
Commercial and Fair Business Section, Department of Law, Juneau,
responded that a complaint was filed about a naturopath for
using or administering prescriptive drugs in 2008. During the
investigation, the division asked the naturopath where and how
the prescription drugs were being obtained and the naturopath
indicated an unwillingness to provide that information. Then the
division served several local pharmacies with administrative
subpoenas regarding any prescriptions they may have filled for
the naturopath. The division investigator gave a heads up to the
Pharmacy Board as to why the subpoenas were being served. The
Pharmacy Board eventually sent a cautionary letter to the one
pharmacy that had been filling the prescriptions. He surmised,
Alaska being a small state, that word of the subpoena and
perhaps the letter got discussed on the pharmacist grapevine and
passed along. So, it is not surprising that other naturopaths in
other parts of the state found pharmacists who may have normally
been filling prescriptions written by naturopaths were less
willing to do so.
MR. HARRINGTON said that any pharmacist either in state or out
who called him would have been told that Alaska statute very
clearly prohibits naturopaths from giving, prescribing or
recommending in the practice a prescription drug. The division
felt compelled to interpret its regulations consistent with that
statutory prohibition. Director Habegar is correct that since
shortly after the regulations were enacted the division has
consistently taken the position that the regulations did not
forge any kind of an exception to the statutory prohibition. It
is also fair to say that the naturopaths who were saying they
assumed the regulations trumped the statute are also being very
truthful in their testimony, but regulations don't trump
statute.
2:14:32 PM
SENATOR PASKVAN asked why it isn't appropriate to allow a
practice that has been in place for 18 years to continue while
the legal issue is addressed since it appears the risk is
nonexistent.
MR. HARRINGTON replied that it is appropriate because the
problem arises from a mismatch between language of the statute
with its fairly clear prohibition and the language of the
regulations, which leaves much room for debate. If the statute
is not changed to correspond to regulatory language, the
division would have to go through the notice and public comment
procedure to propose a regulatory change that would be more in
accordance with the statute, AS O8.45.050(1)(A). But the
division has wisely decided to await the outcome of the
legislative process and is neutral as to the merits of the bill,
but recognizes the current situation is pretty untenable.
Naturopaths and their patients and the people in the division
who are trying to administer this law are all disserved by the
confusion created for everyone.
2:17:52 PM
SENATOR GIESSEL said AS 08.45.200 says naturopathy means the use
of hydrotherapy and dietetics and later says that "dietetics
includes herbal and homeopathic remedies" and those are not
defined there; they are defined in regulation and that is the
definition that is being offered in this bill.
SENATOR DAVIS asked if a pharmacist was on line. She heard
someone from a pharmacy say that they had been giving out the
medicine but had received information saying it was illegal to
do so.
CHAIR EGAN said Dr. Hurlburt said that.
SENATOR DAVIS said she had been trying to increase the scope of
practice for naturopaths for years and hasn't gotten anywhere.
This bill doesn't give them any more authority, but it would put
current practice in statute and she was ready to move it.
SENATOR PASKVAN removed his objection to the Amendment 1.
CHAIR EGAN said he would hold SB 175 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 149 - Sponsor Statement.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB 149 - Distance Race Schedule.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB 149 - Newspaper Articles.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB 149 - Non-Profit Mushers Associations.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB 149 - Quest Volunteer Form.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB 149 - Race Maps.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB 149 - Synopsis.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB149-DCCED-CBPL-02-03-12.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB149-DCCED-INS-02-03-12.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |
| SB149-DOR-TAX-02-02-12.pdf |
SL&C 2/9/2012 1:30:00 PM |
SB 149 |