Legislature(2005 - 2006)CAPITOL 106

04/06/2006 03:00 PM HEALTH, EDUCATION & SOCIAL SERVICES


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03:04:48 PM Start
03:05:40 PM HB467
04:28:57 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Rescheduled from 04/04/06 --
+= HB 467 ADMINISTRATION OF MEDICATION BY A NURSE TELECONFERENCED
Heard & Held
+= SB 177 PRACTICE OF PSYCHOLOGY TELECONFERENCED
Scheduled But Not Heard
+= HB 482 SCHOOL:BULLYING/HARASSMENT/INTIMIDATION TELECONFERENCED
Scheduled But Not Heard
= HJR 30 PUBLIC HEALTH COMPACT
<Bill Hearing Canceled>
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                         April 6, 2006                                                                                          
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Carl Gatto                                                                                                       
Representative Vic Kohring                                                                                                      
Representative Sharon Cissna                                                                                                    
Representative Berta Gardner                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Tom Anderson                                                                                                     
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 467                                                                                                              
"An Act relating to the administration of prescribed remedies                                                                   
and dietary supplements by a nurse."                                                                                            
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
SENATE BILL NO. 177                                                                                                             
"An Act eliminating the requirement  that persons using titles or                                                               
descriptions   of    services   that   incorporate    the   terms                                                               
'psychotherapy,'  'psychotherapeutic,'  or  'psychotherapist'  be                                                               
licensed  by   the  Board   of  Psychologist   and  Psychological                                                               
Associate Examiners."                                                                                                           
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
HOUSE BILL NO. 482                                                                                                              
"An Act relating to harassment, intimidation, and bullying in                                                                   
schools."                                                                                                                       
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
HOUSE JOINT RESOLUTION NO. 30                                                                                                   
Relating to public health and a prevention compact.                                                                             
                                                                                                                                
     - BILL HEARING CANCELED                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: HB 467                                                                                                                  
SHORT TITLE: ADMINISTRATION OF MEDICATION BY A NURSE                                                                            
SPONSOR(s): REPRESENTATIVE(s) KELLY                                                                                             
                                                                                                                                
02/13/06       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/13/06       (H)       HES, FIN                                                                                               
03/28/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/28/06       (H)       <Bill Hearing Postponed to 03/30/06>                                                                   
03/30/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/30/06       (H)       -- Meeting Canceled --                                                                                 
04/04/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
04/04/06       (H)       <Bill Hearing Postponed to 04/06/06>                                                                   
04/06/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
DEREK MILLER, Staff                                                                                                             
to Representative Michael "Mike" Kelly                                                                                          
Alaska Legislature                                                                                                              
POSITION STATEMENT:  Presented HB 467 on behalf of                                                                              
Representative Kelly, sponsor.                                                                                                  
                                                                                                                                
CATHERINE GIESSEL, Registered Nurse (RN)                                                                                        
Advanced Nurse Practitioner;                                                                                                    
Chairperson, Alaska Board of Nursing                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition of HB 467.                                                                         
                                                                                                                                
GENA EDMISTON, Registered Nurse (RN)                                                                                            
Associate Administrator                                                                                                         
Denali Long-term Care Center                                                                                                    
Fairbanks Memorial Hospital                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 467.                                                                            
                                                                                                                                
RICK SCHIKORA, Certified Public Accountant (CPA)                                                                                
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 467.                                                                            
                                                                                                                                
MIKE POWERS, Administrator                                                                                                      
Fairbanks Memorial Hospital                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 467.                                                                            
                                                                                                                                
CHARLOTTE DAVIS, Registered Nurse (RN)                                                                                          
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 467.                                                                         
                                                                                                                                
VIRGINIA SMILEY, Director                                                                                                       
Division of Pioneer Homes                                                                                                       
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 467.                                                                            
                                                                                                                                
NANCY DAVIS, Registered Nurse (RN)                                                                                              
Representative                                                                                                                  
Alaska Nurses Association (ANA)                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 467.                                                                         
                                                                                                                                
ROD BETIT, President                                                                                                            
Alaska State Nursing Home Association (ASNHA)                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 467.                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 3:04:48  PM.                                                             
Representatives Seaton,  Gatto, Cissna,  and Wilson  were present                                                               
at  the  call to  order.    Representatives Kohring  and  Gardner                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
HB 467-ADMINISTRATION OF MEDICATION BY A NURSE                                                                                
                                                                                                                                
3:05:40 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE BILL  NO. 467,  "An Act relating  to the  administration of                                                               
prescribed remedies and dietary supplements by a nurse."                                                                        
                                                                                                                                
3:06:10 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON stated that her intention  would be to hear and hold                                                               
HB 467, to allow continued committee discussion.                                                                                
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to   adopt  HB  467,  Version  24-                                                               
LS1265\G, as  the working  document.   There being  no objection,                                                               
Version G was before the committee.                                                                                             
                                                                                                                                
3:07:10 PM                                                                                                                    
                                                                                                                                
DEREK  MILLER,  Staff  to Representative  Michael  "Mike"  Kelly,                                                               
Alaska  Legislature,  sponsor, introduced  HB  467  on behalf  of                                                               
Representative  Kelly,  paraphrasing  from a  written  statement,                                                               
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
     Before you today  is HB 467.  This  bill was introduced                                                                    
     with the goal  of working out a  reasonable solution to                                                                    
     the current Board of Nursing  policy that prevents most                                                                    
     registered  nurses   in  the   state  of   Alaska  from                                                                    
     administering    prescribed   remedies    and   dietary                                                                    
     supplements  for patients  in  a  nursing facility,  an                                                                    
     assisted-living home, or an Alaska  Pioneers' Home.  In                                                                    
     recent years  the Board of Nursing  has determined that                                                                    
     it is outside  of the scope of practice for  a nurse to                                                                    
     administer remedies  that are not FDA  approved even if                                                                    
     the patient requests them,  the doctor prescribes them,                                                                    
     and the  facility has  approved written  procedures for                                                                    
     administering   them.     We   believe   this  is   too                                                                    
     restrictive   and  HB   467  would   allow  nurses   to                                                                    
     administer  such   remedies  provided  that  it   is  a                                                                    
     prescribed  remedy or  dietary supplement  administered                                                                    
     within the manufacturer's recommended dosage.                                                                              
                                                                                                                                
     This  legislation  was   introduced  after  Rep.  Kelly                                                                    
     received  a letter  from  Rick  Schikora in  Fairbanks.                                                                    
     Mr.  Schikora's  grandmother  lives  in  the  Fairbanks                                                                    
     Pioneer Home and  she has bad knees and  dementia.  Her                                                                    
     doctor prescribed  glucosamine and  fish oil  pills and                                                                    
     nurses were willing to administer  them, but because of                                                                    
     the  Board  of  Nursing   decision,  the  Pioneer  Home                                                                    
     discontinued  their administration.   Mr.  Schikora was                                                                    
     forced to go to the Pioneer  Home daily to give her the                                                                    
     prescribed remedies.                                                                                                       
                                                                                                                                
     This seems to just make  good sense to fix this problem                                                                    
     and we have  found many lay and  professional folks who                                                                    
     agree.   We  think current  policy is  not in  the best                                                                    
     interest of the  patient and we propose  a common sense                                                                    
     solution.    Other states  have  found  ways to  safely                                                                    
     administer these  supplements and  HB 467  would permit                                                                    
     Alaska to do the same.                                                                                                     
                                                                                                                                
3:08:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  referred to page  1, line 14, and  page 2,                                                               
lines 1-2, and read, "'prescribed  remedy or dietary supplement'"                                                               
includes   over-the-counter,   herbal,   and   vitamin   remedies                                                               
prescribed by a  person authorized under this  title to prescribe                                                               
the  remedy or  supplement."   He asked  who would  be authorized                                                               
under  this title  to prescribe  remedies  or supplements;  would                                                               
more than  one category  of persons  be identified  to prescribe;                                                               
and  do  supplements  generally  require  prescriptive  authority                                                               
prior to purchase.                                                                                                              
                                                                                                                                
MR.  MILLER responded  that prescriptive  authorization would  be                                                               
required for  the administration of supplements  in this context,                                                               
and that  the prescription would be  written by a physician.   He                                                               
stated that there may be  other individuals who would be provided                                                               
prescriptive authority under this statute.                                                                                      
                                                                                                                                
3:10:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  asked to  have  statute  checked in  this                                                               
regard to ascertain if a  requirement exists for the prescription                                                               
of supplements.  Further, he inquired:                                                                                          
                                                                                                                                
     [Is]  ...  this  bill  ...   saying  that  even  if  [a                                                                    
     substance]  doesn't  need  to  be  prescribed,  it  ...                                                                    
     [could]  only be  administered  by a  nurse  if it  ...                                                                    
     [were] prescribed by a physician.                                                                                          
                                                                                                                                
MR.  MILLER confirmed  that  the  bill provides  for  a nurse  to                                                               
administer   prescribed   substances  only,   including   dietary                                                               
supplements.                                                                                                                    
                                                                                                                                
3:10:39 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON inquired who would have prescriptive authority.                                                                    
                                                                                                                                
MR. MILLER stated that he would  be able to provide the committee                                                               
with that information at a later time.                                                                                          
                                                                                                                                
3:11:17 PM                                                                                                                    
                                                                                                                                
CATHERINE   GIESSEL,  Registered   Nurse  (RN),   Advanced  Nurse                                                               
Practitioner; Chairperson,  Alaska Board  of Nursing,  stated her                                                               
history of work in the field  of health care, and highlighted her                                                               
care  for  patients   of  various  ages  and   facilities.    She                                                               
paraphrased from  the following Alaska Board  of Nursing Position                                                               
Paper, March  2006, which read  as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Background                                                                                                               
     The  Alaska  Board  of  Nursing  is  charged  with  the                                                                    
     regulation  of   nursing  practice  to   ensure  public                                                                    
     safety.   The  Board of  Nursing enacts  regulations to                                                                    
     implement safe nursing  practice, reviews and validates                                                                    
     license  application credentials  and oversees  nursing                                                                    
     education.   The Board of Nursing  also reviews issues,                                                                    
     utilizing  scientific   findings  and   best  practices                                                                    
     recommendations,  to  ensure  that  the  Alaska  public                                                                    
     receives safe nursing care.                                                                                                
                                                                                                                                
     The Alaska  Board of Nursing  has considered  the issue                                                                    
     of   nurse  licensee   administration  of   nutritional                                                                    
     supplements,  herbal and  homeopathic preparations  and                                                                    
     other non-FDA  approved medications several  times over                                                                    
     the  last  decade.    Each time  the  Alaska  Board  of                                                                    
     Nursing  has  maintained  that  the  administration  of                                                                    
     nutritional   supplements,   herbal   and   homeopathic                                                                    
     preparations and other  non-FDA approved medications is                                                                    
     an unsafe  practice and outside  the scope  of practice                                                                    
     for nurses in Alaska.                                                                                                      
                                                                                                                                
     Deliberations                                                                                                            
     The   Board   of   Nursing  reviewed   the   issue   of                                                                    
     administration  of  herbal   preparations  in  December                                                                    
     1998.   The  case brought  to  the Board  related to  a                                                                    
     resident  of an  assisted living  home whose  physician                                                                    
     prescribed  a number  of ingested  therapies, including                                                                    
     St. John's  Wort and over-the-counter Tylenol.  (1) The                                                                    
     Board  determined  that "it  is  outside  the scope  of                                                                    
     practice  for nurses  to administer  remedies that  are                                                                    
     not FDA-approved".  Rationale  was based on the unknown                                                                    
     interactions  of these  substances with  pharmaceutical                                                                    
     medications  and the  fact that  education about  these                                                                    
     substances  was  not  part  of  the  nursing  education                                                                    
     curriculum.   The  Board underscored  the  fact that  a                                                                    
     licensed  nurse must  practice  within  their scope  of                                                                    
     practice, regardless of the  presence of a prescription                                                                    
     by a licensed physician.                                                                                                   
                                                                                                                                
     The  Board  of Nursing  again  discussed  the issue  in                                                                    
     March  1999  when  it  was   asked  to  reconsider  its                                                                    
     decision.    This  time the  question  related  to  the                                                                    
     administration  of  homeopathic  remedies.   The  Board                                                                    
     reviewed  the contents  of  a  reference book,  Nursing                                                                    
     Responsibility  Regarding   Herbal  Remedies,   by  the                                                                    
     National Organization  for Homeopathic Remedies.   This                                                                    
     reference  did  not indicate  that  it  was within  the                                                                    
     nurse's  responsibility  to administer  supplements  or                                                                    
     homeopathic remedies.   The  Board upheld  its previous                                                                    
     position statement  that the administration  of non-FDA                                                                    
     approved substances  and nutritional supplements  is an                                                                    
     unsafe practice  and outside the scope  of practice for                                                                    
     nurses in Alaska. (2)                                                                                                      
                                                                                                                                
     On March 15, 2002 the  Board was approached by a member                                                                    
     of  the  Alaska  Mental  Health Trust,  to  review  the                                                                    
     position  on administration  of non-FDA  substances. At                                                                    
     that  time the  Board  of Nursing  reviewed a  document                                                                    
     from the North Carolina Board  of Nursing, "The Role of                                                                  
     the Registered  Nurse in recommending the  use of over-                                                                    
     the-counter    pharmaceutical    products   and    non-                                                                    
     prescription devices".   This reference  stated, "Over-                                                                    
     the-counter    pharmaceutical    products   and    non-                                                                    
     prescription  devices  such  as, but  not  limited  to,                                                                    
     splints,  point stimulators/electro-stimulation  units,                                                                    
     positioning assists, blood  glucose machines, and take-                                                                    
     home blood  pressure machines, are  not subject  to the                                                                    
     prescribing   and  dispensing   regulations  of   North                                                                    
     Carolina.  Consistent with  G.S. 90-171.20  (7) of  the                                                                    
     Nursing Practice  Act and  Administrative Rule  21 NCAC                                                                    
     36.0224 (a)  - (h), the registered  nurse may recommend                                                                    
     the use  of an over-the-counter  pharmaceutical product                                                                    
     and non-prescription  device for an  identified health-                                                                    
     related need  of a  client as  part of  his/her nursing                                                                    
     practice.  The  registered  nurse   who  makes  such  a                                                                    
     recommendation  is  held  accountable  for  having  the                                                                    
     knowledge to  make such  nursing care  decisions safely                                                                    
     and  to monitor  the outcomes  of his/her  actions. The                                                                    
     practice      of     recommending      over-the-counter                                                                    
     pharmaceutical  products  and non-prescription  devices                                                                    
     must also  be consistent with the  established policies                                                                    
     of the  system in which the  registered nurse practices                                                                    
     as  well  as  consistent   with  the  client's  overall                                                                    
     health-related plan of care." (3)                                                                                          
                                                                                                                                
     The   Board  also   reviewed  an   article  summarizing                                                                    
     opinions  of  other  Boards   of  Nursing  who  approve                                                                    
     alternative   therapies   administered  by   Registered                                                                    
     Nurses.   Therapies discussed  in the  research article                                                                    
     were alternative therapies  that were non-invasive. (4)                                                                    
     This was not relevant  to the administration of non-FDA                                                                    
     approved supplements or substances.                                                                                        
                                                                                                                                
     On September  26, 2003 the  Board of Nursing  was asked                                                                    
     to approve  nurse administration of a  non-FDA approved                                                                    
     substance, memantine, to a resident  in a Pioneer Home.                                                                    
     The  substance, memantine,  was  a  medication used  in                                                                    
     Europe  and currently  undergoing FDA  scrutiny.    The                                                                    
     Board  queried  the  other sixty  one  (61)  Boards  of                                                                    
     Nursing    concerning    their    position    on    the                                                                    
     administration  of non-FDA  approved medications  which                                                                    
     have been used in clinical  trials and are awaiting FDA                                                                    
     approval,  and  specifically   memantine.    Thirty-one                                                                    
     state boards responded with 14  banning the practice, 5                                                                    
     allowing  it  if the  nurse  is  knowledgeable and  the                                                                    
     administration   was   in  conjunction   with   medical                                                                    
     research,  and 12  states responding  with no  specific                                                                    
     position on  this.  After discussion,  the Board tabled                                                                    
     the topic for the March  2004 Board meeting. (5) In the                                                                    
     interim,  the   FDA  approved  the  substance   as  the                                                                    
     medication, Namenda.                                                                                                       
                                                                                                                                
     The  Board  was  asked  to  approve  administration  of                                                                    
     nutritional supplements  to a Pioneer Home  resident on                                                                    
     March  8,  2006.     After  more  than   two  hours  of                                                                    
     discussion   with  a   family  member   and  thoughtful                                                                    
     deliberation,   over  a   two-day  period,   the  Board                                                                    
     reiterated    and   continued    the   position    that                                                                    
     administration of  nutritional supplements,  herbal and                                                                    
     homeopathic  preparations  and other  non-FDA  approved                                                                    
     medications is  unsafe and therefore outside  the scope                                                                    
     of practice for a licensed nurse in Alaska.                                                                                
                                                                                                                                
     The Board  of Nursing  is charged with  ensuring public                                                                    
     safety  by  the  regulation  of  nursing  practice  (AS                                                                    
     08.68.100).    There exist  grounds  for  the Board  to                                                                    
     deny,  suspend or  revoke  the license  of  a nurse  in                                                                    
     Alaska  for  several  reasons, one  of  which  includes                                                                    
     intentionally or  negligently engaging in  conduct that                                                                    
     has resulted  in a  significant risk  to the  health or                                                                    
     safety  of  a client  or  in  injury  to a  client  (AS                                                                    
     08.68.270 (1) - (10)).   Unprofessional conduct (12 AAC                                                                    
     44.720    (9))    includes    assuming    duties    and                                                                    
     responsibilities,   on   repeated  occasions,   without                                                                    
     sufficient preparation or for  which competency has not                                                                    
     been maintained (12 AAC 44.770 (2)).                                                                                       
                                                                                                                                
     The  Food and  Drug Administration  (FDA), through  the                                                                    
     Center  for   Drug  Evaluation  and   Research  (CDER),                                                                    
     reviews  and  approves  pharmaceuticals in  the  United                                                                    
     States for  efficacy, safety, purity and  other quality                                                                    
     assurance markers.   This  rigorous review  attempts to                                                                    
     assure safety  for the American public  but, even then,                                                                    
     some  pharmaceuticals  are  withdrawn from  the  market                                                                    
     after approval, due to safety  concerns that arise with                                                                    
     increased use by a diverse population.                                                                                     
                                                                                                                                
     There  is widespread  use by  Americans of  nutritional                                                                    
     supplements,  herbal  preparations,  and  vitamins,  as                                                                    
     well  as  pharmacologic  agents obtained  from  foreign                                                                    
     countries  via  the  Internet.   (6)  There  have  been                                                                    
     increasing  reports  of interactions,  potentiation  of                                                                    
     effect  and   adverse  reactions   between  nutritional                                                                    
     supplements,  herbal and  homeopathic preparations  and                                                                    
     other     non-FDA      approved     medications     and                                                                    
     pharmaceuticals.                                                                                                           
                                                                                                                                
     The   FDA  does   not   regulate   the  production   of                                                                    
     nutritional supplements because  they are classified as                                                                    
     food  products.   In addition,  the Dietary  Supplement                                                                    
     Health and Education Act of  1994 (DSHEA) restricts the                                                                    
     FDA from  regulating any product  that is labeled  as a                                                                    
     "supplement"  and makes  no  disease treatment  claims.                                                                    
     There  is  no  regulatory oversight  of  production  in                                                                    
     quality,  purity,  or  contents of  these  products  or                                                                    
     official   monitoring    of   adverse    events;   this                                                                    
     responsibility  is left  to  the  manufacturer.   There                                                                    
     have been  adverse events resulting in  injury and even                                                                    
     death with the  use of these ingested  products. (7, 8,                                                                    
     9,10,11,12.13)                                                                                                             
                                                                                                                                
     The   United   States    Pharmacopeia   (USP)   is   an                                                                    
     independent,  nonprofit  organization that  establishes                                                                    
     public  standards  of  quality for  medicines,  dietary                                                                    
     supplements, and  related products.   In  October 2001,                                                                    
     the United States  Pharmacopeial Convention, Inc. (USP)                                                                    
     launched   a    verification   program    for   dietary                                                                    
     supplements  in  order   to  evaluate  the  ingredients                                                                    
     listed on the label.   The program provides independent                                                                    
     testing  and review  to verify  ingredient and  product                                                                    
     integrity,  purity, and  potency for  manufacturers who                                                                    
     choose   to   participate.   However,  USP   does   not                                                                    
     comprehensively address the issue of safety.                                                                               
                                                                                                                                
     Two references  are available to the  medical community                                                                    
     that   contain   information    on   some   nutritional                                                                    
     supplements:   the PDR for Herbal  Medicines (1998) and                                                                    
     the German Commission E  Therapeutic Monographs.  These                                                                    
     documents contain  limited information  on indications,                                                                    
     contraindications,  side   effects,  interactions  with                                                                    
     other drugs and dosage.                                                                                                    
                                                                                                                                
     Nurses  are  not educated  in  the  use of  nutritional                                                                    
     supplements,  herbal and  homeopathic preparations  and                                                                    
     other  non-FDA approved  medications  in bachelor's  or                                                                    
     diploma   Registered   Nurse   programs   or   Licensed                                                                    
     Practical Nurse programs.  This  testimony was given by                                                                    
     Dr.  Carolyn  Keil,   University  of  Alaska  Anchorage                                                                    
     faculty, on  December 10, 1998,  and affirmed  on March                                                                    
     10,  2006 by  Terri  Olson, MSN,  University of  Alaska                                                                    
     Anchorage faculty.                                                                                                         
                                                                                                                                
     The populations  of clients in Alaska's  long-term care                                                                    
     facilities  and   assisted  living  facilities   are  a                                                                    
     vulnerable population  with multiple  disease diagnoses                                                                    
     and prescribed pharmaceutical  medications.  This group                                                                    
     of people  is highly susceptible to  adverse events and                                                                    
     interactions  between  nutritional supplements,  herbal                                                                    
     and   homeopathic   preparations  and   other   non-FDA                                                                    
     approved  medications  and prescribed  pharmaceuticals.                                                                    
     Nurses administering  pharmaceuticals have a  wealth of                                                                    
     experience,  knowledge and  resources to  draw upon  to                                                                    
     safely  administer these  medications  to the  clients.                                                                    
     This  is not  the case  with administration  of non-FDA                                                                    
     approved  substances,  about which  little  information                                                                    
     may be known or available to the nurse.                                                                                    
                                                                                                                                
     The licensed  nurse is accountable for  her actions and                                                                    
     has a duty to the  patient that cannot be supplanted by                                                                    
     healthcare  provider prescription  or facility  policy.                                                                    
     This  responsibility  applies  even when  a  healthcare                                                                    
     practitioner has ordered a certain  therapy.  The nurse                                                                    
     is held  responsible to understand the  implications of                                                                    
     any therapy administered to the patient.                                                                                   
                                                                                                                              
                                                                                                                              
     Conclusion                                                                                                               
     It is incumbent  on the Board of Nursing  to review the                                                                    
     medical  evidence  and   make  objective  judgments  to                                                                    
     protect public  safety.   The Board  is aware  that its                                                                    
     decisions   have  widespread   impact  on   vulnerable,                                                                    
     dependent  persons   of  all  ages  in   a  variety  of                                                                    
     healthcare  settings,  who  expect and  trust  in  safe                                                                    
     nursing care.   Nurse licensees  in Alaska look  to the                                                                    
     Board for evidence-based, best practices guidelines.                                                                       
                                                                                                                                
     The Board  of Nursing  considered all the  above facts.                                                                    
     Based on impartial, objective review  of the facts, the                                                                    
     Board of Nursing for the  State of Alaska finds that it                                                                    
     is unsafe  and therefore outside the  scope of practice                                                                    
     for   a  licensed   nurse  to   administer  nutritional                                                                    
     supplements,  herbal and  homeopathic preparations  and                                                                    
     other non-FDA approved medications                                                                                         
                                                                                                                                
     The  Board  of  Nursing   acknowledges  the  rights  of                                                                    
     patients  and their  families to  make the  decision to                                                                    
     self-administer  these  supplements  or  substances  to                                                                    
     themselves or their family members.                                                                                        
                                                                                                                                
MS.  GIESSEL  continued  her testimony  and  explained  how  some                                                               
supplements, that  may otherwise be considered  safe, could cause                                                               
adverse  effects if  administered  in the  company of  prescribed                                                               
medication, and she provided examples.   She stressed that nurses                                                               
are not trained in the area  of non-FDA approved drugs, or how to                                                               
recognize  complications  from  non-regulated supplements.    She                                                               
said that elderly  patients are vulnerable, and  public safety is                                                               
a key  issue.  She  underscored that nurses are  held accountable                                                               
for  the care  provided  to a  patient and  that  these types  of                                                               
substances  are  outside  the  scope of  practice  for  a  nurse.                                                               
Referring to a  research paper provided in  the committee packet,                                                               
she deemed that  the sample was insufficient with only  13 of the                                                               
nation's  61 nursing  boards polled.    Finally, she  highlighted                                                               
that signed  waivers do not  provide a nurse with  adequate legal                                                               
protection.                                                                                                                     
                                                                                                                                
3:24:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER asked  what would  happen if  a physician                                                               
gave  orders, which  a nurse  considered  to be  contrary to  the                                                               
patient's welfare.                                                                                                              
                                                                                                                                
MS. GIESSEL responded that, in such  a situation, it is a nurse's                                                               
responsibility to decline  to carry out a  physician's order; not                                                               
a rare  occurrence.   Responding to a  question, she  opined that                                                               
the  research regarding  supplements  is not  highly regarded  or                                                               
publicized, as it is often  conducted by the supplement industry,                                                               
and  she  stated  that information  on  negative  health  effects                                                               
caused by supplements is not commonly available.                                                                                
                                                                                                                                
3:28:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  offered information on two  supplements, no                                                               
longer available  on the market as  it was alleged that  they may                                                               
have  caused   negative  health  effects,  thus   supporting  her                                                               
concerns.                                                                                                                       
                                                                                                                                
MS. GIESSEL explained  the difference of how  the FDA scrutinizes                                                               
approved drugs  versus the accountability standard  placed on the                                                               
supplement industry.  She stressed  that negative affects of non-                                                               
regulated supplements are  not subject to the  same reporting and                                                               
obligation for recall.  Additionally,  she said that although the                                                               
FDA  may  investigate  when  a   supplement  is  reported  to  be                                                               
injurious,  the  department  is   limited  in  its  resources  to                                                               
determine  the safety  of the  majority  of substances  available                                                               
from the supplement industry.                                                                                                   
                                                                                                                                
3:30:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SEATON   stated   his   understanding   that   a                                                               
physician's   decision  would   be  considered   inadequate  when                                                               
recommending a  supplement, and that  a nurse would be  unable to                                                               
legally administer  prescriptions for  substances other  than FDA                                                               
approved drugs.                                                                                                                 
                                                                                                                                
MS. GIESSEL  explained that Alaskan law  allows physicians, nurse                                                               
practitioners (NPs), and  physician assistants (PAs) prescriptive                                                               
authority; however,  the person on  a patient's medical  team who                                                               
administers  the prescribed  substance  is  the registered  nurse                                                               
(RN).   Further,  she  stated that  the  reason non-FDA  approved                                                               
substances are at issue is  because of the Alaska Pioneer Nursing                                                               
Home  policy;  allowing  the administration  of  over-the-counter                                                               
substances.  She said:                                                                                                          
                                                                                                                                
     It's  not that  [the]  physicians are  not doing  their                                                                    
     job, it's  that the nurse  is responsible to  know what                                                                    
     she's  administering, what  side effects  to look  for,                                                                    
     and  whether or  not  this is  going  to interact  with                                                                    
     other medications  that the  individual is  taking. ...                                                                    
     The nurse is doing ... her  or his part in being one of                                                                    
     those people that assures patient  safety in this whole                                                                    
     delivery of health care scheme.                                                                                            
                                                                                                                                
3:33:56 PM                                                                                                                    
                                                                                                                                
GENA  EDMISTON, Registered  Nurse (RN),  Associate Administrator,                                                               
Denali  Long-term  Care   Center,  Fairbanks  Memorial  Hospital,                                                               
stated  support for  HB  467,  and explained  the  policy of  the                                                               
Denali Center,  which provides for  the pharmaceutical  review of                                                               
medicinal or  supplemental substances  which are  administered to                                                               
residents/patients.     She  explained   that  this   assures  an                                                               
additional  level of  review,  which can  be  implemented when  a                                                               
pharmacy is available.                                                                                                          
                                                                                                                                
3:36:19 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  asked what  the Denali  Center's current  policy is                                                               
for having the nurses administer medications.                                                                                   
                                                                                                                                
MS. EDMISTON responded that Denali  Center has a pharmacy policy,                                                               
and she reiterated the review  process of every substance that is                                                               
administered  to  residents  of   the  center  or  the  hospital.                                                               
However, she said that in  the hospital setting the patient would                                                               
usually be self administering supplements,  which is not the case                                                               
in  the  long-term  facility.    She provided  an  example  of  a                                                               
commonly used supplement that the  nurses administer to residents                                                               
of the Denali Center.                                                                                                           
                                                                                                                                
3:38:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SEATON   inquired    whether   there   are   any                                                               
restrictions  placed  on  non-FDA  approved  Native  foods,  made                                                               
available to facility residents.                                                                                                
                                                                                                                                
MS. EDMISTON  stated that she  is not  aware of any  food issues.                                                               
She opined  that it  is difficult  for her  to imagine  not being                                                               
able  to provide  a patient  with  a necessary  supplement.   She                                                               
pointed  out  that many  of  the  residents  do not  have  family                                                               
members  nearby  who  would  be   able  to  visit  regularly  and                                                               
administer these type of supplemental needs.                                                                                    
                                                                                                                                
3:40:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   GATTO   stated    his   understanding   of   the                                                               
inconsistency  in the  standardization of  many supplements,  and                                                               
asked whether establishing a proper dose has been an issue.                                                                     
                                                                                                                                
MS. GIESSEL responded:                                                                                                          
                                                                                                                                
     That is a  difficult question to answer  because with a                                                                    
     lot of these substances  their effects are difficult to                                                                    
     quantify. ... I can't really  say in my experience that                                                                    
     I've seen a lot of  variation in terms of response. And                                                                    
     yes,   you   are   absolutely  right,   there   is   no                                                                    
     standardization of any of these products.                                                                                  
                                                                                                                                
3:43:14 PM                                                                                                                    
                                                                                                                                
RICK SCHIKORA, Certified Public  Accountant (CPA), stated support                                                               
for HB  467, and  explained his personal  interest in  the issue.                                                               
He described the  situation of his grandmother, as  a resident at                                                               
the   local  Pioneer's   Home,  in   need  of   a  non-prescribed                                                               
supplement.      Although   this  supplement   had   been   being                                                               
administered, he said  that he eventually received  a letter from                                                               
the  Pioneer's home  stating that,  due  to an  inquiry from  the                                                               
Alaska  Board of  Nursing, the  facility  would be  discontinuing                                                               
this  service.   Noting that  his grandmother's  health began  to                                                               
decline  when  the supplements  were  discontinued,  he began  to                                                               
administer  to her  needs,  on a  daily basis,  which  he had  to                                                               
provide off  of the premises.   Although he  was able to  take up                                                               
this  care for  his grandmother,  he realized  that many  nursing                                                               
home residents do  not have the benefit of an  outside person who                                                               
can assist them in this type  of situation.  His understanding is                                                               
that, although the  nurses do not object to  providing this care,                                                               
because of the stance that the  Alaska Board of Nurses has taken,                                                               
they are fearful of losing their licenses.  He said:                                                                            
                                                                                                                                
     The  nursing  board  has not  been  specific  in  their                                                                    
     characterization  of  this and  ...  I  don't have  the                                                                    
     exact  quote but  ... [the  board's  caution to  nurses                                                                    
     stated] "it's  outside of the  scope of  practice," ...                                                                    
     and ... "we may not support  you." ... It was for those                                                                    
     reasons that  the nurses are  afraid to  participate in                                                                    
     this.  The Pioneer's Home  does have a policy that says                                                                    
     that ...  they will  get a  coordinator to  handle this                                                                    
     and that the nurses  can provide this administration to                                                                    
     residents if  they wish  .... ... Based  on that  ... I                                                                    
     put together a  policy that was submitted  to the Board                                                                    
     of Nursing [available in the  committee packet]. ... It                                                                    
     doesn't require  anybody to do anything  that they feel                                                                    
     is  outside of  their scope  of practice.  ... I  think                                                                    
     Alaska ...  ought to be  on the forefront of  trying to                                                                    
     accommodate in these situations, but  we ought to do it                                                                    
     in a fashion  that doesn't require the nurse  to do it,                                                                    
     and doesn't punish  her if she does. ...  There's a lot                                                                    
     of older  ... [residents]  over at the  Pioneer's Home,                                                                    
     and I'm  sure there will  be in the future,  that won't                                                                    
     have  somebody  that can  go  over  and administer  [to                                                                    
     them]. ...  I'm serious  about seeing  something happen                                                                    
     where the  board of nursing  either authorizes  this or                                                                    
     state  law gets  changed to  basically require  them to                                                                    
     authorize it.                                                                                                              
                                                                                                                                
3:52:30 PM                                                                                                                    
                                                                                                                                
MIKE POWERS,  Administrator, Fairbanks Memorial  Hospital, stated                                                               
support for  HB 467, and  referred to Ms. Giessel's  testimony as                                                               
being both accurate  and erroneous.  He concurred  that safety is                                                               
above all  the primary concern  for hospitals and  long-term care                                                               
facilities.   However, a call  for reasonableness should  be held                                                               
that would  allow for nurses  to provide even better  care, which                                                               
may include the administration of  some of these supplements.  He                                                               
suggested a meeting of the  interested parties, and stressed that                                                               
common ground must be sought  that will improve the entire health                                                               
system.                                                                                                                         
                                                                                                                                
3:56:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  asked whether Mr.  Schikora's suggestions                                                               
have been reviewed by the nursing board.                                                                                        
                                                                                                                                
MR. POWERS responded, "I don't know."                                                                                           
                                                                                                                                
CHAIR WILSON  interjected that Mr.  Schikora testified  to having                                                               
provided the  nursing board  with his paperwork  and that  it was                                                               
reviewed.  Additionally, she reported  her understanding that the                                                               
Nursing   Board   has   subsequently  provided   Mr.   Schikora's                                                               
suggestions to a subcommittee for review.                                                                                       
                                                                                                                                
MR.  MILLER  added that  the  Board  of  Nursing did  review  Mr.                                                               
Schikora's  document;  however,  the  Alaska  Nurses  Association                                                               
(ANA) letter  requested that the Nurses  Association Professional                                                               
Practice   Committee   investigate    the   issue   and   provide                                                               
recommendations to the  ANA at large.  The ANA  will then forward                                                               
the recommendation that they adopt to the Board of Nursing.                                                                     
                                                                                                                                
3:57:53 PM                                                                                                                    
                                                                                                                                
CHARLOTTE DAVIS,  Registered Nurse  (RN), spoke in  opposition to                                                               
HB  467,  and   paraphrased  from  a  letter   submitted  to  the                                                               
committee,   which   read   as  follows   [original   punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     As  a  registered nurse,  I  am  urging you  to  defeat                                                                  
     passage   of   House   Bill   #   467   regarding   the                                                                  
     administration  of  prescribed   remedies  and  dietary                                                                    
     supplements  by a  nurse.   There are  numerous reasons                                                                    
     this  bill   should  be   defeated,  however,   I  will                                                                    
     concentrate on  the most important  reasons.   They are                                                                    
     as follows with a more complete discussion below:                                                                          
                                                                                                                                
     ™Dietary    supplements, herbals, and vitamin remedies                                                                    
         are not FDA approved.                                                                                                
                                                                                                                                
     ™These    products are  not drugs  (which  require FDA                                                                  
         approval) and do not require a prescription from a                                                                     
         health care provider.                                                                                                  
                                                                                                                                
                                                                                                                                
     ™Administration     of  these   products  is   not  an                                                                  
         acceptable standard of nursing care.                                                                                 
                                                                                                                                
     ™The   State  of Alaska Board of Nursing states nurses                                                                    
         shall not administer these supplements.                                                                            
                                                                                                                                
     ™The    manufacturer  sets the  dosage of  supplements                                                                    
         without sound scientific study on efficacy or                                                                        
         safety.                                                                                                                
                                                                                                                                
     ™Administration    by a nurse of  supplements violates                                                                  
         the ANA Code of Ethics regarding safety.                                                                             
                                                                                                                                
     ™Administration   of  these supplements is outside the                                                                  
         scope of nursing practice.  Malpractice insurance                                                                    
         companies may not defend claims made against a                                                                         
         nurse's license.                                                                                                       
                                                                                                                                
     ™The     vulnerable  residents  of   these  facilities                                                                    
         deserve the same standard of care as every other                                                                     
         citizen from nurses whose licenses have equal                                                                        
         value with the other 8,000 nurses in Alaska.                                                                         
                                                                                                                                
     Further discussion on these points is as follows:                                                                          
                                                                                                                                
     The short title states  Administration of Medication by                                                                    
     a  Nurse.    Herbals,  vitamin  remedies,  and  dietary                                                                    
     supplements  are NOT  medications.   The Food  and Drug                                                                    
     Administration (FDA)  categorizes them  as food  so the                                                                    
     FDA regulatory focus can only  be on the product labels                                                                    
     and  claims  by the  manufacturers.  The  FDA does  NOT                                                                    
     approve  food  supplements   for  particular  uses,  in                                                                    
     particular doses, or routes of administration.                                                                             
                                                                                                                                
     The  bill states  "unless  the  prescription". The  FDA                                                                    
     must  prove drug  products are  safe and  effective for                                                                    
     their intended  use BEFORE prescribed by  a health care                                                                    
     provider and  administration by a nurse.  A health care                                                                    
     provider does not  prescribe but only advises  use of a                                                                    
     remedy  or dietary  supplement.  Health care  providers                                                                    
     who do  advise or  prescribe use of  dietary supplement                                                                    
     could  be  sued  if  there  were  adverse  affects,  an                                                                    
     unintended  side-effect over  time,  or a  carcinogenic                                                                    
     effect.  The  nurse  in  turn  can  also  be  sued  for                                                                    
     administering the supplement even  when prescribed by a                                                                    
     health care provider.                                                                                                      
                                                                                                                                
     A nurse has  the duty to provide care and  to follow an                                                                    
     acceptable standard  of care.  These standards  of care                                                                    
     come  from different  sources including  Nurse Practice                                                                    
     Acts,  American Nursing  Association, Joint  Commission                                                                    
     on Accreditation of  Healthcare Organizations, and Case                                                                    
     Law. The nurse is  accountable for knowing the standard                                                                    
     of care,  adhering to that standard,  and reporting any                                                                    
     breaches  in  that  standard of  care  by  others.  The                                                                    
     administration of  non-FDA approved supplements  is NOT                                                                    
     an acceptable standard of nursing care.                                                                                    
                                                                                                                                
     The  State of  Alaska Board  of Nursing  has repeatedly                                                                    
     taken  the position  over the  years, most  recently in                                                                    
     March 2006,  that nurses  shall not  administer non-FDA                                                                    
     approved supplements. I support  my Board of Nursing on                                                                    
     this issue.                                                                                                                
                                                                                                                                
     HB  467  states, "unless  the  prescription  is for  an                                                                    
     amount of the  remedy or supplement that  is outside of                                                                    
     the   manufacturer's   recommended    dosage."      The                                                                    
     manufacturer  sets the  dose, route,  and frequency  of                                                                    
     the  supplement use.   It  is the  manufacturer who  is                                                                    
     responsible for  the safety  of the  dietary supplement                                                                    
     products  but there  is  no provision  for  the FDA  to                                                                    
     approve    dietary    supplements   for    safety    or                                                                    
     effectiveness.   These  same   manufacturers  are   not                                                                    
     required by  law to record,  investigate or  forward to                                                                    
     the FDA  any reports of injuries,  illnesses, or deaths                                                                    
     that  may be  related  to the  use  of the  supplement.                                                                    
     After the  product is  on the market,  the FDA  has the                                                                    
     responsibility  for showing  that a  dietary supplement                                                                    
     is "unsafe," to restrict its  use of remove it from the                                                                    
     market.  The  recall of  all  ephedra  products on  the                                                                    
     market after  injury and deaths  is one example  of the                                                                    
     FDA responsibility.                                                                                                        
                                                                                                                                
     The  American  Nurses   Association's  Code  of  ethics                                                                    
     states "The nurse promotes,  advocates for, and strives                                                                    
     to  protect  the  health, safety,  and  rights  of  the                                                                    
     patient."   Supplements   may  interfere   with   other                                                                    
     herbals,  drugs,  or treatment  regimens.  Combinations                                                                    
     cannot  only be  dangerous  by  life threatening  (kava                                                                    
     beans,  ephedra,  St.   Johns  Wort).  Supplements  may                                                                    
     interfere   with    tests,   procedures,    and   cause                                                                    
     complications with  surgery. How many  more supplements                                                                    
     are  currently on  the  market  that the  manufacturers                                                                    
     have determined as  "safe"?  As a nurse,  it is outside                                                                    
     my scope of  practice to determine the  safety of these                                                                    
     supplements.                                                                                                               
                                                                                                                                
     After  repeated calls  to my  malpractice insurance,  I                                                                    
     could not  get a definitive answer  to any hypothetical                                                                    
     question I posed regarding this  issue.  They would not                                                                    
     state  they  would  defend  a   claim  if  I  knowingly                                                                    
     practiced outside  of my scope  of practice  or outside                                                                    
     the  acceptable nursing  standard  of  care. They  will                                                                    
     only defend a claim once it is filed.                                                                                      
                                                                                                                                
     Finally, the bill  states "a registered nurse  ... to a                                                                    
     resident  of a  nursing  facility,  an assisted  living                                                                    
     home, or an  Alaska Pioneers' Home".  Why  is this bill                                                                    
     intended  for only  residents of  these facilities  and                                                                    
     not those  who live  at home  or who  are in  a medical                                                                    
     facility?   The elderly  and disabled  (most vulnerable                                                                    
     in  our society)  deserve an  even  higher standard  of                                                                    
     safety then those who can  advocate for themselves. Why                                                                    
     is  this  bill intended  only  for  a registered  nurse                                                                    
     caring  for those  residents?   My license  is no  less                                                                    
     valuable then  those who  work in  home health  care or                                                                    
     medical facilities.                                                                                                        
                                                                                                                                
     Please  defeat  passage  of  this  bill.    I  will  be                                                                  
     available  for any  questions. I  have  listed my  home                                                                    
     number above or you may reply to this email.                                                                               
                                                                                                                                
                                                                                                                                
4:03:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON clarified that  this bill would restrict an                                                               
RN    to   the    administration   of    prescribed   substances.                                                               
Additionally,  it does  not  mandate that  an  RN administer  any                                                               
substance, and  further, if a  prescription is written  to exceed                                                               
the manufacturer's  recommended dose, the RN  would be disallowed                                                               
from  its  administration.   He  asked  if  that was  Ms.  Davis'                                                               
understanding of the bill action.                                                                                               
                                                                                                                                
MS.  DAVIS stated  that  her  understanding of  this  bill is  to                                                               
provide facility  residents a means  to comply  with prescription                                                               
administration policy.  She maintained  that this would be a mute                                                               
issue  if the  substance  were  to be  self  administered by  the                                                               
patient,  a  family   member,  or  a  hired  agent.     The  non-                                                               
standardization aspect of these  products is her primary concern,                                                               
she said.                                                                                                                       
                                                                                                                                
4:05:21 PM                                                                                                                    
                                                                                                                                
VIRGINIA SMILEY, Director, Division  of Pioneer Homes, Department                                                               
of Health and Social Services  (DHSS), stated support for HB 467,                                                               
paraphrasing  from a  written statement,  which  read as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     For the  record I am  Virginia Smiley, director  of the                                                                    
     Division of Pioneer Homes for  the Department of Health                                                                    
     and  Social Services.  Madame chair,  I  would like  to                                                                    
     give  you  a  very  brief overview  of  the  division's                                                                    
     position  on RNs  involvement in  administering dietary                                                                    
     supplements.                                                                                                               
                                                                                                                                
     The  Pioneer Homes  has a  procedure for  administering                                                                    
     supplements  that includes  a  written  order from  the                                                                    
     primary prescribing  practitioner, who  indicates brand                                                                    
     name and  dosage. We require  a release form  signed by                                                                    
     the   resident   or   his   representative,   privately                                                                    
     purchased  supplements  by   the  family  in  original,                                                                    
     sealed packaging  whose label  must include  brand, lot                                                                    
     number, expiration date,  resident's name, room number,                                                                    
     dosage and frequency.                                                                                                      
                                                                                                                                
     In   addition,  our   pharmacy  is   informed  of   any                                                                    
     supplement  so  they can  monitor  it  in reference  to                                                                    
     resident   diagnosis,   disease    or   possible   drug                                                                    
     interaction.                                                                                                               
                                                                                                                                
     Finally our  policy includes voluntary agreement  by an                                                                    
     RN  to administer  supplements reviewed  on a  case-by-                                                                    
     case basis.                                                                                                                
                                                                                                                                
     We  prefer  to have  a  RNs  involvement in  supplement                                                                    
     administration for the very same  reasons we have their                                                                    
     involvement in medication administration.                                                                                  
                                                                                                                                
CHAIR WILSON asked who administers the supplements.                                                                             
                                                                                                                                
MS. SMILEY responded that the RN is the administrator, and she                                                                  
continued with her written statement as follows:                                                                                
                                                                                                                                
     If  a nurse  is unsure  about something  that has  been                                                                    
     ordered, the  nurse has an  obligation to get  in touch                                                                    
     with the  primary care provider and  ASK questions: why                                                                    
     it is being  ordered, or could it  interfere with other                                                                    
     meds.                                                                                                                      
                                                                                                                                
     We expect our nurses to  1) know their patients, and 2)                                                                    
     know the  risk/benefit of  each medication  ordered. We                                                                    
     expect them to treat supplements accordingly.                                                                              
                                                                                                                                
     We would much rather have  a nurse involved with a well                                                                    
     planned  procedure for  supplement administration  than                                                                    
     have a  family member bringing  in a zip-lock  bag full                                                                    
     of  unknown,  unmarked  pills, dispensing  them  in  an                                                                    
     unsupervised, unstructured manner.                                                                                         
                                                                                                                                
     And  I  would  disagree  that  administering  something                                                                    
     ordered by a care provider  violates any code of ethics                                                                    
     or   is  outside   the  scope   of  nursing   practice.                                                                    
     Practitioners  have   an  obligation   to  try   to  do                                                                    
     everything they can to improve  the quality of life for                                                                    
     their  patients. And  that may  include monitoring  and                                                                    
     administering a supplement that  has shown a benefit to                                                                    
     an individual patient.                                                                                                     
                                                                                                                                
     The Board of Nursing has,  by their own admission, been                                                                    
     grappling  with  this issue  since  1998  yet there  is                                                                    
     still  nothing in  statute  or  their regulations  that                                                                    
     direct  nurses on  how to  handle this  specific issue;                                                                    
     there  have  only been  Board  of  Nursing opinions  or                                                                    
     positions.                                                                                                                 
                                                                                                                                
     In conclusion,  the Pioneer Homes supports  the passage                                                                    
     of HB 467.                                                                                                                 
                                                                                                                                
4:10:49 PM                                                                                                                    
                                                                                                                                
NANCY  DAVIS,  Registered   Nurse  (RN),  Representative,  Alaska                                                               
Nurses Association (ANA), compared  the casual use of supplements                                                               
in  the United  States to  usage in  other countries,  and opined                                                               
that this country  has not "moved as far forward"  on this issue.                                                               
Self administration  of a supplement is  certainly different from                                                               
having a  nurse administer it,  she cautioned.  She  reported how                                                               
the ANA  membership across  the state is  divided on  this issue,                                                               
however,  she said  that every  nurse does  have a  desire to  be                                                               
informed on  safety and  developing health  concerns held  in the                                                               
profession.  The Board of Nursing  is the standard bearer for the                                                               
ANA,  and  as  such  the  board  is  obliged  to  define  nursing                                                               
practices for the  profession.  She said that it  would be remiss                                                               
not to look  at what is current on the  issue of supplements, and                                                               
for  that   reason  the  ANA  is   convening  their  Professional                                                               
Practices Committee.   She explained  that the  U.S. Pharmacopeia                                                               
(USP)   has  a   process  for   review  and   standardization  of                                                               
supplements, if a manufacturer  voluntarily submits their product                                                               
for verification.  The product receives  a USP stamp on the label                                                               
for  having  been subjected  to  this  approval.   Reminding  the                                                               
committee  that nurses  have a  professional  obligation for  the                                                               
safety  of   patients,  she  opined  that   through  joint  board                                                               
discussion  a   safe,  appropriate,   reasonable,  professionally                                                               
responsible  position would  be adopted.   Further,  she provided                                                               
suggestions  why  some supplement  companies  may  not choose  to                                                               
submit their  products for  verification and  review by  the USP.                                                               
She echoed the ANA's stated  opposition to HB 467, stressing that                                                               
it would be  preferential to handle this issue  through a process                                                               
whereby  the State  Board of  Nursing would  examine and  develop                                                               
standards for professional nursing practices.                                                                                   
                                                                                                                                
4:18:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  described her personal use  of supplements                                                               
under the  supportive advice of  a Nurse Practitioner (NP).   She                                                               
expressed concern for the quality of  life of the elderly who are                                                               
currently in  need of daily administration  of supplements, while                                                               
this issue is in the process of being addressed.                                                                                
                                                                                                                                
MS.  DAVIS conceded  that studies  are  available regarding  some                                                               
substances,  and noted  that the  National Institute  of Health's                                                               
Office of  Dietary Supplements provides  reports on  the efficacy                                                               
of certain  supplements.  She  cautioned that this bill  would be                                                               
providing standards for the administration  of a large variety of                                                               
supplements,  some that  are commonly  used, and  others possibly                                                               
more obscure.  Further, she opined  that this issue would be best                                                               
handled, through  the collaborative efforts  of the ANA  with the                                                               
Alaska Pharmaceutical  Association (AkPhA), and the  Alaska Board                                                               
of Medicine.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  asked  whether  a  time-line  exists  for                                                               
resolving this issue.                                                                                                           
                                                                                                                                
MS.  DAVIS responded  that the  ANA expects  to bring  this topic                                                               
before the Board of Nursing, at the June meeting.                                                                               
                                                                                                                                
4:21:58 PM                                                                                                                    
                                                                                                                                
ROD  BETIT,  President,  Alaska State  Nursing  Home  Association                                                               
(ASNHA),  stated support  for HB  467,  and noted  the scope  and                                                               
membership  of the  state  facilities which  he  represents.   He                                                               
agreed that  this issue is  in need  of resolution.   Further, he                                                               
said that the  permissive nature of the bill  allows latitude for                                                               
resolution of conflicts.  He  echoed the need to have supplements                                                               
made part of the health care decision process.                                                                                  
                                                                                                                                
4:25:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  asked   whether  specific  language  was                                                               
needed  in the  bill  that  would clarify  a  nurse's ability  to                                                               
freely   decline  to   participate  in   the  administration   of                                                               
supplements.                                                                                                                    
                                                                                                                                
MR.  BETIT   responded  that  the  bill,   as  drafted,  provides                                                               
allowance  for the  nurse  to decline  and  generally implies  no                                                               
repercussion.   However, specific  language to this  effect could                                                               
be worked  out, he  said.   Responding to  a question,  he stated                                                               
that  he was  not in  receipt  of the  document titled  "Licensed                                                               
Nurse Administration  of Non-FDA Approved  Over-the-Counter Drugs                                                               
and  Nutritional Supplements,"  which  enumerates  a seven  point                                                               
policy.                                                                                                                         
                                                                                                                                
4:26:40 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON asked  Ms. Giessel,  whether  pharmacists are  more                                                               
knowledgeable on the effects of supplements than nurses.                                                                        
                                                                                                                                
MS. GIESSEL  opined that pharmacists  have access to a  wealth of                                                               
information and can  access the FDA website.   However, she said,                                                               
"How many  ... truly understand  the supplements ...,  I couldn't                                                               
tell you."                                                                                                                      
                                                                                                                                
4:27:32 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON closed public testimony  and announced that the bill                                                               
would  be  held  for  further   discussion.    She  directed  the                                                               
committee's  attention to  page  2, lines  1-2, [previously  read                                                               
into  the record  by Representative  Seaton],  and she  suggested                                                               
close scrutiny of the language therein.                                                                                         
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 4:28:57 PM.                                                                                                  

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