Legislature(2001 - 2002)
04/26/2002 03:25 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 274-PHYSICIANS' LOCUM TENENS PERMITS CHAIR MURKOWSKI announced that the next order of business would be CS FOR SENATE BILL NO. 274(L&C), "An Act relating to issuance of a locum tenens permit for a physician or osteopath; and providing for an effective date." Number 2022 DAVE GRAHAM, Staff to Senator Donald Olson, Alaska State Legislature, presented CSSB 274(L&C) on behalf of the sponsor, Senator Olson. Mr. Graham informed the committee that Senator Olson introduced SB 274 at the request of the Alaska State Medical Association (ASMA) in order to expand the locum tenens permit to allow [state licensed] physicians to bring in a physician to take over a practice while the state licensed physician is out. The ASMA would like to expand the definition such that physicians could be invited to observe and practice for short periods of time in order to determine whether the physician wanted to employ the invited physician. Testimony during the Senate Labor & Commerce Standing Committee revealed that hospitals would [like this expansion as well], particularly from state mental health institutions that are having difficulties filling slots with licensed physicians. The locum tenens is viewed as a way in which to be more flexible in staffing and attracting physicians to permanent employment. Mr. Graham pointed out that the main reason ASMA brings this legislation forward is because the physicians in the state are getting older and thus will ultimately need to be replaced. The average age of an Alaskan physician is 51. He related that Senator Olson views this legislation as benefiting the delivery of health services. Number 1872 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Commerce & Economic Development (DCED), related that although the Alaska State Medical Board was able to obtain 75 percent consensus on SB 274, the board still has some concerns with the legislation. She indicated that two members of the board are on-line and can speak to the board's concerns. She informed the committee that the board would prefer that the legislation refer to 180 calendar days rather than 240 calendar days during which an individual could hold a locum tenens permit during any consecutive 24 months. Under CSSB 274(L&C) the locum tenens permits are initially valid for 90 days and under one circumstance can be extended another 60 days. Therefore, allowing one to hold a locum tenens permit for 180 days would allow one to hold two locum tenens permits or one with a 60-day extension. However, the current language of the bill allows two 90-day locum tenens permits of which one can be extended by 60 days. Ms. Reardon pointed out that the condition for extension is when one has submitted an application for permanent licensure; the board would like to encourage people to obtain the permanent licenses. MS. REARDON informed the committee that the board also requests that Section 3 of CSSB 274(L&C) be deleted because the board doesn't believe there should be any situations in which locum tenens permits should be extended indefinitely or pass the limitations established in Section 2. Section 3 allows the board to extend a locum tenens permit beyond the specified time limits if it's determined that the extension is necessary "to provide essential medical services for the protection of public health and safety." MS. REARDON directed attention to page 2, line 9, and noted the preference for the term "packet" rather than "form" because the board wants to ensure that all the necessary paperwork is completed. The board felt that the word "form" could be construed to mean the first ten pages of the packet. However, there is no intention to require a completed application, she said. She noted that the board is also concerned with the protection of public health and safety and thus wants to ensure that all physicians practicing in the state have been fully investigated. Hospitals and the [Department] of Health & Social Services are concerned with the public health and safety risk created by a vacancy in a needed area of service. Number 1589 REPRESENTATIVE CRAWFORD inquired as to who these locum tenens physicians would be and their general qualifications. MS. REARDON answered that some of the locum tenens physicians may be newer physicians while others may be long-time physicians who choose to move around the country serving in a temporary capacity. She related her belief that there are organizations that match physicians with positions that need to be filled. Number 1589 REPRESENTATIVE CRAWFORD inquired as to how the pay of the locum tenens physicians compares to that of local physicians. MS. REARDON said that she didn't have an answer. However, she related that hospitals and facilities have expressed a preference for permanent full-time physicians over juggling locum tenens. She further related that locum tenens physicians are usually more expensive [than permanent full-time physicians] because of the expense of getting the locum tenens physician to the area and housing him/her. CHAIR MURKOWSKI directed attention to page 2, line 6, and related her belief that a permit "shall" be extended for 60 days with completion of the packet. She asked whether there would be any other reason that would result in not granting an extension. If there are grounds for the board not to extend the permit, Chair Murkowski wanted the board to have the authority not to extend the permit. MS. REARDON agreed that the language reads as if the extension is automatic. Therefore, she surmised that the permit would be extended and any problems would be addressed with the person as a licensee. She suspected that the board could probably [impose] a summary suspension if the risk [the locum tenens physician] posed to public health and safety was sufficient to do so. For clear and immediate danger to public health and safety, statute specifies that licenses can be summarily suspended and the person must receive a hearing within seven days. CHAIR MURKOWSKI related that changing the language from "shall" to "may" appears to provide the option of rejecting an applicant. However, she questioned whether the application process for a locum tenens physician is different than that for a licensee. MS. REARDON asked to review the statute while testimony continued. Number 1321 ANNE HENRY, Special Projects Coordinator, Division of Mental Health & Developmental Disabilities, Department of Health & Social Services (DHSS), informed the committee that the department worked with [the interested parties] in order to find some comfort with this legislation. However, the board still isn't comfortable with the legislation. Ms. Henry noted appreciation for the clarification in Section 1, which speaks to temporarily employed folks. Areas throughout the state have difficulties obtaining psychiatrists to come and work. Furthermore, there is great difficulty with recruiting in the Alaska Psychiatric Institute (API). Because of the turnover, the ability to [grant extensions] is a critical piece for the department. If there is a language change in Section 2, Ms. Henry expressed the need for the 60-day extension to continue. CHAIR MURKOWSKI turned to Ms. Reardon's suggestion of reducing the validity of permits and extensions to 180 [calendar] days. MS. HENRY related her belief that [the department] would be very upset with such a change. Ms. Henry then urged the committee to maintain Section 3 in the bill because the business of health is so unpredictable that [the department] would like for the board to have the discretion provided in Section 3. Number 1154 DR. HEAD, Chief of Staff, Norton Sound Health Corporation; Alaska State Medical Board, testified via teleconference. He related that the state medical board has discussed this proposed law at length. He said he thought [CSSB 274(L&C)] embodies necessary modifications in the current locum tenens language. Furthermore, he liked that the legislation allows locum tenens for various reasons. Since the board is charged with protecting the public and the patients, that's why some of the modifications were [desired]. Dr. Head said he understood Ms. Henry's concern with regard to the requested change for permits and extensions for locum tenens physicians to only be valid 180 calendar days rather than 240 calendar days because of her wish to have coverage for facilities across the state. However, Dr. Head charged that the coverage can be maintained under the legislation while also protecting the public. He pointed out that if a locum tenens physician is in a location for 90 days and there is the need for the locum tenens physician to fill the position for a longer period, then the physician would merely have to complete a full application for permanent licensure. Therefore, another 60-day extension could be granted and the locum tenens physician could go through the same scrutiny as every active full-time license holder in the state. Dr. Head said that the board believes that [coverage] can be accomplished by encouraging an active full-time license. The Norton Sound Health Corporation hires locum tenens physicians fairly frequently and each one of them has elected to obtain an active full license. Dr. Head expressed concern that if physicians are allowed to work indefinitely under locum tenens licenses, then the state may become a magnet attracting physicians seeking a lax system in which their past isn't completely scrutinized. Alaska doesn't want to become a location for questionable practitioners, he said. Dr. Head remarked that [the board] wants to maintain control in an effort to protect the public while being able to fulfill the needs of the state. Number 0967 REPRESENTATIVE ROKEBERG related that he read Section 2 to allow an extension of up to 240 days. The new language would only seem to apply when one applies for permanent licensure. Therefore, he surmised that there must currently be a method to obtain an extension beyond the 60 days. DR. HEAD agreed that the current law does allow for [a locum tenens permit to be held for up to] 240 days. However, the [board] is requesting that be changed to 180 days within a 24 consecutive month period, which allows for two 90-day periods. The language specified 180 days because [the board] was told that many locum tenens physicians do come up and cover clinics for three months each summer, and therefore 180 days in a two- year period allow that to continue under a locum tenens permit. Number 0882 CHAIR MURKOWSKI turned to the existing statutes, which specify that a permit is valid for 60 consecutive days and if circumstances warrant an extension may be granted and extensions can't exceed 240 days. Therefore, she understood Dr. Head to be proposing a reduction in the extension to 180 days as well as not allowing for any extenuating circumstances beyond the 180 days. Such tightening moves in the opposite direction of the bill sponsor's [intent]. DR. HEAD agreed. Dr. Head pointed out that the current statute reads such that [locum tenens permits and extensions] could continue indefinitely if, as specified under Section 3, there is a determination [that the extension] is necessary for essential services for the protection of public health and safety. He emphasized that [the board] does want to take into account public health and safety, which is why there is the desire to maintain as much scrutiny as possible. Therefore, [the board] is saying that in order for a person to work longer than [180 days], the person should have to obtain an active full-time license and go through a background check. Therefore, those physicians that are afraid of the background check won't maintain a license in the state and will go elsewhere. Under the current statute, a physician practicing in an essential health care shortage area could practice indefinitely on a locum tenens physician license and never subject themselves to the scrutiny of their past practices. REPRESENTATIVE ROKEBERG asked whether [in such a situation] the board would intercede. DR. HEAD said that the board has no way of interceding. The board isn't given the right to investigate, to the degree such is done for active full-time licenses, a locum tenens physician's past unless he/she has applied for an active full- time license. Number 0693 CHAIR MURKOWSKI inquired as to how long it takes to become licensed, the cost, and the difference between background checks for locum tenens versus [an active full-time physician]. MS. REARDON said that generally it takes about two months to submit all of the information for a complete application. Once everything is received and the applicant's answers and documents don't create cause for investigation, the executive administrator can issue a temporary license allowing the applicant to practice until the board meets and makes the final decision. However, the amount of time [to achieve a complete application] is dependent upon third parties, such as hospital verification, that the division nor the applicant can control. CHAIR MURKOWSKI posed a situation in which a physician practicing under a locum tenens permit reaches 240 days and decides to stay. That locum tenens physician would need to submit an application for full licensure. In such a situation, she asked whether the locum tenens physician could receive a permit to stay and practice until licensure is obtained or is there a window when this physician would be "out of luck." MS. REARDON answered that there could be a window when the physician would be out of luck; it's dependent upon how long the locum tenens physician waited to start the permanent licensure process. The temporary licenses can only be issued if all the documents from the outside organizations are in; without those documents the locum tenens physician with 240 days would have to stop practicing until the documents come in. CHAIR MURKOWSKI specified that she is trying to understand the reason for Section 3. She surmised that a locum tenens physician that is a general practitioner would have an avenue allowing practice between the extensions granted and her ability to obtain full licensure. MS. REARDON replied no. In response to an earlier question regarding the fees, Ms. Reardon informed the committee that the locum tenens fee and application form is a $150 nonrefundable application fee and $200 permit fee. The permanent license has a fee of $250 nonrefundable application fee and a $590 license fee for a two-year license. MS. REARDON then returned to an earlier question regarding the "shall" language on page 2, line 6. Ms. Reardon opined that changing "shall" to "may" would allow denial of the extension. The specific denial authority can be found in AS 08.64.240. References to license are treated as including permits. The aforementioned statute specifies the reasons for which an extension could be denied. Ms. Reardon surmised that the board would specify that under certain circumstances, the permit would be extended while under other circumstances the full board or individual board member would make the decision. She suggested that the language could read as follows: "shall be extended unless it is denied for one of the reasons in AS 08.64.240." TAPE 02-67, SIDE A Number 0001 JIM JORDAN, Executive Director, Alaska State Medical Association, testified via teleconference. He informed the committee that ASMA's main interest in SB 274 lies in Section 1, which expands the uses of locum tenens permits for the purpose of evaluation of a physician for full-time employment. This legislation takes care of an unfair situation that currently exists. Currently, on a de facto basis large group practices are able to use locum tenens permittees as substitutes for one of the many physicians in the practice and review those physicians for potential employment. That option isn't available to the sole practitioner of a small practice. CHAIR MURKOWSKI inquired as to ASMA's position on Section 3, which allows an indefinite extension when the board determines that it's medically necessary to protect public health and safety. MR. JORDAN indicated that ASMA hasn't specifically reviewed [or taken a position on] Section 3. However, the obvious concern is that there are certain medical specialties that are difficult to find, such as pathologists and radiologists. He related his belief that it might be important to have continuity, especially in a situation in which it takes longer than 180 days to find a specialist, such as a pathologist, to hire permanently. Therefore, it may be more advantageous to have the consistency of the [locum tenens pathologist] while hiring for a permanent pathologist. Number 0242 REPRESENTATIVE ROKEBERG pointed out that Section 1 deletes the 60-day validity. He said he wasn't sure that there shouldn't be a cap on the timeframe, and therefore he asked if Mr. Jordan had a suggestion. MR. JORDAN related his understanding that Representative Rokeberg was asking whether the 60-day period should apply to the locum tenens employees that are present for the sake of being scrutinized for employment. Mr. Jordan said that 60 days should be a sufficient timeframe in which to evaluate for employment purposes. Mr. Jordan explained that under the current construction of SB 274 the locum tenens permit, whether for the purpose of substituting for an absent physician or for scrutinizing the physician for future employment, would last 90 days along with the other extensions specified. REPRESENTATIVE ROKEBERG said that seems reasonable, although he said he wasn't sure the statute would read that way. Representative Rokeberg pointed out that the committee packet includes a letter from ASMA specifying that ASMA supports a locum tenens permit being extended beyond 240 days for the purpose of substituting for a physician or a specific specialty that's otherwise unavailable in that location. MR. JORDAN said, "I stand corrected." REPRESENTATIVE ROKEBERG asked if the level of review should be raised [for an extension beyond 240 days]. MR. JORDAN responded that such would seem fair to him. In further response to Representative Rokeberg, Mr. Jordan confirmed that ASMA supports permits and extensions of 240 days rather than the board's suggested 180 days. Number 0492 MS. REARDON returned to the earlier question regarding the difference between the application documents for locum tenens permittees and those seeking permanent licensure. The locum tenens application doesn't require the verification privileges from all the hospitals in which the applicant has held privileges in the five years preceding the application in Alaska. The American Medical Association (AMA) profile and the National Practitioner Database Report aren't required for the locum tenens application. However, the locum tenens applicants must have a clearance report from the Federation of State Medical Boards databank. The aforementioned are the most significant differences in the application. The type of verification of post graduate training is also different. MS. REARDON noted that one must submit quite a few items for the locum tenens permit, such as verifications from all the states in which the individual was ever licensed. However, if an applicant didn't inform the division of one of the states in which the applicant was licensed, the division might be able to find out from the AMA profile. Furthermore, the Federation of State Medical Boards Disciplinary Database should show disciplinary action in other states. CHAIR MURKOWSKI asked if any consideration had been given with regard to the possibility of doing additional background checks in order to accommodate the indefinite extensions. MS. REARDON replied no and explained that it probably wasn't considered because one is fairly close [to having all the documents for a permanent position] when the locum tenens permit is obtained. REPRESENTATIVE ROKEBERG inquired as to how the databanks are used. MS. REARDON explained that [an applicant] completes and submits a request for physician profile form, which is ultimately sent to the division. In further response to Representative Rokeberg, Ms. Reardon specified that filing the form costs $20 and is paid directly to ASMA. The National Practitioner Databank Report is requested by the division on-line. REPRESENTATIVE ROKEBERG asked if [the National Practitioner Databank Report] could be added to Section 3. With regard to "the board or its designee" determining the extension, Representative Rokeberg asked who its designee would be. MS. REARDON clarified that the board has an executive administrator, an employee of the Division of Occupational Licensing, who it generally designates. In some cases, the board has designated that an individual board member has designated an individual to do things. REPRESENTATIVE ROKEBERG pointed out that Section 1(a) specifies, "A member of the board or its executive secretary may grant a temporary permit". MS. REARDON said that the board has never designated someone beyond an individual board member or a division employee. Ms. Reardon confirmed that there is personnel in place to do the verifications. REPRESENTATIVE ROKEBERG surmised that any adjustment to the fee schedule could be done by regulation. MS. REARDON related that the concerns of the division aren't related to the fee schedules. Number 0918 REPRESENTATIVE ROKEBERG directed attention to Section 1 and inquired as to why the 60-day language was deleted. He inquired as to the default. MS. REARDON answered that the locum tenens permit is valid for 90 days. She explained that this was a reorganization of the language so that the purposes and the length could be separated. In further response to Representative Rokeberg, Ms. Reardon said that the 240-day timeframe is in current statute. She explained that when there is a request for an extension, the extension is for the requested time up to 60 days. REPRESENTATIVE ROKEBERG inquired as to the term of art that would be used were the committee to amend Section 3 to include the two other databanks. MS. REARDON National Practitioner Databank and the American Medical Association of Osteopathic Association. CHAIR MURKOWSKI expressed the desire to review the "shall" language in Section 2. Therefore, Chair Murkowski announced that CSSB 274(L&C) would be held. REPRESENTATIVE ROKEBERG asked if Senator Olson would have any difficulties with the committee adding the two databanks in Section 3. MR. GRAHAM answered that he didn't believe Senator Olson would have a problem. [CSSB 274(L&C) was held over.]
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