Legislature(2019 - 2020)BARNES 124

02/12/2020 03:15 PM LABOR & COMMERCE

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Heard & Held
Heard & Held
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            HB  91-NATUROPATHS: LICENSING; PRACTICE                                                                         
3:18:32 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be  HOUSE BILL  NO.  91,  "An Act  relating  to  the practice  of                                                               
naturopathy; relating  to the licensure of  naturopaths; relating                                                               
to   the  Department   of  Commerce,   Community,  and   Economic                                                               
Development; and providing for an effective date."                                                                              
3:19:05 PM                                                                                                                    
ERIN  SHINE,  Staff,  Representative  Jennifer  Johnston,  Alaska                                                               
State Legislature,  presented HB  91 on behalf  of Representative                                                               
Johnston,  prime sponsor  and provided  a presentation  entitled,                                                               
"House  Bill  91 Naturopathic  Medicine  Reform."   She  directed                                                               
attention  to   slide  2  to   highlight  the  definition   of  a                                                               
naturopathic  doctor.   Naturopathic  medicine,  she  said, is  a                                                               
distinct medical  practice that  emphasizes prevention  and self-                                                               
healing processes  to treat each person  holistically and improve                                                               
outcomes  while   lowering  costs.    Naturopathic   doctors  are                                                               
educated   and  trained   at   accredited  naturopathic   medical                                                               
colleges.   They diagnose, prevent,  and treat acute  and chronic                                                               
illness,  as well  as  restore and  establish  optimal health  by                                                               
supporting the  person's inherent  self-healing process.   Rather                                                               
than  just suppressing  symptoms,  naturopathic  doctors work  to                                                               
identify  underlying  causes  of  illness  and  develop  personal                                                               
treatment  plans  to  address  them.     Ms.  Shine  went  on  to                                                               
paraphrase  slide 3  entitled,  "What  Education do  Naturopathic                                                               
Doctors  Receive,"   which  read  in  its   entirety  as  follows                                                               
[original punctuation provided]:                                                                                                
        4-Year Medical School Program accredited by the                                                                         
     Council of Naturopathic Medical Education; including:                                                                      
        • 2 years of medical sciences (anatomy, physiology,                                                                     
          microbiology, immunology, etc.)                                                                                       
        • 2 years of clinical sciences and treatment                                                                            
        • 4 year undergraduate degree and additional pre-                                                                       
          medical coursework                                                                                                    
        • 1-3 year residency options throughout the                                                                             
          country; however, there are not enough residency                                                                      
          opportunities for every graduate                                                                                    
        • Naturopaths must pass the two-part Naturopathic                                                                       
          Physicians Licensing Examination (NPLEX) before                                                                       
          being licensed to practice                                                                                            
MS.  SHINE  continued  with  slide  4 entitled,  "Who  is  not  a                                                               
Naturopathic Doctor?"  She  said, unfortunately, "naturopath" has                                                               
become a  catch-all term for  many non-naturopathic  doctors that                                                               
get  lumped  together  with the  practicing  physicians  who  are                                                               
licensed in this state.   In other states, naturopaths have title                                                               
protections so  that people  can't use  their name  without being                                                               
licensed and  going through  the same  educational process.   She                                                               
turned  attention to  slide 5  entitled, "Legislative  History of                                                               
Naturopath  Statutes in  Alaska," and  paraphrased the  following                                                               
[original punctuation provided]:                                                                                                
     ESTABLISHING STATUTES                                                                                                    
     1986: AS 08.45 (Naturopaths) established                                                                                   
     LEGISLATION PASSED                                                                                                       
       2004: SB 306 - Established a Naturopathic Medicine                                                                       
     Task Force                                                                                                                 
     2005: SB 42 - Extended Task Force one year and updated                                                                     
      2005: SB 52 - Updated statutes to correct "division"                                                                      
     to "department"                                                                                                            
     LEGISLATION ATTEMPTS                                                                                                     
     2007: SB 107                                                                                                               
     2008: HB 363                                                                                                               
     2010: HB 282 & SB 70                                                                                                       
     2011: HB 122                                                                                                               
     2012: HB 266 & SB 175                                                                                                      
     2013: HB 7                                                                                                                 
     2017: HB 326 & SB 120                                                                                                      
     2019: HB 91                                                                                                                
MS.  SHINE  directed attention  to  two  maps  on slides  6-7  to                                                               
discuss licensing  and prescriptive authority for  naturopaths in                                                               
America.    Prescriptive  authority  is one  of  the  contentious                                                               
issues in  HB 91.  She  explained that there are  varying degrees                                                               
of prescriptive  authority, as  the map  on slide  7 illustrates.                                                               
She  pointed  out  that  Vermont  is the  only  state  with  full                                                               
prescriptive  authority.   Alaska,  in  contrast,  is one  of  10                                                               
states where  naturopaths are regulated and  have no prescriptive                                                               
authority.    She  noted that  naturopathic  doctors  complete  a                                                               
rigorous education  in pharmacology during their  4-year science-                                                               
based  medical  education.   Naturopathic  doctors  believe  that                                                               
natural  medicine  and  conventional medicine  are  not  mutually                                                               
exclusive  and   recognize  that   there  are  times   when  both                                                               
approaches can be utilized together  for patients' benefits.  She                                                               
addressed  slide  8  entitled,  "House Bill  91,"  and  read  the                                                               
following [original punctuation provided]:                                                                                      
     Modernizes  statutes  for  Naturopaths by  cleaning  up                                                                    
     outdated   language,  requiring   continuing  education                                                                    
     every  2 years,  and  imposing the  same public  health                                                                    
     duties on Naturopaths as other medical providers                                                                           
      Updates scope of practice for Naturopaths to include                                                                      
       limited prescriptive authority and allowing minor                                                                        
     office procedures                                                                                                          
       Removes the need for duplicative office visits and                                                                       
     improves access to care for patients in Alaska                                                                             
MS.  SHINE  concluded   by  preemptively  addressing  forthcoming                                                               
testimony that  will "undoubtedly" be given  on HB 91.   She said                                                               
the  testimony  will  come  from   several  providers  who  share                                                               
personal  anecdotes  about  frightening stories  and  substandard                                                               
medical care  provided by naturopaths; however,  the stories have                                                               
never been substantiated or linked  to any licensed naturopath in                                                               
Alaska.     More   importantly,   she  said,   the  Division   of                                                               
Corporations,  Business and  Professional Licensing  has received                                                               
no reports  alleging the  kinds of  ethical and  medical breaches                                                               
purported in  these accounts.   She  added that  in the  20 years                                                               
that naturopaths  have been licensed  there have been a  total of                                                               
33   complaints  that   have   been   investigated,  albeit   not                                                               
necessarily sanctioned.                                                                                                         
3:29:01 PM                                                                                                                    
REPRESENTATIVE    STORY   sought    clarification   on    limited                                                               
prescriptive authority.                                                                                                         
MS. SHINE  explained that each state  allows different approaches                                                               
to prescriptive authority  for naturopathic doctors.   HB 91, for                                                               
example, would  be exclusionary [prescriptive  authority] because                                                               
it excludes controlled substance and chemotherapeutic agents.                                                                   
3:29:57 PM                                                                                                                    
MS. SHINE  provided a  sectional analysis of  HB 91  [included in                                                               
the committee packet], which she  read in its entirety as follows                                                               
[original punctuation provided]:                                                                                                
      Section 1  AS 08.02.010(a) Professional designation                                                                     
     requirements. (Amended)                                                                                                  
     Requires naturopathic practitioners to use appropriate                                                                     
     letters, title and specialist designations                                                                                 
        Section 2      AS 08.45.030 Issuance of license.                                                                      
        • Establishes that, to be issued a license, an                                                                          
          applicant must be of good moral character, have                                                                       
          graduated from an accredited naturopathic college                                                                     
          and have passed a licensing examination.                                                                              
        • Removes outdated language requiring that to be                                                                        
          issued  a  license   to  practice  naturopathy  in                                                                    
          Alaska,  if an  individual graduated  before 1988,                                                                    
          they  must  also have  been  issued  a license  to                                                                    
          practice in another state previously.                                                                                 
       Section 3      AS 08.45.035(a) Temporary licenses.                                                                     
     Allows the department to issue a temporary license to                                                                      
     a naturopath if they are signed up to                                                                                      
     take licensing exams at the next available date after                                                                      
     the date of the application and have not                                                                                   
     previously failed the licensing exam.                                                                                      
     Section 4   AS 08.45.045  Practice of naturopathy. (New                                                                  
        • Allows naturopaths to practice within  the scope                                                                      
          of their education and training                                                                                       
        • Allows naturopaths  to  prescribe   natural  and                                                                      
          therapeutic substances, natural therapies, drugs                                                                      
          and contraceptive devices                                                                                             
        • Allows naturopaths to perform minor surgeries and                                                                     
          perform or order diagnostic procedures                                                                                
        • Defines "naturopathic physical application"                                                                           
     Section 5    AS  08.45.050 Restrictions on  practice of                                                                  
     naturopathy. (Amended)                                                                                                   
        • Removes prohibition   for   prescribing   drugs,                                                                      
          performing minor surgeries, and using the word                                                                        
          "physician" in titles                                                                                                 
        • Prohibits naturopaths from giving,  recommending                                                                      
          or prescribing cancer drugs and controlled                                                                            
     Section  6    AS  08.45.053 &  08.45.057 Public  health                                                                  
     duties and renewal of license. (New sections)                                                                            
        • Imposes same public health duties on naturopaths                                                                      
          as other physicians                                                                                                   
        • Requires naturopaths to  complete  24  hours  of                                                                      
          continuing education every two years for license                                                                      
          to be renewed                                                                                                         
     Section 7   AS  08.45.200(3) Definitions. (Repealed and                                                                  
     Repeals and replaces definition for "naturopathy"                                                                          
     Section  8    AS 08.45.200(4)  & (5)  Definitions. (New                                                                  
     Defines  "approved  naturopathic  medical  school"  and                                                                    
     Section 9  Transitional Language (Uncodified law)                                                                        
     Transitional   language  allowing   currently  licensed                                                                    
     naturopaths to practice under the new law                                                                                  
     Section 10  Transitional Regulations (Uncodified law)                                                                    
     Allows   the    Department   to    adopt   transitional                                                                    
     regulations immediately following  passage and prior to                                                                    
     the bill's effective date.                                                                                                 
     Section 11  Effective date. (Uncodified law)                                                                             
     Establishes immediate effective date for section 10                                                                        
     Section 12  Effective date. (Uncodified law)                                                                             
     Establishes  effective  date  for  sections 1  -  9  as                                                                    
     January 1, 2020                                                                                                            
3:32:44 PM                                                                                                                    
REPRESENTATIVE  STUTES, referencing  Section 5,  asked if  "minor                                                               
surgeries" is defined in the bill.                                                                                              
MS.  SHINE  explained  that  sutures,  punch  biopsies,  and  the                                                               
removal  or insertion  of an  IUD [intrauterine  device] are  all                                                               
examples of what would constitute a minor surgery.                                                                              
REPRESENTATIVE STUTES asked if the  word "minor" is defined in HB                                                               
3:35:48 PM                                                                                                                    
MS. SHINE directed attention to page  4, lines 1-7, which read as                                                               
     perform  procedures  in  the  office  using  operative,                                                                    
     electrical,  or other  methods,  including  the use  of                                                                    
     antiseptics  and local  anesthetics,  for the  surgical                                                                    
     repair   and  care   of  superficial   lacerations  and                                                                    
     abrasions,  superficial  lesions,  and the  removal  of                                                                    
     foreign bodies  located in  the superficial  tissues of                                                                    
     the human body; the  procedures may not include general                                                                    
     or spinal  anesthetics, major  surgery, surgery  of the                                                                    
     body cavities,  plastic surgery, surgery  involving the                                                                    
     eyes, or surgery  involving tendons, ligaments, nerves,                                                                    
     or blood vessels; and                                                                                                      
REPRESENTATIVE  RASMUSSEN  questioned  whether  the  pharmacology                                                               
classes  that  naturopathic  doctors  take  during  their  4-year                                                               
college  education  align  with  the material  that  a  physician                                                               
learns in school.                                                                                                               
MS.  SHINE offered  her  understanding that  over  the first  two                                                               
years, [naturopaths]  follow the same  track as a  medical doctor                                                               
with pharmacology learned throughout most  of their courses.  She                                                               
offered to follow up with a cross-comparison.                                                                                   
CHAIR SPOHNHOLZ,  in response to Representative  Rasmussen, added                                                               
that  naturopaths are  "naturopathic  doctors  (NDs"), just  like                                                               
medical  doctors.    She  explained that  the  term  "doctor"  is                                                               
generally  used  in  short  for medical  doctor  (MD),  but  also                                                               
applies to anyone that's received a doctorate degree.                                                                           
3:36:30 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that HB 91 was held over.                                                                             

Document Name Date/Time Subjects
HB 91 Fiscal Note DCCED-CBPL 1.16.2020.pdf HL&C 2/12/2020 3:15:00 PM
HB 91
HB 91 Supporting Document - Naturopathic Concerns and Answers 4.2.19.pdf HL&C 2/12/2020 3:15:00 PM
HB 91
HB 91 Supporting Document - Naturopathic One-Pager 3.26.19.pdf HL&C 2/12/2020 3:15:00 PM
HB 91
HB 91 Presentation 2.12.2020.pdf HL&C 2/12/2020 3:15:00 PM
HB 91
HB 91 Sectional Analysis v. M 3.26.19.pdf HL&C 2/12/2020 3:15:00 PM
HB 91
HB 91 Sponsor Statement 3.26.19.pdf HL&C 2/12/2020 3:15:00 PM
HB 91
HB 91 Supporting Document - Educational & Scope Comparison 3.26.19.pdf HL&C 2/12/2020 3:15:00 PM
HB 91
SB 106 Sectional Analysis 1.29.2020.pdf HL&C 2/12/2020 3:15:00 PM
SB 106
SB 106 Fiscal Note DCCED-IO 1.17.2020.pdf HL&C 2/12/2020 3:15:00 PM
SB 106
SB 106 Support Testimony Packet 1.29.2020.pdf HL&C 2/12/2020 3:15:00 PM
SB 106
SB 106 Sponsor Statement 1.29.2020.pdf HL&C 2/12/2020 3:15:00 PM
SB 106