Legislature(2019 - 2020)BARNES 124

02/28/2020 03:15 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 24 LIMITED TEACHER CERTIFICATES; LANGUAGES TELECONFERENCED
Moved CSHB 24(L&C) Out of Committee
-- Public Testimony --
+= HB 91 NATUROPATHS: LICENSING; PRACTICE TELECONFERENCED
Heard & Held
-- Public Testimony --
+= HB 235 AK WORKFORCE INVESTMENT BOARD:ALLOCATIONS TELECONFERENCED
<Bill Hearing Canceled>
+= HB 84 WORKERS' COMP: POLICE, FIRE, EMT, PARAMED TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
            HB  91-NATUROPATHS: LICENSING; PRACTICE                                                                         
                                                                                                                                
3:47:45 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final 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."                                                                              
                                                                                                                                
3:48:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JENNIFER  JOHNSTON,   Alaska  State  Legislature,                                                               
recounted  that  years ago,  her  father-in-law  was the  driving                                                               
force in  getting osteopaths hospital  privileges.  She  shared a                                                               
personal anecdote  about her daughter.   She went on to  say that                                                               
this  bill gives  Alaskans an  affordable alternative  to primary                                                               
care  and that  naturopaths have  the education  and training  to                                                               
provide the  practice outline in this  bill.  She noted  that the                                                               
proposed  prescriptive authority  in  HB  91 excludes  controlled                                                               
substances and chemotherapy  drugs.  She expressed  her hope that                                                               
the committee will  listen to the forthcoming  testimony and that                                                               
they will pass the bill out of committee.                                                                                       
                                                                                                                                
3:50:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  noted that after speaking  with Ms. Shine,                                                               
she  was reassured  about several  issues regarding  prescriptive                                                               
authority.  She asked Ms. Shine to elaborate.                                                                                   
                                                                                                                                
3:51:00 PM                                                                                                                    
                                                                                                                                
ERIN  SHINE,  Staff,  Representative  Jennifer  Johnston,  Alaska                                                               
State  Legislature,  recounted   that  Naturopathic  doctors  are                                                               
educated in pharmacology throughout  various courses during their                                                               
four-year medical  school.  She  said that although  their school                                                               
is  similar to  that of  medical doctors  (MDs), they  diverge in                                                               
some  training.   She  highlighted  that  for naturopaths  (NDs),                                                               
their  education and  training is  the same  or more  than health                                                               
professionals  who  are  practicing   with  a  broader  scope  of                                                               
practice than this bill provides.                                                                                               
                                                                                                                                
CHAIR  SPOHNHOLZ  clarified   that  nurse  practitioners  receive                                                               
either a  master's degree  or a doctorate,  which is  between six                                                               
and eight years of school.                                                                                                      
                                                                                                                                
MS. SHINE acknowledged that.                                                                                                    
                                                                                                                                
3:52:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS said that he is  "between a rock and a hard                                                               
place" because trusted  doctors have strongly opposed  it, but he                                                               
would like  to support his  colleague.  He  asked if there  is an                                                               
opportunity for consensus on a  narrow expansion of authority for                                                               
naturopaths.                                                                                                                    
                                                                                                                                
REP JOHNSTON  opined that it  is already narrow.   She reiterated                                                               
that  the bill  excludes controlled  substances and  chemotherapy                                                               
drugs.    She  said  it  allows  naturopaths  to  prescribe  cold                                                               
medication  for their  patients, for  example.   Furthermore, she                                                               
added that because  they are naturopaths, they're  less likely to                                                               
write prescriptions.                                                                                                            
                                                                                                                                
CHAIR  SPOHNHOLZ noted  that  they have  received  31 letters  of                                                               
opposition and 116 in support of HB 91.                                                                                         
                                                                                                                                
3:54:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES asked  if any  of the  "nightmare" stories                                                               
heard during the bill's previous  period of public testimony have                                                               
been substantiated.                                                                                                             
                                                                                                                                
MS.  SHINE  said  no.    She explained  that  after  hearing  the                                                               
testimony last  year, she  followed up  with Sarah  Chambers, the                                                               
Director  of   the  Division   of  Corporations,   Business,  and                                                               
Professional Licensing,  and not  one of  those stories  has been                                                               
reported  or  investigated  in  Alaska.    She  said  it's  quite                                                               
possible that  those are  stories coming  from outside  Alaska in                                                               
states  that are  unregulated where  people  can call  themselves                                                               
naturopaths  and  potentially operate  like  a  naturopath.   She                                                               
reiterated  that  those  claims  have  never  been  substantiated                                                               
throughout  the  years  that  this   bill  has  been  before  the                                                               
legislature.                                                                                                                    
                                                                                                                                
3:55:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   STORY   reported  concerns   about   naturopaths                                                               
identifying themselves differently than doctors.                                                                                
                                                                                                                                
MS. SHINE replied that she did  a deep dive into other states and                                                               
how  they've outlined  titles for  naturopaths  and other  health                                                               
care professionals.  Of the  states that regulate, there are many                                                               
that put a prohibition on using  the word "physician."  In HB 91,                                                               
it does  remove the  current prohibition  from the  1986 statutes                                                               
that were  put into place.   In states that do  allow naturopaths                                                               
to call  themselves naturopathic physicians, they  also recommend                                                               
that they must identify that  they are a "naturopathic physician"                                                               
instead of just "physicians" to prevent confusion for patients.                                                                 
                                                                                                                                
CHAIR SPOHNHOLZ  clarified that the  title "doctor" is  short for                                                               
"doctorate,"  which many  people  hold.   She  added  that it  is                                                               
colloquially used because historically,  medical doctors were the                                                               
primary care givers; however, that is no longer true.                                                                           
                                                                                                                                
3:58:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN inquired  as to the level  of concern about                                                               
naturopaths' licensure.                                                                                                         
                                                                                                                                
3:58:57 PM3`                                                                                                                  
                                                                                                                                
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional  Licensing,  Department  of  Commerce,  Community  &                                                               
Economic Development,  replied that the Division  of Corporation,                                                               
Business, and  Professional Licensing does not  see many problems                                                               
concerning  licensed naturopaths.   She  offered her  belief that                                                               
the department  averages approximately 7 investigations  every 10                                                               
years.  Furthermore, last year  there was only one complaint that                                                               
was not  followed through with.   She stated that  naturopaths do                                                               
not have a problematic profession.                                                                                              
                                                                                                                                
3:59:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN asked of  the professional licensure boards                                                               
that  the   department  currently  oversees,  how   many  include                                                               
prescriptive authority.                                                                                                         
                                                                                                                                
MS.  CHAMBERS  listed  the  State Medical  Board,  the  Board  of                                                               
Nursing, the Board  of Dental Examiners, the  Board of Veterinary                                                               
Examiners, and the Board of Examiners in Optometry.                                                                             
                                                                                                                                
REPRESENTATIVE HANNAN  asked how  often there  are investigations                                                               
of  a disciplinary  nature into  those  boards with  prescriptive                                                               
authority   and  whether   there   are  associated   prescriptive                                                               
problems.      She   contemplated  whether   giving   naturopaths                                                               
prescriptive authority should be a legitimate concern.                                                                          
                                                                                                                                
MS.   CHAMBERS   acknowledged   the  nationwide   concern   about                                                               
controlled substances.   She reassured  the committee  that there                                                               
is  nothing in  the bill  that  would give  naturopaths even  the                                                               
illusion   of  having   the  ability   to  prescribe   controlled                                                               
substances.  She  reiterated that this would match  the state law                                                               
with their training.                                                                                                            
                                                                                                                                
4:02:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STORY  reported  that medical  professionals  are                                                               
concerned about naturopaths being inexperienced.                                                                                
                                                                                                                                
4:03:26 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  sought clarification  on the complaint  that was                                                               
filed and not followed through with.  She asked what that means.                                                                
                                                                                                                                
MS. CHAMBERS explained  that there was nothing  to pursue because                                                               
the person lost  interest or didn't take  the complaint seriously                                                               
enough to pursue.                                                                                                               
                                                                                                                                
4:06:09 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
4:06:31 PM                                                                                                                    
                                                                                                                                
ALEX MALTER,  Alaska State Medical  Association, stated  that his                                                               
purpose in testifying  is to respectfully urge  the committee not                                                               
to support expanding the scope  of practice for naturopaths under                                                               
HB 91.   He opined that  these changes would not  enhance patient                                                               
care or  improve Alaskans'  access to  care.   He shared  a brief                                                               
history of  his medical background  and a personal anecdote.   He                                                               
reiterated  his  belief  that  expanding  naturopaths'  scope  of                                                               
practice  would not  enhance medical  care in  Alaska or  improve                                                               
patient  access.    He offered  his  understanding  that  medical                                                               
training for  naturopaths is less  rigorous than that  of medical                                                               
doctors.   He said its  emphasis in alternative healing  does not                                                               
allow adequate time for students  to study the accepted pathology                                                               
and  physiology to  safely treat  most medical  conditions.    In                                                               
general,  medical  doctors  don't  believe  that  the  first  two                                                               
didactic  years  of  naturopath school  and  medical  school  are                                                               
comparable, he  said.  Furthermore,  he argued that even  if they                                                               
are  similar, medical  students are  still required  to spend  an                                                               
additional four  years in clinical  training or  residency before                                                               
being licensed  in the state  of Alaska.   Under HB 91,  he said,                                                               
naturopaths could  be licensed to  prescribe with  less training,                                                               
little  of   which  being  focused  on   relative  pharmaceutical                                                               
treatments.   To conclude, he  said it's unlikely  that expanding                                                               
the  scope of  practice for  naturopaths will  improve access  to                                                               
care for the  underserved.  He urged the committee  to vote no on                                                               
HB 91.                                                                                                                          
                                                                                                                                
4:11:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN declared  a conflict  of interest,  as Mr.                                                               
Malter  has been  her  primary  care physician  for  the last  25                                                               
years.                                                                                                                          
                                                                                                                                
4:12:02 PM                                                                                                                    
                                                                                                                                
KATHERINE  BROWN,  noted that  she  is  the great-niece  of  Dora                                                               
Sweeney  an   elected  delegate   to  the   state  constitutional                                                               
convention,   representing   Juneau   from   1955-1965   in   the                                                               
territorial and state legislatures.   She stated that NDs receive                                                               
the  same training  as  MDs  for the  first  two  years of  their                                                               
education,  focusing on  natural medicine  afterwards.   She said                                                               
they are fully  qualified to function as  primary care physicians                                                               
and to competently perform minor  surgeries and prescribe certain                                                               
medications.   She offered her  belief that not  taking advantage                                                               
of the full  capacities of Alaska's NDs "is madness."   She added                                                               
that if stories of malpractice  by naturopaths are not documented                                                               
and legally  reported as required by  law, they have no  place in                                                               
the  present discussion.    All Alaskans  should  have access  to                                                               
[naturopathic] care if they so  choose, she opined.  To conclude,                                                               
she asked members to pass HB 91 out of committee.                                                                               
                                                                                                                                
4:15:08 PM                                                                                                                    
                                                                                                                                
MARY  FOLAND,  MD, State  Medical  Association,  stated that  she                                                               
opposes the expansion  of practice.  She reported  that the State                                                               
Medical  Board  has opposed  this  legislation,  adding that  the                                                               
board  believes  these changes  are  the  practice of  allopathic                                                               
medicine and  are not appropriate  or safe  for the public.   She                                                               
indicated  that  she  is  privy   to  substantiated  stories  and                                                               
proceeded to share one about malpractice  committed by a ND.  She                                                               
went  on  to  say  that  HB  91  would  allow  NDs  to  prescribe                                                               
potentially    dangerous   pharmaceuticals    including   cardiac                                                               
antiarrhythmics,   antipsychotics,  blood   thinners,  or   amino                                                               
suppressants,  as  well  as   contraceptive  devices,  which  are                                                               
implanted under the skin or inside  the uterus and carry the risk                                                               
of infection  and uterine perforation.   It would also  allow NDs                                                               
to  order  diagnostic procedures,  she  stated.   She  urged  the                                                               
committee  to act  to protect  the health  and safety  of Alaskan                                                               
patients by not passing the bill.                                                                                               
                                                                                                                                
CHAIR SPOHNHOLZ asked if Dr.  Foland reported the naturopath from                                                               
her story.                                                                                                                      
                                                                                                                                
DR. FOLAND  answered no.   She  said she heard  the story  from a                                                               
physician that was  sharing the results of  an endometrial biopsy                                                               
with a patient.   She alleged that she knows  of a different case                                                               
that  was investigated  by the  State Medical  Board because  the                                                               
investigator  called  her about  "a  naturopath  who did  have  a                                                               
complication injecting  phenol for  back pain," resulting  in the                                                               
patient's collapsed lung.  She declined  to share the name of the                                                               
naturopath who was allegedly involved.                                                                                          
                                                                                                                                
4:19:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN  asked  if  the  endometrial  cancer  case                                                               
involved a naturopath practicing in the state of Alaska.                                                                        
                                                                                                                                
DR. FOLAND said yes.                                                                                                            
                                                                                                                                
REPRESENTATIVE  HANNAN  asked  if the  aforementioned  case  took                                                               
place in Alaska.                                                                                                                
                                                                                                                                
DR. FOLAND answered yes.                                                                                                        
                                                                                                                                
REPRESNTATIVE  HANNAN  asked if  doctors  have  a legal  duty  to                                                               
report medical  incompetence if they encounter  it while treating                                                               
a patient.                                                                                                                      
                                                                                                                                
DR. FOLAND  offered her understanding  that reports to  the State                                                               
Medical Board  and to the  State Medical  Association's grievance                                                               
committee must come from the patient, not the physician.                                                                        
                                                                                                                                
CHAIR SPOHNHOLZ asked  Ms. Chambers to clarify  who should submit                                                               
the report.                                                                                                                     
                                                                                                                                
4:20:49 PM                                                                                                                    
                                                                                                                                
MS. CHAMBERS  said anyone can  file a complaint, adding  that the                                                               
division  would do  the investigation  by  interviewing both  the                                                               
doctor and  patient.   Some health  care professions  require the                                                               
report  of sexual  abuse  or  child abuse,  she  explained.   She                                                               
offered  her belief  that there  is  no requirement  to report  a                                                               
medical procedure that didn't work out.                                                                                         
                                                                                                                                
CHAIR  SPOHNHOLZ repeated  that  if there  are people  practicing                                                               
health care  in an  unsafe manner,  there is  a process  by which                                                               
health care  providers should take  action on to ensure  that the                                                               
public is safe.                                                                                                                 
                                                                                                                                
4:22:21 PM                                                                                                                    
                                                                                                                                
PATRICK NOLAN,  MD, informed  the committee that  he is  a board-                                                               
certified  internist   and  endocrinologist.    He   said  he  is                                                               
testifying  in opposition  to  HB  91 for  several  reasons.   He                                                               
argued that NDs  don't have the same education  as osteopathic or                                                               
allopathic  physicians  and  for  that reason,  should  stick  to                                                               
naturopathy.   He  opined  that  they should  not  be allowed  to                                                               
prescribe  drugs because  they are  not adequately  trained.   He                                                               
stated   that   the   complexity  of   medicine   has   increased                                                               
tremendously  in the  last 40  years, adding  that NDs  need more                                                               
specialized medical training.                                                                                                   
                                                                                                                                
4:26:40 PM                                                                                                                    
                                                                                                                                
RHENE MERKOURIS,  MD, Alaska State Medical  Association, reported                                                               
that  she is  an obstetrician-gynecologist,  adding  that she  is                                                               
speaking  against HB  91.   She argued  that medical  schools are                                                               
accredited through  standardized tests  that guarantee a  base of                                                               
knowledge, whereas naturopaths do not  have these types of tests.                                                               
In comparison,  she said, there's  no question about  the ability                                                               
to diagnose disease, perform  surgery, or [prescribe] medication.                                                               
She  shared a  personal anecdote.    She stated  that she  speaks                                                               
strongly against HB 91 for these reasons.                                                                                       
                                                                                                                                
4:30:07 PM                                                                                                                    
                                                                                                                                
JOHN DEKEYSER,  MD, informed the  committee that he is  a medical                                                               
doctor  and is  board certified  in family  practice, as  well as                                                               
obstetrics  and gynecology.   He  addressed different  aspects of                                                               
the  Naturopathic Physicians  Licensing  Exam  (NPLX) and  shared                                                               
several anecdotes.                                                                                                              
                                                                                                                                
4:33:53 PM                                                                                                                    
                                                                                                                                
JEFFERY DEMAIN,  MD, offered his belief  that naturopaths provide                                                               
a good service, enhance the  wellness of patients, and treat "the                                                               
whole person."   He  said he also  co-manages patients  with NDs.                                                               
Nonetheless,  he opined  that their  therapies and  approaches to                                                               
diagnostic  management   are  inconsistent   with  evidence-based                                                               
principles.    He  further  stated   that  they  are  counter  to                                                               
scientific evidence  of standard care.   As a result, he  said he                                                               
has  seen patients  misdiagnosed and  mismanaged completely.   He                                                               
addressed the  difference in education  between MDs and NDs.   He                                                               
voiced  his  opposition  to  HB  91, adding  that  it  would  put                                                               
Alaskans at risk and would add  to the shortage of health care in                                                               
the state.                                                                                                                      
                                                                                                                                
4:37:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN questioned  whether  Dr.  Demean has  ever                                                               
seen his patients misdiagnosed from previous medical doctors.                                                                   
                                                                                                                                
DR. DEMAIN  said misdiagnosis is infrequent  and shared anecdotal                                                               
examples.                                                                                                                       
                                                                                                                                
4:39:55 PM                                                                                                                    
                                                                                                                                
AMY   SEIBERLICH,   ND,   Alaska  Association   of   Naturopathic                                                               
Physicians, provided  a history of her  education through college                                                               
and her work experience beginning  in Fairbanks as a naturopathic                                                               
doctor.   She  recounted  helping patients  with food  addictions                                                               
lose a significant amount of  weight through finding and treating                                                               
underlying medical  conditions, implementing a whole  foods diet,                                                               
targeted nutrient  replacement, and a  lot of counseling.   Along                                                               
with the  wight loss, she  reported regularly seeing  their blood                                                               
pressures  drop  by 40  points,  cholesterol  levels decrease  by                                                               
half, and  blood sugars normalize within  weeks; however, because                                                               
of the  current scope of  practice she  is forced to  refer these                                                               
patients elsewhere  to manage  their medication.   She  said that                                                               
like other  MDs, she is  trained to manage these  medications and                                                               
if  she were  to practice  somewhere else,  she could  easily and                                                               
safely do  so.  This  discrepancy costs Alaska  qualified primary                                                               
care providers, which lowers health  care access and competition,                                                               
while driving up  costs.  HB 91 seeks to  correct this, she said,                                                               
and she encouraged the committee to pass it.                                                                                    
                                                                                                                                
4:43:14 PM                                                                                                                    
                                                                                                                                
ADAM  GROVE, ND,  noted that  he  is a  naturopath practicing  in                                                               
Anchorage and is  also certified as a brain  injury specialist by                                                               
the  Brain   Injury  Association  of   America.    He   shared  a                                                               
description  of   his  educational  background  and   early  work                                                               
experience,  as well  as personal  anecdote about  his work  with                                                               
brain  injuries in  Alaska.   He said  he runs  into problems  in                                                               
rural areas because without prescriptive  rights he cannot manage                                                               
medications or provide the guidance to  those who might be on the                                                               
wrong  medications.   He concluded  by offering  his belief  that                                                               
naturopaths are more equipped to  provide care for complex issues                                                               
like brain  injury.  He urged  the passage of HB  91 and stressed                                                               
that naturopaths  are a  valuable asset  to Alaska  and expanding                                                               
their  privileges to  manage medication  through prescription  is                                                               
essential.                                                                                                                      
                                                                                                                                
4:47:53 PM                                                                                                                    
                                                                                                                                
DOUG  VERMILLION, MD,  stated  that  he is  a  medical doctor  in                                                               
Anchorage  and is  having trouble  getting  patients cleared  for                                                               
surgery and making  sure their optimized.  He said  there are not                                                               
enough primary care doctors and  that more access to primary care                                                               
would  benefit  the  residents  of  Alaska.    As  far  as  being                                                               
credentialed, he  said, it  can be  worked out.   He  offered his                                                               
belief that  Alaskan citizens need  additional access  to primary                                                               
care and many [naturopaths] are very good.                                                                                      
                                                                                                                                
4:49:04 PM                                                                                                                    
                                                                                                                                
JOSHUA  GREEN,   ND,  informed  the   committee  that  he   is  a                                                               
naturopathic physician in the state  of Vermont and the president                                                               
of the Vermont  Association of Naturopathic Physicians.   He said                                                               
he is calling in  support of HB 91.  He  provided a brief history                                                               
about  the licensure  of naturopaths  in Vermont.   He  addressed                                                               
several  claims in  the  testimony put  forth  by physicians  and                                                               
their  opposition to  the bill.   He  pointed out  that NDs  have                                                               
additional training in mechanical  medicine, homeopathy, diet and                                                               
lifestyle counseling,  which is  different than  most physicians.                                                               
To  conclude he  said NDs  refer to  other specialists  often, as                                                               
appropriate, and are  referred by other specialists.   He said he                                                               
is thankful  to have  opening prescribing  rights in  Vermont and                                                               
expressed his hope that Alaska is open to that as well.                                                                         
                                                                                                                                
CHAIR SPOHNHOLZ  noted that HB  91, as proposed, would  not allow                                                               
for open prescribing rights in the state of Alaska.                                                                             
                                                                                                                                
4:53:51 PM                                                                                                                    
                                                                                                                                
COURTNEY BOWERS, ND, provided a  history of her education through                                                               
college and  her work experience  in Vermont  as a ND  in primary                                                               
care.   She  acknowledged the  lack of  residencies available  in                                                               
[naturopathic] education, which lead her  to create her own.  She                                                               
addressed   several  concerns   voiced  by   earlier  testifiers,                                                               
stressing that as  a ND in primary care, she  would never implant                                                               
an intrauterine  device (IUD) or  prescribe anti-cancer  drugs or                                                               
heart failure drugs,  because all require specialists.   She said                                                               
she doesn't  get the  sense that's  what Alaskan  naturopaths are                                                               
asking for - they are asking  for a formulary that is appropriate                                                               
to the scope in which they are trained.   That is what they do in                                                               
Vermont and it's been working very well, she added.                                                                             
                                                                                                                                
4:57:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN  asked  if  Dr.  Bowers  prescribes  birth                                                               
control.                                                                                                                        
                                                                                                                                
DR. BOWERS  said yes,  adding that  she is  very well  trained in                                                               
oral contraceptive.   She  reiterated that  she does  not implant                                                               
IUDs, instead opting to refer  those patients to gynecologists or                                                               
Planned Parenthood  for the consultation and  application.  Other                                                               
than  oral  contraceptive,  she  noted  that  she  can  prescribe                                                               
diaphragms and spermicide.                                                                                                      
                                                                                                                                
REPRESENTATIVE  HANNAN   asked  if   Dr.  Bowers   does  Norplant                                                               
implants.                                                                                                                       
                                                                                                                                
DR. BOWERS answered no.                                                                                                         
                                                                                                                                
4:58:39 PM                                                                                                                    
                                                                                                                                
DANIEL  YOUNG,  ND,  said he  has  been  practicing  naturopathic                                                               
medicine for  28 years, four of  which have been in  Eagle River.                                                               
He voiced his support for HB 91.   He shared his belief that it's                                                               
a  good   bill  and  that   it's  reasonable  to   allow  trained                                                               
naturopathic  doctors  for  what   they're  asking  for  in  this                                                               
legislation.   He  summarized the  licensure process  for NDs  in                                                               
Alaska.    It  requires  accreditation   and  passing  the  NPLEX                                                               
professional board exams, which are  rigorous and contain a minor                                                               
surgeries  module,  as  well  as a  pharmaceutical  module.    He                                                               
explained  that the  U.S. Department  of  Education oversees  the                                                               
accreditation of  naturopathic medicine just  as well as  they do                                                               
allopathic and  osteopathic medicine.   He  said that  for years,                                                               
naturopaths have been  trying to educate the  legislature on what                                                               
they  can  provide to  Alaskans.    He  added  that NDs  have  an                                                               
excellent safety record.  He urged  the members to pass HB 91 out                                                               
of committee.                                                                                                                   
                                                                                                                                
5:02:10 PM                                                                                                                    
                                                                                                                                
GARY  FERGUSON,   ND,  informed   the  members   that  he   is  a                                                               
naturopathic doctor in  the state of Alaska.  He  said he went to                                                               
naturopathic  medical school  because  he  believes in  wholistic                                                               
based  approaches and  indigenous  based  approaches to  healing,                                                               
which includes botanical  and physical medicine.   He stated that                                                               
he supports HB  91.  He stated that naturopaths  pass a stringent                                                               
licensing exam.   He went on  to say that without  the ability to                                                               
prescribe  they can't  help patients  appropriately manage  their                                                               
medications.  He said HB 91  would allow NDs to practice how they                                                               
were trained.   He shared a  personal anecdote and said,  being a                                                               
Native  Alaskan person,  he sees  the need  for culturally  based                                                               
approaches that NDs can bring to Alaskans.                                                                                      
                                                                                                                                
5:05:53 PM                                                                                                                    
                                                                                                                                
ANNETTE O'CONNELL  shared an anecdote  about her  personal battle                                                               
with  celiac  disease and  how  a  ND  was  the first  doctor  to                                                               
accurately diagnose and treat her.   She revealed that because of                                                               
Alaska's current  laws, she must  travel outside of the  state to                                                               
receive the  care she has come  to trust and the  medications for                                                               
her thyroid  condition.   She asked the  committee to  "stop this                                                               
vendetta  the   medical  establishment  has  against   any  other                                                               
profession that impedes  on their territory."   They believe they                                                               
are  the  only  branch  of the  medical  professionals  that  are                                                               
qualified to  offer services  and that others  are not  safe, she                                                               
said.    She made  several  observations  on statements  made  by                                                               
previous testifiers.   She concluded  by urging the  committee to                                                               
pass HB 91.                                                                                                                     
                                                                                                                                
5:08:54 PM                                                                                                                    
                                                                                                                                
DAVID SCHLEICH noted his credentials.   He pointed out that there                                                               
is  an  uneven  and   inadequate  understanding  of  naturopathic                                                               
training and credentialing.   He said the growth  in the activity                                                               
of naturopathic professionals has been  remarkable in the last 20                                                               
years and that  it's a very good idea to  support and enhance the                                                               
managing   of  medications   within   the   scope  for   Alaska's                                                               
naturopathic professionals,  as outlined  in HB 91.   He  went to                                                               
explain that  naturopaths go through  programmatic accreditation,                                                               
as  well as  state  and regional  accreditation.   He  encouraged                                                               
allopathic  and  biomedicine  professional colleagues  to  become                                                               
more familiar with  the rigor, depth, and  extent of naturopathic                                                               
practice  and  training  -  particularly   to  the  training  and                                                               
education.                                                                                                                      
                                                                                                                                
5:13:52 PM                                                                                                                    
                                                                                                                                
NATALIE  WIGGINS,  ND,  informed  the committee  that  she  is  a                                                               
naturopathic  physician  practicing  in Anchorage  Alaska.    She                                                               
voiced her  support for HB 91.   She shared an  anecdotal example                                                               
illustrating  how the  lack of  prescriptive  rights impacts  her                                                               
ability to treat  her patients.  She stated  that naturopaths are                                                               
highly trained to maintain medication and she urged the                                                                         
committee to support this bill.                                                                                                 
                                                                                                                                
5:16:20 PM                                                                                                                    
                                                                                                                                
CAMERON O'CONNEL, read the following statement:                                                                                 
                                                                                                                                
     I'm writing  in support  of House  Bill 91  and I  am a                                                                    
     naturopathic  doctor.   Born and  raised  in Alaska,  I                                                                    
     hoped to come back to the  state once I had finished my                                                                    
     medical  training and  residency to  set up  a practice                                                                    
     and give back to the  greater Anchorage community.  The                                                                    
     decision was not easy.   My residency was in California                                                                    
     and  as such,  I had  prescription rights.   Having  to                                                                    
     give up  the ability to  do something as simple  as put                                                                    
     my  patients on  (indisc.) for  hypothyroidism made  my                                                                    
     move  back to  Alaska  a much  more difficult  decision                                                                    
     than it should  have been.  A few examples  of how this                                                                    
     limited scope  of practice has  impacted my  ability to                                                                    
     provide care.  A woman came  into my office and she had                                                                    
     fears  about  vaccination   and  subsequently  had  not                                                                    
     vaccinated her children.  I  alleviated those fears and                                                                    
     she agreed to get her  children vaccinated.  However, I                                                                    
     was  unable  to write  a  prescription  or provide  any                                                                    
     vaccines in  my office.   An opportunity was  missed to                                                                    
     give  treatment   and  this,   from  a   public  health                                                                    
     perspective, is a poor outcome.   I have a patient with                                                                    
     a lower respiratory infection come  into my office, and                                                                    
     I provided the naturopathic  standard of care including                                                                    
     informing the  patient when she would  need to progress                                                                    
     from  conservative treatment  to pharmaceuticals.   The                                                                    
     patient was discouraged  to find she would  have to pay                                                                    
     another large  fee to go  to an Urgent Care  or another                                                                    
     provider  to receive  basic antibiotic  therapy if  the                                                                    
     need arose.   In closing, please  consider updating our                                                                    
     bill to  a more modern  scope that lets us  utilize all                                                                    
     of  our   training.    The  statute   that  governs  my                                                                    
     profession was  passed in  1987.  I  was born  in 1982.                                                                    
     I've  grown  a  lot  in  32 years  and  so  should  our                                                                    
     legislation.                                                                                                               
                                                                                                                                
MS. O'CONNEL said the last time she testified residency has was                                                                 
a hot topic.  She explained that she was overseen by three                                                                      
medical doctors and one naturopathic doctor.                                                                                    
                                                                                                                                
5:18:49 PM                                                                                                                    
                                                                                                                                
VICKI KENNEDY  said she  is overwhelmingly in  support of  HB 91.                                                               
She declared that  nearly 400 medical doctors were  put in prison                                                               
for  overwriting opioid  prescriptions in  the last  eight years.                                                               
Nonetheless, she  went on  to say that  most medical  doctors are                                                               
phenomenal;  however,  they  are  in  the  pockets  of  "the  big                                                               
pharma."  She reiterated her support for HB 91.                                                                                 
                                                                                                                                
5:20:23 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony and announced that HB 91                                                                
was held over.                                                                                                                  

Document Name Date/Time Subjects
HB24 Sectional Analysis v. K 2.27.2020.pdf HL&C 2/28/2020 3:15:00 PM
HB 24
HB24 Explanation of Changes Ver M to Ver K 02.27.2020.pdf HL&C 2/28/2020 3:15:00 PM
HB 24
HB 24 Work Draft v. K 2.27.2020.pdf HL&C 2/28/2020 3:15:00 PM
HB 24
HB 84 Supporting Document- Women Firefighters Biomonitoring Collaborative Research Update.pdf HL&C 2/28/2020 3:15:00 PM
HL&C 3/20/2020 3:15:00 PM
HB 84
HB 84 Letter of Support ACOA 2.26.20.pdf HL&C 2/28/2020 3:15:00 PM
HL&C 3/20/2020 3:15:00 PM
HB 84
HB 84 APEI Letter of Opposition 02.25.2020.pdf HL&C 2/28/2020 3:15:00 PM
HL&C 3/20/2020 3:15:00 PM
HB 84
HB 91 Responses to L&C Committee Questions 02.14.2020.pdf HL&C 2/28/2020 3:15:00 PM
HB 91
HB 84 Labor and Commerece Committee Question Responses 2.26.20.pdf HL&C 2/28/2020 3:15:00 PM
HL&C 3/20/2020 3:15:00 PM
HB 84
HB 91 Testimony in Opposition Redacted 2.28.2020.pdf HL&C 2/28/2020 3:15:00 PM
HB 91
HB 91 Testimony in Support Redacted 2.28.2020.pdf HL&C 2/28/2020 3:15:00 PM
HB 91
HB 24 Anchorage School District Comment on TRS and Tenure 02.28.2020.pdf HL&C 2/28/2020 3:15:00 PM
HB 24