Legislature(2019 - 2020)BARNES 124
02/28/2020 03:15 PM LABOR & COMMERCE
Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
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.