Legislature(2007 - 2008)BUTROVICH 205
03/10/2008 05:00 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB149 | |
| SCR19 | |
| SB107 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 149 | TELECONFERENCED | |
| *+ | SCR 19 | TELECONFERENCED | |
| += | SB 107 | TELECONFERENCED | |
SB 107-NATUROPATHS
CHAIR DAVIS announced consideration of SB 107.
5:42:58 PM
TOM OBERMEYER, Staff to Senator Davis, presented an overview of
CSSB 107, Version \K, labeled 25-LS0702\K. This act related to
naturopaths and naturopathic practice, establishing an Alaska
Naturopathic Council, amending the duties of the Board of
Pharmacy relating to naturopathic practice, and providing for an
effective date. He explained that the CS before the committee
was drafted after the committee hearing of February 13, because
the committee chair concluded that changes were required in
oversight, training and experience in order to expand
naturopathic practice into areas that had formerly been reserved
to MD's [Medical Doctors] and DO's [Doctors of Osteopathy].
Those areas included minor surgery, prescribing prescription
drugs and ordering medical laboratory tests and imaging.
Changes in the CS were as follows:
1) The Alaska Naturopathic Council was increased from 5 to 7
members including 3 naturopaths, 1 medical doctor, 1
pharmacist and 2 members of the public who have no direct
financial interest in naturopathic practice or the health
care industry.
2) Members of the Naturopathic Council would be appointed by
the Governor.
3) Naturopaths would have to be in practice for 5 years before
being allowed the expanded scope of practice in minor
surgery, prescribing drugs and ordering medical laboratory
tests.
4) Naturopaths who were licensed to prescribe drugs would have
to take 15 hours of pharmacy education each year; those who
would perform minor surgery must have received a minimum of
1200 clinical hours of training under the supervision of
medical doctors, physician's assistants and [or] nurse
practitioners.
MR. OBERMEYER continued that the advisory council had no power
to adopt regulations as a board under the Boards and
Commissions; but it could advise the Department of Commerce,
Community & Economic Development regarding regulation.
He also noted that there was no attempt to recognize what other
states had done, because he had spent a great deal of time
looking at other states and found that each had a different way
of dealing with this particular set of practices.
CHAIR DAVIS asked Mr. Obermeyer to go back over the CS and point
out each change from the original bill.
MR. OBERMEYER recapped the changes. First, the council was
increased from 5 to 7 members, to include 3 naturopaths, 1
medical doctor and 1 pharmacist appointed by their respective
boards and recommended to the Governor for final appointment.
Second, naturopaths would be required to practice for 5 years
before being allowed the expanded scope of practice described.
Third, prescribing naturopaths would have to take 15 contact
hours of pharmacy education training each year after being pre-
qualified as explained in the bill, with 60 hours of training
and satisfaction of other specific requirements. Finally, they
would have to complete clinical training under the supervision
of medical doctors, physician's assistants or nurse
practitioners in minor surgery and anesthetics.
The effective date of the bill, as indicated in section 13,
would be July 1, 2009.
SENATOR THOMAS moved to adopt the proposed committee substitute
CSSB 107, Version \k, as the working document of the committee.
There being no objection, the motion carried.
5:51:05 PM
SENATOR ELTON asked for clarification regarding the makeup of
the council. He said the bill provided that "When appointing
pharmacists and physicians … the governor may appoint a
pharmacist from the list of names submitted by the Board of
Pharmacy … and a physician from the list of names submitted by
the State Medical Board," but there was no provision for the
governor to request a list from the naturopaths. He wondered why
the appointment of a doctor or pharmacist was different from the
appointment of a naturopath.
MR. OBERMEYER answered that the naturopaths did not have their
own board at that time.
SENATOR ELTON said that a quorum of the council was at least 4
members for the transaction of business; one of the most
important chores of the naturopathic council was establishing
and maintaining a list of prescription drugs and medical
devices, but that could be done without a pharmacist present. He
asked if that was correct.
MR. OBERMEYER replied that he was probably correct, but doubted
they would take action without the advice of the pharmacy board
or the pharmacist who was responsible for it. He noted that even
in Kansas they had 2 medical doctors on a formulary council and
one on an advisory council under the medical board; so they were
trying to keep those professionals totally involved in the
naturopathic practice. He assumed they would involve the
appropriate people to deal with any changes to the list of
authorized drugs.
CHAIR DAVIS added that the effective date on the bill gave them
one year to work out those details and differences. That was why
the effective date was moved from July 2008 to July 2009.
5:55:47 PM
SENATOR ELTON directed Mr. Obermeyer to page 5, line 5. He said
that what they had structurally was a council appointed by the
governor. The council would have specific responsibilities that
were delineated earlier in the bill; but the department
[Department of Commerce, Community & Economic Development,
Division of Corporations, Business and Professional Licensing]
would set the fees. He questioned why the department, rather
than the council, would set the fees.
MR. OBERMEYER responded that was what made this an advisory
board; it would not be like the State Medical Board or the Board
of Pharmacy, which had regulatory powers. This board would still
fall under the Department of Commerce, Community & Economic
Development.
CHAIR DAVIS advised that Alphaeus Bullard was on the line and
could answer that question.
5:59:14 PM
SENATOR ELTON asked if he would do so. He re-stated his question
and added that, given Mr. Obermeyer's response that the council
would be advisory in nature, he questioned the language on page
4 under "Duties of the Council," which stated that the council
"shall (1) establish a list of prescription drugs and medical
devices." He asked if that list would be only advisory and could
be amended or modified by the department.
ALPHEUS BULLARD, Attorney at Law, Legislative Legal and Research
Services Division, Legislative Affairs Agency, replied that the
council was completely advisory as indicated by the "may" in
that paragraph. The department would enjoy the end authority to
add, subtract or delineate what drugs would be on that list.
SENATOR ELTON wondered why, if the department would have the
final say on everything, they were establishing a council.
CHAIR DAVIS said she thought, because members were appointed by
the Governor's office, it would no longer be under the
Department of Commerce; she asked what they would have to do to
remove it from Department of Commerce purview.
MR. BULLARD answered that they would be creating a state board
or commission. It remained under the department because it was
purely advisory.
CHAIR DAVIS asked why the governor was appointing the members of
an advisory board.
MR. BULLARD advised that it was a drafting request; it did not
have to work that way.
CHAIR DAVIS asked if there was any reason that all appointments
should not be made by one entity.
MR. BULLARD replied that it was not unusual for the commissioner
to appoint the members of an advisory board or council, or for
the board or council to have no regulatory authority.
6:03:13 PM
SENATOR ELTON was struggling with the notion of adding a council
that would have no authorities or whose authorities could be
"trumped" by the department. Instead of adding advisory groups
he opined, they might want to subtract some if they had no real
powers.
6:04:04 PM
DR. JOHN RASTER, Alaska State Medical Association, testified
that, although they appreciated the changes in the CS, the
Alaska State Medical Association still felt it was somewhat
unregulated and had misgivings about it. The Naturopathic
Council could potentially allow all drugs to be in formulary;
that could include narcotics, OxyContin, Schedule 2 drugs or
chemotherapy. Although the Department of Commerce was given
oversight of the list, he did not believe they had a physician
or pharmacist on staff who could sign off on those drugs; so the
council would essentially decide the formulary. In addition, the
bill allowed in-office minor surgeries [Sec. 6 AS 08.45.200
(4)(A) and (B)] but did not allow surgeries "... involving
tendons, ligaments, nerves or blood vessels;" even one
millimeter beneath the skin there were nerves.
With the medications that could potentially be prescribed along
with the surgery, this would give naturopaths the most broad
prescription and surgical authorities in the country. He noted
also that it was not clear who would handle patient complaints.
CHAIR DAVIS said she did not agree with some of Mr. Raster's
comments; other states were already allowing naturopaths to do
what this bill was proposing. She reproved him for opposing the
bill without offering any practical suggestions, and reminded
him that she had asked repeatedly for the Medical Association's
assistance in this process.
DR. RASTER responded that he would definitely discuss it with
their board of trustees the following day and would come up with
some suggestions.
SENATOR ELTON offered his understanding that the council could
not do the formulary; that power was reserved for the
Department, which "may approve," not "shall approve" the list.
Also, at the bottom of page 4, line 30-31, it stated that "(c)
An endorsement issued under (a) of this section is valid for two
years unless revoked or suspended by the department." That would
seem to give the department the ability to suspend the
privilege.
6:10:56 PM
IRMA NORLAND, representing herself, supported CSSB 107. She said
that her primary medical provider was Emily Kane, a naturopath,
and it would be helpful to her if naturopathic doctors were
empowered to use all the skills they were trained for, including
prescribing medication and performing minor surgery. She
currently had to contact an MD for those services; because
General Practitioners were not readily available, she often had
to go to the Emergency Room, which was more time-consuming and
costly to both her and the medical insurance industry.
MS. NORLAND related an incident that occurred in 2006, when Dr.
Kane diagnosed her as having a life threatening deep vein
thrombosis (DVT) or blood clot, and recommended the proper
treatment. The problem had not been correctly diagnosed by the
MD at the emergency room, which nearly caused her to travel
without the necessary medication to thin her blood. What is
more, Dr. Kane was the only doctor who had worked with her to
reduce the clot.
MS. NORLAND was a nurse for 30 years and it was her opinion that
naturopathic medicine was not only legitimate, but preferable in
many cases to conventional treatments. She was currently being
treated for hypertension, which might require medication, and it
would be less expensive and more convenient if Dr. Kane could
prescribe those medications for her.
6:13:48 PM
DR. SCOTT LUPER, President, Alaska Association Of Naturopathic
Physicians (AKANP), supported CSSB 107. He appreciated the
testimony and wanted to speak to the essence of the bill, which
was that it allowed naturopathic physicians to practice as they
were educated. Naturopaths came into the practice after 4 years
of college, an additional 4 years of medical education, and
testing by a national board in a wide variety of competencies
including minor surgeries and the use of pharmaceuticals. Most
states that licensed Naturopathic Doctors did allow some degree
of prescription authority; Alaska was one of the places that did
not.
DR. LUPER stressed that he wanted to provide the care to his
patients that he was trained to provide. He said he had seen a
patient that week, a 43 year old woman with 3 children, who
complained of fatigue, menstrual problems and headache. He
gathered history, performed a number of tests and examinations,
and came back with a diagnosis of hypothyroidism. Because he
could not prescribe the necessary medication, she had to endure
the added time and expense and the delay in treatment required
to see an MD. He said he would be happy to answer any questions
the committee might have.
SENATOR THOMAS noted that they had heard previous testimony that
the difference in education [between MD's and naturopaths] was
the residency served by MD's that required them to work under
licensed physicians in a hospital environment for a period of
time. He asked if Dr. Luper could explain why he thought that
was not valid, or if in fact the residency was also required of
naturopaths.
DR. LUPER said he was in charge of the residency program at
Southwest School of Naturopathic Medicine and he did think
residency was a good idea; residency was the place that doctors
got to hone their skills. He felt it was unfortunate that the
residency positions available to naturopathic physicians were
fewer than the physicians themselves. The reason was that
naturopathy was not subsidized by the federal government as was
medical or osteopathic practice. The AKANP was trying to correct
that, but it would take some time.
He said that the bottom line however, was that Naturopathic
Doctors were trained well enough after 4 years of medical school
and the thousands of hours of patient contact they had while in
school, to diagnose, treat, prescribe and perform minor surgical
procedures. He pointed out that naturopaths were all trained
under licensed physicians.
6:20:06 PM
EMILY KANE, Naturopathic Physician, Juneau, AK, wanted to make a
point that might alleviate Dr. Raster's concerns and those of
his board. She said her understanding was that one version of
this bill specifically excluded narcotics and chemotherapy from
the potential list of legend drugs; she was not personally
interested in either narcotics or chemotherapeutics and would
guess that she spoke for most naturopaths in that regard. She
asked if her understanding was correct.
CHAIR DAVIS agreed that it was still written that way as far as
she knew and asked Mr. Bullard to speak to that.
DR. KANE asked why then, Dr. Raster was concerned about those
categories.
CHAIR DAVIS said that although Dr. Raster spoke to them, they
were never in the bill.
6:22:03 PM
DR. RASTER said he could not find those exclusions in the
current version of the bill.
SENATOR THOMAS questioned whether on page 2, [line 28], the
verbiage "except as authorized under AS 08.45.056" would cover
that.
MR. BULLARD advised that the exclusions were not in the current
bill.
CHAIR DAVIS wondered why they had been removed. She said they
were running out of time, but the bill was clearly not in the
shape they thought it was; those exclusions should not have come
out.
MR. BULLARD referred Chair Davis to Version \A where the
exclusions did appear on page 2, lines 30-31.
MR. OBERMEYER said he believed that Section 08.45.050 had not
changed except under AS 08.45.056 and that the current
restrictions on controlled substances would cover narcotics.
Chemotherapy was not addressed. If they determined that this
profession should be regulated by the Alaska State Medical
Board, then the law would have to be changed.
SENATOR ELTON asked Mr. Bullard about a possible anomaly on page
4, line 3 and lines 27-29. Line 3 provided that the council
would create a list that the department "may" approve for use by
naturopaths; beginning on line 27 it said that "(b) An
endorsement issued under (a) of this section authorizes the
licensee to prescribe and administer prescription drugs and
medical devices that are on the formulary approved by the Alaska
Naturopathic Council under AS 08.45.054." He asked if line 29
should say approved by the Department rather than by the
Naturopathic Council.
MR. BULLARD agreed with Senator Elton that the verbiage as
written was incorrect.
CHAIR DAVIS announced her intention to close public comment on
the bill until corrections could be made. She held SB 107 in
committee.
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