Legislature(2021 - 2022)BUTROVICH 205
04/08/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB26 | |
| SB99 | |
| SB38 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 38 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 26 | TELECONFERENCED | |
| += | SB 99 | TELECONFERENCED | |
SB 38-NATUROPATHS: LICENSING; PRACTICE
1:41:06 PM
VICE CHAIR HUGHES reconvened the meeting and announced the
consideration of SENATE BILL NO. 38 "An Act relating to the
practice of naturopathy; establishing the Naturopathy Advisory
Board; relating to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to the
Department of Commerce, Community, and Economic Development; and
providing for an effective date."
1:42:25 PM
SENATOR SCOTT KAWASAKI, Alaska State Legislature, Juneau,
Alaska, Sponsor of SB 38, introduced the bill on behalf of
Alaska approximately fifty licensed naturopath practitioners.
He stated naturopaths provide valuable healthcare services and
can help Alaska's primary healthcare provider shortage. Vague
statute on the authority of naturopaths caused Alaska to adopt
among the most restrictive naturopathic medicine regulations in
the nation. SB 38 seeks to establish a clear scope of practice
for naturopathic physicians and allow them to practice
consistent with their education and training. Naturopaths are
prohibited from performing minor routine office procedures that
they have been trained in, such as sutures, wart removal and IUD
placements. Many naturopaths have accredited pharmacology
degrees and training but are prohibited from writing
prescriptions and must refer patients to other providers.
1:43:49 PM
SENATOR KAWASASKI stated that overly restrictive regulations
cause naturopaths to rethink practicing in the state. SB 38
would correct this by outlining clear statutory guidelines. The
bill would allow licensed naturopath practitioners to perform
minor office procedures and prescribe vitamins, minerals and
other noncontrolled substance medications. The same scope is
practiced safely in other states and by other healthcare
providers. Many Alaskans' struggle with basic healthcare access.
Naturopathic medicine can provide valuable and complementary
care in the Alaska healthcare setting. Giving naturopaths the
ability to practice the scope of medicine consistent with their
training expands the availability of primary care in Alaska.
1:44:56 PM
JOE HAYES, Staff, Senator Scott Kawasaki, Alaska State
Legislature, Juneau, Alaska, presented SB 38 reading the
following:
[Original punctuation provided.]
SENATE BILL 38 NATUROPATHIC MEDICINE REFORM
WHAT IS A NATUROPATHIC DOCTOR?
A primary care provider with a four-year post graduate
medical degree, who practices evidence-based primary
care, with a patient-centered focus that prioritizes
disease prevention over symptom management and drug
therapies
WHAT EDUCATION DO NATUROPATHIC DOCTORS RECEIVE?
Education
4-Year Medical School Program accredited by the
Council of Naturopathic Medical Education; including:
2 years of medical sciences (anatomy, physiology,
microbiology, immunology, etc.)
2 years of clinical sciences and treatment methods
Prerequisites
4 year undergraduate degree and additional pre-medical
coursework
Residencies
13 year residency options throughout the country;
however, there are not enough residency opportunities
for every graduate
Licensing
Naturopaths must pass the two-part Naturopathic
Physicians Licensing Examination (NPLEX) before being
licensed to practice
1:46:30 PM
At ease
1:47:13 PM
SENATOR COSTELLO asked who prepared the slides.
1:47:47 PM
MR. HAYES answered that the Naturopathic Association prepared
the slides.
1:47:55 PM
SENATOR COSTELLO asked where the Naturopathic Association is
located.
MR. HAYES replied that people online could clarify where the
association is located.
VICE CHAIR HUGHES requested Mr. Hayes recommend which
association would answer.
MR. HAYES replied that Ms. Lange can address the question.
SENATOR COSTELLO restated the question regarding the location of
the Naturopathic Association.
1:49:06 PM
ABBY LANGE, Representative, Alaska Association of Naturopathic
Physicians, Anchorage, Alaska responded that the association is
in Anchorage, Alaska.
SENATOR COSTELLO asked if the presentation was prepared by the
Anchorage office or a national associate.
1:49:22 PM
MS. LANGE answered that it was prepared in conjunction with the
local office, not national.
1:49:34 PM
MR. HAYES continued reading the presentation at slide 4:
WHO IS NOT A NATUROPATHIC DOCTOR?
Other conventionally-trained or allied health care
providers practicing integrative, functional, or
holistic healthcare such as Medical Doctors (MD),
Doctors of Osteopathy (DO), Chiropractors (DC), Nurse
Practitioners (NP), Physicians Assistants (PA), or
Massage Therapists (LMT)
Other licensed or unlicensed providers marketing
themselves as natural care providers, holistic
healthcare providers or healers
Health food store employees
Essential oil sales representatives
Someone who completed an online certificate course
LEGISLATIVE HISTORY OF NATUROPATH STATUTES IN ALASKA
ESTABLISHING STATUTES 1986: AS 08.45 (Naturopaths)
established
LEGISLATION PASSED
2004: SB 306 - Established a Naturopathic Medicine
Task Force
2005: SB 42 - Extended Task Force one year and updated
membership
2005: SB 52 - Updated statutes to correct "division"
to "department"
LEGISLATION ATTEMPTS
2007: SB 107
2008: HB 363
2010: HB 282 & SB 70
2011: HB 122
2012: HB 266 & SB 175
2013: HB 7
2017: HB 326 & SB 120
2019: HB 91
2021: SB 38
1:51:02 PM
SENATOR BEGICH asked if attempted changes to legislation from
2007-2019 were based on the 2004 task force findings.
MR. HAYES replied that Ms. Chambers has the history and could
address the question.
1:51:57 PM
VICE CHAIR HUGHES supposed that attempts for changes mentioned
in the bill began in 2007. This bill is the nineth attempt for
legislative change.
MR. HAYES explained that slide 6 shows the licensing of
naturopathic doctors (NDs) across the United States. NDs in
Alaska are licensed and have some degree of insurance coverage
for services. There are eleven states aiming to file bills for
NDs. Several states are unregulated. He stated that slide 7
addresses the more controversial topic, which is prescriptive
authority for NDs. In Alaska NDs have neither prescriptive nor
controlled substance authority; Arizona and California have
both.
MR. HAYES read slide 8:
[Original punctuation provided.]
Senate Bill 38
Modernizes statutes for Naturopaths by cleaning up
outdated language, requiring continuing education
every 2 years, and imposing the same public health
duties on Naturopaths as other medical providers
Updates scope of practice for Naturopaths to include
limited prescriptive authority and allowing minor
office procedures
Removes the need for duplicative office visits and
improves access to care for patients in Alaska
1:53:55 PM
SENATOR BEGICH asked if a pharmacological training provision
would be in the bill, if prescriptive authority is allowed.
VICE CHAIR HUGHES noted that page two of the presentation lists
other courses but not pharmacology.
SENATOR KAWASAKI replied that someone will speak to the
pharmacological training NDs receive. He stated that the bill is
not trying to expand prescriptive authority to naturopaths
beyond the four-year science-based training they receive.
1:55:21 PM
SENATOR BEGICH offered that page 5, lines 23 - 25 of the bill
limits prescriptive authority to naturopaths who pass the
pharmacological portion of the Naturopathic Physicians Licensing
Examination.
SENATOR COSTELLO referenced page 6 lines 14-15. She noted that
the prohibition on surgery and using the term physician in a
naturopath's title are removed from statute, see page 6 lines
14-15. She questioned if it is deceptive to allow someone to be
called a physician and then state they can only perform minor
surgery. She asked if there will be public confusion, about a
person's training, if naturopaths are called physicians.
1:57:10 PM
SENATOR KAWASAKI replied that the term surgery implies more than
naturopaths are requesting. A definition, consistent with the
request should be included in the bill, such as minor office
procedures.
1:57:44 PM
SENATOR COSTELLO requested the bill clarify what minor office
procedures are versus major surgery.
SENATOR KAWASAKI concurred.
1:58:59 PM
VICE CHAIR HUGHES asked for sectional analysis.
1:59:10 PM
MR. HAYES presented the sectional analysis:
[Original punctuation provided.]
SB 38
Sectional Analysis
"An Act relating to the practice of naturopathy;
establishing the Naturopathy Advisory Board; relating
to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to
the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
Section 1 AS 08.02.010(a) Professional designation
requirements. (Amended)
Requires naturopathic practitioners to use appropriate
letters, titles and specialist designations.
Section 2 AS 08.45.015 Naturopathy Advisory Board
(New Section)
Establishes a five-person Naturopathy Advisory Board
for the purpose of making recommendations on adoption
of regulations and other matters relating to the
functions of the department under AS 08.45.
1:59:59 PM
Section 3 AS 05.45.020 Application for license
(Amended)
Requires applicants applying for licensure to use a
form provided by the department; to submit
fingerprints for purposes of a criminal history
background check for licensure; and pay a fee
established by the department.
Section 4 AS 08.45.030 Issuance of license.
(Amended)
Establishes, to be issued a license, an applicant
must:
• have graduated with a doctoral degree from
an accredited naturopathic college;
• have passed the Naturopathic Physicians
Licensing Examination;
• is not subject to an unresolved
disciplinary action in another
jurisdiction;
• complies with application requirements;
and
• have not been convicted or, or pled
guilty, or no contest to a crime that
adversely reflects on the applicant's
ability to practice or jeopardizes the
safety of a patient
Removes outdated language requiring that to be issued
a license to practice naturopathy in Alaska, if an
individual graduated before 1988, they must also have
been issued a license to practice in another state
previously.
2:01:12 PM
Section 5 AS 08.45.032 Documentation of license
refusals and revocations (New Section)
Requires the department to provide in writing, a
concise statement for refusal to issue licenses or for
license revocation.
Section 6 AS 08.45.035(a) Temporary licenses.
(Amended)
Allows the department to issue a temporary license to
a naturopath if they are signed up to take a licensing
exam at the next available date after the date of the
application and meets all the other licensing
requirements outlined in AS 08.45.030(1)(A) and (2)
(4).
2:01:53 PM
Section 7 AS 08.45.038 Standards for license
renewal. (New Section)
Outlines the requirements for naturopathic license
renewal.
Section 8 AS 08.45.045 Practice of naturopathy. (New
section)
Allows naturopaths to:
• practice within the standards and scope of
their education and training;
• prescribe natural and therapeutic
substances, natural therapies, and
contraceptive devices;
• prescribe allowed drugs only if the
naturopath has passed the Naturopathic
Physicians Licensing Examination
pharmacology portion; and
• perform minor surgeries and order diagnostic
procedures. Defines "naturopathic physical
application"
2:02:40 PM
Section 9 AS 08.45.050 Restrictions on practice of
naturopathy. (Amended)
Removes the prohibition for prescribing drugs,
performing minor surgeries, and using the word
physician" in titles. Prohibits naturopaths from
giving, recommending or prescribing cancer drugs and
controlled substances.
Section 10 AS 08.45.053 Public health duties. (New
Section)
AS 08.45.055 Duty of naturopaths to report. (New
Section)
AS 08.45.058 Naturopaths to report certain injuries.
(New Section) Imposes same public health duties on
naturopaths as other physicians.
Section 11 AS 08.45.060 Grounds for suspension,
revocation, or refusal to issue a license. (Amended)
Amends and applies the same suspension, license
revocation, or refusal to issue a license grounds on
naturopaths as other physicians.
2:03:33 PM
Section 12 AS 08.45.060 Grounds for suspension,
revocation, or refusal to issue a license. (New
Subsection)
Adds a new subsection to clarify the authority of the
entity taking disciplinary action against a license
under AS 08.45.060(a)(14)
Section 13 AS 08.45.070(a) Disciplinary sanctions.
(Amended)
Amends to clarify that disciplinary sanctions apply
for all of AS 08.45 and imposes a limit of $25,000 for
civil penalties.
Section 14 AS 08.45.070 Disciplinary sanctions. (New
Subsections)
Establishes and outlines when the department may
reinstate or suspend a license and requires the
department to report actions on licensees to the
National Practitioner Data Bank.
Section 15 AS 08.45.105 Automatic suspension for
mental incompetency. (New Section)
AS 08.45.110 Voluntary surrender. (New Section)
AS 08.45.115 Medical and psychiatric exams. (New
Section)
AS 08.45.120 Reports relating to malpractice actions
and claims. (New Section)
AS 08.45.125 Penalty for practicing without a license.
(New Section
AS 08.45.130 Prohibited use of title. (New Section)
Establishes new sections and applies the same grounds
for naturopaths as physicians for licensing:
• Automatic suspension of a license for mental
incompetency;
• Voluntary surrender of a license;
• Requiring medical and psychiatric exams;
• Requires reporting for malpractice actions
and claims;
• Applies penalties for practicing naturopathy
without a license; and
• Prohibits using the title "naturopath"
without a license.
Section 16 AS 08.45.200(3) Definitions. (Repealed
and Reenacted)
Repeals and replaces definition for "naturopathy"
Section 17 AS 08.45.200(4) & (5) Definitions. (New
Paragraphs)
Defines "approved naturopathic medical school" and
"naturopath"
Section 18 AS 12.62.400(a) National criminal history
record checks for employment, licensing, and other
noncriminal justice purposes. (New Paragraph)
Amends 12.62.400 to include and require naturopaths to
submit fingerprints to complete the national criminal
history record check.
Section 19 Transitional Language (Uncodified law)
Transitional language allowing currently licensed
naturopaths to practice under the new law.
2:06:20 PM
Section 20 Transitional Regulations (Uncodified law)
Allows the Department to adopt transitional
regulations immediately following passage and prior to
the bill's effective date.
Section 21 Effective date. (Uncodified law)
Establishes immediate effective date for section 20
Section 22 Effective date. (Uncodified law)
Establishes effective date for sections 1 19 as
January 1, 2022
2:06:48 PM
SENATOR COSTELLO expressed concern, about the provision in
Section 10 requiring naturopaths to report gun wounds and other
potential life-threatening injuries to the Department of Public
Safety. She asked if it misleads the public to assume
naturopaths treat such injuries. She noted that on page 5
Section 8 pharmacology, as an elective portion of the licensing
exam, creates a variance in licensure. This could make the scope
of a naturopath's practice confusing to the public. The public
should be aware that prescriptive authority is an elective
credential for naturopaths.
2:09:31 PM
SENATOR KAWASAKI answered that he believes Section 10 is
conforming language that has naturopaths adhere to the same
reporting requirements as medical doctors.
VICE CHAIR HUGHES commented that Ms. Chambers nodded her head in
agreement.
SENATOR COSTELLO added to her previous comment on prescriptive
authority. She stated that a portion of an exam that provides
different licensure should be its own test and license.
2:10:50 PM
VICE CHAIR HUGHES asked if the bill requires extra
certifications to be listed on the license. She is aware of
other practitioners who take exams in order to have added
privileges.
2:11:11 PM
SENATOR BEGICH suggested that naturopaths could be required to
publicly post their qualifications on a placard.
2:11:47 PM
MR. HAYES replied that Senator Kawasaki's office is willing to
work with the committee on changes.
2:12:08 PM
SENATOR COSTELLO commented that AS 08.45.050 prohibits the use
of the word physician in a naturopath's title. She asked if this
legislation reverses the restriction.
MR. HAYES replied that clear definitions need to be determined.
2:13:06 PM
SENATOR COSTELLO commented that the presentation used the term
doctor of naturopathy. She found use of the term confusing since
there is no statutory right to do so.
VICE CHAIR HUGHES commented that the word doctor applies to many
professions, whereas Americans associate the word physician to
mean medical doctors (MDs) and doctors of osteopathy (DOs). She
questioned the necessity of changing the statute to allow
naturopathic doctors to be referred to as physicians, since they
are called NDs. Referring to the presentation, she asked whether
some vitamins and minerals are prescribed.
SENATOR KAWASAKI replied that someone online will talk about
prescriptive authority.
2:15:06 PM
VICE CHAIR HUGHES recalled from the presentation that there was
a lack of residency locations for naturopathic graduates. She
asked if some NDs do not complete a residency.
MR. HAYES replied yes.
2:15:29 PM
VICE CHAIR HUGHES opined that NDs not completing residencies and
being elevated to the level of physician is a problem. MDs, DOs
and even behavioral health doctors, complete residencies. She
asked how limited ND residency opportunities are. She suggested
that the legislature consider making residency a requirement.
2:16:01 PM
SENATOR KAWASAKI responded that there are other medical
professions governed by the state medical board, such as
physician assistants and nurse practitioners, which do not
require residency but have advanced levels of prescriptive
authority.
2:16:18 PM
VICE CHAIR HUGHES countered that physician assistants and nurse
practitioners are not called doctors. She asked for the student
to residency ratio. She asked how many students do not complete
a residency.
SENATOR KAWASAKI replied that practicing naturopaths could
answer the question.
2:16:52 PM
VICE CHAIR HUGHES mentioned that the bill allows a person to
obtain a temporary license if all course work, except the exam,
has been completed. She asked if a temporary license limits
authority to function and practice as a ND.
SENATOR KAWASAKI replied that Ms. Chambers will answer the
question.
2:17:22 PM
VICE CHAIR HUGHES expressed concern that a person, who has not
passed an exam, might possess full authority to act as an ND.
She noted that the bill refers to the National Practitioner Data
Bank. She wondered if the data bank is specific to NDs or if it
is used for all licensed healthcare providers.
SENATOR KAWASAKI stated that the National Practitioners
Databank, maintained by the US Department of Human Services, is
a large bank containing all associated licensing and
accreditation information of an individual.
2:19:12 PM
VICE CHAIR HUGHES asked if NDs want licensure for insurance
billing purposes.
MR. HAYES stated that insurance billing will be discussed. He
explained that the 1986 statutes are outdated, and enforcement
of 2021 regulations is difficult. Updating the statues would
make issues, such as continuing education, easier for
naturopaths. The primary point of updating the statutes is to
make them reflective of what is happening in the field of
naturopathy today.
2:20:16 PM
SENATOR KAWASAKI shared an example of the need for statute
updates. He stated that several years ago by happenstance, a
naturopath found out that a mineral procedure, he had been
permitted to do and was still doing, had been affected by
medical board regulation changes. As a result of the changes,
only MDs and ODs could do the procedure. He concluded that
updating the statues is essential to understanding how the
practice of naturopathy has changed over the years.
VICE CHAIR HUGHES asked if naturopaths could bill insurance,
Medicaid and Medicare.
MR. HAYES replied that question can be answered by online
participants.
2:21:29 PM
SENATOR BEGICH responded that naturopaths can bill insurance. He
stated he was married to someone who went to a naturopath and
used his insurance. He asked if the terms ND or Doctor of
Naturopathy are currently in use and if the use is allowed under
current regulation.
2:22:14 PM
VICE CHAIR HUGHES speculated that insurance may only cover
certain procedures, which may be a reason updates to current
statutes are being sought.
2:22:30 PM
SENATOR KAWASAKI stated that a lot of answers will be given from
people online and Ms. Chambers. The bill was brought forward to
allow naturopathic healthcare providers to practice consistent
with their education and scope of practice.
2:22:54 PM
VICE CHAIR HUGHES stated that access and affordability is better
when trained providers can work to their full scope of practice.
She stated that naturopaths are a valuable part of Alaska's
medical professions.
2:23:31 PM
SENATOR REINBOLD stated that she has visited a naturopath,
values their expertise and is thankful for the alternative care
they provide.
2:24:15 PM
SENATOR COSTELLO expressed that her concern with the bill
resides in the authority naturopaths will be given to prescribe
drugs. Although the bill states categories of drugs naturopaths
will not be allowed to prescribe, she would like a list of drugs
that will be allowed. The bill is presumed to update statute
based on naturopathic training. She would like to know how
naturopath and medical doctor trainings compare, before allowing
the terms doctor and physician to be used by naturopaths. As
proposed statutes are opposite of current statutes, she believes
there is more to the bill than updating statute.
2:25:57 PM
SENATOR BEGICH stated he would like a list of drugs naturopaths
could prescribe. He reminded the committee that prescribing
power is limited to naturopaths who pass the pharmacological
portion of the licensing test. He suggested a copy of the
pharmacological portion of the test be obtained and its content
viewed. He suggested members look through the pharmacological
portion of the test to gain understanding of its content.
2:26:34 PM
VICE CHAIR HUGHES asked the sponsor to provide a thorough
overview of AP, MD and ND pharmacological requirements and
whether they are comparable.
2:27:02 PM
SENATOR COSTELLO reminded the committee that MDs complete years
of residency training. She stated that in terms of public
protection and the transparency of what a person is allowed to
do, legislators need to be careful.
2:27:42 PM
VICE CHAIR HUGHES called Sara Chambers to the table.
2:27:54 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, stated that the
administration has not taken a position on the bill. She is
present as a technical resource. She provided the following
answers and comments to members' questions:
• The term naturopathic doctor is allowed by current law.
• The language that requires naturopaths to report certain
injuries to public safety was taken from the Medical Board
statutes and regulations. She noted that like Senator
Johnston's bill last session, an objective of Senator
Kawasaki's bill is to provide greater responsibility and
accountability to naturopaths. Current statute has a gap in
patient protections. This bill contains accountability not
found in legislation
• She addressed the trend of updating statues and keeping
laws relevant as licensing and investigation concerns are
identified. For this legislation that means allowing a
person to perform to the full extent of their education and
providing public protections. In recent years, the
legislature has seen scope of practice updates for
optometrists, advanced practice registered nurses and
chiropractors. These updates were in recognition of modern
advancements in education and training. Current legislation
recognizes the need for modernization and flexibility for
paramedic and physical therapists. She is aware of other
boards working to identify and update statutes.
• Naturopaths can bill insurance. Names of insurance experts
working for the state can be provided. She understood
insurance was not the onus for the legislation.
• The National Practitioner Data Bank (NPDB) is monitored by
the federal government. Before a State of Alaska
professional healthcare license is issued, the Department
of Commerce, Community and Economic Development (DCCED) has
a responsibility to check the NPDB for violations against
the individual. By state law DCCED ensures all
jurisdictions share data about licensee violations. It is
used for NDs and other healthcare professions.
2:33:08 PM
VICE CHAIR HUGHES asked if the databank is checked for all
healthcare professions, including NDs.
MS. CHAMBERS replied yes.
2:33:22 PM
SENATOR BEGICH asked if naturopaths are currently allowed to use
the term Doctor of Naturopathy and the abbreviation ND in their
practice.
MS. CHAMBERS replied that naturopaths are allowed to use the
term naturopathic doctor and ND. They are not allowed to use the
term physician.
2:33:41 PM
She stated that temporary licensure before passing an exam is a
convention among healthcare professions because some exams occur
only twice a year. In conjunction with a temporary license a
board may require oversight from a sponsor. A licensing board
may require sponsor oversight as a condition of temporary
licensure.
2:34:40 PM
VICE CHAIR HUGHES stated that a supervisory statute requirement
for a temporary license is not in the bill. She asked if it is
in statute for other professions.
2:34:56 PM
MS. CHAMBERS replied that supervision while under a temporary
license is either in statute or regulation, depending on the
profession. She offered to provide template language.
2:35:13 PM
VICE CHAIR HUGHES said she would be more comfortable with a
supervisory provision if the sponsor agrees.
2:35:21 PM
MS. CHAMBERS noted that prescriptive endorsement is another
convention that exists in healthcare professions. Advanced
practice registered nurses (APRN) can opt to have a prescriptive
endorsement. Dentists and optometrists are other professions
that offer specialized endorsements beyond a basic license. She
stated that models exist for how to clearly state and display an
ND's prescriptive authority.
2:36:19 PM
VICE CHAIR HUGHES asked if prescriptive endorsement would need
to be in statute.
MS. CHAMBERS replied that it is akin to a license, therefore it
needs to be in statute.
2:36:38 PM
SENATOR COSTELLO asked if naturopaths have a voice or seat on
any boards.
MS. CHAMBERS answered that naturopaths have no official voice in
licensure. Naturopaths are fully regulated by the Division of
Corporations, Business and Professional Licensing. When a
regulatory matter arises, it is handled informally with the
director. If a regulations package is moved forward, it goes
through the public process.
2:37:35 PM
SENATOR COSTELLO noted a section in the bill mentions
naturopaths would provide recommendations for policy. She asked
if that language is found in all licensure board statues.
2:37:55 PM
MS. CHAMBERS responded that there are twenty-one boards. All
boards are authorized, by the legislature, to adopt regulations
and create policy, within statutory restrictions, for their
profession. The director, through the commissioner, establishes
regulations and policy for non-boarded professions. There is no
middle ground. For example, construction contractors, like
naturopaths, do not have an official voice on a board. She.
offered her belief that the bill proposes an advisory board be
created. It is not a full board. It would not have the full
ability to adopt its own regulations through the public process.
Naturopaths would have an official seat at the table to advise
the division on policy changes and help accomplish them more
efficiently and effectively.
2:39:11 PM
SENATOR COSTELLO asked what other professions do not have
boards.
MS. CHAMBERS recalled that construction contractors, mechanical
administrators, electrical administrators and others in that
family of professions do not have a board. Recently DCCED
proposed regulations on behalf these professionals, as they do
not have a voice except through the public process. She recalled
healthcare professions without boards are behavioral analysts,
athletic trainers, speech language pathologists, audiologists
and hearing aid dealers.
2:40:21 PM
SENATOR COSTELLO commented that advisory boards are sometimes
created temporarily to offer recommendations. A permanent
advisory board purpose would be to make recommendations about
statutes. She opined that naturopath's administering their own
licensing would be better than trying to make changes through
regulations forwarded to the state. An advisory board is a
departure from established procedure. She questioned whether an
advisory board is being created because past efforts haven't
worked. She stated it is important to figure out and satisfy
actual need. She speculated that the limited number of
naturopaths in Alaska and the bureaucracy that establishing a
board would necessitate are reasons why naturopaths would not
want a full board.
2:41:51 PM
MS. CHAMBERS confirmed that the concept for an advisory board
initially was to limit bureaucracy. She opined that if the bill
passes, naturopaths will have more authority and accountability;
the division will have more to oversee and investigate. She
stated that as a director having a naturopathic board, whether
appointed, full or advisory, would be a support. In the past
five years there were six investigations. The number of
investigations is expected to go with increased authority.
2:43:48 PM
SENATOR BEGICH stated that he no longer has a question.
2:44:12 PM
VICE CHAIR HUGHES questioned whether staffing a full board would
result in higher licensing fees. She presumed that having only
fifty naturopaths in Alaska could be why an advisory board is
preferred.
MS. CHAMBERS agreed.
2:44:41 PM
VICE CHAIR HUGHES called on Abby Lange.
2:44:46 PM
ABBY LANGE stated that the Alaska Association of Naturopathic
Doctors is passionate about providing Alaskans with the best
care possible. In answer to legislator's questions, she stated:
• Some vitamins and minerals do require a prescription.
Vitamin B12 does not absorb well orally; many people take
it by prescribed injection.
• Page 5 line 26 specifies which surgeries naturopaths are
excluded from performing. Providing a list of drugs
naturopaths can prescribe would be problematic. New drugs
become available frequently. Updating the list would
require use of the public process and delay usage of new
drugs and vaccines.
• Naturopaths do not have a problem billing insurance.
Insurance does reimburse naturopathic doctors in Alaska.
• Naturopathic residency is optional. Nationwide there are
more graduates than available residencies. In this bill
naturopaths are seeking a scope of practice equal to or
less than a nurse practitioners or physician assistant
scope of practice, neither require a residency.
2:48:19 PM
Ms. Lange asserted that Alaska law does not allow naturopaths to
provide the full scope of care they trained for. Current law
creates unnecessary inefficiencies in the health care system and
Alaska's healthcare consumers incur the negative consequences SB
38 creates a statutory framework allowing naturopathic doctors
to provide a scope of care consistent with training and
education. It would improve healthcare access, remove the need
for Alaskans to seek costly duplicative services, aid Alaska's
primary care provider shortage and allow Alaskans greater choice
in healthcare. Two main provisions of the bill allow
naturopathic doctors to issue non controlled substance
medications and perform minor surgeries, such as wart removal,
stitches and skin biopsies. The bill specifically excludes
controlled substances and any surgeries that go beyond
superficial tissues. She asserted that the central question
before the committee is whether a naturopathic doctor training
meets the scope of practice outlined in the bill. She informed
legislators that bill packet documents manifest that naturopaths
are qualified for the scope of practice contained in the bill.
NDs follow a standard premed undergraduate track and attend a
four-year doctoral program, which includes 140 hours of
pharmaceutical training. Naturopathic doctors in other states
prescribe medications and controlled substances. They also
safely perform minor surgeries.
2:50:55 PM
In Alaska, healthcare providers, with less pharmacology training,
prescribe a broader range of pharmaceuticals than naturopaths are
allowed to prescribe under this bill. Although naturopaths promote
diet and lifestyle modification, there are circumstances when having
prescriptive authority benefits patients. For example: during a
routine visit a patient could receive a vaccination; an antibiotic
prescription could be written in case a condition worsened, such as
an earache; a medication dosage could be adjusted following weight
loss. Not providing these services during a visit means the patient
must set up an appointment with a different healthcare provider, miss
additional time off work and pay another doctor fee. Consequently, it
is not uncommon for a person to forego vaccination due to additional
costs or end up at the ER seeking antibiotics.
2:54:45 PM
VICE CHAIR HUGHES noted that under Alaska law naturopaths are
not allowed to use the term physician. Any naturopath using the
term should make sure they are within the present scope of the
law.
2:55:37 PM
CLYDE JENSEN, State Naturopathic Medical Association, St.
George, Utah, testified by invitation on SB 38. He stated that
he has a PhD in Pharmacology and has taught and been the
president of various schools of medicine. He currently teaches
pharmacology to students of osteopathic medicine and physician
assistants. He shared three observations. He stated that the
pharmacology content that NDs, MDs and DOs study is the same.
NDs are taught far more pharmacology content than APs and NPs.
Regarding residency, he acknowledged that NDs receive roughly
the same amount of clinical experience during their four-year
degree program as MDs and DOs. Less of the experience is devoted
to clinical supervision with the use of drugs because
naturopathic students study more nutrition, lifestyle and other
clinical interventions than MDs and DOs. NDs are more inclined
to use nutrition than prescriptive drugs in their practice. The
number and the scope of drugs used by NDs is considerably
narrower and involves few drugs than those used by MDs, DOs, PAs
and NPs. He commented that it is not uncommon for healthcare
professions that prescribe less frequently to consult with
professionals who prescribe more frequently. He concluded that
there is no reason for Alaska naturopathic physicians to not
prescribe a limited scope of drugs.
2:59:22 PM
VICE CHAIR HUGHES called on David Schleich.
2:59:38 PM
DAVID SCHLEICH, Retired President, National University of
Natural Medicine, Saskatchewan, Canada, testified by invitation
on SB 38. He stated has been a post-secondary and post-graduate
education administrator for thirty-five years. His doctoral work
and research have been in policy and theory, with particular
interest in how healthcare professional formations take place in
civil society.
MR. SCHLEICH stated that the clinical doctorate for the
naturopath profession is a rigorous program of quality. Over the
past twelve years the program has grown significantly. Research
activity in the field of natural medicine has been robust. He
named the Helfgott Research Institute in the United States and
the Cancer Research Institute in Canada as exemplary. The number
of states licensing and registering naturopathic physicians has
also increased dramatically in the last decade. He mentioned
that the increase is due to naturopaths' outreach to the
communities they serve and the rigor and quality of their
educational background.
He stated the regional and programmatic accreditors for
naturopathic medicine are the same as for other primary care
practitioners and physicians. He then clarified that the
accreditors, accredit the institutions. The amount of education
to become a naturopath is quite substantial relative to other
healthcare professions. He stated the 4100 hours that includes
pharmacology and clinical training are a case in point. At an
institute where he was president, 140 term credit hours (TCH)
were required in pharmacology.
Mr. Schleich commented that naturopathic doctors historically do
not work in hospitals and do not have access to annual residency
matching; they receive extensive residency experience though
clinical rotations during their final years in the program. The
statutory framework of the Division of Corporate and Business
and Professional Licensing does not align appropriately to the
healthcare professional status of naturopathic doctors.
The presence of naturopathic doctors in clinical care is
increasing in the United States and Canada. The largest
naturopathic degree granting institution in North America has a
robust research institute in natural medicine and strong
affiliations with functional and integrated medicine
practitioners. He recommended the legislature adopt the bill
with alacrity.
3:03:09 PM
VICE CHAIR HUGHES opened public testimony on SB 38; finding none
she closed public testimony.
SB 38 was held in committee.