Legislature(2021 - 2022)BUTROVICH 205
02/03/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB132 | |
| HB133 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 132 | TELECONFERENCED | |
| *+ | HB 133 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
1:48:29 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 132
"An Act exempting veterinarians from the requirements of the
controlled substance prescription database."
1:48:39 PM
SENATOR COSTELLO and SENATOR HUGHES joined the committee.
1:48:40 PM
SENATOR ROGER HOLLAND Alaska State Legislature, Juneau, Alaska,
sponsor of SB 132, introduced the legislation by reading the
sponsor statement:
Alaska's 25th legislature created the Prescription
Drug Monitoring Program (PDMP) in 2008. The
legislative intent behind the PDMP was to create a
database of prescriptions for controlled substances in
the state. The PDMP may create obstacles for
individuals seeking opioids to obtain multiple
prescriptions from registered providers and may be a
useful tool for human doctors in combating the opioid
crisis. Under the current statutory framework,
Alaska's veterinarians are required to participate in
the PDMP, despite the irreconcilable differences
between human and veterinary medical practice. PDMPs
have been implemented in all 50 states, but 34 states
have recognized the unsuitability of veterinary
participation in the PDMP and exempted veterinarians.
SB 132 would add Alaska to that list.
The majority of states exempt veterinarians from PDMP
because they have recognized that PDMPs are designed
for use in human medicine; and veterinary exclusion
from PDMPs does not increase risk to the public.
Alaska's inclusion of veterinarians in the PDMP has
produced no identifiable benefit; yet the PDMP has
created a multitude of verifiable harms to the
veterinary profession and the Alaskans they serve. The
PDMP is inappropriate and not effective for use with
animal patients, as animals do not have identifiers
such as a social security number, and veterinarians
must view human owners' private health data before
treating an animal.
Alaska has the highest veterinary licensure cost in
the United States. Veterinary participation in the
PDMP contributes to this unnecessary financial burden
on a profession already experiencing extreme staffing
shortages, decreasing availability of veterinary
services to Alaskans. Moreover, a recent survey found
attempted veterinary doctor shopping across the entire
United States is essentially non-existent.
Veterinarians are tightly regulated by the Drug
Enforcement Agency, the Know Your Customer Act, and
the State licensing board. SB 132 seeks to correct an
expensive overreach so that Alaskans can have access
to treatment for their pets without compromising
public safety.
1:51:50 PM
SENATOR BEGICH thanked the sponsor for introducing the bill and
relayed that he reviewed the evidence and changed his mind about
requiring veterinarians to participate in the Prescription Drug
Monitoring Program (PDMP). Clearly it is an unnecessary burden
and does not serve the intended purpose.
1:52:49 PM
NIKKI ROSE, Staff, Senator Roger Holland, Alaska State
Legislature, Juneau, Alaska, read the sectional analysis for SB
132:
[Original punctuation provided with minor formatting changes.]
Sec. 1
AS 17.30.200(o), relating to the controlled substance
prescription database, is amended by deleting the
Board of Veterinary Examiners from the list of
required notification by the Board of Pharmacy when a
practitioner registers with the database.
Sec. 2
Adds veterinarians to the list of practitioners not
required to comply with the controlled substance
prescription database under AS 17.30.200(t).
Sec. 3
Adds a definition of "practitioner" to AS 17.30.200(u)
Sec. 4
Repeals AS 08.98.050(a)(10), which obligates the board
of veterinary examiners to require licensees to
register with the controlled substance prescription
database.
1:54:23 PM
CHAIR WILSON turned to invited testimony.
1:54:35 PM
At ease.
1:54:59 PM
CHAIR WILSON reconvened the meeting and asked Dr. Berngartt to
proceed.
1:55:09 PM
DR. RACHEL BERNGARTT, Chair, Alaska State Board of Veterinary
Examiners, Department of Commerce, Community and Economic
Development (DCCED), Juneau, Alaska stated that she has
practiced veterinary medicine in Alaska for 20 years in a wide
variety of fields.
DR. TRACY WARD, President, Alaska State Veterinary Medical
Association, Juneau, Alaska, stated that she has practiced
veterinary medicine for 32 years in several fields and also
spent considerable time in the pharmaceutical industry. She is
currently a small animal practitioner and in several months will
transition to a shelter veterinarian.
DR. WARD stated that both the Alaska State Veterinary Medical
Association and the Alaska Board of Veterinary Examiners
strongly support SB 132. As the sponsor indicated, Alaska's PDMP
was established in 2008. In response to the growing opioid
epidemic, the PDMP was amended in 2017 to require participation
by all federal Drug Enforcement Administration (DEA) permit
holders, including veterinarians. Veterinarians were not
consulted when the amendment was proposed.
1:57:06 PM
DR. WARD stated that the PDMP is not an effective database for
veterinarians. It was established for human medicine and the
software does not interface with the recordkeeping software that
veterinarians use. Querying and downloading data is not
automatic for veterinarians and the data is based on human
identifiers such a Social Security number or date of birth. This
caused some confusion before it became clear that veterinarians
were supposed to query the animal owner's prescription data when
they prescribed a controlled substance for the animal. This is
despite the fact that the information is not useful to
veterinarians because they are not trained in human medicine and
dosages do not translate from one field to the other. The data a
veterinarian enters into the PDMP for an animal patient is
similarly not useful for a medical doctor.
DR. WARD pointed out that it is also an invasion of the animal
owner's medical privacy to have a veterinarian query their
personal medical data in the PDMP. This creates an uncomfortable
situation because the client is not a patient and veterinarians
are not trained in or bound by the federal Health Insurance
Portability and Accountability Act (HIPPA) Privacy Rule. She
directed attention to the list of medications on slide 5 that
medical doctors may have prescribed for their client's that
veterinarians have no use for but are able to see.
2:00:54 PM
SENATOR BEGICH stated that he found this point particularly
compelling because it was not the intent of the 2017 change to
the PDMP law. Veterinarians who are not bound by HIPAA have
access to the animal owner's private prescription data that
their medical doctor entered into the PDMP. He described this as
an unintended consequence.
SENATOR REINBOLD recalled that she voted "No" on the 2017
legislation.
DR. WARD explained that while the 2017 legislation sought to
address growing opioid abuse, the PDMP was never intended to
prevent the diversion of controlled substances to the illicit
market. It was intended to prevent individuals from going to
multiple doctors and later veterinarians to access controlled
substances for their own use or for diversion. Backdoor or
diversion sales are never entered into the PDMP. She said the
PDMP is strictly intended for shopping. The Drug Enforcement
Agency (DEA) is primarily responsible for preventing diversion.
Veterinarians who prescribe or dispense controlled substances
are licensed through the DEA and must adhere to strict
accountability, record keeping, and medication storage
requirements. Those records must be available to the DEA on
demand and local law enforcement agencies may also request
access.
DR. WARD continued to explain that manufacturers and
distributors of controlled substances are bound by the
Suspicious Order Monitoring System. These companies must
monitor, flag, and report a veterinarian's unusual purchase
patterns to the DEA. She drew a parallel to a credit card
company calling clients to ask about unusual/potentially
fraudulent charges on their card. She said the DEA is already
providing oversight of veterinarians and this is the most common
way that diversion situations are identified.
DR. WARD deferred to Dr. Berngartt to continue the presentation.
2:04:52 PM
DR. BERNGARTT turned to slide 7 and restated that 34 states
already have exempted veterinarians from participating in the
PDMP and no problems have been identified. Public health and
safety protections have not decreased and there has been no
demonstrated increase in doctor shopping or decrease in
diversions. Exempting Alaskan veterinarians from the PDMP
requirements makes sense, she said.
2:06:22 PM
DR. BERNGARTT reported that veterinarians prescribe less than
one percent of the opioids prescribed by all medical
professionals in Alaska. That one percent does not include
fentanyl, heroin, or methadone because these drugs are not
prescribed in veterinary practice. This is consistent with
nationwide data. Further, the one percent is not comprised of
the drugs that significantly contribute to addiction, overdose,
and accidental death. She also described the natural barrier to
veterinary shopping that hospitals do not enjoy. Hospitals are
required to treat all patients regardless of ability to pay,
whereas animal owners must pay up front for the care, even if
they have pet insurance. She described a typical appointment to
demonstrate that veterinarians are a poor choice for individuals
who are trying to score opioids or other more dangerous
controlled substances. She emphasized that there have been no
identified cases of veterinary shopping in Alaska through the
PDMP.
2:10:52 PM
CHAIR WILSON asked her to be cognizant of the time.
DR. BERNGARTT highlighted that investigative costs associated
with the PDMP are very burdensome to veterinarians. The Alaska
Board of Veterinary Examiners is mandated to investigate
veterinarians who do not comply with the requirement of the
Prescription Drug Monitoring Program. She directed attention to
the chart on slide 9 that shows that the board's costs to
investigate PDMP violations rose exponentially from FY2017 to
FY2021. She clarified that these are not investigations
involving negligence or bad behavior. Rather, they are technical
violations that reflect the difficulty associated with using an
unusable system.
DR. BERNGARTT highlighted that the veterinary board is self-
supporting so it is the licensees who pay when investigative
costs go up. Alaska already has the highest licensing fees for
veterinarians in the country. There is already a severe shortage
of veterinarians and veterinary technicians in the country,
particularly in Alaska. She emphasized that the actual risk of
veterinary shortage to public health far outweighs the
theoretical risk of exempting veterinarians from the PDMP.
DR. BERNGARTT concluded the presentation by recounting the
advantages of exempting veterinarians from participating in the
PDMP. She paraphrased the following points:
Will allow veterinarians to provide the appropriate,
timely, medical management appropriate for each
patient.
Will increase the efficiency of the PDMP system for
its intended purpose, by allowing for accurate
interpretation of data and trends in human medicine.
Will allow continued judicious use of controlled
substances that is already practiced by veterinarians.
Will eliminate unnecessary and disproportionate
business burdens for veterinarians.
DR. BERNGARTT identified the PDMP as a tool in the toolbox that
does not work for veterinarians.
2:13:55 PM
CHAIR WILSON noted who was available to answer questions.
SENATOR REINBOLD commented on the small number of veterinarians
and veterinary technicians in the state compared to the large
number of animals. She voiced support for lightening their load.
2:14:53 PM
CHAIR WILSON asked what the potential decrease in licensing fees
would be, should SB 132 pass.
2:15:13 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development, Juneau, Alaska, explained that a federal
grant pays most of the PDMP costs and the ancillary
investigative costs are difficult to anticipate. Therefore, the
division will need to perform an annual analysis to ensure that
program fees match the expenses.
She related that costs increased in 2022 because a large number
of veterinarians were not using the program and that triggered a
data investigation. She said that proved to be an anomaly and
the division changed some processes...
CHAIR WILSON noted the call was dropped and suggested she try to
call again.
2:16:42 PM
CHAIR WILSON asked for confirmation that veterinarians do have
access to dangerous medications such as Propofo, but it is not
prescribed after a procedure.
DR. WARD answered that is correct. The majority of controlled
substances are administered to the animal in the clinic either
as pre-operative anesthetic or post-operative pain control.
Propofo would not be sent home with the animal.
2:17:39 PM
CHAIR WILSON opened invited testimony on SB 132.
DR. SARAH COBURN, Board Member-at-Large, Alaska Veterinary
Medical Association, Anchorage, Alaska, stated that she has been
a veterinarian for 13 years and she worked in the profession for
10 before that. She described SB 132 as good public policy that
has broad bipartisan support. She said the PDMP was designed to
identify doctor shopping by humans who are seeking controlled
substances and it was a broad oversight to include
veterinarians. The mandates are not relevant and have no
practical utility in fighting opioid abuse. She suggested
letting the PDMP do what it does well in human medicine.
Veterinarians will continue to practice in accordance with state
and federal laws, professional ethics, and national guidelines
when prescribing controlled substances for animals. She urged
the committee to pass SB 132.
2:20:33 PM
DR. JAMES DELKER, Legislative Liaison, Alaska Veterinary Medical
Association (AVMA), Soldotna, Alaska, stated that he has
practiced veterinary medicine for more than 25 years and with
his wife has owned a practice for 19 years. He related that he
has served as an unpaid volunteer on the Alaska Veterinary
Medical Association board since 2010.
DR. DELKER stated that AVMA identified numerous problems with
the PDMP and attempted to share those concerns with the Board of
Pharmacy during their November 21, 2013 meeting. During his
testimony he asked how veterinarians could be expected to comply
with a system that was based on human identifiers. He said he
cited a study from Minnesota that documented minute amounts of
[veterinary] doctor shopping in a more populated state with many
more veterinarians. His testimony also pointed out that the PDMP
database would only collect useless data from veterinarians that
were forced to participate. The board subsequently decided not
to support veterinarians' view on the issue but no details were
given for the decision.
DR. DELKER stated that eight years has passed and the issues he
presented are still problematic. Veterinarians have never had a
seat at the table in any facet of the development of the PDMP,
although they have articulated the pitfalls from the outset. The
result is that veterinarians are burdened with daily manual
reporting even on days that they do not prescribe controlled
substances. He reported that some veterinarians found that the
data they entered did not show up in the system when it was
accessed for a subsequent prescription. This is a waste of time
and shows a lack of respect for these licensed professionals. He
asked the committee to remove the PDMP burden from veterinarians
by passing SB 132.
SENATOR REINBOLD thanked Dr. Delker for his volunteer services
and dedication.
2:25:20 PM
CHAIR WILSON opened public testimony on SB 132.
DR. MARY ANN HOLLICK, representing self, Eagle River, Alaska,
asked the committee to support SB 132 because it makes sense and
is good public policy. She related that she previously owned a
veterinary practice and currently represents Alaskan
veterinarians on the American Veterinary Medical Association.
She stated that veterinarians treat animals and the PDMP was
created for the human healthcare system. In 34 years of practice
seeing thousands of patients, she said she has not seen any drug
shopping behavior. She also pointed out that 34 states have
already exempted veterinarians from the PDMP. Opioids generally
are not the veterinarian's drug of choice and commonly abused
drugs are not sent home with the animal and owner. She said it
is important for Alaska animal owners to understand that if
their animal needs a controlled substance dispensed or
prescribed, the PDMP requires the veterinarian to look at the
pet owner's personal, private history of controlled drugs even
though that information is not relevant to the treatment of the
animal. It also has no practical utility in the fight against
opioid abuse. She asked the committee to pass SB 132.
2:27:11 PM
DR. MCKAYLA DICK, former President, Alaska State Veterinary
Medical Association, North Pole, Alaska, stated that she is a
mixed animal practitioner who also does emergency and shelter
medicine. She stated that for multiple reasons the PDMP is not
suitable for veterinary medicine. It was designed to monitor
drug shopping by humans, which is nonexistent in the veterinary
profession. When animal patients are prescribed an opioid, it is
a tiny dose and is not the opioids that are causing overdosing
in humans. When an opioid is administered in a veterinary
hospital, the drug does not go home. She said veterinarians are
under strict guidance by the DEA and Board of Veterinary
Examiners and they work closely with local animal control
agencies. She described the requirement to look at an owner's
private prescription drug information as awkward and increased
work. Ultimately it will be costly to license holders because
the federal grants will not last forever. She asked the
committee to join the other 34 states and pass SB 132.
2:30:02 PM
DR. ARIANNA ANDERSON, representing self, Juneau, Alaska, stated
that she is a substitute and relief veterinarian who travels
throughout Alaska. She offered her belief that the PDMP
requirement for veterinarians is potentially harmful to animal
owners and definitely burdensome and useless for veterinarians.
She explained that when she prescribes a controlled drug to an
animal she is supposed to look at the owner's private medical
information in the PDMP database. This is inappropriate
according to HIPAA and if she sees they have controlled drug
prescriptions she is not trained to evaluate the information.
She noted that an owner may have more difficulty getting their
own prescriptions filled if their pet was prescribed a similar
controlled substance. She said it takes time to enter the
prescription data into the PDMP and she is required to report
even if she does not write prescriptions every day. Like many
veterinarians she has chosen to dispense just 72 hours of
medication to avoid the reporting requirement even though many
patients need more. She related that veterinarians are in short
supply statewide, but particularly in Juneau, and the time spent
on the PDMP when it provides no benefit to the animal means more
sick patients and worried clients will be turned away. She asked
the committee to support the exemption of veterinarians by
passing SB 132.
2:32:26 PM
DR. JON BASLER, Medical Director, College Village Animal Clinic,
Anchorage, Alaska, related that the clinic has three fulltime
veterinarians and two who work part time. They have
conscientiously complied with the Alaska PDMP requirements since
2017. This is despite the fact that the database provides no
useful information for the clinic's patients or in identifying
or avoiding inappropriate use by the animal owners. He said it
took several years of actively recording patient information
before the data started to show in future queries. Further,
despite having medical records that show a patient was seen and
had received prescriptions in another clinic, the information
never shows in a PDMP query. He stated that the DEA requires
veterinarians to extensively document and control any drugs that
are prescribed or dispensed. Recordkeeping is done daily,
verified weekly, and clinically crosschecked anytime a new
bottle of drug is opened. Complete inventories are conducted
quarterly. All controlled drugs are ordered under his DEA and
veterinary licenses and he maintains tight control. The
prescribing veterinarians do the verification with the PDMP. He
said the PDMP requires daily reporting by each provider even if
they do not dispense any controlled drug. He now prescribes
drugs that are less effective and writes shorter prescriptions
to avoid the reporting burdens and risks.
DR. BASLER noted that the veterinarian pharmacy board has said
there are enough licensed technicians to do this work but that
is not accurate. There is a critical shortage of both
veterinarians and veterinary technicians. He shared that in 3.5
years of advertising for a technician the clinic has received
just one application.
DR. BASLER encouraged the committee to pass SB 132. He also
advocated for the expansion of the UA MatSu Veterinary Assistant
Program into a full veterinary technology program.
DR. BASLER concluded his testimony stating that the PDMP is
ineffective for veterinary patients and their owners, is
burdensome, and is of little benefit in preventing diversion.
2:36:30 PM
CHAIR WILSON closed public testimony on SB 132.
CHAIR WILSON advised that the committee would accept written
comments on SB 132 at shss@akleg.gov until Monday at 5:00 p.m.
CHAIR WILSON asked Sara Chamber to respond to Senator Begich's
question.
2:37:03 PM
SENATOR BEGICH asked if any of the investigations on PDMP
violations indicated misuse of a controlled substance. He noted
that in 2017 when the Alaska PDMP was amended to include
veterinarians the assumption was that this might happen.
2:37:48 PM
SARA CHAMBERS stated that she would follow up with specific
data, but she did not recall an instance since 2017 of a
violation of a controlled substance by a veterinarian or
veterinary technician.
SENATOR BEGICH noted the heads nodding that supported those
comments.
2:38:50 PM
SENATOR HOLLAND thanked the committee for hearing the bill and
opined that 34 other states cannot be wrong.
CHAIR WILSON held SB 132 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CSHB 133 Summary of Changes ver B to ver I 1.19.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| CSHB 133 Supporting Document - 10 Things You Should Know About ABLE 1.19.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| CSHB 133 Sponsor Presentation UPDATED 2.1.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| CSHB 133 Supporting Document - IRS ABLE Accounts Info 1.19.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| CSHB 133 Supporting Document - UA Press Release 1.19.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| CSHB 133 ver I Sponsor Statement 1.19.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| CSHB 133 Version I 1.19.2022.PDF |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| HB 133 ver B 1.19.2022.PDF |
SHSS 2/3/2022 1:30:00 PM |
HB 133 |
| SB 132 AKVMA White Paper.pdf |
HHSS 4/19/2022 3:00:00 PM HL&C 5/13/2022 9:00:00 AM SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Fiscal Notes DCCED 2.1.22.pdf |
HHSS 4/19/2022 3:00:00 PM SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 FN DCCED.pdf |
HHSS 4/19/2022 3:00:00 PM SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Legislation version A.PDF |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Sectional Analysis.pdf |
SFIN 3/17/2022 9:00:00 AM SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Sponsor Statement.pdf |
SFIN 3/17/2022 9:00:00 AM SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Support Flyer.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Testimony 1- Received 2.1.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Testimony 2 Flyer PDMP 2.1.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Testimony 3 PDMP Flyer - Received 2.1.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Testimony 4- Recieved 1.23.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Testimony 5 -Received 2.1.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB132 Testimony 1.28.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| CSHB 133 Fiscal Note UA-SYSBRA 1.19.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| CSHB 133 Sectional Analysis Ver I 1.31.2022.pdf |
SHSS 2/3/2022 1:30:00 PM SHSS 2/8/2022 1:30:00 PM |
HB 133 |
| SB 132 Testimony Will McKenna, MD- Received 2.2.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 ppt.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |
| SB 132 Testimony Bundle Received 2.2.22.pdf |
SHSS 2/3/2022 1:30:00 PM |
SB 132 |