Legislature(2003 - 2004)
02/19/2004 01:35 PM Senate L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 306-NATUROPATHIC MEDICINE
CHAIR CON BUNDE announced SB 306 to be up for consideration.
MR. BRIAN HOVE, staff to Senator Seekins, sponsor of SB 306,
said it updates current law relating to naturopathic medicine
and, as a result, Alaskans' accessibility to safe,
comprehensive, high-quality health care will be significantly
enhanced.
The key elements of this legislation include:
1. Safeguarding Alaskans' use of naturopathic medicine
by insuring that the highest quality of care
possible from licensed, well-trained and
professional naturopathic physicians.
2. Mandating continuing education requirements so that
practitioners are subject to a state and national
examination process.
3. Establishment of scope of practice to include the
use of natural substances, homeopathic medicine,
dietary, nutritional and health counseling, minor
surgery and all necessary diagnostic and imaging
studies.
4. Providing prescriptive writing authority to those
naturopathic physicians earning licenses.
5. Establishment of a qualified trade association of
naturopathic physicians to work with the Division of
Occupational Licensing towards the implementation of
regulations requiring specific state and federal
examinations and licensure requirements.
He explained that naturopathic physicians go through four years
of undergraduate pre-professional training followed by an
intensive four-year natural program emphasizing both academic
and clinical studies. The practice of naturopathic medicine was
first licensed in Alaska 17 years ago and the proposed
legislation updates the statute where needed. Similar
legislation exists in 14 other states.
CHAIR BUNDE said that complaints about a regular M.D. get taken
up with the State Medical Board and asked if naturopathic
physicians follow that same route if a complaint was filed.
MR. HOVE replied that he thought that complaints would be
circulated through the Division of Occupational Licensing.
CHAIR BUNDE asked if the Division of Occupational Licensing
would act like the Medical Board.
DR. SCOTT LUPER, Fairbanks naturopath, stated support for SB
263. [END OF TAPE]
TAPE 04-13, SIDE A
DR. LUPER said he has had a lot of experience with naturopathic
education and has practiced in Fairbanks for the past 3.5 years.
The central issue of SB 306 is whether naturopathic physicians
have enough education to have prescription rights and do minor
surgery. He referred the committee to a Journal of American
Medical Association (JAMA) article that said naturopathic
physicians are trained as primary care providers (family
doctors).
Naturopathic doctors are trained to take a history, do
physical exams, order the appropriate tests or
diagnostic images and come up with a diagnosis and a
treatment. Naturopathic physicians are also trained to
refer when necessary. We're trained in all the basic
things that family doctors are trained to do including
minor surgery, including the use of
pharmaceuticals.... Their [naturopathic] clinical
education, which is entirely outpatient-based, is
designed to prepare them to be primary care providers.
Another handout from Dr. LUPER showed that the number of course
hours required by the three leading naturopathic and the three
leading allopathic colleges are comparable and run around 4,000
hours. Another article averaged the pharmacological training of
126 allopathic, naturopathic and osteopathic schools across the
country and indicated that they all provide about 100 hours of
instruction.
Instructors at the naturopathic colleges are comparable in
training and experience to the instructors at the allopathic
colleges. When he was in school, his instructor also taught at
the local medical school. Clerkship hours, for hands-on
training, are comparable for both naturopathic and allopathic
colleges at about 3,000 hours. The last thing he pointed out was
a comparison of the pharmacology catalogues from the College of
Naturopathic Medicine and Stanford University, which indicated
that they basically have the same courses and cover the same
material.
CHAIR BUNDE asked why naturopaths would not have their
disciplinary problems addressed by the Medical Board if doctors
and naturopaths have similar training and now begin to do
similar duties.
DR. LUPER said that is a good question and explained that the
original intention was to create a naturopathic board. However,
the Legislature as well as the governor's office are reluctant
to create new bureaucrats. Director, Rick Urion, of the Division
of Occupational Licensing, said that the division already
functions in an oversight capacity for the naturopathic
profession, as well as others. "If there is a complaint, they
hear the complaint."
CHAIR BUNDE interrupted to say that the division hears
complaints from barbers and hairdressers. "You're talking about
medicine. Why wouldn't you want this to be under the State
Medical Board?"
SENATOR RALPH SEEKINS remembered that originally a separate
board was discussed, but the department recommended that
oversight be contained within the administration at this time.
"It's not that these folks were trying to avoid any kind of
oversight of professional practices."
CHAIR BUNDE said he wasn't indicating that at all; rather let
doctors be judged by doctors.
DR. LUPER agreed and said that Mr. Urion suggested creating an
advisory board. The complaints would go to the advisory board
first, and it would let the division know if a particular
complaint is valid. "It takes the people who would have been on
the board and takes them out of state government and puts them
in the private sector to act as an advisory board."
SENATOR HOLLIS FRENCH asked why naturopaths would not fall under
the purview of the State Medical Board.
DR. LUPER replied:
I think it's because the State Medical Board doesn't
have the expertise and knowledge to know what's
appropriate in the practice of naturopathic medicine.
Naturopathic doctors will do things which are outside
the educational scope and experience of M.D.s - for
example, the use of herbs or the use of homeopathics,
the use of physical therapy modalities, those kinds of
things.
SENATOR FRENCH asked if that problem would be solved if
naturopaths had better representation on the board, itself.
DR. LUPER said the M.D.s would have to be asked if they would
want naturopaths on the Medical Board. He concluded saying that
his real passion is for giving quality care to his patients. He
spoke about one of his patients who needed an anti-hypertensive
medication right away and while Dr. Luper has the training to
write it, he can't legally do that in Alaska.
In Fairbanks, where I practice, it's difficult for him
to get an appointment with another doctor. It's three
weeks out. And, I know exactly what he needs. I've
been trained in knowing what he needs. In Arizona I
can write the prescription, because I have a DEA
license that allows you to write prescriptions,
already. But only in Alaska am I prevented from doing
what is best and appropriate for my patients.
So what did he do? He went to another doctor; he spent
the money. The doctor took his case and said, 'Oh
yeah, Doctor Luper is right; that's exactly what you
need.' He complained. It's stories like his that drive
me to sit across from you. I don't have any monetary
gain in this. I'm a busy doctor. I'm seeing as many
patients as I can see, but I want to provide the best
care I can to my patients. Right now one of my hands
is tied behind my back. I don't use drugs very much, I
don't need to. But every once in a while, in cases
like that, it's in the best interests of public
health, I think, to do that.
DR. CLYDE JENSEN, Juneau, said he is frequently called upon to
speak at hearings comparing educational programs because of his
leadership experiences at naturopathic, osteopathic and
allopathic colleges. He has a doctorate in pharmacology and has
been a faculty member and chief executive officer at
osteopathic, allopathic and naturopathic medical schools. The
requirements to get into these medical schools are all the same,
the basic sciences are taught at the same level of intensity and
for the same number of hours. Clinical education of naturopaths
differs in some instances from training for physicians.
Naturopaths receive stronger training in areas of nutrition,
botanical medicine, physical medicine (with the exception of
osteopaths), preventive medicine and referrals. Medical and
allopathic schools have an advantage over naturopathic schools
in that much of their training takes place in inpatient
facilities. Naturopathic physicians typically don't have
hospital privileges. They don't have the opportunity to do
residencies or other types of post-graduate medical education
because there is no federal reimbursement for those types of
programs for naturopathic physicians.
In summary, I have learned naturopathic medical
students have some areas of training that are superior
to, and other areas of training that are not as strong
as, conventional medicine, but most areas of training
I've learned were quite comparable.
CHAIR BUNDE thanked him for his comments.
DR. DAN YOUNG, Eagle River, said that Dr. Jensen's resume' is
very unique and comprehensive. Dr. Young reviewed his own
credentials, which were quite extensive, as well. He said that
Alaska is the only state that does not allow naturopaths a full
scope of practice. The main issues are inclusion of minor
surgery and prescriptive rights. He noted several letters of
support from medical doctors, nurse practitioners, physicians'
assistants and dentists and the letters keep coming in. The goal
is complementary medicine so patients get the best care
possible. He wanted the committee to understand that some M.D.s
attend naturopathic medical schools, under an advanced standing,
to learn naturopathic therapies.
We are the foremost experts in drug and nutrient
interactions. My wife [another naturopathic doctor]
specifically who does women's health, is really
limited because when she needs to do conjugated
estrogen for one of her patients, she cannot write for
that and that is absolutely absurd. We are very well
trained in these cutting edge therapies and it serves
Alaskans for us to be able to do this.
DR. YOUNG pointed out that naturopaths have been licensed for 17
years in Alaska and have been regulated by the Division of
Occupational Licensing. There have been very few disciplinary
actions. And, of the 601 practicing naturopaths in Portland,
Oregon, two have committed improprieties, a very low percentage.
So, we practice safe medicine, our patients like us,
we have very low malpractice rates and we are very
good at what we do. We are trained to refer to those
people who do the thing that we don't do, just like
any primary care would do.
CHAIR BUNDE thanked him for his comments and said the committee
would take this bill up again, but time had run out. He
adjourned the meeting at 3:33 p.m.
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