Legislature(1993 - 1994)
02/24/1994 02:20 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATOR KELLY introduced SB 266 (DIRECT-ENTRY MIDWIVES/BOARD & PRACTICES) sponsored by SENATOR LOREN LEMAN, and invited ANNETTE KRIETZER, Aide to SENATOR LEMAN. to testify. MS. KRIETZER gave a brief review of the six sections in a Sectional Analysis, and she began by explaining SB 266 would extend the termination date of the Board of Certified Direct-Entry Midwives, define the scope of practice of certified direct-entry midwives, and provide for an effective date. MS. KRIETZER directed the attention of the committee to a report prepared by RANDY WELKER, CPA, for the Legislative Budget and Audit Committee. She quoted SENATOR LEMAN as being encouraged by the professionalism of the allied health professionals such as physical therapists, nurse practioners, physician Assistants, and others who have called SENATOR LEMAN'S office, fearful they were being kept out of the health care reform debate by physicians. MS. KRIETZER reviewed the letters in the bill packet, some in opposition and others in support of the bill, including a letter from GOVERNOR WALTER HICKEL. MS. KRIETZER explained she has drawn on her experience as a health policy maker in the Aleutians East Borough, and as the health director from her former community in the Aleutians, which involved hiring mid-level practioners for their clinic and emergency medical services, for her experise. She described how overlapping client populations can produce friction among health providers. Number 060 MS. KRIETZER focused on possible reservations about SB 266, which she determined had to do with putting into regulation the list of women, for whom a midwife may not knowingly assist in delivery. She directed attention to the statutes and reviewed the list in the bill packet dealing with the serious conditions that would preclude the assistance of a midwife. MS. KRIETZER defined the difference in practice by physicians assistants, EMTs, and nurses, all who practice under the liability protection of a physician, but she said advanced nurse practioners and midwives do not. She discussed the problems for the midwives in being solely liable for their work. SENATOR KELLY thanked MS. KRIETZER, and called on WENDY THON, on teleconference from Anchorage. Number 103 MS. THON identified herself as being on the Legislative Committee for the Alaska Nurses Association, and testified to some opposition to SB 266. She explained the nurses association does support the extension of the Direct-Entry Midwife Board until 1998. However, they had reservations concerning the scope of practice issues in Section 2, paragraph (6). MS. THON explained all professional groups are defined in statute, but the definition of direct-entry midwives does not indicate they see a certain subset or narrow group of population such as low risk pregnant women. She further explained the definition was lacking in statute without the specific language in AS 08.65.140 (a-f) as repealed in Section 4 of the bill. SENATOR KELLY turned the teleconference network to Wasilla to hear from PAM WEAVER, a member of the Board of Certified Direct-Entry Midwife. MS. WEAVER spoke to the comments from MS. THON and thought there could be an agreeable solution. She wanted the legislation to move forward. In Juneau, SENATOR KELLY invited KAYE KANNE, Chair of the Board of Certified Direct-Entry Midwife from Talkeetna, to testify. MS. KANNE testified in support of SB 266, the extension of the board, and moving the laundry list from the statute to regulation, where she thought it belongs - technically. Number 151 MS. KANNE explained the board has written thirty seven pages of regulations and licensed 20 midwives. She referred to the high risk list conditions in statute, which she said needs to be in regulation where the board can update it from year to year. She explained the list, which changes, was put in statute in 1985 when there was no board established. She further explained, although it was updated in 1992, the board was not yet in place and regulations hadn't been written yet. She thought updating was an important reason to put the list in regulation. MS. KANNE said the Legislature approved the creation of the Board of Certified Direct-Entry Midwife to regulate the practice of midwifery in Alaska, but midwives do not want to take on the liability of delivering high risk babies and have no intention of changing the list or deleting anything from it. She thought there might be additions in the future. SENATOR KELLY asked if that's the case, why does the board want to take it out of statute, and MS. KANNE answered that they might want to add to the list. She used an entry dealing with 42 weeks post dates, to explain the changes that have made in the medical guidelines. SENATOR KELLY suggested she was giving conflicting testimony on changing the list. MS. KANNE clarified they had no intention of making the list more lenient, and high risk deliveries would not be allowed. SENATOR KELLY asked for clarification on what was requested in Section 4, and MS. KANNE explained it was the statute on page 6 (d) of the booklet. Number 200 MS. KANNE explained, in researching other professional definitions, no other professional group had a laundry list of things they cannot do. SENATOR KELLY countered by saying there was a list for optometrists as opposed to ophthalmologists which don't. SENATOR RIEGER thought there was good policy in pushing as much practice as possible to primary care providers, but was concerned about the implications of the legislation in relation to proposed statutes. He wanted to see a list of what was being proposed before repealing current law. MS. KANNE explained why the list needed to be placed in regulation, but thought the regulations would be returned to the legislature for confirmation. MS. KRIETZER clarified the regulation process was a public process and allows for public comment, where concerns are raised. Number 245 SENATOR KELLY reminded MS. KRIETZER the bureaucracy enacts regulations all the time that people don't want, and he explained how the board could change the regulations. MS. KANNE said they have a certified nurse-midwife and an OB-GYN on the Board of Certified Direct-Entry Midwives as well as two direct- entry midwives and a public member. She explained it has been an agreeable membership, and everyone wanted to see the safe practice of midwives. She referred to the regulations the board has written and said they were strict. SENATOR KELLY said he didn't see the necessity for change and asked MS. KRIETZER for her answer. MS. KRIETZER explained the changes would make it more accessible for a board through the public process to keep up with changes in medical standards, and she explained possible changes in standard of care. SENATOR LINCOLN admitted to being confused on the changes, and she quizzed MS. KANNE on the reasons for the changes. She asked if there was anything on the list that should not be in statute, and MS. KANNE repeated her contention about updating the list. She referred to the 1992 changes, when the board met with the nurses association, and she reviewed the additions to the list at that time. Number 297 SENATOR LINCOLN asked if it was difficult to get the changes, and MS. KANNE reviewed the 1992 changes that set up the board. SENATOR LINCOLN asked if there was anything on the list now that needed to be changed, and MS. KANNE said there wasn't, but she knew the guidelines change each year. SENATOR LINCOLN assured MS. KANNE the legislature has always complied to the wishes of the midwives, and she didn't think it was difficult to get a statute changed. MS. KANNE said the midwife association cannot afford a lobbyist, and since she lives in Talkeetna, it is difficult and expensive to come to Juneau. SENATOR LINCOLN said she has 93 communities who are in her same shoes, but she thought the prevailing mechanism was the one for the legislature to use. She didn't think there should be a need to hire a lobbyist each time a change in statute is required, and she suggested the committee hold the bill. SENATOR KELLY admitted to the same reservations, but had no opposition to extending the board, and there was agreement among the members of the committee. SENATOR KELLY said he would hold the bill and work with SENATOR LEMAN'S staff for a future meeting for some other arrangement. SENATOR SHARP said he would want some idea as to what is proposed.