Legislature(2023 - 2024)ADAMS 519
03/05/2024 09:00 AM House FINANCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB126 | |
| HB115 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 126 | TELECONFERENCED | |
| + | HB 115 | TELECONFERENCED | |
| + | HB 111 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
March 5, 2024
9:09 a.m.
9:09:55 AM
CALL TO ORDER
Co-Chair Foster called the House Finance Committee meeting
to order at 9:09 a.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative DeLena Johnson, Co-Chair
Representative Julie Coulombe
Representative Mike Cronk
Representative Alyse Galvin
Representative Sara Hannan
Representative Andy Josephson
Representative Dan Ortiz
Representative Will Stapp
Representative Frank Tomaszewski
MEMBERS ABSENT
Representative Bryce Edgmon, Co-Chair
ALSO PRESENT
Renee Gayhart, Director, Division of Health Care Services,
Department of Health; Tracy Dompeling, Director, Division
of Behavioral Health, Department of Health; Sylvan Robb,
Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community
and Economic Development; Representative Stanley Wright,
Sponsor; Rachel Gunn, Staff, Representative Stanley Wright;
Representative Mike Prax, Sponsor; Riley Nye, Staff,
Representative Mike Prax.
PRESENT VIA TELECONFERENCE
Scott Luper, Alaska Association of Naturopathic Doctors;
Tim Birdsall, Naturopathic Doctor, Alaska Association of
Naturopathic Doctors.
SUMMARY
HB 126 ASSOCIATE AND PROFESSIONAL COUNSELORS
HB 126 was REPORTED out of committee with six "do
pass" recommendations and three "no
recommendation" recommendations and with one new
fiscal impact note from the Department of
Commerce, Community and Economic Development, and
three new zero fiscal impact notes from the
Department of Health.
HB 115 NATUROPATHS: LICENSING; PRACTICE
HB 115 was HEARD and HELD in committee for
further consideration.
Co-Chair Foster reviewed the meeting agenda.
HOUSE BILL NO. 126
"An Act relating to the Board of Professional
Counselors; and relating to licensing of associate
counselors."
9:12:00 AM
Co-Chair Foster relayed that no amendments had been
received for HB 126. He intended to review the fiscal notes
and move the bill from committee if it was the will of the
committee. He asked to hear a review of the fiscal notes
from the Department of Health (DOH).
RENEE GAYHART, DIRECTOR, DIVISION OF HEALTH CARE SERVICES,
DEPARTMENT OF HEALTH, reviewed the department's fiscal
notes for the Medicaid component and Health Care Services.
The fiscal impact was zero and there was no revenue change
in cost to DOH; the department intended to absorb the cost.
The first fiscal note for Medicaid was OMB component 3234.
She relayed that the associate professional counselors that
would be coming on board were already included in the
budget. The second fiscal note for Health Care Services,
OMB component 242, would result in an uptick in enrollment
and additional work for the department's Quality Assurance
Unit, which was responsible for enrollment and post payment
reviews. She stated there would be a limited systems
configuration, but the division would absorb the cost,
resulting in a zero fiscal note.
9:13:31 AM
Representative Stapp asked if there needed to be any
language in the operating budget or bill referencing that
the funding for the positions was already included in the
budget. He remarked that there was not a fiscal note for
the cost because the positions were already in the budget.
Co-Chair Johnson noted that even though the positions were
not referenced in the fiscal note, she did not see how it
could be put in the budget when it was part of the fiscal
note even though it was zero. She would take a look at the
issue with her staff. She suggested that may be done when
the fiscal notes were all integrated at the end of the
[budget] process.
Ms. Gayhart commented that the department contemplated that
the funding was already in the budget. She relayed that it
was included with the existing staffing pattern that was in
FY 24 and would go forward in FY 25.
9:15:41 AM
Representative Hannan asked if the bill would allow more
Alaskans to get coverage for mental health counseling.
Additionally, she asked if the services would be Medicaid
reimbursable once the licensure was in place.
Ms. Gayhart responded that the bill would increase the
mental health services capacity and the services would be
covered through Medicaid.
Co-Chair Foster asked for a review of the next fiscal note.
TRACY DOMPELING, DIRECTOR, DIVISION OF BEHAVIORAL HEALTH,
DEPARTMENT OF HEALTH, reviewed fiscal note OMB component
2665. The zero note showed no revenue change or cost to the
department. She detailed that the Division of Behavioral
Health was involved with enrollment of individuals who were
1115 providers. The division would use existing staff to
perform any additional requirements needed to bring the new
professional counselors on board.
9:17:10 AM
Co-Chair Foster asked for a review of fiscal note from the
Department of Commerce, Community and Economic Development
(DCCED).
SYLVAN ROBB, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS,
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, addressed the fiscal
impact note, OMB component 2360. The fiscal note included a
request in FY 25 for $131,000 for an additional
occupational licensing examiner to handle the licensing of
the new associate counselors. The only cost that did not
continue into the outyears was $2,900 for a regulations
project. The rest of the costs that continued into the
outyears were all related to the new position. The fiscal
note reflected a change in revenue because the fund source
for the position was 1156, receipt supported
services/designated general funds. She explained that DCCED
was required through statute to have its licensing fees
cover the cost of operations for professional licensing.
Representative Galvin asked if the one DCCED position would
oversee all of the associate counselors. She believed the
position would keep track of counselors' hours. She asked
how many counselors one person would keep track of.
Ms. Robb replied that the position would be added to the
staff that currently licensed professional counselors. The
team would license professional and associate professional
counselors. She explained that because the department did
not currently license associate professional counselors, it
did not have an accurate estimate of how many there were.
There were 993 professional counselors in FY 23 and 577
board approved supervisors who would oversee the
individuals who would become the licensed associate
counselors.
Representative Galvin assumed the number of associate
counselors would be in the 100s if there were 577
supervisor counselors.
Ms. Robb replied that there was not a count of how many the
individuals there were. She explained that each board
approved supervisor may supervise more than one person or
may currently not be supervising anyone.
Representative Galvin asked for verification the department
had confidence that the one position would be sufficient.
Ms. Robb responded affirmatively.
9:20:49 AM
Co-Chair Foster asked the bill sponsor and his staff to
provide a quick summary of the bill.
REPRESENTATIVE STANLEY WRIGHT, SPONSOR, deferred to his
staff to provide a brief overview of the bill.
RACHEL GUNN, STAFF, REPRESENTATIVE STANLEY WRIGHT, relayed
that the bill created a tier designation within the
counseling profession in Alaska. She detailed that after a
person completed their graduate degree and prior to full
licensure, the bill offered more supporting guidance along
their professional pathway and supported supervisor
supporting associate counselors. She shared that a local
Juneau therapist had testified that they have four interns
currently. She stated that supervisors were overseeing
anywhere from one person to a handful of people.
Representative Ortiz asked what was currently required in
order for a person to gain full licensure.
Ms. Gunn replied that there were federal guidelines
governing the counseling profession that included 3,000
hours of training, passing a national exam, and other
rigorous standards. The bill would give counseling interns
a licensure to report their hours more often and
supervisors could keep everything together. The bill would
make sure that everyone graduating with a postsecondary
degree in behavioral health would have the opportunity to
become a licensed professional counselor.
Representative Ortiz the bill was intended to streamline
the licensing process.
Ms. Gunn responded affirmatively. She added that the bill
had the additional benefit of offering billable hours. She
explained that currently counseling interns could not bill
many insurances including Medicaid. She detailed that
supervisors were overloaded with clients with only a few
billable self-pay clients. For example, a counselor in
Juneau with four interns only had two billable self-pay
clients to share between the interns.
9:24:14 AM
Co-Chair Johnson MOVED to REPORT HB 126 out of committee
with individual recommendations and the accompanying fiscal
notes.
There being NO OBJECTION, it was so ordered.
HB 126 was REPORTED out of committee with six "do pass"
recommendations and three "no recommendation"
recommendations and with one new fiscal impact note from
the Department of Commerce, Community and Economic
Development, and three new zero fiscal impact notes from
the Department of Health.
9:24:53 AM
AT EASE
9:26:30 AM
RECONVENED
HOUSE BILL NO. 115
"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."
9:27:33 AM
REPRESENTATIVE MIKE PRAX, SPONSOR, provided a brief history
to explain the need for the bill. He read from prepared
remarks:
Advances in pharmaceutical research accompanied by
government licensing of pharmaceuticals and medical
practice has caused the American medical industry to
evolve towards fighting disease as opposed to
maintaining health. But a renewed interest in
maintaining health to avoid the need to fight disease
started to take hold in the late 50s as stories of
serious side effects from modern pharmaceuticals began
to emerge. Medical schools focused on training their
students to understand how our bodies naturally
respond to disease and how to maintain that healthy
response grew in response to this renewed interest. As
schools of naturopathy grew, nationally recognized
accrediting standards comparable to other schools were
established. This led states to issue licenses
specific to practicing naturopathic medicine.
The Alaska Legislature first recognized the practice
of naturopathic medicine as a licensed profession in
1986, but it did not allow naturopaths to give,
prescribe, or recommend prescription drugs, controlled
substances or poisons, or to engage in surgery.
Naturopaths need to understand pharmacology so they
are able to recognize when prescribing drugs might
benefit their patients and especially to recognize
when their patients might be suffering from the
adverse effects of drugs previously prescribed to
them. Accredited schools of naturopathy provide the
same pharmacological education as other medical
schools. Recognizing that naturopaths receive the same
level of pharmaceutical education as other
practitioners, other states trust naturopaths to use
their best judgement when prescribing drugs, just as
they trust other medical practitioners to use their
best judgement when prescribing drugs.
Similarly, other states recognize that naturopaths
receive the same surgical training as general
practitioners, so they know what surgical procedures
they can perform and what is beyond their capability,
so other states allow naturopaths to perform surgeries
according to their best judgement. Consequently,
naturopaths are discouraged from opening a practice in
Alaska because they were restricted from practicing to
the level that they're trained. Furthermore, Alaskans
who could obtain a prescription or a surgical
procedure directly from their naturopath in other
states must pay for an additional office visit to
obtain a prescription or a surgical procedure that
their Alaska licensed naturopath could provide or
perform were it not for Alaska's overly restrictive
licensing statutes. This causes Alaskans to pay more
than necessary for medical care and it exacerbates
Alaska's shortage of primary care practitioners.
HB 115 is intended to align Alaska's professional
licensing standards with nationally accredited
naturopathic medical schools' doctorial degree
standards. Passing 115 will allow licensed
naturopathic doctors to serve Alaskans to the full
extent of their training. Allowing naturopaths to
practice to the full extent of their training will
encourage more naturopathic doctors to practice in
Alaska. Having more naturopaths practice in Alaska
will alleviate Alaska's shortage of primary care
professionals and relieving our shortage of primary
care professionals will improve public health.
Representative Prax asked his staff to review the bill and
a sectional analysis.
9:32:21 AM
RILEY NYE, STAFF, REPRESENTATIVE MIKE PRAX, introduced a
PowerPoint Presentation titled "House Bill 115 Naturopaths;
Licensing; Practice" dated March 5, 2024 (copy on file). He
read from slide 2:
WHAT IS A NATUROPATHIC DOCTOR?
• primary care provider with a four-year post graduate
medical degree who:
• practices evidence-based primary care, with a patient-
centered focus,
• prioritizes disease prevention and discovering root
cause of illness,
• whose treatments focus on lifestyle modifications,
nutrition and low-risk intervention
Mr. Nye read from slide 3:
WHAT ABOUT THEIR EDUCATION?
Education
• 4-Year Medical School Program accredited by the
Council of Naturopathic Medical Education with
• 2 years of medical sciences (anatomy, physiology,
microbiology, immunology, etc.)
Pre-requisites
• 4-yr undergraduate degree and additional pre-med
coursework
Residency
• Less common because they are not trained as
hospitalists
• 1-3 yr residency options available; nationwide
there's a shortage
• Note that residencies are not required for
independent primary care providers who hold
prescriptive privileges
Licensing
• Naturopaths must pass the two-part Naturopathic
Physicians Licensing Examination (NPLEX) before
being licensed to practice
Mr. Nye skipped slide 4 and turned to slide 5 showing a map
of the United States with states licensing naturopaths
represented in green. He noted that 23 states were
licensing naturopaths. He moved to slide 6 titled
"Prescriptive Authority for Naturopaths." States where
naturopaths had prescriptive authority were shown in green
and states that licensed naturopaths but did not grant
prescriptive authority were shown in yellow. He noted that
California was shown in light green indicating a
collaborative agreement that allowed naturopaths to
prescribe a certain number of prescriptions for one year
and prescription authority without collaboration after that
one-year period.
Mr. Nye addressed a map on slide 7 reflecting states where
naturopaths had prescriptive authority. The states in dark
green gave naturopaths prescriptive authority of controlled
substances. The light green states gave naturopaths
prescriptive authority but did not allow them to prescribe
controlled substances. The yellow states reflected areas
where naturopaths were licensed but did not have
prescriptive authority. He concluded the presentation on
slide 8:
House Bill 115
• Modernizes statutes for Naturopaths
• Cleans up outdated language
• Imposes the same public health duties on Naturopaths
as other medical providers
• Updates scope of practice for Naturopaths that
includes limited prescriptive authority
• Allows minor office procedures
• NO MORE duplicative office visits
• Improved access to care for Alaskans
• More choice for patients
9:36:49 AM
Co-Chair Foster pointed out that the third paragraph of the
sponsor statement (copy on file) stated that HB 115 set
clear statutory guidelines to allow licensed naturopaths to
perform minor office procedures and to prescribe non-
controlled medications. He noted that the presentation
specified that Alaska did not allow naturopaths to
prescribe controlled substances. He looked at slide 8,
which specified the bill would update the scope of practice
for naturopaths to include limited prescriptive authority.
He asked for verification that the bill would not allow
naturopaths to prescribe controlled substances including
opioids.
Representative Prax responded affirmatively. He explained
that there was a difference between prescription drugs and
controlled substances. He detailed that controlled
substances were considered by the federal government to not
have sufficient medical value to justify the risk.
9:38:37 AM
Representative Josephson stated that he had a number of
concerns with the bill. He believed the presentation
referenced Section 6 and observed that a person could
obtain a temporary license without passing an exam. He was
concerned about the specific item because there was no
requirement for post-degree residency or internships. Yet
there was a way to get to a temporary license that would
allow a person to prescribe and do minor surgical
procedures. He asked if the committee should be concerned
about the provision. He noted that even if a person had
failed the exam, the only requirement in Section 6 was for
a person to register for the next exam. He stated that
theoretically a person could be treating a patient without
passing the exam. He asked if his understanding was
accurate.
Representative Prax deferred the question to Dr. Luper with
the Alaska Association of Naturopathic Doctors.
9:42:09 AM
SCOTT LUPER, ALASKA ASSOCIATION OF NATUROPATHIC DOCTORS
(via teleconference), responded that he did not believe a
person could practice under a temporary license. He stated
the information was news to him.
Representative Josephson stated that the issue struck him
as hugely important. He explained that the bill specified
that a person could have failed an exam. He remarked that
the current law seemed to express concern about having
failed exam. The bill would delete the language and
indicate there was not concern over a failed exam.
Additionally, the bill allowed a person to obtain a
temporary license even though they had failed an exam.
Additionally, there did not seem to be restrictions on
prescribing or doing minor surgical procedures. He asked if
the committee should be concerned.
Mr. Luper responded in the affirmative. He shared that he
had trained 18 residents or first year doctors in his
clinic. He detailed that one year his clinic had hired a
resident before she had passed the exams in the hopes the
individual would pass her exams and be able to begin work.
He relayed that the individual had not passed her exams and
she was unable to practice. He stated that common sense
would dictate that if a person did not pass their exams,
they did not get to be a doctor. He noted that the specific
individual had ultimately passed her exams and was now in
practice.
Representative Josephson discussed his primary concern with
the bill. He provided a hypothetical scenario where law
allowed medical doctors and osteopaths to no longer adhere
to the American Medical Association (AMA) requirement of
12,000 to 16,000 hours of internship or residencies. He
asked what the public would think. He asked if it would
gain the public's confidence.
Mr. Luper answered that naturopathic doctors were trained
as primary care providers. He clarified that they were not
trained as specialists. Whereas medical doctors (MDs) and
doctors of osteopathic (DOs) medicine, with their extensive
residencies, were trained to be specialists and more than a
regular doctor. He highlighted that there were other
practitioners in the state who were also trained as primary
care providers (e.g., nurse practitioners) who were not
required to do residencies. The individuals were able to
practice safely and effectively. He underscored it was
already being done in Alaska. In other states where
naturopathic doctors could practice up to the full extent
of their education where they were allowed to prescribe and
do minor surgical procedures, they also practiced safely.
He clarified that the naturopathic doctors would not be
equal to MDs and DOs because they did not have the
training; however, they were adequate to provide primary
care. He highlighted that naturopathic doctors' training
exceeded the hours and patient content of nurse
practitioners. He added that physicians' assistants were
able to provide primary care, and naturopathic doctors'
training far exceeded PA training. The bill was trying to
bring the licensing ability up to what the level of
education was.
9:48:02 AM
Representative Josephson understood there was a pending
bill that would enable PAs to work independently. He
directed a question to the bill sponsor. He noted that
Representative Prax had talked about pharmacology in his
description. He believed the bill purported that
naturopathic doctors' pharmacology classwork was comparable
to the classwork done by medical doctors. However, he noted
that Representative Prax's statement implied that the
things learned by naturopathic doctors were not to be fully
believed. He interpreted the statement to mean that
naturopathic doctors were learning pharmacology but
resisting what they had learned to move in a different
direction to be circumspect of the things they had learned
in terms of the delivery or efficacy of prescription drugs.
He asked if his understanding was accurate. He noted it
struck him as counterintuitive.
Representative Prax responded that the practice of
naturopathy was different than allopathic medicine, which
focused on treating the symptoms of the disease. He noted
that naturopathic medicine focused more on prevention of
disease. He confirmed that naturopaths took a different
approach to their practice; however, they needed to know
how to treat acute medical problems that need immediate
attention in order to prevent a stroke or heart attack. He
explained that in some cases it may be appropriate to
prescribe a drug to do just that. He elaborated that
naturopaths would also want to continue with other things
that people could do to reduce their blood pressure without
relying on medications. He relayed that in some
circumstances people were prescribed a drug that had
adverse effects and naturopaths and physicians needed to
understand adverse effects to determine if it could be the
underlying problem. He stated that naturopaths needed to be
trained to the same level even though did not intend to
rely on prescriptions.
9:51:16 AM
Representative Ortiz referenced the language on slide 8 of
the presentation that specified the bill allowed minor
office procedures. He asked if the presentation should say
that the bill allowed minor surgical procedures rather than
minor office procedures.
Representative Prax agreed it was the intent of the bill.
He used the stitching of a mole as an example. He explained
that the procedures would be more or less the same
procedures a general practitioner may perform in office. It
would be unreasonable to think that a naturopath would
perform internal procedures such as heart transplants.
Representative Ortiz asked what level of training a
naturopath received for performing minor surgical
procedures in their four-year postgraduate degree program.
He asked if minor surgical procedures were part of their
regular training.
Mr. Nye responded that naturopaths received the training
during their four-year doctorate degree. He deferred to Mr.
Tim Birdsall with the Alaska Association of Naturopathic
Doctors for further detail.
TIM BIRDSALL, NATUROPATHIC DOCTOR, ALASKA ASSOCIATION OF
NATUROPATHIC DOCTORS (via teleconference), replied that the
term "minor office procedures" had been used historically
in naturopathic licensing to avoid confusion with major
surgery, which was excluded in the scope of practice in
every state that licensed naturopathic doctors. Usually
there were other specific provisos about other specific
things that were not allowed even though they may not fall
into a general surgery category and surgery involving
tendons, ligaments, blood vessels, eyes, and other
procedures that may be done outside an operating room.
Minor procedures in general were things that involved a
surgical incision or removal of something in addition to
things that did not require incision such as stitching up a
laceration. He relayed that those techniques and skills
were included in the curriculum and training for all
naturopathic doctors.
Representative Ortiz believed that naturopaths made a great
contribution to medical care, and he generally liked the
idea of prioritizing disease prevention. However, he asked
what level of training naturopaths received in their four-
year postgraduate medical degree for prescribing drugs. He
believed there was substantial training in residency
programs where standard medical doctors were under the
supervision of other medical doctors, while that did not
occur for naturopaths because they did not have residency
programs. He highlighted that training in prescribing drugs
and in surgical procedures were a big part of the
supervised residency program that was not available to
naturopaths. He asked where naturopaths received the
training for prescribing drugs.
Mr. Birdsall responded that naturopathic doctors received
extensive didactic training in pharmacology and
understanding of drugs including indications and
contraindications as well as supervised clinical training
in the last two years of medical school.
10:00:26 AM
Representative Ortiz thought the idea of naturopaths
wanting the licensure to prescribe drugs seemed almost
counterintuitive to the underlying mission to prioritize
disease prevention and discover root causes.
Mr. Birdsall believed that some of what Representative Prax
stated in his initial summary of the bill reflected more of
a historical view of pharmaceuticals as opposed to a
current view. He explained that it was the position of all
naturopathic organizations across the country that there
was a hierarchy of therapeutics, meaning there was a place
for everything. He agreed that ideally every case of
hypertension could be controlled by diet and lifestyle
counseling, but it was not the case. He detailed that some
cases would require more intervention, such as an herbal
medicine or dietary change; however, when those things did
not work or when a patient's condition was so acute that
prescription medications were necessary, it was included in
naturopaths' philosophy. Naturopaths did not turn to drugs
as the first line of therapy very often, but they did
occasionally. For example, he had seen a woman with a sore
throat in his office recently who had turned out to be
positive for strep throat. In his opinion, the most
appropriate intervention was for antibiotics. As a
naturopath, he was unable to prescribe the medication and
had sent the patient to a nurse practitioner to receive the
antibiotics. The situation had resulted in delay and
additional cost. He explained that the situation was
unnecessary as he knew exactly what to prescribe. He added
that he used the same resources as anyone else and could
consult references to ensure his actions were compliant
with up to date information. Additionally, if he were to
choose to not prescribe medications because of
philosophical reasons, patients coming to him would be on
drugs and he needed to understand the drugs including their
indications and contraindications to treat a patient.
10:04:46 AM
Co-Chair Foster noted that Representative Tomaszewski had
joined the meeting.
Representative Stapp asked how the scope of practice for
naturopaths in Alaska under the legislation would compare
to those in Montana or Idaho.
Mr. Luper responded that the scope of practice would be the
same. He noted there were some subtle differences, and the
prescription rights would not be identical.
Representative Stapp he referenced a chart showing
physician acts that directly harm patients with a sample of
6,000 licenses (page 3 addendum b). He looked at Idaho
observed there had been no complaints against naturopaths
related to actions for misdiagnosis or failure to use
standard of care protocols. Likewise, there had been no
complaints against naturopaths for performing an inadequate
procedure that was not in the scope of practice or for
inappropriately prescribing drugs. He asked if the
experience in Alaska would be dramatically different than
in Montana, Idaho, or New Hampshire in the event
naturopaths in Alaska were allowed to expand their scope of
practice.
Mr. Luper responded that it would be the same. He explained
that naturopathic medicine had been practiced for 100 years
and in most of the states under discussion safely for
decades. He noted the number of complaints was very low. He
noted that any profession would have an occasional problem,
but the rate of problems was much less than other
professions and particularly much less than MDs and DOs. He
relayed that [naturopathic] doctors were well trained to
conscientiously provide good care to the best of their
ability. He would be glad to bring in experts to testify as
to the quality and depth of education. He pointed out that
the record spoke for itself. In reality, the practice of
naturopathic medicine had been safe and effective. He
highlighted there was a shortage of primary care providers
in Alaska. He relayed that there were about 50 doctors
ready to fill the primary care gap in Alaska if only they
were allowed to practice like they were trained. He
reiterated that naturopaths practiced safely and would
continue to do so.
Representative Stapp asked if there was any material
difference in the education and training for naturopathic
doctors in Montana and Idaho than there would be in Alaska
if the bill passed.
10:09:59 AM
Mr. Birdsall responded that there was no difference
whatsoever. He relayed that there were only five
naturopathic medical schools in the country, which were all
accredited by the Council on Naturopathic Medical
Education. The schools had essentially the same curriculum
and were all eligible for taking the NPLEX [Naturopathic
Physicians Licensing Examinations]. He anticipated there
would be no difference in the training or level of
expertise of doctors licensed in Alaska compared to
Washington, Oregon, Montana, Idaho, and any other states
with licensing laws.
Co-Chair Johnson looked at page 2, Section 2 of the bill
that added a naturopathic board. She referenced a number of
existing executive orders to remove or consolidate boards.
She wondered if there was an existing board the naturopaths
could go under such as the medical board.
Representative Prax deferred the question to Ms. Robb with
DCCED.
SYLVAN ROBB, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT responded that DCCED had
one regulatory board that covered a number of different
professions including architects, engineers, land
surveyors, and landscape architects; however, typically
boards regulated their own professions and were singular.
She did not believe it would be a great fit to put the
naturopaths under a different board. She relayed that the
department was interested in seeing an advisory board for
naturopaths. She added that the profession was very small
and there were only 56 licensed naturopaths in Alaska. She
explained that an advisory board put less burden on the
practitioners. Additionally, it was a small group of
individuals and they all knew each other, which could lead
to some challenges within the board in terms of trying to
regulate the profession.
10:13:10 AM
Co-Chair Johnson referenced an American Association of
Naturopathic Physicians document showing frequently asked
questions (copy on file). She stated she was not
immediately opposed to the bill, but she wanted to see real
facts. She noted that one of the items in the handout read
"reduce the incidence of illnesses and fatalities caused by
hospital errors." She wanted to know how naturopathic
doctors accomplished this. She recalled some elderly
individuals saying they did not go to the hospital because
people die there. She thought it was kind of the same idea.
She asked if the sponsor could elaborate.
Representative Prax responded that answering the question
was a little difficult without being critical of the
current medical industry. He stated that a key point of
using naturopathic medicine as opposed to allopathic
medicine, was that patients needed to be patient because
naturopaths did not generally offer an instantaneous
solution. He stated that the instantaneous solution was
generally powerful medications and maybe even some
derivatives of some less powerful herbs; therefore, when a
mistake was made, it was a big mistake. He stated that the
practice of naturopathy was much more cautious and much
less likely to result in a big mistake. He elaborated a
naturopath could find that a particular treatment may not
work and that a different treatment was needed, but
treatments were not causing emergency reactions to a drug.
He stated it was his primary reason for choosing treatment
from a naturopath.
10:16:31 AM
Representative Josephson commented that one of the things
the committee was hearing was that naturopaths were primary
care providers. He did not believe there was any denying
that. He stated that other MDs and DOs who were primary
care providers were subject to AS 9.55.540 on the burden of
proof and a malpractice action. He stated that it involved
standard of practice, scope of practice, and complying with
the standard. He would want to know why the specific
section defining healthcare provider/patient relationships
was not melded into the bill. He thought the committee
needed to delve into the issue of malpractice within
naturopathy and how the industry reviewed itself in that
way.
Representative Galvin was very supportive of naturopathy
but understood there may be two different lanes under
discussion. She referenced the AMA and oversight over the
medical community and had read that there were no standards
around course content for naturopaths in pharmacology in
particular. She stated it was a concern. She considered
whether a board would help naturopaths have guidelines. She
asked the sponsor to address the issue. She mentioned Dr.
Madara, the AMA director who described what the training
was like. The AMA suggested there was no guarantee a
naturopathic student would ever see patients who were sick
or hospitalized during their clinical rotations and may
never care for some of the most vulnerable patients such as
children or senior citizens. She considered that there may
not be the same level of training for naturopaths [compared
to MDs and DOs] when it came to critical needs. She had
read that a naturopath undertaking a minor office procedure
could result in the removal of a mole that was perhaps
cancerous but could go undetected.
10:21:14 AM
Mr. Nye replied that the legislation would require
naturopaths to take a pharmaceutical exam, which was the
equivalent of anything offered by the state medical board.
He assumed that without the proper training, a naturopath
would be unable to pass the exam.
Mr. Birdsall responded that Dr. Clyde Jensen had provided
testimony in other hearings on the bill. He noted that Dr.
Jensen was a pharmacologist and healthcare administrator.
He stated that Dr. Jensen was the only person to have
served as the president of an allopathic medical school,
and osteopathic medical school, and a naturopathic medical
school. He relayed that Dr. Jensen had testified several
weeks earlier that the curriculum was the same, the
textbooks were the same, and the information presented was
the same. He highlighted Dr. Jensen's experience that the
training [for naturopaths] was comparable [to MDs and DOs].
He relayed that over the past several decades, schools had
worked to ensure a broad scope of patient populations
including homeless. He detailed that the three naturopathic
schools on the West Coast in Seattle, Portland, and San
Diego had students seeing homeless population patients. He
explained that the elderly and pediatric populations were
well represented in the patients seen in naturopathic
training clinics.
Mr. Birdsall stated the challenge was determining how much
training was enough. He believed everyone would likely
agree that more training was better. He believed the intent
of all licensing laws and the intent in the State of Alaska
was to draw the line at safety to ensure the safety of
residents and that no one was licensed in a way that would
create the potential for risk or harm. He referenced data
from the Federation of Naturopathic Medicine Regulatory
Authorities indicating there was a low level of risk of
malpractice and a very low level of risk when looking at an
expanded scope of practice that included prescriptive
authority. From a safety standpoint, the proof was in the
history. He highlighted that naturopathic medicine had been
licensed in some states for over 100 years and there was an
extensive history. As things changed, it was necessary for
naturopaths to keep pace by creating licensing that was
roughly equivalent to the training, education, and
experience naturopathic doctors underwent.
10:26:46 AM
Co-Chair Foster asked the bill sponsor for any closing
comments.
Representative Prax believed it was important to keep in
mind that the choice should be made at the patient level
rather than dictated at the legislative level. He pointed
out that the legislature could write statutes, but it could
not guarantee results. He stated that in the case of
prescriptive drug training versus what was learned. He
stated that what was learned was based somewhat on a
student's focus. He highlighted that a patient would not be
inclined to go to a sports medicine doctor for a stomach
problem, but the sports medicine doctor could technically
offer prescriptions for treatment. He had personal
experience of a general practitioner prescribing drugs for
depression, while a person should really see someone
specializing someone who specialized in mental health
before getting the medication. However, the legislature
could not control that by statute or regulation. He stated
that "we trust the integrity of the medical professionals
and we let the market decide." He believed the same should
be true for the practice of naturopathy.
HB 115 was HEARD and HELD for further consideration.
Co-Chair Foster reviewed the agenda for the afternoon
meeting.
ADJOURNMENT
10:28:46 AM
The meeting was adjourned at 10:28 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 111 Hope - Support Letter.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 111 |
| HB 111 LOS A2P2 - Help Me Grow Alaska.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 111 |
| HB 111 Letter of Support - Deaf and Hard of Hearing Bill of Rights.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 111 |
| HB 111 Sponsor Statement.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 111 |
| HB 111 Summary of Changes.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 111 |
| HB 111 Sectional Analysis VersionS 030124.pdf |
HFIN 3/5/2024 9:00:00 AM |
|
| HB111 presentation 030424.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 111 |
| HB 115 Public Testimony Rec'd by 030424.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 115 |
| HB 126 Public Testimony Rec'd by 030424.pdf |
HFIN 3/5/2024 9:00:00 AM |
HB 126 |