Legislature(2003 - 2004)
05/06/2004 03:12 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
May 6, 2004
3:12 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Carl Gatto, Vice Chair
Representative John Coghill
Representative Paul Seaton
Representative Kelly Wolf
Representative Sharon Cissna
Representative Mary Kapsner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 434
"An Act relating to the practice of naturopathic medicine; and
providing for an effective date."
FAILED TO MOVE OUT OF COMMITTEE
SENATE BILL NO. 306
"An Act relating to the practice of naturopathic medicine; and
providing for an effective date."
SCHEDULED BUT NOT REFERRED
PREVIOUS COMMITTEE ACTION
BILL: HB 434
SHORT TITLE: NATUROPATHIC MEDICINE
SPONSOR(S): REPRESENTATIVE(S) HOLM
02/04/04 (H) READ THE FIRST TIME - REFERRALS
02/04/04 (H) L&C, JUD
02/04/04 (H) HES REFERRAL ADDED AFTER L&C
02/18/04 (H) L&C AT 3:15 PM CAPITOL 17
02/18/04 (H) Heard & Held <Assigned to Subcmte>
02/18/04 (H) MINUTE(L&C)
03/03/04 (H) L&C AT 3:15 PM CAPITOL 17
03/03/04 (H) <Bill Hearing Postponed>
03/24/04 (H) L&C AT 3:15 PM CAPITOL 17
03/24/04 (H) Moved CSHB 434(L&C) Out of Committee
03/24/04 (H) MINUTE(L&C)
03/29/04 (H) L&C RPT CS(L&C) 2DP 2NR 3AM
03/29/04 (H) DP: CRAWFORD, GUTTENBERG; NR: LYNN,
03/29/04 (H) DAHLSTROM; AM: GATTO, ROKEBERG,
03/29/04 (H) ANDERSON
04/13/04 (H) HES AT 2:00 PM CAPITOL 106
04/13/04 (H) Heard & Held
04/13/04 (H) MINUTE(HES)
04/27/04 (H) HES AT 3:00 PM CAPITOL 106
04/27/04 (H) Heard & Held
04/27/04 (H) MINUTE(HES)
05/04/04 (H) HES AT 2:30 PM CAPITOL 106
05/04/04 (H) Scheduled But Not Heard
05/06/04 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JASON HARMON, N.D.
Alaska Association of Naturopaths
Anchorage, Alaska
POSITION STATEMENT: Testified on HB 434 and answered questions
from the members.
Robert Urata, M.D.
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 434 and
answered question from the committee.
SHARON FISCHER, M.D.,
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 434 and
answered questions from the members.
JOY DO NEYHART, M.D.
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 434 and
answered questions from the committee.
KIM POOLE, Registered Pharmacist
Juneau, Alaska
POSITION STATEMENT: Testified on HB 434, and answered questions
from the members.
KATHERINE GRIESEL, Advanced Nurse Practitioner
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
DONALD LEHMANN, M.D.
Sitka, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
JOHN TROXEL, M.D., Plastic Surgeon;
Member, Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 434 and
answered questions from the members.
DOUGLAS EBY, M.D., Physician Executive
South Central Foundation
Alaska Native Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified on HB 434, and answered questions
from the committee.
JOSEPH KLEJKA, M.D., Medical Director
Yukon-Kuskokwim Medical Center
Bethel, Alaska
POSITION STATEMENT: Testified on HB 434.
ELIZABETH ROLL, M.D., Medical Staff President
Yukon-Kuskokwim Health Corporation
Bethel, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
CHARLES STEINER, M.D.
Tanana Valley Clinic
Fairbanks, Alaska
POSITION STATEMENT: Testified on HB 434.
DONALD IVES, M.D.
Tanana Valley Clinic
Fairbanks, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
CLAY TRIPLEHORN, M.D.
Tanana Valley Clinic
Fairbanks, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
ROSEMARY HEWITT
Cordova, Alaska
POSITION STATEMENT: Testified in support of HB 434.
PATRICIA SENNER, Past President
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified on HB 434.
MEGAN LeMASTERS, M.D.
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
LYNN HORNBEIN, M.D.
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 434.
JANICE SHEUFELT, M.D., Medical Director
SEARHC
Juneau, Alaska
POSITION STATEMENT: Testified on HB 434.
JAMES THOMPSON, M.D., Emergency Room Physician
Bartlett Regional Hospital
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
CAROLYN BROWN, M.D.
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 434.
TIMOTHY PETERSON, M.D., Emergency Room Physician
Bartlett Regional Hospital
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 434, and
answered questions from the members.
SCOTT LUPER, N.D.
Fairbanks, Alaska
POSITION STATEMENT: Testified on HB 434 and answered questions
from the committee.
JASON HARMON, N.D.
Alaska Association of Naturopaths
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 434 and answered
questions from the members.
ALEX MALTER, M.D., President
Alaska State Medical Association
Juneau, Alaska
POSITION STATEMENT: Testified on HB 434, and answered questions
from the members.
ACTION NARRATIVE
TAPE 04-41, SIDE A
Number 0001
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:12 p.m.
Representatives Wilson, Wolf, Seaton, and Cissna were present at
the call to order. Representatives Gatto, Coghill, and Kapsner
arrived as the meeting was in progress.
CHAIR WILSON announced for the record that Representative Gatto
has joined the meeting.
HB 434-NATUROPATHIC MEDICINE
Number 0067
CHAIR WILSON announced that the only order of business would be
HOUSE BILL NO. 434, "An Act relating to the practice of
naturopathic medicine; and providing for an effective date."
She reminded the members that the committee has previously heard
this bill, but a new version will be heard today.
Number 0115
REPRESENTATIVE SEATON moved to adopt CSHB 434(HES), 23-LS1574\W,
as the working document. There being no objection, CSHB
434(HES), version W, was before the committee.
CHAIR WILSON explained that the differences between this bill
and [SB 306] are that two provisions were removed from the bill.
The provision which said that medical doctors would not be held
responsible was removed; and also, the sunset provision has been
removed from the bill. In response to an unidentified person in
the audience's question if minor surgery is still in the bill,
Chair Wilson responded that the minor surgery provision has also
been removed.
CHAIR WILSON commented that there has been some confusion
related to definitions of naturopaths versus naturopathic
physicians.
Number 0301
JASON HARMON, N.D., Alaska Association of Naturopaths, testified
on HB 434, and answered questions from the members. He
explained that currently it is unlawful to utilize the term
"physician" in a naturopath's title, so the terms naturopath or
doctor of naturopathic medicine are used. In other states where
naturopaths are licensed the term naturopathic physician is
utilized in most of those states, he said. Dr. Harmon explained
that in Seattle, Washington, where he attended school, he
graduated as a naturopathic physician. The current bill would
reflect the standards as are addressed in other states so those
who graduate with doctorate degrees would be called naturopathic
physicians, he added.
CHAIR WILSON pointed out that there are individuals who take a
course in naturopathy and hang up a shingle. What is the
difference between those folks and those who are being addressed
in this bill, she asked.
Number 0369
DR. HARMON said that he understands that there is concern for
those who do not have an undergraduate degree; who have not
attended a five-year medical school; and have not passed
Naturopathic Physicians Licensing Examination (NPLEX). The
State of Alaska requires that these exams be passed before a
doctor of naturopathy can practice. He emphasized that it has
been that way since the law was first passed 17 years ago. Dr.
Harmon commented that the Division of Occupational Licensing can
confirm what he is telling the committee. Copies of statutes
related to licensing of naturopathic doctors have also been
provided to the committee, he added.
Number 0455
CHAIR WILSON asked if HB 434 changes those statutes.
DR. HARMON replied that this bill does not change the statutes.
It clearly states that an individual would have to have
completed an undergraduate degree, graduated from a four to five
year medical university for a post-graduate degree, and then
pass the NPLEX board exams in order to apply for a [license to
practice] naturopathy in the state of Alaska.
CHAIR WILSON announced for the record that Representative
Kapsner has joined the meeting.
Number 0504
REPRESENTATIVE SEATON clarified that this bill does change the
current situation in Alaska where anyone can hang up a shingle
as a naturopath. He pointed out that if HB 434 passes doctors
of naturopathy, naturopaths, and naturopathic physicians would
be reserved terms and could only been used by those who have
gone through the Division of Occupational Licensing process.
DR. HARMON said that the current bill maintains the current
standards in statute. Since 1985 it has been unlawful to
practice naturopathy in Alaska unless the individual has gone
through an undergraduate degree, four to five year accredited
naturopathic medical school, and passed the NPLEX board exams.
He commented that he can see how the committee could be confused
because some physicians who have testified have told the
committee something different. Dr. Harmon added that that
misunderstanding could have been one of the reasons for concern
among physicians also. He acknowledged that if individuals who
where not educated at the level naturopathic doctors are, and
were asking for the ability to practice as this bill sets out,
there would be danger to the public. He said he hopes that
process clarifies that point.
Number 0649
Robert Urata, M.D., testified in opposition to HB 434, and
answered question from the committee. He told the committee
that he is a family physician and has lived and worked in Juneau
since 1984. Dr. Urata shared that he was born and raised in
Wrangell and graduated from the high school in Wrangell, a
picture of which is on the wall behind the members. A beautiful
school, he commented.
DR. URATA said he is here to testify in opposition to HB 434 and
the [SB 306] which gives naturopaths the authority to do minor
surgery and prescribe medicine. He commented that he
understands that minor surgery is no longer included in the
current version of the bill. Dr. Urata stated that he is
testifying in opposition to the bill because he believes this
will affect the safety of his fellow Alaskans.
DR. URATA shared some experiences he has had with patients here
in Juneau. One patient who had breast cancer was undergoing
chemotherapy which caused a low white blood cell count. She was
also seeing a naturopath who was not aware of that, he said.
The naturopath was giving the patient a colonic to remove her
body of toxins. These colonics forced bacteria that normally
live in the colon into her bloodstream which caused a severe
infection call sepsis. She was hospitalized several days, where
she was given IV medications to get rid of the infection. Dr.
Urata shared that he has now changed his practice and always
asks his cancer patients if he/she is seeing a naturopath,
advises patients to never take a colonic when receiving a
therapy, and advises patients not to take treatments and herbs
because of the potential for drug interaction with the
chemotherapy. It could make the chemotherapy less effective or
more toxic, Dr. Urata explained.
Number 0781
DR. URATA pointed out that it is now found that Chinese herbs
can cause liver damage. This experience reflects the
differences in ideas in how a naturopath believes the body
works, and how a medical doctor believes the body works, which
is based on medical training.
DR. URATA shared that another problem he has experienced with
safety issues is related to ineffective naturopathic treatments.
A common example is the drug Laetrile, which was a big cancer
treatment by naturopaths a few years ago. It has since been
found to be ineffective and toxic, he said. He explained that
it builds up cyanide and the result is cyanide poisoning. Dr.
Urata told the members that he believes his patient who had
stomach cancer suffered and died from cyanide poisoning. What
occurred is that the patient would stop his medical therapy to
go get Laetrile therapy, he said. Unfortunately, he died on his
way from Mexico to Alaska.
Number 0877
DR. URATA said that this example illustrates a problem with
naturopathic science. When naturopaths do research it does not
necessarily involve good scientific methods which employ double-
blind studies and also sometimes using placebos. Naturopathic
studies involve cases that have been "successful." There are no
long-term double-blind studies, so individuals know what they
getting and what they are not getting, he explained. Medical
research done by naturopaths does not follow the same rules of
medical science and he said he believes it can lead to safety
issues, he reiterated.
DR. URATA commented that naturopath's diagnosis methods are also
different. For example, naturopaths use electro-diagnosis and
hair analysis to check mineral levels [in the body]. Some of
their diagnosis methods for chronic yeast infections and toxemia
are also different. Naturopaths' theories of why diseases occur
include things like toxins in the body, so they like to do
things to clear the body of toxins, he explained. Medical
science has developed theories over the past century including
germ theory and genetic theory of diseases. Dr. Urata
acknowledged that there are also toxins so in that way medical
doctors' diagnosis may be similar to naturopathic doctors. He
summarized that medical science is different, developed over
many years of research, and treatment by a medical doctor is
different than that of a naturopath.
Number 0950
DR. URATA pointed out that medical doctors train differently
than naturopathic doctors. He stated that medical doctors are
exposed to much more rigorous training with sick patients. That
is true particularly in medical hospital and medical centers, he
said. Medical doctors do four years of pre-medical school, and
four years of medical school. In the first or second year of
medical school students are exposed to sick patients, and it
gets more intense until the student is spending 100 percent of
his/her time with sick patients in the hospital. It is then
required to do an internship and residency which now blends into
what is called a residency. The shortest residency is three
years long. Dr. Urata shared that during the residency the
doctor is taking care of patients with supervision at multiple
levels. For example, a surgeon takes at least five years of
this intensive training, he commented. He told the members that
he did three years of intensive training to become a family
physician. In Alaska medical doctors are required to have two
years of an internship in order to get a license to practice
medicine, to do minor surgery, and prescribe medications, Dr.
Urata said.
Number 1053
DR. URATA reiterated that naturopath and medical physicians
approach the human body in different ways. Naturopaths have
different theories of diseases, treatments, and diagnosis.
Physicians have their own which has been developed over many
years in a very scientific way, he emphasized. Dr. Urata
commented that it is puzzling to him that naturopaths want to
expand their scope of practice to include medications without
the same education and training that physicians are required to
have. In addition, he said he believes that naturopaths who
wish to expand their scope of practice need to accept medical
science's point of view and approach to prescribe medications,
treatments, and diagnosis. Dr. Urata stated that if that is not
the case it is his opinion that it would not be safe. He said
he believes it would work better for naturopaths to stay in
their own arena and worked cooperatively with physicians rather
than copying them.
DR. URATA pointed out that there is a model of that happening
today. The University of Washington Cancer Center has hired a
naturopath who works on staff and who does research on a lot of
the naturopathic medications. It is important to have a good
understanding of what these medications do, what the side
effects are, and what the drug interaction might be with
medications that are prescribed. Dr. Urata said that he
believes that may be the direction of the future; however, he
does not support giving naturopaths the power to prescribe
medications and collaborate at this point. It is too early in
the development of these two different specialties. Dr. Urata
stated that he does not believe it is right to force the issue
because he believes it is unsafe.
Number 1158
REPRESENTATIVE WOLF asked if it is normal practice to ask
patients if they are taking anything for an illness.
DR. URATA asked if he is referring to the example he posed with
the breast cancer patient.
REPRESENTATIVE WOLF noted that the patient did not inform him of
her actions.
DR. URATA replied that is correct, she did not inform him and he
did not ask.
REPRESENTATIVE WOLF asked if it is fair to blame the naturopath.
DR. URATA questioned that his example was blaming the
naturopath. He said he wonders if the naturopath knew that he
was giving her chemotherapy. Dr. Urata emphasized that he was
not blaming the naturopath. He said he believes naturopaths
have a role in caring for patients, just as he accepts that
chiropractors can help people with back pain.
DR. URATA stated that if everyone sticks to what they know,
everyone should be safe. By mixing and matching areas of
expertise, philosophy, and culture there will be trouble. He
stated that he does not give Chinese herbs or colonics to his
patients because he does not understand those practices. By the
same token, why would a naturopath want to prescribe penicillin
to patients, he asked. If a naturopath wants to prescribe
medication then they should be required to have the same
training that medical doctors go through, which is seven years
of education and training after college. He commented that this
does not make sense to him.
DR. URATA said that he would be happy to work with naturopaths,
but does not want to work in a collaborative arrangement as is
provided in [SB 306].
Number 1304
REPRESENTATIVE SEATON pointed out that surgery is no longer
included in this bill and that drugs must be prescribed in
collaboration with a medical doctor. He acknowledged that Dr.
Urata does not want to work in a collaborative arrangement with
naturopaths, but asked if he wishes to prohibit other physicians
who might wish to have this kind of arrangement.
Number 1337
DR. URATA replied that there is no model for that kind of
arrangement, and would not want to see it become legal until it
is determined that it would work well. He acknowledge that it
may be happening in other states, but it would be an experiment
in Alaska. He offered that doctors have collaboration with
nurses, nurse practitioners, and physician's assistants, but
those people are trained very similarly to the way a medical
doctor is trained. There understanding of how the body works is
very similar, he commented. For example, if a naturopath
determined that a patient has strep throat, he would not be sure
how it was diagnosed. Dr. Urata said he would have to work with
a naturopath and understand how he/she works and develop a
trust, but is not ready for that now.
REPRESENTATIVE SEATON pointed out that this legislation has no
requirement that any physician would have to enter into a
collaborative agreement. He said he does not understand one
physician saying he does not trust another physician to exercise
his/her responsibility in forming that kind of collaborative
relationship.
DR. URATA said he understands what Representative Seaton is
saying. He told the members that he cannot answer for other
doctors because he has never asked other physicians about that
point. Dr. Urata emphasized that he is speaking for himself in
answering these questions.
Number 1431
REPRESENTATIVE CISSNA asked for more information about the model
at the University of Washington Cancer Center.
DR. URATA replied that he does not know how it is being done.
He told the members that an oncologists and naturopath came to
Alaska and gave a lecture on upgrading cancer therapy. He said
he has not heard anything since and is not even sure if the
naturopath is still there. Dr. Urata said he is very curious to
see how it goes as it could be the wave of the future.
REPRESENTATIVE GATTO asked if he practices at Bartlett Regional
Hospital.
DR. URATA responded yes, that's correct.
REPRESENTATIVE GATTO asked if he also has his own office.
DR. URATA said yes.
Number 1486
REPRESENTATIVE GATTO asked if he has a nurse practitioner and
physician's assistant who operate within earshot of him.
DR. URATA said yes.
REPRESENTATIVE GATTO surmised that it is no problem for the
nurse practitioner and the physician's assistant to get an
approval to write a prescription because they are within earshot
of him. He asked if he understands correctly that this bill
would permit a naturopath to be at a separate location and
request approval for a prescription. Representative Gatto
questioned if that is the source of Dr. Urata's problem with the
bill.
DR. URATA acknowledged that distance may play a role, but in
Alaska where there are a lot of rural areas, and there are many
nurse practitioners practicing in rural areas without a
physician onsite. A physician is a phone call away, and by law
chart reviews are required to ensure that the standard of care
is maintained. The relationship between a medical doctor and a
naturopathic doctor is so far apart because the sciences are
different, that he believes it would be difficult to have a good
healthy collaborative relationship. Dr. Urata told the
committee that if the work at the University of Washington works
and other states' collaborative agreements work, then in the
future this may be a good idea. At this point he said he does
not believe it is safe to do this.
Number 1624
CHAIR WILSON announced that due to time constraints she would be
limiting testimony to three minutes.
SHARON FISCHER, M.D., testified in opposition to HB 434 and
answered questions from the members. She told the members that
her testimony would focus on the patient safety issue with
respect to prescription medications. Dr. Fischer said as a
physician she is aware that prescribing medications is a complex
task. Most have read about the incidents of medication errors
and the potential consequences of these errors which include
things like allergic reaction and in some cases death. If that
happens when medications are prescribed by people who are
extensively trained in prescription medications then those who
are not as well trained are even more likely to make those sorts
of errors, she added. Dr. Fischer shared that what she believes
makes a good physician, whether a naturopathic physician or
medical doctor, is appreciating his/her limitations,
understanding the scope of his/her practice, and understanding
when something is outside of that scope. She said she thinks
that prescription of medications is outside the scope of
practice of naturopathic physicians, and therefore, the ability
to prescribe should not be granted to them because it is too
much of a safety issue.
Number 1720
REPRESENTATIVE SEATON commented that while Dr. Fischer may not
want to have a collaborative relationship with a naturopath, if
a physician was comfortable with that collaborative relationship
how would it be different from that of a nurse practitioner or
physician's assistant [prescribing medications].
DR. FISCHER clarified that a nurse practitioner does not have to
have a collaborative agreement with a physician in the state of
Alaska; however, a physician's assistant does. She shared that
she has been in a collaborative agreement with a physician's
assistant and said it is difficult to provide the oversight
because of distance and weather. A lot will happen because
often it is not possible to give oversight for every
prescription that is written. It would be less of a concern if
the collaborative agreement were with someone in the same
office, she said.
REPRESENTATIVE SEATON asked if a collaborative agreement works
with a physician and a physician's assistant that are not in the
same locality, why wouldn't it work between a naturopathic
physician and a medical doctor. Perhaps, all collaborative
agreements between doctors and physician's assistants should
also be prohibited, he commented.
DR. FISCHER responded that she believes it is the scope of
practice that is the issue. It is fully within the scope of
practice for a physician's assistant to learn about prescribing
medications, infections, blood pressure, etc., but that is not
within the scope of practice for a naturopathic physician. She
emphasized that is not what naturopaths learn in school. The
training in pharmacology is more extensive than that of a
naturopathic physician. Naturopath school's focus is on natural
healing techniques, not prescription of medicines, Dr. Fischer
commented.
REPRESENTATIVE SEATON asked if it is true that it is the
physician's oversight that allows that prescriptive ability for
physician's assistants.
Number 1844
DR. FISCHER replied that is correct. She said she would argue
that is okay because the physician's assistant is trained to
prescribe medicine.
Number 1853
REPRESENTATIVE KAPSNER asked how different is the naturopath's
education. It is not like someone who is educated as an
engineer or someone with completely different educational
background prescribing medicine. She pointed out that medical
doctors not only collaborate with physician's assistants in
Alaska, but also with health aides. In Rural Alaska if a
community has a health aide it is fortunate. She said she knows
health aides are provided with huge algorithms and questioned
whether medical doctors would be required to create algorithms
for naturopaths if this legislation were to pass.
DR. FISCHER said she believes that is what would happen if she
understands the bill correctly. In response to an affirmative
answer by an unidentified person, Dr. Fisher suggested that some
of her colleagues might be better able to address some of these
questions.
Number 1945
JOY DO NEYHART, M.D., testified in opposition to HB 434 and
answered questions from the committee. She told the members
that she is a pediatrician in Juneau and agrees with her
colleagues that have testified in opposition to HB 434. She
said she is concerned that expanding the scope of practice for
these health care practitioners, whom are less educated and
trained, would not enhance patient care, but could very well be
unsafe for those seeking health care from naturopaths. To be
able to safely and effectively prescribe pharmaceutical
substances it is essential to be trained in the diagnosis and
treatment of diseases. Dr. Neyhart told the members that she
found in her review of several curriculum of schools that
educate individuals to become naturopaths only one school listed
pharmacology as a course offering. She read a definition of
naturopathy that was published by one of the colleges as
follows:
Naturopathy is a system of therapy that employs
natural forces such as light, heat, air, water, and
massage. This system differs most significantly from
allopathy by focusing on building health rather than
treating disease. The techniques used are noninvasive
and may include foods, herbs, fasting, nutritional
supplements, bodywork, hydrotherapy, forms of
exercise, body movement and/or meditation.
DR. NEYHART said that given that definition, prescribing
pharmaceutical substances is beyond the scope of practice of
naturopathy. As a physician who has earned, through seven years
of education and training, the privilege to diagnose and
appropriately treat patients who choose me as their health care
provider, she urged the members not to approve this legislation.
REPRESENTATIVE GATTO asked if Dr. Neyhart would oppose any of
the remedies that she quoted in the definition of naturopathy.
DR. NEYHART replied no.
REPRESENTATIVE GATTO asked if she would choose to incorporate
them in her own practice.
DR. NEYHART responded that if she chose to learn about them she
could incorporate them in her practice.
Number 2066
KIM POOLE, Registered Pharmacist, testified on HB 434, and
answered questions from the members. She told the members that
she has a lot to lose no matter how this bill goes.
Economically to allow naturopathic physicians to prescribe would
boost business. She commented that there is a bill to take away
the privilege of collaborative agreements with pharmacists. Ms.
Poole said she has a problem with one group being given the
privilege of having a collaborative practice, while her own
profession is being called into question. She acknowledged that
she believes naturopathic and allopathic medications are not
mutually exclusive, but not mutually inclusive either. For that
reason, she opposes the bill. Ms. Poole said that drugs are
very different than herbs. Homeopathic medications are very
different than the medications that pharmacists go to school [to
learn about]. To be an entry-level pharmacists it is now
necessary to graduate with a doctor of pharmacy degree for six
years. During that time only medications and the body are
learned, not the diagnostic skills of a physician, she
explained.
MS. POOLE explained that for many years the simple practice of
homeopathy has been to take a substance and dilute it into very
small portions to get the body to heal itself. Medications that
pharmacists prescribe do not work like that and many are very
toxic and dangerous. She told the members that physicians make
errors in prescribing as well. Ms. Poole said that she does not
believe the training in homeopathic field is to the level where
safety of the public can be assured and for that reason she
opposes HB 434. She told the members that she agrees with Dr.
Urata's statement that the future may be in collaborative work
with naturopaths, but not yet. In summary she said she would
not feel comfortable filling a prescription that comes from a
homeopathic physician.
Number 2179
REPRESENTATIVE GATTO asked if pharmacists have an option to
refuse to fill a prescription if the doctor is not someone the
pharmacist is comfortable with.
MS. POOLE replied yes. If a prescription is presented that a
pharmacists does not feel is good, it will not be filled. She
told the members that she has refused to fill prescriptions from
a licensed provider in Alaska.
REPRESENTATIVE GATTO asked Ms. Poole what she says to the
patient.
MS. POOLE responded that she tells the patient that it is her
opinion that the prescription would be dangerous for his/her
best interest. She said she would explain that she needs to
talk with the prescribing physician. The patient is free to go
elsewhere to get the prescription filled, however.
REPRESENTATIVE GATTO asked where she works.
MS. POOLE responded that she works in the city of Juneau.
Number 2221
REPRESENTATIVE SEATON clarified that this bill requires
collaboration with an M.D. and N.D. He asked Ms. Poole if a
prescription comes to her from a health aide or physician's
assistant who works with the oversight of a medial doctor, does
she view the prescription in the same way. Representative
Seaton asked if she would have philosophical problem with that.
MS. POOLE replied that she would have both a philosophic and
ethical problem with it. However, she agreed that the only way
to provide health care for all Alaskans is to move to
collaborative orders for many of the health fields. She pointed
out that Alaska is too small a state, without a medical school,
dental school, pharmacy school, or law school. There needs to
be trained professionals in Bethel, Wrangell, Gustavus, and
Petersburg. It is almost impossible to sustain a medical
practice in those areas, she said. Ms. Poole told the members
that if there is a health professional who wishes to dedicate
his/her time to a community it is important to allow him/her to
do that. She asked the members not to rush this through. Ms.
Poole suggested next year the bill be reintroduced and more work
could be done. In that case, she might speak differently, she
summarized.
Number 2310
KATHERINE GRIESEL, Advanced Nurse Practitioner, testified in
opposition to HB 434. She reiterated some statements by earlier
speakers by saying that she is concerned that naturopaths are
not trained in the use of conventional pharmaceuticals. It is
important for the committee to be aware that there is a
difference between a collaborative relationship and supervisory
relationship, she commented. A collaborative relationship is
much looser. The bill refers to a review at six months, then
once a year, she said. This is much loser that what a health
aide has with a supervising physician in a medical center such
as Anchorage. For example, a health aide at Fort Wainwright
will speak with the supervising physician on a daily basis so
all his/her actions are closely monitored, she said.
TAPE 04-41, SIDE B
MS. GRIESEL summarized that there are only four states in the
country that allow naturopaths to prescribe controlled
substances. Three of those four states significantly limit
which those controlled substances are, she said. Ms. Griesel
told the members that Arizona allows naturopaths to widely
prescribe drugs and has a regulatory oversight board in place.
If this bill is passed she urged the members to create a
regulatory board.
Number 2278
DONALD LEHMANN, M.D., testified in opposition to HB 434. He
told the committee that he has practiced in sports medicine in
Fairbanks, Bethel, and Sitka. He said he believes HB 434 is
unnecessary, unsafe, and not in the best interest of the welfare
of Alaskans. Naturopaths prescribe herbs, and do not have the
training necessary to do what medical doctors do, nor should the
legislature give it to them. He said he has listened to the
discussions concerning collaborative relationships physicians
have with nurse practitioners, physician's assistants, and
health aides. It is important to note that these health care
professionals are all singing off the same page.
DR. LEHMANN commented that naturopaths have said that a four-
year undergraduate degree is required for admission into a
naturopathic college; however, the facts speak otherwise. He
told the members that his nephew is currently a first year
student in naturopathy at Bastyr University in Seattle. That is
one of the premier naturopathic schools in the country. His
nephew was accepted without a four-year degree, he said.
DR. LEHMANN told the members that his medical training has
reinforced his belief in science and the scientific methods and
the value of double blind studies. Naturopathy relies on
antidotal reports. If naturopaths wish to prescribe drugs or
perform surgery then he believes they should be required to go
to medical school.
DR. LEHMANN summarized that it does not make sense to have a
collaborative relationship with naturopaths because their
training is so different than physician's assistants and nurse
practitioners.
Number 2188
JOHN TROXEL, M.D., Plastic Surgeon; Member, Alaska State Medical
Board, testified in opposition to HB 434 and answered questions
from the members. He told the members that the Alaska State
Medical Board discussed HB 434 and sent a letter to the governor
in which its position on the bill was presented. It is the
Alaska State Medical Board's position not to support this bill
because of the training of naturopaths. He said that
naturopaths are trained to rid the body of toxins and the use of
natural medicines.
DR. TROXEL commented that since he is a surgeon he was most
interested in that element of the bill. He told the members
that he called [Bastyr University] in Seattle, one of the
largest naturopathic medicine schools in the country, and found
that neither its students nor residents are trained in any type
of surgical procedures.
CHAIR WILSON advised Dr. Troxel that there is a committee
substitute before the committee which has removed the minor
surgical provision.
DR. TROXEL said that the last he heard there was discussion
about collaborative agreements with physicians and asked if the
prescriptive authority is the basic issue of the bill in its
current form.
CHAIR WILSON replied that is correct.
Number 2055
REPRESENTATIVE SEATON explained that the current bill requires
an ongoing collaborative agreement, not one that is for a short
period of time, between medical doctors and doctors of
naturopathy. The bill also includes a requirement for a
formulary to be part of that collaborative agreement. There is
also a requirement that the agreement be in writing with the
extent of supervision required by the physician delineated.
Representative Seaton clarified that no physician is required to
enter into this kind of agreement. With those requirements in
place, he asked if he trusts physicians to enter into this kind
of agreement and protect themselves with respect to the
supervisory function that would be incurred.
DR. TROXEL commented that his sense is that the board would
probably still be opposed to collaborative agreements with
naturopaths. Speaking only for himself he said if he had been
asked this question a year ago he would have considered the
request pretty reasonable. In the physician community there 95
percent of the medical doctors are in mainstream thinking;
however, there probably are about 5 percent of medical doctors
that are outside the mainstream. Dr. Troxel acknowledged that
there probably are doctors who would enter into these
collaborative agreements, but he said he is not convinced that
the collaborative agreement would guarantee that good medicine
would be practiced.
REPRESENTATIVE SEATON surmised that what Dr. Troxel is saying is
that if there are doctors that cannot be trusted, then the
collaborative agreements cannot be trusted either.
DR. TROXEL responded that it is a difficult question to answer.
He emphasized that he is not saying there are a lot of bad
doctors out there, there are not. He explained that there could
be one physician who would enter into a collaborative agreement
who is not in that mainstream. There is a risk with any
collaborative agreement, Dr. Troxel said.
Number 1873
DOUGLAS EBY, M.D., Physician Executive, South Central
Foundation, Alaska Native Medical Center, testified on HB 434,
and answered questions from the committee. He explained that
part of the reason the foundation has a lot of interest is
because it has worked on a great deal of integrated health care
service delivery. The Alaska Native Medical Center now employs
allopath, osteopaths, chiropractors, massage therapists,
acupuncturists, and Native traditional healers. Naturopaths are
also employed under contract as the center explores how
naturopathy might fit into the health care delivery system. He
read the following statement into the record:
The Southcentral Foundation is very interested in the
integration of allopathic and other health
professionals as much as possible. To this point we
have integrated allopath, osteopath, chiropractic,
massage therapy, acupuncture, and Native traditional
healers. We employ naturopaths to incorporate their
skills and knowledge into the system. We feel they do
add to the additional value to spectrum of services we
offer, but the details we are still working out. With
the question regarding prescriptive authority, which
is currently under discussion and debate, we at
present, do not have a position. We think it is an
important conversation and one that we are very
interested in being part of. However, we do not have
a position yet and at present we do not feel that we
will be able to arrive at one in the immediate future.
Our request would be that we opt for any decision
particularly around prescriptive authority be delayed
for a number of months to allow for a more thorough
evaluation of the various possible options, and for
the medical community and the community at large to be
able to give more informed input and have the time and
opportunity to have an informed debate. We look
forward to continue to participate in this process.
DR. ELY summarized that Alaska Native Medical Center is very
supportive of integrated health care. The center is becoming
recognized as one of the national leaders in funding integrated
health care. He said that prescriptive authority is not an
issue the center has addressed and said that he believes there
needs to be more time to deal with this in an informed manner.
Number 1713
CHAIR WILSON asked Dr. Ely to comment on the naturopaths that
have recently been hired at the Alaska Native Medical Center.
DR. ELY replied that two naturopaths have recently been hired.
One has been there for six months, and it has been a slow
process to determine how the naturopath might fit into the
system effectively. There has been a significant shift in the
way the center is operating. There is a more systematic
approach to cost effective decisions and quality health care, he
added.
REPRESENTATIVE SEATON asked if he has a copy of the most current
version of the bill that removes the minor surgery provision and
also provides for an on-going collaborative relationship between
medical doctors and naturopaths, established formulary, and the
extent of supervision delineated in writing. He asked if those
provisions were what he was testifying on or only the
prescriptive authority issue.
DR. ELY said that he has a copy of [SB 306], which was given to
him today and assumes it is the most current version. He
commented that more oversight is always a good idea for any
profession. It is the prescriptive piece that needs more time
and processing before an informed decision can be made by all
the people weighing in on the conversation. He said that he
does applaud having a physician involved in the oversight, but
it is very broad prescriptive authority.
REPRESENTATIVE KAPSNER asked Dr. Ely to tell her how many of the
professions prescribe medicine at this point.
DR. ELY responded that only the allopathic and osteopathic
doctors prescribe medicines. He told the members that there is
a credentialing and privileging process by which the medical
center controls the scope of practice within the system.
Number 1518
JOSEPH KLEJKA, M.D., Medical Director, Yukon-Kuskokwim Health
Corporation, testified on HB 434. He told the members that
their main concern is about prescriptive authority. It is
important that more thought go into this issue. Dr. Klejka said
serious problems could occur. He explained that health aides
are trained by physicians to think as they do. Health aides
work under very specific algorithms which spells out exactly
what can and cannot be done; if there is any variation, then the
health aide must speak with the physician. The health aides do
speak with the physician every day, he commented. Dr. Klejka
said he would be very cautious about providing prescriptive
authority to naturopaths.
Number 1447
ELIZABETH ROLL, M.D., Medical Staff President, Yukon-Kuskokwim
Health Corporation, testified in opposition to HB 434. She said
she is concerned about providing prescriptive authority to
naturopaths at this time. When reviewing education received by
naturopaths it does appear that they do not receive much
pharmacology training. There could be serious side effects by
prescribing the wrong medication. Dr. Roll encouraged the
members not to vote in favor of this bill.
REPRESENTATIVE KAPSNER asked if she could provide copies of the
e-mails sent her from Dr. Roll and Dr. Klejka. In response to
their affirmative response she thanked them.
CHARLES STEINER, M.D., Tanana Valley Clinic, testified in
opposition to HB 434. He told the members that there are three
doctors at the clinic who would like to testify. He told the
members that they share the same main point and that is that
naturopaths do not have the same training as medical doctors.
It is a public health issue because the opportunity for
misadventure are huge, simply out of ignorance. Dr. Steiner
summarized that he has not seen or heard of anything with
respect to training of naturopaths that would convince him that
they are capable of managing medications safely or effectively.
He urged the members not to support HB 434.
Number 1325
DONALD IVES, M.D., Tanana Valley Clinic, testified in opposition
to HB 434. He told the members that his main concern with the
bill is related to public health. Once prescriptive authority
is open there is the ability to do great harm. Dr. Ives shared
that he has personally cared for patients who have been under
naturopathic care for hypertension that was poorly controlled
and not referred properly. Some of these patients had kidney
failure. He encouraged the members not to support HB 434.
Number 1231
CLAY TRIPLEHORN, M.D., Tanana Valley Clinic, testified in
opposition to HB 434. He told the members he opposes HB 434 for
two reasons. The current bill is similar to one written in the
state of Arizona in which there was a board of naturopaths
providing oversight for themselves. Dr. Triplehorn explained
that what happened is that naturopathic physicians actually
increased the scope of their care without notifying the
legislature to get authorization to do so. There were some
disastrous consequences of this. Subsequently the state of
Arizona had to significantly modify the scope of practice for
the naturopaths. Dr. Triplehorn told the members that this
report could be viewed on the Internet. It is the [State of
Arizona, Office of the Auditor General, Naturopathic Physicians
Board of Medical Examiners (June 2000, Report No. 00-9)], which
requires naturopaths to have direct observation with a
collaborating physician and substantially increases the amount
of therapeutic training that naturopaths receive, he said.
DR. TRIPLEHORN said he is also concerned with statements made by
naturopaths that their training is equivalent or adequate. He
said he would dispute that statement. The state of
Massachusetts actually reviewed naturopaths training in the
United States and the findings were that naturopathic physicians
only received about two-thirds the amount of material that is
provided to traditionally trained osteopaths or allopathic
students. As a result the state of Massachusetts declined to
allow naturopathic physicians to prescribe medication. Dr.
Triplehorn said he agrees with the comments made by the family
practice physician who spoke earlier. Dr. Triplehorn asked the
members to look at the experience of other states, as he
believes they will find that Alaska would be unusual to allow
naturopaths to practice in the state of Alaska with prescriptive
rights. He encouraged the members to look at naturopathic
training, as he believes it is substantially less than what is
being represented.
Number 0942
ROSEMARY HEWITT, testified in support of HB 434, version W. She
questioned why physician's assistants can write prescriptions
without adequate supervision and naturopaths cannot.
Number 0893
PATRICIA SENNER, Past President, Alaska Nurses Association,
testified on HB 434. She told the members that the association
agrees with Dr. Eby's comments that it is important to be
deliberate and systematic in approaching this issue. The nurses
association believes there are four criteria that the
legislature should apply to all instances. First, the basic
education that the health care provider receives should be from
an accredited institution and cover the areas that the providers
are allowed to practice. Second, the licensure/certification
exams that the health care providers must pass are conducted by
a reputable entity and cover the area in which the provider
wishes to practice. Third, the provider should be engaged in
continuing education to ensure continued competency. Fourth, a
regulatory board should be established which oversees the
profession and ensures that complaints by the public are
addressed and that individual providers can seek advice
concerning the change in scope of his/her practice.
Number 0813
MS. HEWITT told the members that she has some concerns regarding
the way the collaborative model is set out in this bill. Under
this bill the individual physician that is supervising the
naturopath could decide which medication the naturopath could
prescribe. She questioned how the pharmacists is suppose to
know what those limitations are. It may be a nightmare for
pharmacists in determining what the individual's scope is, Ms.
Hewitt added.
MS. HEWITT shared that another concern is that the board of
three naturopaths will overseeing their own profession. She
said that the association believes there should always be room
for the consumer to be involved in regulating health care
professions. Since physicians have a significant role in all of
this she suggested that perhaps the oversight should go under
the Alaska State Medical Board.
MS. HEWITT summarized that she believes the legislature should
take its time on this; address some of these issues by involving
other health care professionals, and come back with a committee
substitute that protects the public next year.
Number 0740
MEGAN LeMASTERS, M.D., testified in opposition to HB 434. She
told the members that the training received by medical doctors
in the field of pharmacology is a 27-credit course which is
completed over the course of a year. There is nothing in any
naturopathic school that comes close to that level of training,
she said. This does not even address the additional training
medical doctors received in residency. Naturopaths have no
residency training, only clinical trials that they receive
during their four years of medical school. She agreed that
naturopathic medical schools are similar to medical school for
M.D.s. Dr. LeMasters shared that she believes there is a role
for naturopaths and was the president of the integrated medicine
society at the medical school she attended.
DR. LeMASTERS acknowledged that Alaska has a very unique
situation with PAs being offsite in remote situations. She said
that actually only about 10 percent of what PAs do is overseen
by a physician. When physicians come to review the paperwork it
is usually a quarterly visit to look at a select group of
charts. Due to the limitations in care in Alaska it has to be
done this way, she said. If the question is no care versus some
care it is better to have a provider with some training, Dr.
LeMasters stated.
DR. LeMASTERS summarized her comments by saying that to spread
that collaboration even thinner than it is now would jeopardize
the safety of the public.
Number 0570
LYNN HORNBEIN, M.D., testified in support of HB 434. She read
the following statement into the record:
I am a board certified family physician and have been
practicing mainstream medicine in Anchorage for about
14 years. Over the last three to four years I have
gotten to know some of the naturopathic physicians in
Anchorage and Eagle River, and consider them
colleagues in the care of some of our mutual patients.
I gather that some of my allopathic colleagues think
that naturopathic physicians don't have any formal
training or maybe got their training through the mail
with a mail order degree. The doctors or naturopathic
physicians that I know are graduates of accredited
naturopathic medical schools. I'm not sure most
allopathic physicians know what the course content is
of a naturopathic medical education. Before I went to
medical school I was considering going to naturopath
medical school so I researched both of them in great
detail. My impression was that the training in the
first two years was very similar. There were courses
in radiology, lab medicine, and pharmacology. The
second two years was similar in that there were few
chances to have hands-on experiences with patients.
My training was spent a lot of time in the hospital.
As I understand it naturopaths do all of their
training in an out patient setting. You are probably
wondering why didn't I go to naturopathic school. I
decided to attend allopathic medical school at the
University of Washington so I could pursue a masters
in public health at the same time.
Number 0486
Other committees have heard the testimony of Dr.
Jensen who has been involved in the training of
osteopathic, allopathic, and naturopathic physicians
for many years. I heard him speak to the Senate
Finance Committee and he pointed out that the
pharmacology courses that are taught in naturopathic
medical schools are taught by Ph.D.s in pharmacology.
Those are the folks that are trained in conventional
allopathic pharmacology. So it seems to me that the
basic knowledge is the same, how we use it later in
our training is what differs. I think that
naturopathic physicians are very adept at using drugs
that come from natural sources like bio-identical
hormones, antibiotics, and thyroid medications. State
regulations prevent them from prescribing them to
their patients. I know that and have been hearing
concerns that naturopathic physicians do not have as
much training as allopathic physicians, as they do not
do residency. This is true, but I am not sure that
that necessarily supports disallowing them to have
prescriptive rights. Many allopathic physicians
actually work with and employ physician's assistants
and nurse practitioners and they do not have residency
training but do have prescriptive rights. As has been
discussed P.A.s do have collaborative agreements with
M.D.s and can practice independently.
As a died-in-the-wool allopathic physician, I do
believe in the scientific process and practicing
evidence-based medicine, but naturopathic physicians I
know do also practice evidence-based medicine and they
keep up with both allopathic and alternative medical
research. They have a clear vision of their scope of
practice and know when to refer a patient for
allopathic medical care. I have heard some horror
stories about harm to patients by naturopaths. I have
also heard some horror stories about allopathic
physicians. I am not aware of any reliable evidence
based data that elucidates whether patients are harmed
more often by naturopathic physicians than allopathic
physicians or any data that suggests that naturopathic
physicians with prescriptive rights harm their
patients more frequently than do allopathic
physicians.
DR. HORNBEIN summarized her comments by saying that there are
good reasons to support HB 434 as it will provide a possibility
of oversight of naturopathic medicine and will increase more
primary care available to Alaskans. It will give naturopaths
the ability to work to the full scope of their training, she
added.
Number 0070
JANICE SHEUFELT, M.D., Medical Director, SEARHC, testified on HB
434. She told the members that she is speaking in opposition to
HB 434 only on behalf of herself. Her specific objection is the
prescriptive authority that would be given to naturopaths, she
said. Much of the discussion has been on collaborative
agreements. Dr. Sheufelt explained that she believes the level
of collaborative agreements that would ensure patient safety in
Alaska would have to be for every single prescription for any
drug. Without that level of detail of oversight there would be
a serious risk of endangering patient safety. That is clearly
not feasible.
DR. SHEUFELT summarized her comments by saying that she does not
believe naturopathic training covers a wide scope of treatments
and she does not believe there is adequate time in four years of
training to be adequately prepared to prescribe medications.
Number 0023
JAMES THOMPSON, M.D., testified in opposition to HB 434. He
told the members that he is an emergency room physician, has
worked with many health aides, and has had over 25 collaborative
agreements in the 29 years he has been here. Dr. Thompson said
he is very concerned about the prescriptive authority that is
provided for in this bill. Collaborative agreements work not by
what is written on a page, but how the practitioner has learned
how to apply it. The practitioner needs to know his/her
limitations because if they do not it does not matter what is
written on the paper, they can still make a mistake. He shared
that he was on the Alaska State Medical Board for eight years
and has seen instances where there have not be tight quality
review.
TAPE 04-42, SIDE A
DR. THOMPSON explained the process of recertification for a
physician and noted that there are naturopaths that have
practiced in Alaska for over 17 years. He pointed out if that
individual had a pharmacology class 17 years ago there is no way
that naturopath is trained to prescribe medicine today. There
needs to be some kind of mechanism which provides for an
internship with the collaborating physician to ensure that there
is competency, he suggested. He said it really does not have
anything to do with training, but really how it is applied. Dr.
Thompson summarized that he believes it is premature to
authorize prescriptive authority and should not be approved this
year.
Number 0160
CAROLYN BROWN, M.D., testified in opposition to HB 434. She
told the committee that she is a practicing gynecologist. She
came to Alaska in 1965 and has spent most of her career in
Alaska with the exception of 12 years when she taught at the
University of Vermont School of Medicine, she said. Dr. Brown
shared that she has worked with health aides, physician's
assistants, and advanced nurse practitioners, and that in her
clinical experience she has dealt in a collaborative way with a
number of naturopaths. Dr. Brown commented that most of the
naturopaths she respects highly and believes that there is a
place for naturopathy in the care of patients. She told the
committee that while she collaborated with naturopaths across
the years, she did not interfere with their herbs and botanicals
and they did not interfere in allopathic medicine. Dr. Brown
stated that she would never be comfortable collaborating with
prescriptive authority for naturopaths because they do not have
the same training that physicians have. Physicians spend a
great deal of time doing intensive inpatient care, while
naturopaths do not.
Number 0254
DR. BROWN pointed to the section of the bill related to services
excluded from coverage [page 8, lines 21 and 22] which states
that naturopaths cannot provide medical services to persons in
the custody of the Department of Corrections. She questioned if
that is not discriminatory care.
DR. BROWN commented that she sees giving naturopaths
prescriptive authority as a slippery slope and urged the members
not to approve this bill.
Number 0376
TIMOTHY PETERSON, M.D., testified in opposition to HB 434, and
answered questions from the members. He told the members that
he does not want to be redundant, but keeps hearing the
discussion about education. He shared that he has a good friend
who is a naturopathic physician and they have shared notes of
their training. The first two years of training was
indistinguishable, he said. At that point there was a
divergence, where he went into the hospital and started taking
care of sick people, and his friend went to an outpatient
setting. In comparing the training he said he assumes everyone
went to college and then there is a naturopathic medical school
or allopathic medical school, but those last two years of
medical school and three years of residency is a period of time
when medical doctors are dealing with drugs and patients on a
daily basis. During that time medical doctors become aware of
the many nuances of prescribing drugs. Once a doctor has worked
in that environment a healthy respect is developed when bad
things happen and it is necessary to respond quickly, he said.
DR. PETERSON told the members that he has had collaborative
agreements with midwives, health aides, and nurse practitioners.
Dr. Peterson pointed out that it is most important to know the
point where he/she is not sure. Representative Seaton's
questions about collaborative agreements was excellent, he said.
Any doctor that is willing can have a collaborative agreement
with another person, but the difference is that in a P.A.'s
training they work with the doctor. They learn to work side-by-
side, as opposed to being an independent entity where there is a
little bit of a philosophical disagreement about how things
should be done, he commented.
Number 0603
DR. PETERSON summarized that the latitude that is being asked
for in this legislation is huge. Since Alaska does not have a
medical school or research facilities, he does not believe this
is the place to try to develop a program like this because there
is no way to monitor what happens. Dr. Peterson said, however,
that he believes in the future it will happen.
DR. PETERSON explained for example, that there is a drug called
Celebrex that is used on a daily basis that if used with a blood
thinner can cause serious side effects. Dr. Malter has a copy
of a "PDR" that is very thick, he commented.
REPRESENTATIVE KAPSNER asked what a PDR is.
DR. PETERSON said a PDR is a physician's desk reference.
Number 0699
SCOTT LUPER, N.D., testified on HB 434 and answered questions
from the committee. He explained that what is being asked for
in HB 434 is not new. In 14 states that license naturopathic
physicians 12 of them have some sort of prescriptive rights.
Only one of the 12 states has a collaboration agreement; all the
others have independent formularies or a broad list of drugs
that can be prescribed, he added. On a personal note, he told
the committee that he was able to write prescriptions both in
Oregon and Arizona. He told the members that he only writes a
prescription once every two weeks because he tends to not use
drugs whenever possible.
Number 0759
DR. LUPER shared that in Oregon and Arizona, where naturopaths
have the broadest prescriptive rights the safety record in those
states is very good. The mark of safety in this case is the
number of disciplinary actions that have been taken against
doctors. That includes letters of reprimand all the way up to
suspended licenses. The rate in Arizona is about half of that
for N.D.s as it is for M.D.s, he stated. For M.D.s it is about
one percent and for N.D.s it is about .5 percent. In Oregon the
rate is better, the rate for M.D.s is about .5 percent and for
N.D.s .3 percent. Dr. Luper shared that the rate of complaints
nationwide is about one-third of a percent. He emphasized that
N.D.s have been using prescription medications for years safely.
The reason why prescriptions are being used safely is that
naturopaths are well trained and it is a reasonable levelheaded
profession. People who become naturopathic doctors are high
quality people with good strong backgrounds, he said.
DR. LUPER shared his own background. He said that he got a
four-year degree from Portland State University and graduated
with honors in history. He then taught school for two years,
after which he went to naturopathic school. Dr. Luper commented
that he could have gone to medical school, but resonated with
the approach of naturopathic medical school. He went on to say
that he graduated from naturopathic medical school with honors
in research. The area of research that he worked on was
hypothyroidism. He told the members that he knows a lot about
thyroid disease. In the state of Alaska when someone comes to
him with thyroid disease, he can diagnose it, but cannot
prescribe medication for it. He shared that it is frustrating
for his patients to have to go to another doctor who will run
the test and say, "oh yes, you do have thyroid disease." Dr.
Luper clarified that it is not that he wants to do everything
for everyone, it is that he wants to give the best possible care
to his patients. He said he is here testifying before the
committee because he is frustrated that he has one hand tied
behind his back. Dr. Luper told the members that he doesn't
know everything, but does know his limitations. With the
collaborative agreement, which provides more safety than any
other state with the exception of California, the patients are
well served.
DR. LUPER shared that for three years he taught at the Southwest
College of Naturopathic Medicine where he was chairman of
diagnostics. There were two M.D.s and one D.O. on staff working
with them. There were two M.D.s and one D.O. that presented
information at a recent naturopathic conference in Oregon. It
was mentioned earlier that one naturopath, Dr. Dan Labriola, is
working with oncologists in Washington state. The quality of
people and the science naturopaths bring can help to solve
problems, he said. Dr. Luper emphasize that he wants to provide
the best quality of care that he can to his patients and that is
the reason why he is asking to write prescriptions in
collaboration with medical doctors.
REPRESENTATIVE KAPSNER asked Dr. Luper if he could collaborate
on every single prescription.
DR. LUPER replied yes, but it would slow him down if he had to
call every time he wanted to do a prescription. It is possible
he acknowledged.
REPRESENTATIVE KAPSNER commented that he said earlier that he
does not like to prescribe medication and only prescribed
infrequently. The committee heard testimony that said
ultimately that would be the best-case scenario for safety
purposes.
DR. LUPER replied that he believes it would be more appropriate
to create protocols. For example, if someone tests low in
his/her thyroid, then you prescribe thyroid medication. If
someone has a bladder infection then this is the appropriate
type of antibiotic to use. He added that of course a culture
and sensitivity test would be done which would indicate the
appropriate antibiotic to use. With protocols in place Dr.
Luper said he believes it would be redundant and unnecessary to
run every prescription through an M.D. That is not to say that
if he believes he is outside of his area of expertise, then he
would call someone on the phone or refer the patient to another
doctor. Dr. Luper stated that he is trained as a primary care
physician and he knows his limitations.
Number 1052
REPRESENTATIVE KAPSNER asked Dr. Luper if he believes it is
appropriate to limit what can be prescribed or does he believe
naturopaths should be able to prescribe everything.
DR. LUPER responded that he believes it is appropriate to limit
the scope of what is prescribed. There should be a rational
system that takes into account a physician's area of expertise
or focus of their practice. He explained that he believes the
best system would be one in which the naturopathic physician and
the collaborating physician sit down and create a list of
medications that is appropriate for that particular practice.
It is important for the naturopathic physician to make a case
about wanting to use a particular kind of medication.
Number 1097
REPRESENTATIVE KAPSNER asked who would do the oversight on that
kind of list. It sounds like an administrative nightmare trying
to determine which naturopath can prescribe which medication,
she commented.
DR. LUPER suggested that the collaborative agreements be modeled
after physician's assistants agreements. He added that
naturopaths have much more education that physician's assistants
and nurse practitioners and have asked for less prescriptive
authority than any of the other profession. Dr. Luper shared
that the way he envisions it, he will send a list to the
pharmacy on what drugs he can prescribe, and then will write
prescriptions on rare occasions as he did in Arizona.
REPRESENTATIVE KAPSNER commented that Dr. John Troxel [Member,
Alaska State Medical Board] said that he would be most
comfortable if this legislation had more time to go through the
system. She explained that one of the things that concerns her
as a public policy issue is that this bill was only recently
introduced and it is difficult to push legislation like this
through in the final days of the session. Representative
Kapsner acknowledged that a lot of energy has gone into the
legislation, but asked how Dr. Luper would feel if it did not go
through this year. She suggested that it is worthy of seeing it
go through next session.
Number 1199
DR. LUPER replied that he would be disappointed. He said his
patients would also be disappointed because it would require
them to go to another doctor to get an anti-biotic or estrogen.
He said he realizes it is a process, and the original bill
requested prescription rights and then as the bill evolved more
and more was negotiated away. Dr. Luper commented that it is
now down to the thing we care about the most, the ability to
provide the best possible care for our patients. He told the
members that if he looses the ability to prescribe some
medications, then he looses the ability to help people in the
best way he knows how.
Number 1244
REPRESENTATIVE CISSNA shared that she has been through cancer
treatment this year. She said when she looks at the profession
of naturopathy she thinks of prevention; the integration of
ancient knowledge, and the way to keep people well.
Representative Cissna stated that when she thinks about disease
she wants the latest knowledge. She said she thinks the health
system integration is still in its infancy; there is a lot to
learn; and it is okay if this process goes slower.
Number 1389
DR. LUPER responded that his experience with patients is that
what works best is for him to pay attention to them, and to use
his knowledge and experience to understand the patient's
particular problems. As a naturopathic physician he focuses on
the basic foundations of health, diet, circulation or exercise,
sleep, and purpose in life. Dr. Luper said it is his abilities
to observe and understand, run lab tests, and do physical exams,
which help him to know patients and that helps him to find the
obstacles to achieving health on their own. Everyone has the
capacity to be healthy, he said, it is his job to find what is
in the way. Occasionally people need a crutch. For example, if
a person twists their ankle, he/she may need a crutch for a
while. A naturopath's job at that point is to find out what can
be done with that ankle to speed up the healing so the patient
can throw the crutch away. Medications are a crutch to used on
rare occasions to assist someone to manage the symptoms. Dr.
Luper shared that it is in that way that he wishes to use
prescriptions. It is an aide to buy time while working to find
out what the real problem is and solve the problem. He said if
it is necessary to spend time to educate everyone then he
accepts that. Dr. Luper said he believes the time is now, the
constraints in this bill ensure Alaskans are quite safe, and
patients are going to get better care. This bill is quite
appropriate today, he stated.
Number 1510
JASON HARMON, N.D., Alaska Association of Naturopaths, testified
in support of HB 434 and answered questions from the members.
He told the members that he is a fourth generation Alaskan, grew
up right up the street from the Capitol, and has two beautiful
daughters. Dr. Harmon said he understands the perspective of
his medical colleagues who are concerned for the welfare of
Alaskans. He commented that there has been a lot of testimony
against this bill, and many reasons to vote against this bill
have been put forth. He asked the members to understand that
for example, his education included an undergraduate degree,
five years of medical school at Bastyr University in Washington
with a degree in biochemistry. He told the members that he
considers himself a scientist, interested in studies, and he
does not prescribe natural remedies that do not have science
based substances. He does not do iridology or homeopathy.
There are many times when he has to require medication for
patients. Many times it is not just a case where the patient
must be referred to another doctor and it costs them more money,
it can be a life-threatening situation.
DR. HARMON commented that he has heard some testimony that says
naturopaths training is not up to par. Much of what has been
presented here today is actually incorrect, he said. He told
the committee that naturopaths are well-trained physicians. He
commented that the term "physician" cannot be used in this
state, but that is what naturopathic doctors are, he stated.
Number 1628
DR. HARMON responded to Representative Cissna's question about
the urgency in pushing this forward now. Some medical doctors
who testified acknowledged that there is future potential for
collaboration in these areas, he said. Dr. Harmon said that he
believes this bill will encourage collaboration. The medical
community does not have to move. It is a 100-year-old
establishment. Naturopaths have things to offer the medical
community through collaboration, and support. What we offer can
help their patients. Dr. Harmon told the members that he has a
practice in Anchorage and works with many M.D.s as a referral
point. He said these colleagues work as a reference point for
questions he might have and he works as a reference point for
them. This law not only protects Alaskans, but also offers
Alaskans an opportunity for health care that is a very high
standard of medicine.
DR. HARMON commented that there may be a perception that this is
being rushed through, but he suggested that it is not rushed.
For 18 years naturopaths have practiced in Alaska.
Number 1697
DR. HARMON told the members that he works collaboratively with
oncologists in Anchorage. In response to an earlier comment
that naturopaths have given Laetrile to their patients, he
stated that to his knowledge no naturopath has ever prescribed
Laetrile in this state. However, it has been prescribed by
medical doctors. He said he has no intention of using a drug
that is in the realm of an oncologists. He said his role is to
support those patients in any way he can.
DR. HARMON shared one point that had not been mentioned about
naturopaths' training. He told the members that naturopaths
have externships of 1,000 hours. Dr. Harmon urged the committee
to support this bill. It will bring the medical community
together through the collaborative provision, he emphasized.
Number 1803
REPRESENTATIVE GATTO commented that he is sure that Dr. Harmon
has heard the axiom "do no harm.". He commented that Dr. Harmon
said that patients would be unsafe if the bill does not pass.
Representative Gatto stated that he does not believe that is
true. At another hearing Dr. Harmon referred to himself as a
naturopathic physician and he called him on that at the time.
That is a violation of a statute. Representative Gatto told the
committee that these issues concern him because he gets the
impression that Dr. Harmon wants something and wants it now.
Representative Gatto said he does not believe that a four-hour
conversation with naturopathic doctors and a 30-minute
conversation with medical doctors that a case has been made that
he could support. In the example of a patient with pneumonia it
seems it would be easy to send the patient to the emergency room
or a medical doctor. If naturopaths are only writing a
prescriptions once in two weeks this is not an impediment to
their ability to practice medicine, he said.
DR. HARMON responded that he does not recall saying that
patients would be "unsafe" and if he did, he misspoke. He posed
a hypothetical example that it could be unsafe for a patient in
a rural setting that had pneumonia, and he had the ability to
prescribe a drug for that patient, but was unable to do so, that
would be unsafe for that patient. Dr. Harmon pointed out that
it depends on the setting. He acknowledge that he has the
luxury in Anchorage to do exactly what Representative Gatto
suggests which is to send patients to the emergency room. In
fact, that is exactly what he currently does. There are cases
in rural Alaska where that is not an option, he commented. Dr.
Harmon said that he does not see himself as a "cowboy." The
nature of naturopaths' medicine is to first do no harm, but also
to choose the least invasive therapy. He emphasized that if he
has the option of using something that is noninvasive he would
use that first.
Number 1986
ALEX MALTER, M.D., President, Alaska State Medical Association,
testified on HB 434, and answered questions from the members.
He commented that he has already testified on HB 434 and does
not want to reiterate that testimony. He shared that the
medical doctors do not want to be disrespectful to the
naturopaths, most respect them very much, and think that they do
a very good job in their scope of practice. The concern is
centered on the belief that the proposed expansion of the scope
of practice by naturopaths into a sophisticated area is not
merited because M.D.s do not believe naturopaths have adequate
training.
DR. MALTER shared that he was on faculty at the School of Public
Health at the University of Washington before he came to Alaska.
He added that he has an M.Ph. as well as an M.D. At one point
he brought in the president of Bastyr University to give two or
three lectures to a course he was teaching to second year
medical students so there could be a clearer idea in how medical
doctors and naturopaths could interact. He said he believes
that most M.D.s are comfortable with naturopaths. Infact, he
said he felt comfortable enough to bring them into the class to
help raise awareness. Dr. Malter explained that the medical
community is still uncomfortable with naturopaths broadening
their scope of practice. He said he heard that there was some
discussion about limiting prescriptive ability to simply allow
anti-biotics and hormones. Dr. Malter stated that he would also
be opposed to that. Even though it may seem simplistic to
prescribe anti-biotics it really can be a complicated decision
in many cases.
DR. MALTER referred to Dr. Luper's statement about prescribing
anti-biotics for a urinary tract infection and that culture and
sensitivity [tests] should be done, and explained that current
guidelines from the American College of Physicians say no
culture and sensitivity tests for folks who have urinary tract
infections should be done. He said he does not mean to imply
that it is criminal to do them after prescribing the anti-
biotic, his only point in mentioning this is that in general
M.D.s do not do culture and sensitivity [tests] to further
define the type of infection it is. He shared another example
of a misstatement and said the important thing to note is that
M.D.s' approach to medicine is based on science.
DR. MALTER commented on Dr. Harmon's statement that he went to
five years of medical school at Bastyr University. The
University of Washington is a medical school; Oregon Health
Sciences University, where he went to college, is a medical
school; the University of Colorado, Health Sciences Center,
where he did his internship and residency, is a medical school,
Bastyr University is a naturopathic school, Dr. Malter stated.
He cautioned that it is slippery slope when referring to Bastyr
University as a medical school.
Number 2124
REPRESENTATIVE GATTO asked in the case of a patient who came to
the office and was diagnosed with hypothyroidism, would he
simply prescribe medication, or try to determine how that
condition came about. Would his approach be different than that
of a naturopath, he asked.
DR. MALTER responded that most of the well-trained naturopaths
would order similar tests that he would order, and ultimately
make the same decisions that he would make. He explained that
some of the decisions are not that complex. However, he said
Dr. Peterson alluded to something important to note in his
testimony, and that is if a doctor has not seen some of the
disasters that can happen when prescribing incorrectly, as a
M.D. would see during residency, then it is possible to be a
little cavalier in the use of medications. Residency training
helps M.D.s be better physicians, he emphasized.
Number 2170
REPRESENTATIVE SEATON referred to materials that Dr. Malter gave
to the committee on training received in a variety of medical
schools in which there was poor training of naturopaths. He
asked if Dr. Malter wants to correct any of his earlier
statements.
DR. MALTER commented that Representative Seaton is referring to
his April 27th testimony, in which Representative Seaton
believes he misrepresented naturopath education and training.
He admitted that he is not an expert in state law.
REPRESENTATIVE SEATON interrupted Dr. Malter to say that he
wants it on the record that the information Dr. Malter provided
to the committee at the April 27th meeting was on naturopathic
schools that are not accredited. In order to be licensed in
Alaska a person would have to graduate from an accredited
naturopathic school, Representative Seaton emphasized.
Number 2180
DR. MALTER agreed that is a fair point.
Number 2229
REPRESENTATIVE GATTO moved Conceptual Amendment 1.
REPRESENTATIVE SEATON objected.
REPRESENTATIVE GATTO explained that Conceptual Amendment 1 would
remove sections of the bill dealing with prescriptive authority.
REPRESENTATIVE SEATON told the members that he believes there is
good language in HB 434 that provides for collaborative
agreements in prescribing drugs. The bill sets forth that an
M.D. would have to put in writing a formulary, procedures, the
amount of supervision, and reviews that would be part of the
collaborative agreement. Representative Seaton said that what
he thinks the members are dealing with is fear of bad doctors.
TAPE 04-43, SIDE A
[Due to technical difficulty recording was not continued on tape
42-B.]
Number 0056
REPRESENTATIVE KAPSNER disagreed with Representative Seaton.
She said what she heard is the concern about collaboration and
the nature of differences between the two professions. One has
inpatient treatment, the other outpatient treatment. The other
difference mentioned is that after two years of medical school
the training is very different. Representative Kapsner added
that she did not hear any concern about board certified
physicians working in Alaska. Representative Kapsner clarified
that her comments are not concerning the amendment, but rather
the previous speaker's statements.
Number 0130
REPRESENTATIVE WOLF shared that his wife and children are
treated by a naturopath. Dr. Alan Kessler, a surgeon in Beverly
Hills, California, told him that medical doctors are like anyone
else, very competitive. He commented that the medical world is
changing and it is difficult for anyone to accept change.
Representative Wolf said the naturopathic world is new and it is
important to keep an open mind. He stated that he opposes the
conceptual amendment.
Number 0320
REPRESENTATIVE SEATON clarified that there is nothing in this
bill that forces any physician to collaborate. He emphasized
that the person who has control is the collaborating physician.
There appears to be a fear that there will be many prescriptions
written without any supervision; however, that cannot be the
case since the supervision is outlined in writing in a
collaborative agreement with the M.D. Representative Seaton
reiterated that he does not understand how anyone could believe
that there will be prescriptions written without oversight.
REPRESENTATIVE GATTO replied that if he were a naturopath he
would shop for the best physician to match his intentions. He
said that his intentions would be to get as much prescriptive
drug rights as possible with the least amount of opposition or
interference. Representative Gatto commented that if a
physician were assigned to a naturopath that would be a
different story. This bill makes no attempt to arrange for a
board of physicians to assign naturopaths and physicians. It is
a free market. In fact, all naturopaths could collaborate with
a single physician under this bill.
CHAIR WILSON clarified that the bill provides for a limit of six
collaborative agreements.
REPRESENTATIVE GATTO commented that the members can see how it
would be possible to defeat the intent of the bill.
Number 0472
REPRESENTATIVE SEATON responded that the entire argument that is
being made is based upon the idea that naturopaths are going to
want prescribe many different drugs. Naturopaths' entire focus
and training in medicine is based upon whole body medicine in
the least invasive way. This argument is in direct opposition
to their discipline, he pointed out.
REPRESENTATIVE CISSNA told the members that she believes this
amendment is a good idea. The University of Washington and the
Southcentral Foundation are both currently working on this very
issue. She said she believes it is important to give it time
and do it right. The amendment would allow for that, she added.
Number 0640
REPRESENTATIVE COGHILL pointed out that this is a contract. He
said he believes the collaborative agreement on prescriptive
drugs should stay in the bill because those who have the most
experience are the ones who will be driving the issue.
Number 0785
A roll call vote was taken. Representatives Gatto, Cissna, and
Kapsner voted in favor of Conceptual Amendment 1.
Representatives Wolf, Coghill, Seaton, and Wilson voted against
it. Therefore, Conceptual Amendment 1 failed to be adopted by a
vote of 3-4.
Number 0800
REPRESENTATIVE KAPSNER moved Conceptual Amendment 2 which would
insert language that would require that collaboration be done on
every single prescription.
REPRESENTATIVE COGHILL objected.
REPRESENTATIVE GATTO commented that if this is the initial stage
in development of collaborative agreements and there is no
willingness to go slow, then he said he believes this amendment
would be important to ensure no harm is done. This legislation
is a major change in authority, he stated.
REPRESENTATIVE SEATON pointed out that the collaborative
agreement as it is set out is to develop a formulary,
procedures, and supervision. This amendment basically says
there will be no formulary, but that every prescription must be
called in to the medical doctor even if it is the same
circumstance and the same prescription that was called in three
days earlier, he summarized. Representative Seaton said he does
not see this benefiting the collaborative agreement process.
REPRESENTATIVE COGHILL told the members that one of the reasons
he felt comfortable having the collaborative agreement in the
bill is that it forces the issue of having a patient protocol.
It also establishes a formulary in the arena that naturopath and
medical doctor will be working on collaboratively. He said that
if there is going to be an interface between two disciplines of
medicine then there must be agreement on the protocol between
them; not the legislature.
Number 0928
REPRESENTATIVE WOLF said that this amendment would actually
define the contract. He stated that he is not comfortable with
that.
REPRESENTATIVE KAPSNER commented that the members are thinking
about a lot of issues right now. She pointed out that the chair
is as close to a doctor as anyone on the committee, and the Vice
Chair is the next closest to a doctor. She told the members
that she is not comfortable giving prescriptive authority to
naturopaths since she has no background in medicine and has
never even been to a medical board meeting. The only medical
expertise she has is that she's been to a doctor, she said.
Representative Kapsner told the members that when she first
talked with naturopaths she did not understand the issue at all.
She shared that she believes it would be an abdication of her
duty by allowing individuals who do not have the same level of
medical expertise and pharmacology training to prescribe
medication.
REPRESENTATIVE KAPSNER said that perhaps she should amend
Conceptual Amendment 2 to say that naturopaths must collaborate
on every medication for a year.
REPRESENTATIVE SEATON pointed out that this is defining away the
authority of the medical doctor to develop a formulary and
procedures. What this amendment says is that the legislature
does not trust the medical doctor and naturopath to come
together and collaborate on these points. He summarized his
comments by saying he opposes the amendment.
REPRESENTATIVE KAPSNER made a motion to amend Conceptual
Amendment 2 to read as follows:
...to collaborate for the first 10 prescriptions, with
monthly medical review of all prescriptions there
after.
Number 1136
REPRESENTATIVE COGHILL objected. He said he wants to review the
amendment after it is written up.
CHAIR WILSON replied that she believes it can be accomplished
with a conceptual amendment. Chair Wilson restated Conceptual
Amendment 2 which would say that naturopaths would have to talk
with the doctor for the first 10 prescriptions and then have a
monthly review there after.
A roll call vote was taken. Representatives Cissna, Kapsner,
Gatto, and Wilson voted in favor of Conceptual Amendment 2.
Representatives Wolf, Coghill, and Seaton voted against it.
Therefore, Conceptual Amendment 2 was adopted by a vote of 4-3.
Number 1236
REPRESENTATIVE GATTO pointed out that there are seven members
sitting on the committee making state policy on medical care,
and none of the members are [medical doctors]. He pointed out
that one member returned to the committee meeting who was out of
the room through most of the debate and the entire outcome of a
vote was changed. He said he is appalled by what has happened
in the last three and a half hours with respect to this policy
decision. Representative Gatto emphasized that this is a
horrible way to determine public policy.
REPRESENTATIVE KAPSNER commented that no insult is intended to
the member.
REPRESENTATIVE COGHILL said he is insulted and will at least
respond to what has been said. He acknowledged that it is true
that the members are not experts, this is a citizen legislature.
That is true throughout this room, halls, and building he told
Representative Gatto. If the members are to be experts in every
field that comes before us in this body then he suggested that
Representative Gatto quit and everyone else along side him
should quit as well. Legislators are here on the citizen behest
to look at the principles that drive public policy.
Representative Coghill rejected the notion that members must be
experts in every field in order to make policy calls. It is a
benefit when someone is an expert, but many times experts come
before us in testimony that have an agenda that it not
principally driven. That is true whether it is childcare,
speeding, or judiciary issues. He commented that he has been in
three different committees with the same accusation and he
stated he rejects it. Decisions are made on the floor when
there are several bills per day, and the members are not experts
on those issues, but are making those policy calls,
Representative Coghill pointed out.
REPRESENTATIVE COGHILL suggested that it is a good idea to allow
collaborative agreements by letting those involved in different
areas of medical care work together. By amending the bill there
is now a bigger burden on the doctors, he pointed out. Without
this amendment the doctors could have set up a protocol that
would have been more easily and flexibly administered. With the
passage of this amendment the committee has told the doctors
what to do based upon the committee's vote. Representative
Coghill summarized that when he comes to the committee he does
not do it with the idea that he believes he is an expert in all
areas.
Number 1384
CHAIR WILSON agreed that when the people vote for their
legislators it is done with the knowledge that the
representatives are not experts, just everyday people trying to
do their best.
REPRESENTATIVE CISSNA said it is important to note that while
the representatives are human we need to seek to do better. She
commented that she would like to see this kind of conversation
take place at a time when it is not the closing days of the
legislature. The members are all dealing with so many things it
is easy to get frustrated, but it is also important to spend
time on issues this important, Representative Cissna stated.
Number 1424
REPRESENTATIVE COGHILL responded that he has seen this bill in
various versions not only this session, but also previous
sessions. The policy call has been discussed before, he
emphasized.
CHAIR WILSON said for the record that it is her wish that the
two groups, medical doctors and naturopaths, get together and
discuss these issues because there is a place in our society for
both. Work together to build the relationship so the trust is
there, she urged. It is very frustrating for the committee to
sit here listening to both sides, not knowing whom to believe.
She pointed out that in the not too distant future there will be
a shortage of doctors. By the year 2010 Alaska will be short
4,000 nurses. That being the case, the same thing will be
happening with doctors. Chair Wilson suggested the president of
the Alaska Medical Association take this message back and begin
the process. She said a first good step would be to place a
naturopath on the board.
Number 1567
REPRESENTATIVE SEATON moved to report CSHB 434(HES), 23-
LS1574\W, Mischel, 5/4/04, out of committee with individual
recommendations and the accompanying fiscal notes.
CHAIR WILSON objected. She commented that there was discussion
about limiting prescriptive authority to anti-biotics and
hormones. Does anyone wish to offer an amendment. There being
no response, she order a roll call vote.
A roll call vote was taken. Representatives Wolf, Coghill, and
Seaton voted in favor of CSHB 434(HES), version W.
Representatives Kapsner, Gatto, Cissna, and Wilson voted against
it. Therefore, CSHB 434(HES) failed to be reported out of the
House Health, Education and Social Services Standing Committee
by a vote of 3-4.
CHAIR WILSON urged the naturopaths not to give up. She
reiterated her wish that naturopaths and medical doctors work
together.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 6:03 p.m.
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