Legislature(2021 - 2022)BARNES 124

04/10/2021 03:30 PM House HEALTH & SOCIAL SERVICES

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Audio Topic
03:33:34 PM Start
03:34:25 PM Alaska Mental Health Trust Authority
04:29:03 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Please Note Time & Location Change --
+ Consideration of Governor's Appointees: TELECONFERENCED
- State Medical Board: Sarah Bigelow Hood, Larry
Daugherty, Maria Freeman, Lydia Mielke, Steve
Parker, David Boswell, & Richard Wein
- Alaska Mental Health Trust Authority:
Rhonda Boyles, Brent Fisher, Annette
Gwalthney-Jones, & Anita Halterman
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 10, 2021                                                                                         
                           3:33 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Liz Snyder, Co-Chair                                                                                             
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Ivy Spohnholz                                                                                                    
Representative Mike Prax                                                                                                        
Representative Christopher Kurka (via teleconference)                                                                           
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Zack Fields                                                                                                      
Representative Ken McCarty                                                                                                      
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
State Medical Board                                                                                                           
                                                                                                                                
     Steve Parker - Palmer                                                                                                      
     Maria Freeman - Wasilla                                                                                                    
     Lydia Mielke - Big Lake                                                                                                    
     David Boswell - Fairbanks                                                                                                  
     Richard Wein - Sitka                                                                                                       
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
     Sarah Bigelow Hood - Anchorage                                                                                             
     Larry Daugherty - Anchorage                                                                                                
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
Alaska Mental Health Trust Authority                                                                                          
                                                                                                                                
     Rhonda Boyles - Anchorage                                                                                                  
     Brent Fisher - Anchorage                                                                                                   
     Annette Gwalthney-Jones - Anchorage                                                                                        
     Anita Halterman - Eagle River                                                                                              
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
STEVE PARKER, MD, Appointee                                                                                                     
State Medical Board                                                                                                             
Division of Corporations, Business and Professional Licensing                                                                   
Department of Commerce, Community, and Economic Development                                                                     
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:  Testified as appointee to the State Medical                                                              
Board.                                                                                                                          
                                                                                                                                
MARIA FREEMAN, MD, Appointee                                                                                                    
State Medical Board                                                                                                             
Division of Corporations, Business and Professional Licensing                                                                   
Department of Commerce, Community, and Economic Development                                                                     
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified as appointee to the State Medical                                                              
Board.                                                                                                                          
                                                                                                                                
LYDIA MIELKE, Appointee                                                                                                         
State Medical Board                                                                                                             
Division of Corporations, Business and Professional Licensing                                                                   
Department of Commerce, Community, and Economic Development                                                                     
Big Lake, Alaska                                                                                                                
POSITION STATEMENT:  Testified as appointee to the State Medical                                                              
Board.                                                                                                                          
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:33:34 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LIZ SNYDER  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:33   p.m.                                                               
Representatives  Prax,  Spohnholz,   Zulkosky,  and  Snyder  were                                                               
present  at  the  call  to  order.    Representative  Kurka  (via                                                               
teleconference) arrived as the meeting was in progress.                                                                         
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                        
                    CONFIRMATION HEARING(S)                                                                                 
^State Medical Board                                                                                                            
                      State Medical Board                                                                                   
^Alaska Mental Health Trust Authority                                                                                           
              Alaska Mental Health Trust Authority                                                                          
                                                                                                                              
3:34:25 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER announced  that the only order  of business would                                                               
be  the confirmation  hearings for  the governor's  appointees to                                                               
the State Medical Board [and the Alaska Health Trust Authority].                                                                
                                                                                                                                
CO-CHAIR SNYDER  provided a brief  overview of the  State Medical                                                               
Board.  She  noted that the governor appoints a  board of medical                                                               
examiners to be  known as the State Medical  Board, consisting of                                                               
five physicians  licensed in  the state and  residing in  as many                                                               
separate  geographical  areas  of  the  state  as  possible,  one                                                               
physician assistant licensed under  AS 08.64.107, and two persons                                                               
with  no direct  financial interest  in the  healthcare industry.                                                               
Duties  include but  are  not limited  to  examining and  issuing                                                               
licenses to  applicants, developing written guidelines  to ensure                                                               
that  licensing  requirements  are not  unreasonably  burdensome,                                                               
imposing  disciplinary  sanctions  on  persons  who  violate  the                                                               
regulations  and  orders  of the  board,  and  adopt  regulations                                                               
ensuring  that renewal  of licenses  are contingent  on proof  of                                                               
continued competency on the part of the licensee.                                                                               
                                                                                                                                
CO-CHAIR  SNYDER invited  appointee Dr.  Steve Parker  to provide                                                               
testimony stating why  he is qualified and  interested in serving                                                               
on the State Medical Board.                                                                                                     
                                                                                                                                
3:36:30 PM                                                                                                                    
                                                                                                                                
STEVE  PARKER, MD,  Appointee, State  Medical Board,  Division of                                                               
Corporations, Business and  Professional Licensing, Department of                                                               
Commerce,  Community,  and  Economic  Development,  testified  as                                                               
appointee to  the State Medical Board.   He stated he  has been a                                                               
private physician  for the  past 12  years, his  medical training                                                               
was at Michigan  State University College of  Human Medicine, and                                                               
he served in  the military for about 10 years  and did his family                                                               
medical  residency  at Fort  Bragg.    Since  then, he  has  been                                                               
employed,  a solo  physician, a  hospitalist, a  medical director                                                               
for a nursing  home, and until recently did  full spectrum family                                                               
practice with obstetrics.                                                                                                       
                                                                                                                                
DR. PARKER said his desire to  be involved with the State Medical                                                               
Board stems  from an  interest in  protecting patients  from poor                                                               
practices, helping other physicians  improve their practices, and                                                               
protecting his  colleagues from bureaucratic overreach.   Without                                                               
reasoned and measured response, he  stated, Alaska can be made an                                                               
undesirable   place  for   the  varied   specialists  the   state                                                               
desperately needs.  A benefit that  he brings to the board is his                                                               
exposure to medicine  at the various levels and he  has served on                                                               
many committees  with similar goals  to the State  Medical Board.                                                               
Currently,  he has  had one  year  serving on  the State  Medical                                                               
Board.                                                                                                                          
                                                                                                                                
3:38:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX offered  his understanding  that Dr.  Parker                                                               
has served one year on the State Medical Board.                                                                                 
                                                                                                                                
DR. PARKER replied yes.                                                                                                         
                                                                                                                                
REPRESENTATIVE PRAX  asked whether  Dr. Parker has  been involved                                                               
in any disciplinary hearings of physicians.                                                                                     
                                                                                                                                
DR. PARKER responded yes.                                                                                                       
                                                                                                                                
REPRESENTATIVE PRAX inquired about  the qualities that are looked                                                               
for in a member of the State Medical Board.                                                                                     
                                                                                                                                
DR.  PARKER  answered that  a  typical  example is  someone  will                                                               
complain about a  situation in their medical  experience and will                                                               
present that  complaint to the State  Medical Board.  It  will be                                                               
investigated and  then the board  will review  it to see  if they                                                               
meet the  standards based  on the  regulations of  the regulatory                                                               
body of  the medical  board.   If they are  meeting all  of those                                                               
standards, the board  would just close the case.   If they do not                                                               
meet those standards, the board  would try to find an appropriate                                                               
disciplinary measure usually based on some precedent.                                                                           
                                                                                                                                
3:39:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  asked whether Dr. Parker  owns or works                                                               
for Coho Family Medicine.                                                                                                       
                                                                                                                                
DR. PARKER replied that it is his private business.                                                                             
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  asked whether  it  is  true that  Coho                                                               
Family Medicine has sponsored Alaska Right to Life.                                                                             
                                                                                                                                
DR. PARKER responded yes.                                                                                                       
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  presumed that Dr. Parker  is personally                                                               
anti-abortion.                                                                                                                  
                                                                                                                                
DR. PARKER confirmed he is personally anti-abortion.                                                                            
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  noted that  Alaska has a  clear privacy                                                               
clause which guarantees  the right to safe and  legal abortion in                                                               
the state.   She  asked if Dr.  Parker is  comfortable separating                                                               
his personal beliefs about abortion  from his responsibilities as                                                               
a State  Medical Board member  to ensure that  regulations around                                                               
abortion continue to maintain safe and legal access in Alaska.                                                                  
                                                                                                                                
DR.  PARKER replied  that  his personal  views  would not  affect                                                               
whether he  thought something  was appropriate  or inappropriate.                                                               
It would not be his place, he  added, to say whether it was moral                                                               
or immoral but whether they acted professionally.                                                                               
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ stated that  the most important standard                                                               
isn't just that they acted  professionally but whether they acted                                                               
legally.  She asked whether Dr. Parker agrees.                                                                                  
                                                                                                                                
DR. PARKER responded that he agrees.                                                                                            
                                                                                                                                
3:41:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY asked  whether Dr. Parker can  balance his time                                                               
between his business and the  significant amount of time required                                                               
for being  a State  Medical Board  member.   She noted  that over                                                               
2020 a significant amount of  time was needed because of COVID-19                                                               
and  data is  being seen  that there  continues to  be widespread                                                               
transmission of COVID-19 in the Matanuska-Susitna Valley.                                                                       
                                                                                                                                
DR. PARKER answered  that he has so far, and  that the commitment                                                               
has declined significantly.   He related that early  on the board                                                               
was meeting almost weekly but many  of those issues are now taken                                                               
care of.   In  the future,  even with  more COVID-19,  the issues                                                               
arising should be easier to work through.                                                                                       
                                                                                                                                
3:43:24 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER requested  examples  of  specific situations  or                                                               
issues of  bureaucratic overreach  that are of  greatest interest                                                               
to Dr. Parker.                                                                                                                  
                                                                                                                                
DR. PARKER  replied he views  the State  Medical Board as  one of                                                               
the most dangerous  things to a doctor's career.   The board must                                                               
be very careful  before doing any type of  disciplinary action or                                                               
even  a  letter  of  advisement because  those  things  add  huge                                                               
hurdles   to  physicians   later  and   then  those   things  can                                                               
potentially snowball.  For instance,  if a doctor receives a non-                                                               
disciplinary action  and then 10  years later forgets  having had                                                               
this non-disciplinary  action that  can turn into  a disciplinary                                                               
action in  the future.   So,  even though the  board at  the time                                                               
didn't think  the doctor was  doing anything wrong and  gives the                                                               
doctor  a   letter  of  advisement   then  the  doctor   can  get                                                               
disciplinary  action down  the road  which  could potentially  be                                                               
very damaging  to that doctor's  career.   So, the board  must be                                                               
very careful that  anything it does to a physician,  such that if                                                               
it's not  going to have  a significant benefit to  that physician                                                               
or  protect patients,  the board  should try  not to  do anything                                                               
because  the burden  on the  physician can  snowball, and  no one                                                               
wants  to work  in a  state where  doctors have  this unnecessary                                                               
burden that snowballs on them.                                                                                                  
                                                                                                                                
3:45:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  stated  she  understands  the  concern                                                               
about  the  impact  that  State  Medical  Board  decisions,  even                                                               
informal decisions, can have on  somebody's career.  She said the                                                               
State Medical Board  has an obligation to  ensure that physicians                                                               
are adhering  to licensing  requirements and  that they  are safe                                                               
and acting in  the public's best interest.  There  have been some                                                               
well documented  examples of physicians  who have not  adhered to                                                               
best practices,  and it's been very  dangerous to the state.   An                                                               
example is physicians  over-prescribing opioids which contributed                                                               
to opioid abuse in Alaska.   She asked Dr. Parker to describe the                                                               
kinds of things  he thinks are appropriate for  the State Medical                                                               
Board to act on.                                                                                                                
                                                                                                                                
DR. PARKER responded  that clearly it is a big  issue when people                                                               
are not having good care  with their opiate prescribing.  Another                                                               
is if people  are having serial complications of  surgery that is                                                               
related to  not having proper  technique.  Those kinds  of things                                                               
are very  actionable.  He  said his  concerns are more  along the                                                               
lines  of paperwork  issues  where  there is  no  benefit to  the                                                               
patient  yet  potentially  significant harm  to  the  physician's                                                               
career.  Patients being harmed  or the potential for patient harm                                                               
are the things he would strongly encourage action on.                                                                           
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ requested Dr.  Parker to give an example                                                               
of paperwork issues that have no  impact on patient care that the                                                               
State Medical Board has identified in the past that concern him.                                                                
                                                                                                                                
DR.  PARKER answered  that one  of the  biggest issues  the State                                                               
Medical  Board  has right  now  is  doctors registering  for  the                                                               
Prescription Drug  Monitoring Program  (PDMP).  About  50 percent                                                               
of the physicians are not registering  for PDMP, so based on that                                                               
the  board could  literally discipline  half the  doctors in  the                                                               
state, some  of which prescribe very  little or no opiates.   The                                                               
doctors who  are going  to be registered  with PDMP  are probably                                                               
doctors who prescribe  opiates multiple times a day.   He said he                                                               
therefore believes  the board  potentially could  be disciplining                                                               
doctors who very  rarely prescribe opiates and are  not likely to                                                               
be the cause  or problem related to  opiates, potentially harming                                                               
their careers without any significant benefit to patient safety.                                                                
                                                                                                                                
3:49:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  related   that  the  legislature  felt                                                               
strongly enough about the issue  of opioid prescription and over-                                                               
prescription  that  it  passed  several  pieces  of  legislation,                                                               
mostly in  2016 and  2017, which were  designed to  reduce opioid                                                               
prescription and increase tracking  of opioid prescription in the                                                               
state.    She inquired  whether  Dr.  Parker is  suggesting  that                                                               
participation in  a state  required PDMP is  not a  serious thing                                                               
for ensuring that it is being enforced.                                                                                         
                                                                                                                                
DR. PARKER  replied he  does believe  it is  a serious  thing and                                                               
agreed it's  a good tool.   He  said approximately 50  percent of                                                               
the doctors in  Alaska are not interested or  not registering and                                                               
asked  whether enforcing  that on  50 percent  of the  doctors in                                                               
Alaska is wanted.                                                                                                               
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ asked  what Dr. Parker would  deem as an                                                               
appropriate  remedy  for  people  not participating  in  a  state                                                               
required prescription drug monitoring database.                                                                                 
                                                                                                                                
DR. PARKER responded  that the best remedy is to  show that it is                                                               
a useful program.                                                                                                               
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ inquired whether  Dr. Parker thinks that                                                               
people should have to be persuaded to follow the law.                                                                           
                                                                                                                                
DR.  PARKER answered,  "I  guess  so because  they're  not."   He                                                               
stated he is registered with the  PDMP and uses it every time, so                                                               
he is  not saying he is  justifying what these people  are doing.                                                               
But, he  continued, in a very  busy clinic this adds  another two                                                               
to three minutes  for each prescription a doctor  writes and with                                                               
limited  staffing  this may  make  it  almost impossible  to  see                                                               
patients in  a timely  manner.  He  related that  while reviewing                                                               
the people  who were  giving information on  that project  he saw                                                               
very few  physicians, so legislators  may not have  gotten enough                                                               
information from the  people seeing these patients  and who could                                                               
have given better information on how to get physicians involved.                                                                
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ offered her  belief that the legislature                                                               
added some flexibility  to the PDMP to allow  doctors to delegate                                                               
data  entry  into  the  PDMP  to other  staff  working  in  their                                                               
offices.  Having suggestions for  how to make the PDMP compliance                                                               
process more  streamlined is valid,  but she is concerned  by the                                                               
suggestion   that   participating   in  the   Prescription   Drug                                                               
Monitoring Program  wouldn't be  enforced, given  the legislature                                                               
felt a need for  this program to exist.  She  stated she finds it                                                               
deeply concerning  that Dr. Parker  would suggest  that following                                                               
the law in this specific example is optional.                                                                                   
                                                                                                                                
3:52:48 PM                                                                                                                    
                                                                                                                                
DR. PARKER insisted he did not say that.                                                                                        
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ said she thinks he did say that.                                                                       
                                                                                                                                
DR.  PARKER responded  that all  he said  was 50  percent of  the                                                               
physicians and to follow that  by rote would potentially take out                                                               
50 percent of  the physicians working in Alaska.   Any time there                                                               
is legislation  the unintended consequences  must be  thought of,                                                               
and  this is  potentially a  significant unintended  consequence.                                                               
Several  times  at  the  State Medical  Board  he  has  presented                                                               
options for  making the  PDMP easier or  less burdensome.   Right                                                               
now, it  is a significant burden  to a doctor writing  any number                                                               
of opiate prescriptions.   It is also burdensome to  enroll in it                                                               
because  it's  confusing  and  there  is a  lot  of  issues  with                                                               
renewing it.  It is far from a perfect situation.                                                                               
                                                                                                                                
CO-CHAIR SNYDER  stated that it  seems Dr. Parker  has identified                                                               
some challenges with the PDMP system.   She asked how, as someone                                                               
sitting on the State Medical  Board, Dr. Parker would communicate                                                               
those concerns, to whom would  he communicate those concerns, and                                                               
what  would he  like to  see  the outcome  be, understanding  and                                                               
acknowledging the problem  that the law is not  being followed by                                                               
nearly 50 percent of Alaska's  physicians.  While challenges have                                                               
been identified, she  continued, the State Medical  Board is here                                                               
to  ensure  that the  licensees  are  following  the laws.    She                                                               
further asked what Dr. Parker's  recommendations would be and how                                                               
he would act sitting on the board to address this problem.                                                                      
                                                                                                                                
DR.  PARKER answered  that  at  his clinic  he  has attempted  to                                                               
integrate the  PDMP with  his own electronic  records so  that it                                                               
immediately pops  up once he  opens an opiate prescription  for a                                                               
patient.  He  said he contacted the company the  state works with                                                               
but had  no success  getting through to  them, although  he knows                                                               
certain people  have that option.   He  suggested that if  it was                                                               
integrated  into electronic  health records  where it  would just                                                               
pop up  automatically, that's  where the state  might want  to be                                                               
interacting with  electronic health records to  make this happen.                                                               
The  best way  to  ensure that  a  doctor is  checking  it is  to                                                               
absolutely force the doctor to do it.   In a busy clinic, even if                                                               
registered, a doctor  is going to miss from time  to time, that's                                                               
just a reality.  Also,  Dr. Parker continued, the renewal process                                                               
is weird, it's  different from the licensing process,  and it's a                                                               
different process  and different set  of money that must  be sent                                                               
in.  [The board] has talked  about getting that integrated so the                                                               
registration is  automatic with the  medical license so  a doctor                                                               
can't do  one without the other.   If it's automatic,  it's done.                                                               
If it's not  automatic, it will lose  a lot of people  and lose a                                                               
lot of unchecked scripts.                                                                                                       
                                                                                                                                
3:57:51 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  offered  her appreciation  for  Dr.  Parker's                                                               
experience  and perspective  in the  field  with the  PDMP.   She                                                               
noted  that  the  State  Medical Board  is  responsible  for  the                                                               
licensing regulation  and discipline of health  care providers in                                                               
Alaska,  not necessarily  the setting  of policy.   She  said she                                                               
respects Dr.  Parker's position on  the policy  improvements that                                                               
can  be made,  such as  the PDMP  which could  lead to  paperwork                                                               
issues of physicians  that may come before the board.   She asked                                                               
whether  Dr. Parker  can separate  his ideology  on these  policy                                                               
issues to  uphold his responsibilities  as a member of  the State                                                               
Medical Board.                                                                                                                  
                                                                                                                                
DR.  PARKER  asked  what  Co-Chair   Zulkosky  perceives  as  his                                                               
ideology.                                                                                                                       
                                                                                                                                
CO-CHAIR ZULKOSKY recounted Dr. Parker  mentioning that if a PDMP                                                               
related  disciplinary action  came before  the board  it may  not                                                               
necessarily  be something  that should  be considered  for acting                                                               
on.   She said Dr.  Parker's responsibility on the  State Medical                                                               
Board is  to ensure that all  the state's laws are  being upheld.                                                               
She  stated she  would  like to  better  understand Dr.  Parker's                                                               
reference of  maybe not  holding somebody to  laws that  he might                                                               
feel are problematic.                                                                                                           
                                                                                                                                
DR.  PARKER replied  he can  differentiate  between his  personal                                                               
views and doing what is required  by regulation.  He said the big                                                               
issue with  the PDMP is that  no one is complaining  about people                                                               
not being  registered in PDMP, so  it's not going to  come to the                                                               
board  typically.   The  board  is  complaint  based, so  when  a                                                               
patient  complains it's  usually  not about  whether  his or  her                                                               
doctor  is checking  to make  sure  that the  patient is  getting                                                               
opiates in  only one place.   There isn't  a good way  of pulling                                                               
out the  physicians who are a  problem with the PDMP.   The board                                                               
is not designed to reach out  and grab people, the complaint must                                                               
come to the board.                                                                                                              
                                                                                                                                
CO-CHAIR ZULKOSKY stated  that that wasn't the  question, but the                                                               
response is appreciated.                                                                                                        
                                                                                                                                
4:02:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA  inquired  about  the reasons  for  why  50                                                               
percent  of the  doctors in  Alaska  are not  complying with  the                                                               
things they are supposed to report  by law.  He asked whether Dr.                                                               
Parker thinks  those 50  percent are  not complying  because they                                                               
didn't have  the time to  do so, or are  only doing a  few opioid                                                               
[prescriptions], or not prescribing opioids at all.                                                                             
                                                                                                                                
DR. PARKER responded he is  sure that pain doctors are registered                                                               
with the PDMP and that a  pain doctor probably has a staff member                                                               
who acts as the doctor's delegate  to provide the PDMP forms when                                                               
the doctor walks  into the room and therefore  the doctor doesn't                                                               
have to  do anything extra.   The people  who will be  gotten for                                                               
the  PDMP  are  probably   family  practice,  internal  medicine,                                                               
private physicians, solo  practices, those in the  Bush, or those                                                               
serving  smaller communities  who rarely  prescribe opiates.   He                                                               
qualified that this  is his perception, and he does  not have any                                                               
studies or numbers on this.  He  added that it is mostly going to                                                               
hurt  primary care  if [the  board] were  to reach  out and  yank                                                               
those doctors.                                                                                                                  
                                                                                                                                
REPRESENTATIVE KURKA said  it seems Dr. Parker  is identifying an                                                               
issue that the  committee was unaware of  where the legislature's                                                               
plan to tackle  the opioid crisis is not  being fully implemented                                                               
or working.   He inquired whether Dr. Parker would  be willing to                                                               
provide in writing  some suggestions for how to  solve this piece                                                               
of the problem.                                                                                                                 
                                                                                                                                
DR.  PARKER answered  that the  two  options he  just gave  would                                                               
remedy the whole  issue   1) Make it impossible  to get a medical                                                               
license without also  being registered in PDMP; and  2) Some type                                                               
of requirement  for electronic health  records used in  Alaska to                                                               
automatically have the PDMP information  appear once a controlled                                                               
substance prescription  is opened  or once the  prescription part                                                               
of  the program  is opened  for a  patient.   That would  make it                                                               
impossible not  to do the process  and at the same  time it would                                                               
take away all  that burden.  He explained that  logging into PDMP                                                               
multiple times a  day probably takes about 30 minutes  of his day                                                               
if he is seeing a lot of patients of that nature.                                                                               
                                                                                                                                
4:08:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX offered  his understanding  that Dr.  Parker                                                               
thinks  that  the  regulation  relative to  the  PDMP  should  be                                                               
enforced but  on the other hand  he would like an  opportunity to                                                               
improve the regulation process so that it isn't a burden.                                                                       
                                                                                                                                
DR. PARKER replied, "Absolutely."                                                                                               
                                                                                                                                
CO-CHAIR  SNYDER   noted  that  appointees   Sarah  Bigelow-Hood,                                                               
[Physician Assistant  (PA)], and  Larry Daughtery, [MD],  are not                                                               
in attendance  or online to  testify.  She invited  appointee Dr.                                                               
Maria Freeman to  provide testimony stating why  she is qualified                                                               
and interested in serving on the State Medical Board.                                                                           
                                                                                                                                
4:09:33 PM                                                                                                                    
                                                                                                                                
MARIA FREEMAN,  MD, Appointee, State  Medical Board,  Division of                                                               
Corporations, Business and  Professional Licensing, Department of                                                               
Commerce,  Community,  and  Economic  Development,  testified  as                                                               
appointee to the State Medical Board.   She stated she has been a                                                               
family medicine physician in Alaska  for 27 years, the first four                                                               
years  in Barrow,  then seven  years in  Anchorage, and  the last                                                               
sixteen  years in  the Mat-Su  Valley area.   Through  her family                                                               
medicine practice  in Wasilla, she serves  many people, including                                                               
Medicare,  Medicaid, and  Tri-Care  patients.   Five  and a  half                                                               
years ago  she developed a medication  assisted treatment program                                                               
for  opioid use  disorders  and patients  with  dependency.   She                                                               
works  at the  Algone  Interventional Pain  Clinic  and serves  a                                                               
patient population  with great needs  and difficulties.   She has                                                               
been  involved with  the Mat-Su  Opioid  Task Force,  which is  a                                                               
multi-disciplinary group.  She related her religious activities.                                                                
                                                                                                                                
DR. FREEMAN  said she was invited  to serve on the  State Medical                                                               
Board and  that it offers  an opportunity  to learn and  to serve                                                               
her community of  Alaska.  She brings to the  board over 30 years                                                               
of medical  practice and experience  and hopefully  common sense.                                                               
Having  joined the  State  Medical Board  some  months after  her                                                               
colleagues, she has  learned much about how  the members interact                                                               
and address  the issues  and concerns  that have  been presented.                                                               
As well, she has appreciated  the interaction with other interest                                                               
groups.   She  said she  has  the time  for board  duties as  her                                                               
husband's three children are grown and live out of state.                                                                       
                                                                                                                                
4:12:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  offered  her  understanding  that  Dr.                                                               
Freeman  is   involved  in  medication  assisted   treatment  for                                                               
substance abuse disorder.                                                                                                       
                                                                                                                                
DR. FREEMAN replied, "Correct."                                                                                                 
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ asked whether  Dr. Freeman does that via                                                               
distance.                                                                                                                       
                                                                                                                                
DR. FREEMAN responded that it is in person.                                                                                     
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  inquired about  the kind  of medication                                                               
assisted treatment that Dr. Freeman is doing.                                                                                   
                                                                                                                                
DR.  FREEMAN answered  that currently  two medications  are being                                                               
used primarily, Suboxone and Vivitrol.                                                                                          
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ asked  how  long Dr.  Freeman has  been                                                               
doing that work.                                                                                                                
                                                                                                                                
DR. FREEMAN  replied that it  has been  for at least  eight years                                                               
with five and a half years at Algone Group.                                                                                     
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  recalled Dr.  Freeman's mention  of her                                                               
religious values.  She asked if Dr. Freeman is anti-abortion.                                                                   
                                                                                                                                
DR. FREEMAN answered yes, she is personally anti-abortion.                                                                      
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ asked whether  Dr. Freeman is aware that                                                               
Alaska has  a strong right to  privacy and that abortion  is safe                                                               
and legal in the state.                                                                                                         
                                                                                                                                
DR. FREEMAN confirmed she does know that.                                                                                       
                                                                                                                                
REPRESENTATIVE   SPOHNHOLZ  inquired   whether  Dr.   Freeman  is                                                               
comfortable separating  her personal beliefs about  abortion from                                                               
her professional  responsibility as a State  Medical Board member                                                               
to ensure that  abortion continues to be legal  and accessible in                                                               
Alaska.                                                                                                                         
                                                                                                                                
DR. FREEMAN  answered she understands  the regulations  that have                                                               
been in place.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ inquired  about Dr.  Freeman's interest                                                               
in passing  regulations to  make it more  difficult for  women to                                                               
get a safe and legal abortion in Alaska.                                                                                        
                                                                                                                                
DR. FREEMAN replied, "Not unless it's brought up."                                                                              
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  requested  clarification on  what  Dr.                                                               
Freeman means about her statement "not unless it's brought up."                                                                 
                                                                                                                                
DR.  FREEMAN responded  that if  this question  presented itself,                                                               
she  would   have  certain   personal  beliefs   but  she   is  a                                                               
representative  of the  State Medical  Board and  so she  will be                                                               
regulated by the  board as opposed to her personal  beliefs.  She                                                               
said she can separate the two.                                                                                                  
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  posed a  scenario of  regulations being                                                               
introduced  that  are  designed  to make  it  more  difficult  to                                                               
provide   abortions   in  Alaska,   which   is   a  legally   and                                                               
constitutionally  required  service  in the  state.    She  asked                                                               
whether  Dr.  Freeman would  be  able  to separate  her  personal                                                               
beliefs   that  abortion   is  wrong   and  vote   against  those                                                               
regulations.                                                                                                                    
                                                                                                                                
DR. FREEMAN answered that she believes she can.                                                                                 
                                                                                                                                
CO-CHAIR  SNYDER invited  appointee Ms.  Lydia Mielke  to provide                                                               
testimony stating why she is  qualified and interested in serving                                                               
on the State Medical Board.                                                                                                     
                                                                                                                                
4:16:13 PM                                                                                                                    
                                                                                                                                
LYDIA  MIELKE,  Appointee,  State   Medical  Board,  Division  of                                                               
Corporations, Business and  Professional Licensing, Department of                                                               
Commerce,  Community,  and  Economic  Development,  testified  as                                                               
appointee to the State Medical Board.   She stated she has worked                                                               
in tourism  for several summers  and spent five  sessions working                                                               
in the  legislature.  About a  year and a half  ago she graduated                                                               
with a  bachelor's in business management.   She took a  gap year                                                               
to travel  and spend  time with  family but was  unable to  do so                                                               
because of  COVID-19.   However, she was  appointed to  the State                                                               
Medical  Board just  over a  year  ago and  was able  to spend  a                                                               
significant amount of  time learning about the board  and what it                                                               
does and  jumping into her  role as a  public member.   The board                                                               
had  weekly meetings  for quite  a while  and met  more than  any                                                               
other  state board  as the  COVID-19 pandemic  began.   The board                                                               
stayed  on top  of  things and  passed  emergency regulations  to                                                               
ensure having the physicians needed  to support Alaska during the                                                               
pandemic.                                                                                                                       
                                                                                                                                
MS.  MIELKE  said  she  currently   works  for  the  Division  of                                                               
Community and Regional Affairs as  a local government specialist.                                                               
She related that during her  time in the legislature, she learned                                                               
to  do  research, find  solutions  to  problems, and  communicate                                                               
effectively with others.   That experience has now  helped her on                                                               
the  regulative side  of  things.   She  brings  to  the board  a                                                               
younger voice  and perspective to  help balance things out.   She                                                               
does  her  research   for  meetings  and  isn't   afraid  to  ask                                                               
questions.  She has learned a  lot and will continue to learn for                                                               
however long she is on the board.   Ms. Mielke added that she and                                                               
her family  are consumers in Alaska,  and she is excited  for the                                                               
opportunity to continue to serve and help ensure public safety.                                                                 
                                                                                                                                
4:18:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY asked  what motivated  Ms. Mielke  to put  her                                                               
name forward.                                                                                                                   
                                                                                                                                
MS. MIELKE  replied she  is motivated by  public service  and the                                                               
opportunity to bring a voice for  the consumer.  She said she has                                                               
always been interested  in the medical field  and loves learning.                                                               
While  she doesn't  personally  want  to go  into  the field  she                                                               
enjoys learning and serving Alaska and  felt this was a good fit.                                                               
As a  public member  she wants  to be an  advocate and  voice for                                                               
consumers.  This past year  has been a rewarding experience being                                                               
a part  of making Alaska  a great  place for both  physicians and                                                               
consumers.                                                                                                                      
                                                                                                                                
CO-CHAIR  ZULKOSKY   requested  Ms.   Mielke  to   speak  further                                                               
regarding  her  comment about  approaching  this  work through  a                                                               
public safety lens.                                                                                                             
                                                                                                                                
MS. MIELKE  responded that as a  public member she relies  on her                                                               
colleagues  for their  expertise on  the more  technical aspects,                                                               
but she  also wants  to ensure that  public safety  and consumers                                                               
are protected.   When the  board is  looking at a  physician, she                                                               
thinks about  whether the  doctor is  following the  statutes and                                                               
how  she would  feel as  a consumer  of the  medical field.   She                                                               
wants to  make sure she protects  other consumers and be  a voice                                                               
for them too.                                                                                                                   
                                                                                                                                
4:20:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX offered  his understanding  that Ms.  Mielke                                                               
was appointed to the State Medical Board about a year ago.                                                                      
                                                                                                                                
MS. MIELKE answered correct.                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX asked  whether Ms. Mielke has a  sense of the                                                               
types of complaints that are coming before the board.                                                                           
                                                                                                                                
MS. MIELKE replied  that usually complaints come in  and then the                                                               
board's investigative  staff will do  a quick overview to  see if                                                               
anything  is  there  and  then   forward  the  complaint  to  the                                                               
physicians on  the board.   Because she  is a public  member, she                                                               
has a  more limited role  in the disciplinary and  complaint side                                                               
of  things.    Some  of them  are  frivolous  complaints  against                                                               
physicians but the board ensures  it thoroughly investigates them                                                               
all before taking any action or dismissing anything.                                                                            
                                                                                                                                
4:21:21 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:22:01 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER offered her appreciation  for Ms. Mielke's desire                                                               
to serve  on the State Medical  Board to protect consumers.   She                                                               
requested Ms.  Mielke to  elaborate on  the types  of protections                                                               
she  is looking  for and  whether she  heard them  from community                                                               
members.                                                                                                                        
                                                                                                                                
MS. MIELKE responded that a  lot of times the physicians applying                                                               
to be  licensed in Alaska  will bring certain baggage  with them,                                                               
so  the board  thoroughly inspects  their background.   Sometimes                                                               
they will  have certain  things on their  record, such  as sexual                                                               
allegations against  them.  As a  consumer she looks at  that and                                                               
thinks about  whether she would  feel comfortable  being attended                                                               
to by  this physician  or her family  seeing this  physician, and                                                               
sometimes  the answer  is  no.   She  reads  the regulations  and                                                               
statutes and their application, and  sometimes she will say no to                                                               
approving a physician  for licensing in Alaska  because she cares                                                               
about the safety of herself and other Alaskans.                                                                                 
                                                                                                                                
4:23:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  noted  that  Ms.  Mielke  is  a  state                                                               
employee serving  on a  board, which seems  atypical.   She asked                                                               
whether Ms. Mielke  received any guidance from  the Department of                                                               
Law  on the  legality and  whether there  is a  problem with  the                                                               
Ethics Act  with a state employee  serving on a state  board; for                                                               
example, state employees cannot run for office.                                                                                 
                                                                                                                                
MS. MIELKE answered she has not heard of anything personally.                                                                   
                                                                                                                                
MS. MIELKE,  responding to  Co-Chair Snyder,  stated that  she is                                                               
from Big Lake.                                                                                                                  
                                                                                                                                
4:25:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER opened public testimony  on the appointees to the                                                               
State  Medical   Board.    She  closed   public  testimony  after                                                               
ascertaining no one wished to testify.                                                                                          
                                                                                                                                
4:25:54 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER expressed  a desire  to  forward the  appointees                                                               
names to the joint legislature.                                                                                                 
                                                                                                                                
CO-CHAIR ZULKOSKY noted that  two appointees, Sarah Bigelow-Hood,                                                               
PA]  and Larry  Daugherty, MD  did not  participate in  a hearing                                                               
before  the  committee;  therefore, she  questioned  whether  the                                                               
committee  should  forward  their  names   at  this  time.    She                                                               
explained she  does not feel comfortable  making a recommendation                                                               
to joint session without having heard from them in committee.                                                                   
                                                                                                                                
CO-CHAIR SNYDER concurred  and said her intent is  to forward the                                                               
names of only those that testified.                                                                                             
                                                                                                                                
4:26:50 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER stated that the  House Health and Social Services                                                               
Standing  Committee  has  reviewed  the  qualifications  for  the                                                               
governor's appointees to  the State Medical Board  and the Alaska                                                               
Mental  Health  Trust  Authority, and  recommends  the  following                                                               
names be  advanced to a  joint session for consideration:   Lydia                                                               
Mielke, Maria  Freeman, Steve Parker, David  Boswell, and Richard                                                               
Wein  for  the State  Medical  Board;  and Rhonda  Boyles,  Brent                                                               
Fisher,  Annette Gwalthney-Jones,  and  Anita  Halterman for  the                                                               
Alaska Mental  Health Trust Authority.   [Testimonies of Boswell,                                                               
Wein, Boyles,  Fisher, Gwalthney-Jones, and Halterman  were heard                                                               
on 4/1/21.]   She reminded  committee members that this  does not                                                               
reflect intent by  any of the members to vote  for or against any                                                               
of these appointees during any  further sessions for the purposes                                                               
of confirmation.                                                                                                                
                                                                                                                                
4:29:03 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 4:29 p.m.                                                                                                          
                                                                                                                                

Document Name Date/Time Subjects
Maria Freeman Board Application_Redacted_ SMB.pdf HHSS 4/10/2021 3:30:00 PM
HHSS Gov Appointees SMB
Mielke Resume_SMB.pdf HHSS 4/10/2021 3:30:00 PM
HHSS Gov Appointees SMB
Bigelow Resume_SMB.pdf HHSS 4/10/2021 3:30:00 PM
HHSS Gov Appointees SMB
Freeman Resume_SMB.pdf HHSS 4/10/2021 3:30:00 PM
HHSS Gov Appointees SMB
Steve Parker Resume_SMB.pdf HHSS 4/10/2021 3:30:00 PM
HHSS Gov Appointees SMB
HSS_Lydia Mielke Resume_Redacted.pdf HHSS 4/10/2021 3:30:00 PM
HHSS Gov Appointees SMB