Legislature(1999 - 2000)
02/08/1999 03:15 PM House L&C
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
February 8, 1999
3:15 p.m.
MEMBERS PRESENT
Representative Norman Rokeberg, Chairman
Representative Andrew Halcro, Vice Chairman
Representative Jerry Sanders
Representative Lisa Murkowski
Representative Tom Brice
Representative Sharon Cissna
MEMBERS ABSENT
Representative John Harris
COMMITTEE CALENDAR
* HOUSE BILL NO. 10
"An Act extending the termination date of the Board of Certified
Direct-Entry Midwives; and providing for an effective date."
- MOVED HB 10 OUT OF COMMITTEE
(* First public hearing)
PREVIOUS ACTION
BILL: HB 10
SHORT TITLE: EXTEND CERTIFIED DIRECT-ENTRY MIDWIVES BD
SPONSOR(S): REPRESENTATIVES(S) HUDSON
Jrn-Date Jrn-Page Action
1/19/99 20 (H) PREFILE RELEASED 1/8/99
1/19/99 20 (H) READ THE FIRST TIME - REFERRAL(S)
1/19/99 20 (H) HES
1/21/99 47 (H) REMOVE FROM HES
1/21/99 47 (H) L&C REFERRAL ADDED
1/21/99 47 (H) REFERRED TO L&C
2/08/99 (H) L&C AT 3:15 PM CAPITOL 17
WITNESS REGISTER
REPRESENTATIVE BILL HUDSON
Alaska State Legislature
Capitol Building, Room 108
Juneau, Alaska 99801
Telephone: (907) 465-3744
POSITION STATEMENT: Presented HB 10 as the bill's sponsor.
MARILYN HOLMES, Public Member and Secretary
Board of Certified Direct-Entry Midwives;
Member, Citizens for Midwifery
969 Goldbelt Avenue
Juneau, Alaska 99801
Telephone: (907) 586-2316
POSITION STATEMENT: Testified in support of HB 10.
CATHERINE REARDON, Director
Division of Occupational Licensing
Department of Commerce and Economic Development
P.O. Box 110806
Juneau, Alaska 99811-0806
Telephone: (907) 465-2538
POSITION STATEMENT: Testified in support of HB 10, provided
additional information.
PAM WEAVER, Chair
Board of Certified Direct-Entry Midwives;
Board Member, North American Registry of Midwives
P.O. Box 671427
Chugiak, Alaska 99567-1427
Telephone: (907) 688-2000
POSITION STATEMENT: Testified in support of HB 10.
KAYE KANNE
Midwives Association of Alaska;
Member, Board of Certified Direct-Entry Midwives
3225 Hospital Drive, Number 106
Juneau, Alaska 99801
Telephone: (907) 586-1203
POSITION STATEMENT: Testified in support of HB 10.
ACTION NARRATIVE
TAPE 99-5, SIDE A
Number 0001
CHAIRMAN NORMAN ROKEBERG called the House Labor and Commerce
Standing Committee meeting to order at 3:15 p.m. Members present
at the call to order were Representatives Rokeberg, Halcro,
Sanders, Brice and Cissna. Representative Murkowski arrived at
3:21 p.m.
HB 10 - EXTEND CERTIFIED DIRECT-ENTRY MIDWIVES BD
Number 0049
CHAIRMAN ROKEBERG announced the committee had before it HB 10, "An
Act extending the termination date of the Board of Certified
Direct-Entry Midwives; and providing for an effective date."
Number 0064
REPRESENTATIVE BILL HUDSON, Alaska State Legislature, came forward
to present HB 10 as the legislation's sponsor. He thanked the
chairman for his welcome, noting the references to his previous
service on the House Labor and Commerce Standing Committee.
Representative Hudson stated that HB 10 would extend the operation
of the Board of Certified Direct-Entry Midwives (CDMs) for another
four years to June 30, 2003. He indicated board members and
midwives were present to answer questions. Representative Hudson
commented that Alaska was among the forerunners in the worldwide
movement to establish a midwifery model of care as an alternative
choice to the medical model, as noted in the sponsor statement,
and, since the board was in its final year, he indicated some
legislation must pass this session if the board was to continue.
He noted they appreciated the timely hearing of the legislation.
Representative Hudson indicated he would be happy to try to answer
any questions before stepping back to allow others to testify on
the good works of the Board of Certified Direct-Entry Midwives and
to answer questions.
CHAIRMAN ROKEBERG asked Representative Hudson about the decision to
use the year 2003, rather than 2004, as was recommended in the
audit report done by the Division of Legislative Audit [audit
control number: 08-1454-9; January 9, 1998].
Number 0267
REPRESENTATIVE HUDSON indicated the same bill had been introduced
the previous session, originating on the Senate side and he thought
the 2003 date had come from discussion that year with the prime
sponsor of the previous Senate bill, and Kaye Kanne and some of the
others, in order to avoid contention. In answer to Chairman
Rokeberg's follow-up question, Representative Hudson confirmed that
previous bill had not made it to "conference."
CHAIRMAN ROKEBERG noted the committee would proceed to further
testimony and indicated the 2003 issue might be addressed later.
Number 0379
MARILYN HOLMES, Public Member and Secretary, Board of Certified
Direct-Entry Midwives; Member, Citizens for Midwifery, came forward
to testify in support of HB 10. Ms. Holmes stated Citizens for
Midwifery was a national grassroots organization which promoted
midwifery in general. She commented the organization promoted the
midwifery model of care: medical midwives as well as direct-entry
midwives. Ms. Holmes referred to the past legislative session's HB
459 which provided Medicaid funding to certified direct-entry
midwives. Ms. Holmes indicated the reason the board had not been
extended the previous year was because of some confusion around the
comparatively high licensing fees for certified direct-entry
midwives. She indicated the fees were high because there were
currently very few certified direct-entry midwives in Alaska, but
because they were becoming licensed their numbers would increase as
time went on. She added that it was to the state's advantage to
regulate and license midwives in order to have control over safety
issues and the other items governed by licensure. Ms. Holmes said
the previous year's sunset bill had gotten somewhat "hung-up" on
that issue of Medicaid funding. She noted the Medicaid funding had
gone through and was now available for direct-entry midwives; it
should now just be a matter of course to extend the board because
if there were midwives practicing and receiving third-party
reimbursement, they should be regulated.
REPRESENTATIVE CISSNA confirmed with Ms. Holmes that the receipt of
Medicaid funding did not change the higher licensing fees.
Number 0551
MS. HOLMES indicated the receipt of funding did not change the fees
but it did mitigate them, noting that there was now another market
for the services so there would be an expansion of the profession
into that area. She indicated the licensing fees would decrease as
the number of midwives increased. Ms. Holmes additionally
indicated the board's costs would decrease because increased
regulation of midwives would reduce the number of people operating
outside of the system, lowering the board's costs associated with
investigations. She said the more regulation and more state
control over the body of midwives, the less cost to the state. Ms.
Holmes added that the state actually made money on midwifery
through Medicaid dollars, explaining that a midwifery birth cost
approximately 57 percent of a medical birth. Therefore, the same
mother on Medicaid receiving care would be paying less and the
state would be paying less. Ms. Holmes added that the babies were
healthy, with few problems, so follow-up costs were lower.
Additionally, she said these babies were breast-fed most of the
time, which made for healthier babies, so there were lower costs
down the line.
REPRESENTATIVE SANDERS asked if the Medicaid payment was a lump sum
to the state or if it was per each birth.
Number 0700
MS. HOLMES replied it was per each birth. She commented there were
4,500 pregnant women in the state. In response to Representative
Sanders' further question about how the state would save money, Ms.
Holmes indicated the state matched funds to the Medicaid dollars
received from the federal government.
CHAIRMAN ROKEBERG clarified that there were "two different baskets
of money, so to speak," and there was no connection between
licensing fees and state savings. He said he appreciated Ms.
Holmes' point of view that Medicaid costs to the state were reduced
by using direct-entry midwives' services, but he indicated there
was no resulting monetary benefit to the board.
Number 0763
REPRESENTATIVE HALCRO asked how many licensed certified
direct-entry midwives there were as of January 1999.
MS. HOLMES said she thought the number was 19.
AN UNIDENTIFIED SPEAKER noted the number was 14.
Number 0777
REPRESENTATIVE HALCRO referred to the auditor comments section of
the audit report, noting the comments seemed a bit dated because
they spoke of a July 1997 letter. He indicated the comments spoke
of the high licensing fees as a barrier to entry into the
profession and asked Ms. Holmes if she thought having Medicaid
reimbursement would help draw more people into the program.
Representative Halcro commented the audit report noted 15 licensed
CDMs, so apparently one had been lost.
MS. HOLMES said she was unsure about the count of 14.
Number 0825
CATHERINE REARDON, Director, Division of Occupational Licensing,
Department of Commerce and Economic Development, stated she would
call to confirm that information, at the chairman's request.
Number 0833
MS. HOLMES replied, in response to Representative Halcro's
question, that the licensed midwives were happy to pay their fees
and willing to carry that cost. She said she thought it had been
conjecture on the part of the auditor that the high fees were a
possible deterrent to the profession's growth. Ms. Holmes
commented they had created a procedures guide in the last year
which clearly spelled out the fee structure. She indicated she
thought this had not deterred anyone; in many ways it had made it
clearer. She said people were trying to apply all the time. Ms.
Holmes said she thought it was difficult to become licensed in
Alaska because of the many requirements, including tests and a
large number of births. She indicated she thought the level of
difficulty was appropriate. Ms. Holmes noted, however, the money
was only part of it, and now that they had the Medicaid
reimbursement there would be more money to go around.
REPRESENTATIVE MURKOWSKI asked if Ms. Holmes could tell her how
many pregnant women would use a midwife's services as opposed to
the services of a regular physician. She commented on information
in the bill packet stating that 95 percent would use a physician
and four percent would use a midwife.
Number 0932
MS. HOLMES replied that there were 4,500 pregnant women in Alaska
eligible for Medicaid, noting those were just the Medicaid births.
She indicated she thought midwifery births accounted for about five
percent of all births, both in Alaska and nationally, and the
numbers were increasing. Ms. Holmes referred to materials in the
bill packet pointing out that the countries with the lowest
incident of infant mortality used midwives for 70 percent of
births, without a physician in attendance. She emphasized this was
the model that was the safest and was having the best effect in the
world, indicating the United States was twenty-second on the list
in terms of birth outcomes. Ms. Holmes noted the United States
might use a medical model for 95 percent of its births but it was
twenty-second when it came to safety.
Number 0997
REPRESENTATIVE CISSNA said she had some questions about the
apparent high number of unlicensed individuals. She confirmed from
Ms. Holmes that unlicensed midwives had to go through enough births
in order to qualify for licensure and this was part of the reason
for having apprentices.
Number 1054
PAM WEAVER, Chair, Board of Certified Direct-Entry Midwives; Board
Member, North American Registry of Midwives (NARM), testified next
via teleconference from Anchorage in support of HB 10. She
indicated she was a practicing licensed certified direct-entry
midwife in Anchorage. She noted the North American Registry of
Midwives was the national certification board; she said she also
served as liaison to state legislators and policymakers. Ms.
Weaver indicated she had spoken with the Division of Medical
Assistance, Department of Health and Social Services, for some
updated facts and figures that morning. She stated approximately
45 percent of Alaskan pregnant women were currently eligible for
Medicaid, and her understanding was that another approximately 800
pregnant women were expected to become eligible as of April 1
because the federal poverty guidelines were changing. Ms. Weaver
noted Ms. Holmes had mentioned 4,500, but she indicated she had
heard the number 10,000 from Nancy Weller's office [Nancy Weller,
Medical Assistance Administrator, Division Medical Assistance,
Department of Health and Social Services] that morning. Ms. Weaver
indicated this figure made approximately 50 percent of the market
accessible to midwives, which she said was "going to change the
face of direct-entry midwifery and out-of-hospital births here in
Alaska." On that note Ms. Weaver said she highly recommended the
extension of the board as a regulatory process: keeping the
oversight, guiding the issues and public safety, the "minimal"
competency of practitioners, et cetera.
CHAIRMAN ROKEBERG asked if Ms. Weaver could clarify the difference
between the legislation's 2003 extension date and the legislative
audit's recommendation.
Number 1211
MS. WEAVER stated she knew the auditors had recommended a six-year
board extension because the auditors had given them "high marks
(indisc.) as a board," and said she also understood, from
conversations with legislators, that it was rare or nonexistent for
board to be extended past the normal four years. Commenting that
she hadn't been involved the discussions regarding the 2003 date,
Ms. Weaver said she assumed it was a happy medium.
CHAIRMAN ROKEBERG noted Ms. Reardon's return and requested her
clarification on the previously-mentioned number of licensees.
Number 1256
CATHERINE REARDON, Director, Division of Occupational Licensing,
Department of Commerce and Economic Development, stated her
division provided the staff assistance to the Board of Certified
Direct-Entry Midwives. Ms. Reardon said there were currently 14
licensed midwives and 6 licensed apprentices. She said the
expiration and renewal date had been December 31, 1998, and it was
not unusual to see one or two people choose not to renew but,
generally, that loss was regained as new people came in during the
two-year period. Ms. Reardon commented that perhaps one or two of
the apprentices would move up. She confirmed for the chairman that
the biennial cycle ran January 1, 1999, to 2000.
Number 1305
CHAIRMAN ROKEBERG asked if there were any further questions for Ms.
Weaver.
REPRESENTATIVE MURKOWSKI observed there was a discrepancy between
the number of licensed midwives, 14, and the number of
Medicaid-eligible women. She asked what efforts were being made to
recruit and train more [midwives].
Number 1344
MS. WEAVER responded that all of those women were not necessarily
going to choose, or be eligible for, direct-entry midwifery care,
noting that CDMs could only attend low-risk women through their
pregnancies and childbirth. Ms. Weaver indicated the majority of
those women would choose or fall into the conventional medical
model of care. Ms. Weaver stated the majority of that eligible 50
percent of pregnant women would choose physicians or in-hospital
care with certified nurse midwives. She indicated, however, the
small fraction certified direct-entry midwives would receive of
those Alaskan Medicaid-eligible women was a great deal more than
the current zero amount.
REPRESENTATIVE MURKOWSKI asked again if there were efforts being
made to recruit and train additional midwives, noting these efforts
would probably not be through the licensing board.
Number 1403
MS. WEAVER answered in the affirmative. She indicated there were
education and advocacy efforts in place and advancing, commenting,
"Getting the word out about midwifery model of care specifically,
out-of-hospital births, safety issues, and all of those things that
you can imagine would be of concern to policymakers and the
public."
CHAIRMAN ROKEBERG mentioned the July 7, 1997, letter from Ms.
Reardon in the audit which contained eight suggestions for
cost-containment on the board to lower the rather high biennial
licensing fees caused by the relatively small number of licensees.
He asked Ms. Weaver if the board had considered the suggestions and
if anything had come of those recommendations.
Number 1464
MS. WEAVER said, speaking as a member of the association, that they
had definitely considered the suggestions. She said the board had
also discussed the suggestions and she herself had spoken with Ms.
Reardon at fair length about them. Ms. Weaver indicated none of
the points satisfied the association enough for the association to
advocate moving towards the suggestions. She noted Ms. Reardon's
presence at the meeting and said their discussion was more
regarding the fiscal matters if the board was or was not extended
as a result of those eight points. Ms. Weaver added it was her
recollection that there would not be an appreciable decrease in the
licensure fees should the board not be extended.
CHAIRMAN ROKEBERG said he had been struck by the recommendation to
lower the board size from the current five members. He commented
it seemed the board had a pretty good cross-section: a mandated
nurse midwife, a physician in the area, two midwives [certified
direct-entry midwives], and a public member. He asked if going to
three members would hurt the board's ability "to have proper
oversight and input into the activities of the board."
Number 1569
MS. WEAVER replied she personally thought that was a possibility.
She said she was not sure if that change could ever be successfully
proposed, indicating legislators in 1992 when the statute was
enacted were strongly in favor of the board's current composition.
Ms. Weaver noted she personally wouldn't mind seeing it reduced,
commenting on the situation of members from one profession
governing members of another profession.
CHAIRMAN ROKEBERG noted it was the committee's purview to make sure
the regulatory structure was in place and working effectively. He
asked to what degree they relied on the department for their
licensing and examinations.
Number 1628
MS. WEAVER indicated their licensing examiner accepted and screened
applications initially before forwarding the applications to the
board for review. She stated, "He also (indisc.) with the national
testing agency for test dates for those applicants who are ready to
test." Ms. Weaver indicated the licensing examiner additionally
arranged for proctors and performed the staff duties of that
nature. She confirmed for the chairman that they used the national
standardized examination. She added that the national
certification board she belonged to [NARM] had developed this
examination.
CHAIRMAN ROKEBERG confirmed there were no more questions for Ms.
Weaver.
Number 1698
KAYE KANNE, Midwives Association of Alaska; Member, Board of
Certified Direct-Entry Midwives, came forward to testify in support
of HB 10. Ms. Kanne stated she was a practicing certified
direct-entry midwife in Juneau, noting she had been practicing here
for 15 years and the previous April they had opened a freestanding,
nonprofit birth center in Juneau. She invited the committee
members to visit the birth center. Ms. Kanne addressed some of the
questions which had arisen. She stated that they did 10 percent of
the births in Juneau and sometimes more. At the birth center there
was another certified direct-entry midwife and herself, and three
students. Ms. Kanne indicated the 10 percent figure was based on
500 births a year in Juneau, although sometimes there were fewer
than 500 births, of which the midwives were doing at least 50. She
stated she was really proud of the certified direct-entry midwives
in Alaska and their accomplishments, noting she had served on the
board since its inception in 1992 and had worked very hard to get
the board into place. She said she felt they really had
accomplished a lot in that time: written the regulations, defined
the scope of practice, and defined the required course of study for
apprentices. She noted the statistics for midwives in Alaska had
been very good. Ms. Kanne said she thought the midwives as a group
were doing very well. They continued to provide quality care for
low-risk women who chose that option. She noted that option was
low-cost in addition to being safe, indicating it was available for
people without insurance or for those who didn't qualify for
Medicaid. She clarified for Representative Sanders that there were
two midwives in Juneau and they did all the births together as a
team.
REPRESENTATIVE SANDERS asked what their capacity was, wondering
whether they could do one birth a week and be adequate.
Number 1807
MS. KANNE replied that sometimes they did three or four births a
week, noting the births tended to come in bunches, with sometimes
four in one week and none in the next. She said they could
probably do twice that and still be functioning very well,
mentioning they had three students who worked very hard also. Ms.
Kanne noted she thought their maximum capacity, doing it well,
would be ten births a month as a group, two midwives together. She
said they were actually recruiting for a third midwife. Ms. Kanne
referred to the figure of six that had been given for licensed
apprentices. Ms. Kanne stated there were many more apprentices
than that in the state of Alaska; she knew because she had three
apprentices who were not licensed with the state at that point.
Ms. Kanne said, "There is a loophole in the law that says that you
don't have to be a licensed apprentice until ... maybe the last two
years of their apprenticeship and they'll get ... their
certification and then go into -- and I have a waiting list of four
people who want to be midwives -- so there's definitely a lot of
women out there that do want to be certified direct-entry midwives
and are working towards that goal." She stated the cost of the
license was not a deterrent to the midwives; they would like it to
be lower but were willing to pay because they thought having the
board was very important. Ms. Kanne noted the apprenticeship for
certified direct-entry midwives was less expensive than going to
medical school or becoming a certified nurse midwife, for example.
She said the apprentices didn't have student loans that needed to
be repaid once they began practicing, indicating the licensing fee
could just be considered part of the education cost.
REPRESENTATIVE MURKOWSKI noted Ms. Kanne mentioned she had both
licensed and unlicensed apprentices. Representative Murkowski
asked what the difference was for a licensed apprentice versus a
non-licensed apprentice in their responsibilities and what they
could do.
Number 1893
MS. KANNE clarified that apprentices were not licensed: it was
just a certificate which said the person could be an apprentice.
She noted all apprentices had to have direct in-room supervision
from a certified direct-entry midwife.
CHAIRMAN ROKEBERG asked Ms. Kanne to explain how her care would
compare to that of an "OB/GYN" [physician specializing in
obstetrics and gynecology] in terms of post and prenatal care, and
the entire services she brought to a birth.
Number 1935
MS. KANNE indicated that was a very long explanation. She stated
that, first of all, they spent a lot more time with women. For a
normal prenatal visit, midwives would spend an hour with a woman
instead of ten minutes or whatever. The midwives spent a lot more
time on nutrition, on the woman's overall health. She indicated
they checked on how the woman was feeling and on areas she might
want to know more about. Regarding postpartum, the midwives spent
the entire labor with the woman, rather than coming in just at the
end and delivering the baby. They also stayed with the woman after
the birth. After the birth the midwives visited the woman every
day for three days; they saw the woman at one, two, three, four and
six weeks after the birth. At each one of those visits they did
well-baby checks, and checked the mother for everything: how she
was doing physically and emotionally, how was breastfeeding going,
how was her life in general. Ms. Kanne said they had new mother
breastfeeding support groups and brought in speakers every week on
subjects like infant massage, breastfeeding and bonding, and
vaccinations. She noted most midwives did the same thing she did.
She commented that there was more of a continuity of care with the
women the midwives saw; there was a relationship that developed.
CHAIRMAN ROKEBERG indicated he would like Ms. Kanne to give the
committee an estimate of the cost for her services to one patient
versus the cost for a typical medical birth.
Number 1991
MS. KANNE replied that the charge for all of their care was $2,800
with an additional $800 if the patient had her baby at the birth
center. She noted those figures did not include lab or ultrasound.
Ms. Kanne said the physicians' fees in Juneau were comparable to
the midwives' fees; the hospital itself made most births cost well
over $5,000, and if the women had medications, epidurals,
interventions, the cost could be close to $10,000.
CHAIRMAN ROKEBERG commented, "So it's a facility that you provide
as much as the services, and then there's a shift in the philosophy
of services and time too, is that correct?"
MS. KANNE agreed, noting they did home births as well as birth
center births.
CHAIRMAN ROKEBERG asked how it worked in terms of their training
with that major issue: when they thought there was an anomaly and
referred to a physician. He questioned how their training gave
them the ability to alert themselves to the fact they needed
additional medical expertise.
Number 2038
MS. KANNE stated that when they needed to refer was spelled out
very clearly in their regulations and scope of practice. She
added, however, that there was also the intuition all midwives had
that a particular birth just wasn't going very well. Ms. Kanne
commented her transport rate was about 10 percent. She indicated
this was mostly first-time mothers and the labor was taking too
long - either the membranes had been ruptured too long or the
contractions were just too painful, they were not progressing, and
the woman might need an epidural. She said if there was an
immediate complication which had to be dealt with at that moment,
for example, a postpartum hemorrhage or a baby that needed to be
resuscitated, the midwives were trained to deal with that and then
transport.
CHAIRMAN ROKEBERG noted there had been two pieces of legislation
passed to assist midwives in terms of insurance coverage mandates
and the previously-mentioned Medicaid coverage. He indicated that
had gone into effect the previous year. Chairman Rokeberg asked
how much increase they had seen in their business, particularly
from the Medicaid eligibility aspects.
Number 2081
MS. KANNE replied the Medicaid [reimbursement] would begin February
12; the regulations had taken that long to be completed and signed
into law. Ms. Kanne said they had continued to take Medicaid
clients in the meantime and written them off as part of the
nonprofit birth center, noting they hadn't turned anyone away.
CHAIRMAN ROKEBERG commented on the excellent lesson this provided
for the newer committee members regarding the effective date of
legislation and the time it took to implement regulations before
there was actual practical effect of passing legislation.
Number 2116
REPRESENTATIVE SANDERS commented on an article about midwives in
that morning's Anchorage Daily News. He highly recommended it to
everyone, indicating it was approximately 20 pieces of Eskimo
advice from the times before Western physicians.
Number 2147
REPRESENTATIVE MURKOWSKI asked Ms. Kanne to describe the
professional relationship between the physicians in Juneau and the
midwives. She asked if the physicians viewed the midwives as a
professional threat because the midwives were taking some of their
patients, or if the physicians had accepted the obvious benefits
that came from midwifery.
Number 2165
MS. KANNE responded she thought it depended on the individual
doctor. She said she would say in Juneau she had always had a good
relationship with the physicians. Ms. Kanne indicated she felt
there was some healthy fiscal competition, but she thought the
relationship was very healthy for the most part. Ms. Kanne stated
the midwives were autonomous practitioners, they did not require
physician backup. In other words, they did not have to have an
official relationship with a physician. She said she thought that
made the physicians feel more comfortable because the physicians
did not have to say officially that they backed the midwives up, so
they then did back them up in reality. Ms. Kanne said the
physicians were there for the midwives, the midwives could call
them at any time.
CHAIRMAN ROKEBERG noted that the committee had received written
testimony as well from Ms. Kanne. He invited Ms. Reardon forward
again.
Number 2208
CATHERINE REARDON, Director, Division of Occupational Licensing,
Department of Commerce and Economic Development, came forward again
to testify. She stated the department strongly supported the
legislation and the continuation of the Board of Certified
Direct-Entry Midwives. Ms. Reardon clarified that her previously-
referred-to memorandum in the audit was her list of all of the
possible steps she could think of for somewhat lower licensing
fees; it was not a list of recommended actions. Ms. Reardon noted
most of the items on the list would have some significant negative
effects. She indicated one of those items had been eliminating the
board and having the department regulate the profession directly,
which meant she and her staff would be writing the regulations and,
more importantly, without the necessary knowledge determining
whether someone had practiced competently as a midwife. Ms.
Reardon indicated her division would probably end up having to hire
experts to review files and such, and that these costs might be
more than the cost of the board. She said, therefore, they found
having a board very useful, especially in a profession like this.
Ms. Reardon mentioned one of the other items which related to the
current five-member board size of one nurse midwife, one
obstetrician, two certified direct-entry midwives, and one public
member. She indicated one of the possible downsides from reducing
the board to three members was the possibility that one of the
members would have a conflict of interest related to a disciplinary
procedure and would be unable to vote.
MS. REARDON stated she knew it had been important to both the
nursing and medical professions to be able to be involved in the
discussions and decisions involving direct-entry midwifery. She
said this was because midwifery was relatively new in terms of a
state-licensed function. Ms. Reardon indicated she thought having
some representation from those other professions was part of the
compromises that permitted the creation of the board. She noted
she thought there might be some concerns if they were to disrupt
the consensus that had developed. Ms. Reardon stated she
personally thought having the option of certified direct-entry
midwifery was very valuable to Alaskan women and she would not want
to see it disappear. She said she thought they did need both the
medical model and the certified direct-entry midwife model, noting
CDMs handled the low-risk cases. Ms. Reardon indicated she thought
they might hear from the nurse midwives and the physicians noting
some of the difference in cost was because the more expensive cases
would go to the medical model. She commented she thought that was
appropriate and only made sense. Ms. Reardon encouraged the
committee to pass the legislation, stating she would be happy to
answer any questions.
Number 2366
REPRESENTATIVE BRICE confirmed from Ms. Reardon that the certified
direct-entry midwives paid for the administration of their board
100 percent.
REPRESENTATIVE CISSNA asked about the distribution of the midwives
throughout the state. She asked how many of the licensed CDMs were
located in the Bush, and if there were unlicensed apprentices in
the Bush who did not have access to a licensed midwife.
Representative Cissna mentioned the high cost of bringing people in
from the Bush, and just the problems there were with childbirth and
the possibilities in the Bush.
Number 2406
MS. REARDON replied she did not believe very many, if any, of their
licensed midwives were actually in a village, and she said that
perhaps some of the midwives that had testified could give the most
feedback about the reasons for that. Ms. Reardon noted part of it
was that they were talking about a licensed profession which had
only developed since 1993. She stated there was an exemption in
the law for practice of midwifery that was part of a person's
cultural inheritance and she indicated she thought that was likely
intended initially to cover probably Native midwives in villages.
Ms. Reardon further indicated the exemption's wording had created
some problems because people from many backgrounds and distances
from that cultural tradition could perhaps legally claim coverage
under the exemption, although that may not have been the
exemption's intent. However, she said she thought for that reason
there very well might be Native midwives in villages who were
legally exempt and who were practicing. Ms. Reardon stated she
would be happy to provide the committee with a list of addresses
for the 14 midwives the division had. She commented she suspected
there were two midwives in Juneau because Ms. Kanne had been active
in reaching out to the community and in the training of other
midwives.
Number 2474
CHAIRMAN ROKEBERG confirmed there was no one else who wished to
testify on HB 10 and stated the public hearing was closed.
Number 2485
REPRESENTATIVE BRICE made a motion to move HB 10 out of committee
with individual recommendations and the accompanying zero fiscal
note. There being no objections, HB 10 moved out of the House
Labor and Commerce Standing Committee.
ADJOURNMENT
Number 2496
CHAIRMAN ROKEBERG adjourned the House Labor and Commerce Standing
Committee meeting at 4:02 p.m.
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