03/18/2011 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB155 | |
| HB139 | |
| HB11 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 139 | TELECONFERENCED | |
| *+ | HB 11 | TELECONFERENCED | |
| += | HB 122 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 155 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
March 18, 2011
3:25 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Mike Chenault
Representative Dan Saddler
Representative Steve Thompson
Representative Lindsey Holmes
Representative Bob Miller
MEMBERS ABSENT
Representative Craig Johnson, Vice Chair
COMMITTEE CALENDAR
HOUSE BILL NO. 155
"An Act relating to public construction contracts."
- MOVED CSHB 155(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 139
"An Act relating to qualifications for licensure as a
veterinarian."
- HEARD & HELD
HOUSE BILL NO. 11
"An Act requiring that retiree health insurance coverage offered
by the state and by certain local governments include coverage
for colorectal screening, including colonoscopies."
- HEARD & HELD
HOUSE BILL NO. 122
"An Act relating to naturopaths and to the practice of
naturopathy; establishing an Alaska Naturopathic Medical Board;
authorizing medical assistance program coverage of naturopathic
services; amending the definition of 'practice of medicine'; and
providing for an effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 155
SHORT TITLE: PUBLIC CONSTRUCTION CONTRACTS
SPONSOR(s): LABOR & COMMERCE
02/11/11 (H) READ THE FIRST TIME - REFERRALS
02/11/11 (H) L&C
02/25/11 (H) L&C AT 3:15 PM BARNES 124
02/25/11 (H) Heard & Held
02/25/11 (H) MINUTE(L&C)
02/28/11 (H) L&C AT 3:15 PM BARNES 124
02/28/11 (H) Heard & Held
02/28/11 (H) MINUTE(L&C)
03/07/11 (H) L&C AT 3:15 PM BARNES 124
03/07/11 (H) Heard & Held
03/07/11 (H) MINUTE(L&C)
03/09/11 (H) L&C AT 3:15 PM BARNES 124
03/09/11 (H) Heard & Held
03/09/11 (H) MINUTE(L&C)
03/11/11 (H) L&C AT 3:15 PM BARNES 124
03/11/11 (H) Heard & Held
03/11/11 (H) MINUTE(L&C)
03/14/11 (H) L&C AT 3:15 PM BARNES 124
03/14/11 (H) Scheduled But Not Heard
03/16/11 (H) L&C AT 3:15 PM BARNES 124
03/16/11 (H) <Bill Hearing Canceled>
03/18/11 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 139
SHORT TITLE: VETERINARIAN LICENSING QUALIFICATIONS
SPONSOR(s): P.WILSON
02/04/11 (H) READ THE FIRST TIME - REFERRALS
02/04/11 (H) L&C
03/18/11 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 11
SHORT TITLE: COLONOSCOPY: PUB. EMPLOYEE RETIREES
SPONSOR(s): GARA
01/18/11 (H) PREFILE RELEASED 1/7/11
01/18/11 (H) READ THE FIRST TIME - REFERRALS
01/18/11 (H) L&C, FIN
03/18/11 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
JENNIFER SENETTE, Staff
Representative Kurt Olson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 155.
DON ETHERIDGE
Lobbyist
Alaska State AFL-CIO
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 155.
KATHIE WASSERMAN, Executive Director
Alaska Municipal League (AML)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 155.
BARBARA HUFF TUCKNESS, Director
Governmental and Legislative Affairs
Teamsters Local 959
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 155.
GREY MITCHELL, Director
Division of Labor Standards & Safety
Department of Labor & Workforce Development
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 155.
REPRESENTATIVE P. WILSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 139.
MICHAEL WISENKAMP, Intern
Representative P. Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 139.
MYRA WILSON, Veterinarian
Secretary; Alaska State Veterinary Medical Association (ASVMA)
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 139.
DON HABENGER, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development (DCCED)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
during the discussion of HB 139.
DAVID HUNT, Veterinarian
Chair, Board of Veterinary Examiners (BVE)
Sitka, Alaska
POSITION STATEMENT: Testified during the discussion of HB 139.
JIM DELKER, Veterinarian; President
Alaska Veterinary Medical Association (AVMA)
Soldotna, Alaska
POSITION STATEMENT: Testified during the discussion of HB 139.
JON BASLER, Member
Alaska Veterinary Medical Association (AVMA)
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 139.
PAM TUOMI, Veterinarian
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 139.
CATHERINE VERSTEEG, Veterinarian
Eagle River, Alaska
POSITION STATEMENT: Testified in opposition to HB 139.
JONATHAN MUSMAN
Homer, Alaska
POSITION STATEMENT: Testified during the discussion of HB 139.
KAREN EWING, Executive Director
Idaho Board of Veterinarian Medicine
Boise, Idaho
POSITION STATEMENT: Testified during the discussion of HB 139.
MARYANN HOLLICK, Veterinarian
Eagle River, Alaska
POSITION STATEMENT: Testified in opposition to HB 139.
REPRESENTATIVE LES GARA
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of HB 11.
WARD B. HURLBURT, M.D., MPH Director and Chief Medical Officer
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 11.
BRIAN SWEENEY, SR., Physician
Alaska Correctol Council
Anchorage, Alaska
POSITION STATEMENT: Testified on behalf of his son in support
of HB 11.
MOLLY MCCAMMON
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 11.
EMILY NEENAN, Alaska Government Relations Director
American Cancer Society Cancer Action Network
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 11.
RICHARD BENAVIDES
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 11.
BOB DOLL, President
Retired Public Employees of Alaska (RPEA)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 11.
MARIE DARLIN, Coordinator
AARP Capital City Task Force
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 11.
ACTION NARRATIVE
3:25:14 PM
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 3:25 p.m. Representatives Olson,
Saddler, Thompson, Holmes, and Miller were present at the call
to order. Representative Chenault arrived as the meeting was in
progress.
HB 155-PUBLIC CONSTRUCTION CONTRACTS
3:25:40 PM
CHAIR OLSON announced that the first order of business would be
HOUSE BILL NO. 155, "An Act relating to public construction
contracts."
3:26:47 PM
REPRESENTATIVE SADDLER moved to adopt the proposed committee
substitute (CS) labeled 27-LS0249\I, Bannister, 3/17/11 as the
working document.
CHAIR OLSON objected for the purpose of discussion. [Version I
was before the committee.]
3:27:22 PM
JENNIFER SENETTE, Staff, Representative Kurt Olson, Alaska State
Legislature, stated that the stakeholders were at odds but the
parties worked to develop a consensus bill.
3:28:19 PM
CHAIR OLSON agreed that the parties have worked for over a year
on this issue but have developed a conceptual committee
substitute (CS).
3:29:50 PM
MS. SENETTE reviewed the three changes contained in the proposed
committee substitute (CS) for HB 155, Version I. She related
that the bill title has changed from a broader to a more
specific title. The second change is that the threshold of when
the Little Davis Bacon Act (LDBA) provisions would apply to
projects is set at $25,000. The third change is that the
definitions in proposed Section 8 of the bill have been removed.
The definition for "maintenance" was a huge sticking point for
some parties. She highlighted testimony before the committee as
well as a 1983 attorney general's (AG) opinion. Those are the
three changes to the bill and all the parties indicated they
could "live with the changes." He commented that it appeared
that this bill was a union versus nonunion issue, and a road
service area (RSA) versus municipality issue. The proposed CS
symbolizes that the issue did not attempt to target one group
but to update an antiquated statute, in particular to update the
dollar threshold amount for LDBA in Alaska to 2011.
3:32:22 PM
DON ETHERIDGE, Lobbyist, Alaska State AFL-CIO, agreed that as
Chair Olson and his staff indicated the parties reached a
compromise. He stated that no one is happy but everyone came
together. He offered his appreciation for Chair Olson's
indulgence. He offered his support for the proposed Version I.
3:33:47 PM
KATHIE WASSERMAN, Executive Director, Alaska Municipal League
(AML), thanked the committee. She stated that although no one
is happy with the result she worked with Mr. Etheridge and Ms.
Huff Tuckness to consider the scenarios and potential results.
She anticipated each will have members from their organizations
with some push back, which is okay. She said she has conferred
with Mr. Etheridge who agreed with the outcome. She reiterated
her gratitude and summarized that she thought the bill
represented an agreement that would be beneficial for everyone.
3:35:15 PM
BARBARA HUFF TUCKNESS, Director, Governmental and Legislative
Affairs, Teamsters Local 959, thanked members and reiterated
previous testimony. She characterized the proposed CS for HB
155, Version I as a product that she supports and will continue
to support as it goes through the legislative process.
3:36:43 PM
REPRESENTATIVE SADDLER asked for the relationship between the
threshold in the bill and filings with the Department of Labor &
Workforce Development's (DLWD).
MS. HUFF TUCKNESS answered that the $25,000 threshold would
match the threshold currently established for a filing fee.
3:37:54 PM
GREY MITCHELL, Director, Division of Labor Standards & Safety,
agreed with Ms. Huff Tuckness that the $25,000 threshold would
match the threshold currently established for a filing fee.
This change would zero out fiscal note. The $25,000 threshold
would be consistent for application of the LDBA and the filing
fee requirement.
CHAIR OLSON removed his objection.
3:39:19 PM
REPRESENTATIVE SADDLER moved to report the proposed committee
substitute (CS) for HB 155, labeled 27-LS0249\I, Bannister,
3/17/11, out of committee with individual recommendations and
the accompanying zero fiscal notes. There being no further
objection, the CSHB 155(L&C) was reported from the House Labor
and Commerce Standing Committee.
3:39:46 PM
The committee took an at-ease from 3:39 p.m. to 3:43 p.m.
3:43:47 PM
HB 139-VETERINARIAN LICENSING QUALIFICATIONS
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 139, "An Act relating to qualifications for
licensure as a veterinarian."
3:43:54 PM
REPRESENTATIVE P. WILSON, Alaska State Legislature, stated goal
of the bill is to increase the number of veterinarians in the
state. Currently, the Board of Veterinary Examiners (BVE)
allows only one certification program to be used to certify
veterinary graduates who have graduated from foreign
certification programs. The certification program is the
Educational Commission for Foreign Veterinary Graduates (ECFVG).
At the time that the statutory board was initiated the ECFVG was
the only credentials certification program available. This bill
would allow the board to decide which certification program to
use. As new programs are developed the veterinarians should
determine which programs are appropriate. In 2003, another
certification program for foreign veterinarians was developed
which she identified as the Program for the Assessment of
Veterinary Education Equivalence (PAVE).
3:45:44 PM
CHAIR OLSON asked whether the Board of Veterinary Examiners
(BVE) had requested the bill since this seems to be a function
of the board.
REPRESENTATIVE P. WILSON responded that two veterinarian
graduates who cannot get licensed in Alaska requested assistance
since it is costly, approximately $6,000, to obtain licensure
using the current certification program. She explained that 32
states and territories use this approach. This bill would allow
the board the option.
3:47:11 PM
MICHAEL WISENKAMP, Intern, Representative P. Wilson, Alaska
State Legislature, reiterated that this bill would give the
Board of Veterinary Examiners (BVE) the latitude to choose which
certification program for veterinarians who have graduated from
foreign universities. He highlighted that this bill is not
about the certification programs themselves. The idea for HB
139 arose with e-mail from a constituent who complained that his
wife could not practice veterinary medicine in Alaska even
though she was licensed in three other states. His wife is a
graduate of a foreign university. She graduated from St.
George's University in Granada and completed her clinical year
in veterinary medicine at the University of Minnesota. She
completed the Program of Assessment of Veterinarian Education
Equivalence (PAVE) in order to ensure she could practice
veterinary medicine in the U.S. He reported that PAVE is one of
two certification programs offered in the U.S. to evaluate
foreign veterinarian programs. Currently, the constituent
cannot practice in Alaska since Alaska exclusively accepts the
Educational Commission for Foreign Veterinary Graduates (ECFVG).
The constituent is currently licensed in California and
Washington to practice veterinary medicine, he said.
3:49:10 PM
MR. WISENKAMP detailed that the constituent had researched the
requirements to complete the ECFVG program and discovered it
would require two round trips to one of the testing sites in the
Lower 48 plus $6,000 in fees. She asked Representative Wilson
to introduce a bill that would allow the state to accept both
programs. In 2000, PAVE began offering services and 32 states
currently accept it as a means for foreign students to have a
path for licensure. He referred to a detailed description
titled, "American Association of Veterinary State Boards PAVE
Standards and Policies" in members' packets. He explained that
other states have evaluated the two programs and deem it as
equivalent to the ECFVG, he said. Washington and Idaho are
among the 32 states that accept PAVE. Since 2006, Idaho or
Washington has not experienced any issues with any PAVE
candidates. This bill, HB 139, would empower the BVE to select
either or both certification programs. The BVE is comprised of
four licensed veterinarians and one public member. He referred
to the mission statement, which read, "The Board adopts
regulations to carry out laws governing veterinarian practice in
Alaska. It makes final licensing decisions and takes
disciplinary actions against people who violate licensing laws."
Currently, the statute precludes the board from making a
licensing decision by directing foreign university graduates to
a specific program. He concluded if the BVE would like to
accept PAVE in addition to the ECFVG that it should be have the
ability to do so.
3:52:11 PM
REPRESENTATIVE MILLER referred to language on page 2, line 2 of
HB 139 that specifies "shall." He asked whether the language
should be softened.
REPRESENTATIVE P. WILSON answered that the specific language he
referred to is current statute.
3:53:11 PM
MYRA WILSON, Veterinarian, stated she is a Past President of the
Alaska State Veterinary Medical Association (ASVMA). The ASVMA
represents 150 licensed veterinarians in Alaska statewide. The
ASVMA is opposed to the bill since it does not believe it is a
good bill for citizens in Alaska. She expressed concern that it
would bring ambiguity to turn over licensing standards to a five
member board appointed by the governor on a rotating basis. The
Educational Commission for Foreign Veterinary Graduates (ECFVG)
is recognized by 50 states and Canada and is the only
certification program with federal approval. She emphasized the
importance of having all 50 states recognize the same
requirements for consistency.
3:55:30 PM
DR. WILSON also expressed concern that the public would not know
their veterinarian's qualifications. Citizens expect competency
and not ambiguity in the certification program, she said.
Additionally, it may cause some ambiguity for business owners
hiring veterinarians. She commended the current level of
excellence in veterinary medicine in Alaska.
3:56:36 PM
REPRESENTATIVE HOLMES asked whether she believes the problem is
the PAVE certification or if the issue surrounds the Board of
Veterinary Examiners' (BVE) ability to make and change standards
or both.
DR. WILSON related that the bill does not specify PAVE
certification but would allow the BVE's choice in selecting
accreditation programs.
REPRESENTATIVE HOLMES asked whether the ASVMA has a position on
the PAVE accreditation program.
DR. WILSON answered that the group has not taken a formal
position so ASVMA would have to meet as group and vote. She
offered to report back to the committee.
3:57:35 PM
REPRESENTATIVE SADDLER asked whether she represents the ASVMA.
DR. WILSON answered yes.
3:57:51 PM
REPRESENTATIVE MILLER asked whether the BVE is an existing
board.
DR. WILSON answered the BVE is an existing board consisting of
four veterinarians and one lay person, with rotating terms.
3:58:30 PM
REPRESENTATIVE MILLER said he assumed she had confidence in
other licensed veterinarians to assess credentials of
candidates.
DR. WILSON suggested that question is better answered by the
BVE's members.
3:58:55 PM
REPRESENTATIVE MILLER related a scenario in which Dr. Wilson was
appointed to the BVE. He asked whether she would trust the
other board members to determine capabilities of veterinary
candidates.
CHAIR OLSON reported the BVE's current chair will testify.
3:59:17 PM
DR. WILSON stated that she preferred not to get into comparisons
between PAVE and ECFVG, but pointed out that the ECFVG
certification process requires a clinical competency test.
However, not all PAVE graduates are required to do so.
3:59:54 PM
REPRESENTATIVE SADDLER asked how many veterinarians are licensed
und ECFVG.
DR. WILSON answered that is currently the only certification
program in statute so she thought all veterinarians licensed in
Alaska were ECFVG certified. She suggested the Department of
Commerce, Community & Economic Development, Division of
Corporations, Business, and Professional Licensing could answer
that question.
REPRESENTATIVE SADDLER clarified that he was seeking the total
number of foreign accreditation licensed veterinarians in
Alaska.
DR. WILSON said she did not know.
4:00:41 PM
DON HABENGER, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development (DCCED), stated he did not have the number
either, but he offered to provide the information to the
committee.
4:01:25 PM
DAVID HUNT, Veterinarian, stated that the Board of Veterinary
Examiners (BVE) does not currently accept PAVE, which is the
program for assessment of veterinary education equivalence.
However, the BVE has researched PAVE and is supportive to accept
it. In 2009, the PAVE Committee presented to the board at its
meeting in Fairbanks. He indicated he has been to the National
Board of Veterinary Examiner's meeting for the past five years
and has learned about the PAVE program requirements. The BVE is
on record that it is supportive of accepting PAVE and has
determined the PAVE program is equal to standards of the ECFGV,
which is the test now being used for foreign graduates given by
the American Veterinary Medical Association (AVMA) for
veterinary candidates. This bill would allow the BVE to decide
which programs to accept for veterinary licensure in Alaska and
to accept the PAVE program.
4:02:47 PM
REPRESENTATIVE SADDLER asked for clarification on the number of
veterinarians practicing in Alaska who graduated from foreign
schools and were certified under the ECFVG.
DR. HUNT answered probably less than ten. He suggested the
department would have the figures.
REPRESENTATIVE SADDLER asked whether he could predict the number
of foreign veterinary candidates who are likely to see licensure
using the PAVE program.
DR. HUNT answered that he is only aware of one veterinary
candidate who is seeing licensure via the PAVE program. He
identified the candidate as a woman from Homer. He did not
believe a rush of candidates would try to get into the program
using the PAVE standard. He offered his belief that the PAVE
program is a solid program and in the future it could be an
important program. He predicted that in the future all the
states would accept the PAVE program. He also offered his view
that the PAVE program is just as good as the ECFVG program. He
remarked that he has been pretty well educated on the elements
of the PAVE program by attending the national meetings. He
related that the bill is structured to allow the BVE to decide
which program to accept. He did not think any other
accreditation programs would surface for veterinary candidates.
REPRESENTATIVE SADDLER related his understanding that this bill
would allow the BVE to choose which of the accreditation
programs to use. He asked whether the BVE board would use one
or the other or both programs.
DR. HUNT answered the BVE would use both programs. The PAVE
process would just represent a different path for veterinary
candidates to gain licensure.
REPRESENTATIVE SADDLER asked for clarification on the reason
that PAVE began in 2000.
DR. HUNT answered that the ECFVG only offers examinations once a
year and it is difficult for people to take the exams all at one
time. The PAVE examination is offered twice a year and has a
practical exam that people can take to familiarize themselves
with the test. He considered the frequency of testing as the
primary reason candidates are interested in PAVE.
4:05:40 PM
REPRESENTATIVE SADDLER remarked that the military license bill
might allow for licensure via a courtesy license.
4:05:53 PM
REPRESENTATIVE HOLMES asked whether the BVE has a position. on
the bill.
DR. HUNT answered he thought that the BVE would want this bill
to pass.
REPRESENTATIVE HOLMES asked whether he could address concerns in
terms of the ambiguity. She further asked whether simply adding
PAVE to the list of accredited programs would suffice.
DR. HUNT responded that he did not have any problem with that
approach but the current bill offers the board flexibility in
the event another program would be offered. He said either way
would work.
JIM DELKER, Veterinarian, President, Alaska Veterinary Medical
Association (AVMA), the Alaska Veterinary Medical Association
(ASVMA) represents the majority of the practicing veterinarians
in Alaska. The AVMA formally adopted a resolution against HB
139. The main reason for opposition is that presently the
licensing standards and requirements are clearly stated in
statute in the Veterinary Practices Act. The AVMA does not
think the bill should be changed to allow a five-member
revolving board since it could subject the board to bias. He
agreed with Dr. Hunt that the PAVE and ECFVG programs are likely
the only programs that will be offered. He does not believe the
board should have the power to select certification programs.
He related a scenario in which in which three of five members
decided that a veterinary school in India not accredited by the
AVMA was sufficient that the BVE could accept students for
licensure. He expressed concern that accepting other standards
could reduce the overall standards of the veterinarian
profession in Alaska. He offered his belief that HB 139 as
written is not a good bill.
4:09:48 PM
DR. DELKER recalled the bill's purpose would be to increase the
number of veterinarians and he did not think this would happen,
especially in rural Alaska. He suggested the National
Veterinary Medical Service Act as another option to increase
rural veterinarians. He reported the NVMSA has allotted five
spots for rural veterinarians. Currently, 20 states offer
veterinarian student repayment plans for veterinarians that
choose to serve in rural communities, which he thought would be
more effective. way to increase veterinarian services in Alaska.
He reiterated that he does not think HB 139 will accomplish this
goal.
DR. DELKER stated that AVMA has not formally taken a position so
his comments on PAVE are his own. He related that two
veterinary schools in the Caribbean gained some benefits by not
requiring its students to take a clinical competency exam as
other foreign veterinary graduates are required to take. The
school arranged to have students take a fourth year in an
accredited school in the U.S. Thus, the veterinary students
would attend three years at the non-accredited school and one
year at the accredited school and would skip the clinical
competency test. The general consensus by the AVMA was that it
was not fair or equitable approach to take since these foreign
graduates do not take the test all the other foreign graduates
must take which is why the PAVE program is not approved by all
states. He acknowledged that PAVE is a very good program, but
it is not equitable in all situations. He offered his belief
that it would not be fair to allow two schools in the Caribbean
to circumvent the standards by not requiring the competency
examination. He acknowledged that one of the two schools just
gained AVMA accreditation so this may become a moot point.
4:12:59 PM
REPRESENTATIVE HOLMES asked how the AVMA would respond if HB 139
specifically listed the PAVE program and did not offer the BVE
any additional discretion.
DR. DELKER acknowledged that it would more palatable, but not
necessarily fully supported since there is still a little
discrepancy in the PAVE program.
DR. DELKER suggested that the AMVA may wish to adopt a Model
Practice Act in the next year or so. He suggested that the AMVA
could review the PAVE program at the time it considers adopting
current standards of veterinary medicine.
4:15:15 PM
REPRESENTATIVE SADDLER asked for the current supply and demand
for veterinarians in Alaska. He further inquired as to whether
there is a shortage of veterinarians in Alaska.
DR. DELKER responded that it can be somewhat difficult in
smaller communities to attract or retain veterinarians. He
commented he has practiced in Alaska since 2003 and has always
been able to fill positions.
REPRESENTATIVE SADDLER stated that he read letters and e-mails
indicated adopting the PAVE program would diminish standards.
He recalled that Dr. Delker reported the program as a good
program. He inquired as to whether HB 139 would diminish the
standards.
DR. DELKER answered that he would not say it specifically would
diminish the standards but it potentially could if programs
other than the PAVE or ECFVG accreditation programs were used.
4:16:43 PM
JON BASLER, Member, Alaska Veterinary Medical Association
(AVMA), stated that he serves as the Alaska delegate to the
American Veterinary Medical Association (AVMA). He spoke in
opposition to the bill. He has practiced in Alaska since 1985
and also spent three years in rural Alaska in the North Slope
Borough. He concurred with earlier testimony that this bill
would not bring a significant number of practitioners to Alaska.
He expressed concern with HB 139 due to its ambiguity since it
leaves it wide open for the BVE to accept other accreditation
processes. He agreed with earlier testimony that PAVE may
become a moot point if the final school in the Caribbean becomes
accredited. He reiterated that his personal opposition to the
bill is because the bill would create ambiguity and leaves wide
open the standards for veterinarian applicants as to what is
acceptable. He related substantial work has been performed
nationally to try to standardize and provide specific guidelines
for veterinarians. He did not see this as a barrier to entry
but as a concern about the level of competency of veterinary
candidates.
4:19:18 PM
REPRESENTATIVE THOMPSON recalled that the PAVE and ECFVG
programs are acceptable. He inquired as to whether other
programs exist.
DR. BASLER answered that currently the only two programs in the
U.S. are the ECFVG and the PAVE process, which he believed was
specifically designed for Caribbean schools without full
accreditation.
4:20:14 PM
DR. BASLER related that other countries have veterinary programs
and it really depends on the country as to the quality of the
program. He offered his belief that the European Union's
programs are likely as extensive as the U.S. programs, but
programs in South America, Africa, or India would not be
anything like the American programs.
4:21:03 PM
REPRESENTATIVE MILLER commented that after hearing each of the
organizations testifying against the bill that people just don't
seem to trust the BVE.
DR. BASLER responded no, that he did not think so. He pointed
out that the people serving on the BVE are his colleagues. He
emphasized that bills should be clear and not ambiguous and not
leave anything open ended. He said he applauded his colleagues
for taking the time out of their personal lives for their
willingness to serve. He characterized their service as adding
to the professionalism of their veterinarian service.
REPRESENTATIVE MILLER stated he would defer to the BVE's
judgment and other testifiers. He pointed out that he did not
see that the bill would "open the door" other than to ask fellow
veterinarians to assess certification programs for foreign
candidates that do not fall under the ECFVG program.
DR. BASLER responded that the national Model Practice Act has
been making a big push to standardize Veterinary Practice Acts
across the country in an effort to create more uniform laws. He
thought this bill would take Alaska away from the model act
rather than to move towards it.
4:23:25 PM
PAM TUOMI, Veterinarian, stated that she previously served on
the BVE and as a veterinarian that has practiced in Alaska since
the 1970s.
CHAIR OLSON interjected that Dr. Tuomi is his veterinarian.
4:24:04 PM
DR. TUOMI stated that she served on the board at the time when
some of the initial statutes were adopted and when veterinarians
wrote and administered the exam. She acknowledged the
difficulty in taking average practitioners appointed by the
governor to design and oversee the licensing process. She
indicated the board took its responsibilities seriously and
welcomed the national examining process. This allowed the board
to use the expertise of national academics to verify that
veterinary applicants were meeting standards and were qualified
to practice nationwide. She expressed concern with HB 139 since
it potentially "throws a door open." She reinforced that
veterinarians trust their board members and acknowledge the
difficult job of serving as a board member. However, the
practices act should not be rewritten to serve one individual.
She related that valid routes for licensure exist that protect
the public health and welfare of animals. The current system
works well. She suggested she would be happier if the BVE would
like to specifically add the PAVE program as an option than to
have a wide open program.
4:26:38 PM
CHAIR OLSON inquired as to whether this bill would expand the
number of veterinarians working in rural Alaska.
DR. TUOMI answered no. She offered her belief that the
potential for harm is greater than any potential benefits.
4:27:11 PM
REPRESENTATIVE SADDLER related his understanding that she did
not like the wide open language to allow the BVE to select its
own accreditation and would feel more comfortable although not
entirely comfortable if the bill specified the PAVE program.
DR. TUOMI answered yes, which is strictly her personal
perspective.
4:27:36 PM
CATHERINE VERSTEEG, Veterinarian, stated she is also a past
President of the AVMA. She stated that she opposes the bill as
written. She has worked in rural Alaska and has worked with
nonprofits to try to increase the number of practicing
veterinarians in Alaska. She did not think HB 139 would attract
veterinarians to practice in rural Alaska. She offered her
belief that it would be better to have the certification program
in statute rather than have a "gray zone" that would allow for
changes in the program.
4:28:47 PM
JONATHAN MUSMAN thanked Representative Wilson for sponsoring the
bill. He originally contacted the BVE in 2009 with respect to
PAVE and was referred to the legislature. He related that the
BVE originally opposed changing the practice act due to a
potential merger of PAVE and ECFVG, but any potential merger is
years away according to his sources at PAVE. He listened to
testimony today relating that the bill would not benefit Alaska.
He said that two Alaskans would benefit if his wife could work
in the state. She would like to work in the state and for the
past year and a half she has flown to Oregon and Washington to
work. Last year she spent nearly three weeks of every month for
six months working in Washington to keep her skills sharp. He
indicated that the cost of taking the ECFVG. Although the
actual test costs are $5,000, the typical process time ranges
from 12 to 24 months and requires two trips to testing centers.
Her classmates have made more than three trips to complete the
testing process.
4:32:12 PM
KAREN EWING, Executive Director, Idaho Board of Veterinarian
Medicine, stated that the Idaho board changed its rules in 2007
to accept PAVE. The Idaho has not had any problems with the
PAVE program. She explained that she has found her board
members to be extremely qualified to evaluate a testing program
to determine whether a foreign graduate meets the same
competency standards. She offered her belief that public could
have great faith in their veterinary board members. She related
that one of her board members served on the PAVE development
committee and he found the program to be outstanding. She
reported that what the Idaho board has found an increase of
about five percent of licensees in the past four years since the
board has accepted PAVE. Additionally, a majority of the
foreign graduates grew up in the U.S. but attended the Idaho
Board received a letter from a student in a foreign university
in a PAVE program who grew up in Idaho and wanted to practice
Veterinary medicine in Idaho upon graduation. She indicated
that the Idaho Board researched the matter and found PAVE to be
an exceptional program, at least as good as the AVMA's ECFVG.
She concluded that the public can trust their board members to
be qualified to make these decisions.
4:35:32 PM
REPRESENTATIVE SADDLER asked whether she was speaking on behalf
of the board.
MS. EWING answered that she is speaking on behalf of the board
to describe Idaho's experience.
4:35:55 PM
REPRESENTATIVE MILLER asked whether the Idaho's board is similar
to Alaska's board, which is a five member board, four of whom
are veterinarians and one public member appointed by the
governor.
MS. EWING answered that the Idaho Board consists of five
licensed veterinarians and one public member. She reiterated
that one former Idaho Board member also served on the PAVE
committee. The current public member also serves as the public
member on the National Board of Veterinary Medical Examiners
(NBVME). The NBVME also created the qualifying exam that is
part of the PAVE program and the Veterinary Clinical Skills
Assessment Test that is part of the PAVE completion pathway, she
said.
4:37:10 PM
REPRESENTATIVE MILLER related his understanding that once the
Idaho Board could accept the PAVE process, the Idaho board
created additional testing.
MS. EWING explained that in Idaho, the authorizing statute
specifically mentioned students of non-accredited universities
and mentioned the ECFVG program. Additionally, the Idaho board
allowed any equivalency program established for the purpose of
evaluating an individual's educational knowledge and clinical
skills as it related to the practice of Veterinary medicine and
as approved an outlined by the rules of the board. Thus, the
Idaho Board did not have to change its statute and just added a
rule that incorporated the PAVE program by reference. She added
that the ECFVG program was also incorporated by reference.
4:38:59 PM
REPRESENTATIVE MILLER related his understanding that the Idaho
Board has not seen any diminished in capabilities of the
veterinary licensees.
MS. EWING answered that in the four years the Idaho Board has
accepted foreign graduates who participated in the PAVE program
that the Idaho Board has not received a single complaint against
any of the veterinarians nor has it taken any disciplinary
action against them. However, it has taken disciplinary actions
against ECFVG graduates. She characterized the disciplinary
process as largely based on individual person since she finds
both the PAVE and the ECFVG programs are excellent programs to
determine educational equivalency for graduates of non-
accredited universities.
4:39:58 PM
MARYANN HOLLICK, Veterinarian, stated that she has been a
veterinarian in Alaska for over 20 years. She testified in
opposition to HB 139. She stated that in addition to clinical
practice, she previously owned and operated a large Veterinary
Hospital in Anchorage. She said, "I object to HB 139. This
bill would delete the requirement for the nationally AVMA
testing standard. In my opinion Alaskan pet owners receive and
deserve the best care." She found it troubling to see bills of
this nature. Since Alaska currently has high standards the
implication is that the standard will be reduced. She offered
her belief that the bill would create uncertainty for practices
from year to year as practitioners await the actions of the
board. She urged members not to adopt HB 139. Additionally,
she related that she personally has visited the non-accredited
Caribbean Veterinary Schools and met with their dean in last six
months. They do not have a Veterinary teaching hospital and do
not provide any clinical training until the students come to the
U.S. She pointed out that a non-accredited university is not
the same as an accredited U.S. university. She indicated that
the AVMA has decided to accept the ECFVG and not to accept PAVE.
If at some point the AVMA accepts PAVE then she would suggest
Alaska should reconsider this issue. Until then she does not
believe the two programs are equal.
[HB 139 was held over.]
4:42:26 PM
HB 11-COLONOSCOPY: PUB. EMPLOYEE RETIREES
4:43:31 PM
CHAIR OLSON announced that the final order of business would be
HOUSE BILL NO. 11, "An Act requiring that retiree health
insurance coverage offered by the state and by certain local
governments include coverage for colorectal screening, including
colonoscopies."
4:43:36 PM
REPRESENTATIVE LES GARA, Alaska State Legislature, stated that
in the State of Alaska, only one group of people is not covered.
All people covered by private insurance plans and state
employees are covered by law. Thus, the group that needs
coverage the most are the Retired Public Employees who are not
covered. Colon cancer is the third leading cause of cancer and
testing is most important for people over the age of 50.
Screening is important since the survival rate for early
detection is high, with an approximately 90 percent survival
rate for longer than five years. Without screening and early
detection the survival rate is 10 percent for over five years.
This bill would ask for coverage under the Retired Public
Employees plan consistent with the standards adopted by the
American Cancer Society. Typically, screening consists of a
colonoscopy but could be some other procedure depending on what
the doctor and patient agree is necessary. Additionally, the
Alaska Native population suffers from colon cancer at a two to
one rate over Caucasians. An alternative blood test is
especially dangerous to Alaska Natives, which makes the
colonoscopy more important. He referred to cost analysis on
colonoscopies. He expressed surprised by the fiscal note since
the studies show colonoscopies save money. The cost of
colonoscopy or other preventive care is offset by cost to treat
someone with colon cancer. He referred to a study in members'
packets by Buck Consultants, which shows a likely cost savings
by screening individuals over the age of 50 as opposed to not
providing screening and paying for cancer coverage. He referred
to the state's fiscal note which indicates a cost of $4 million
to provide a colonoscopy for everyone. He stated that the bill
is requesting colonoscopy coverage for those individuals who are
retired since the test is not necessary for someone who is 20 or
30 years old.
4:48:47 PM
WARD B. HURLBURT, M.D., MPH Director and Chief Medical Officer,
Division of Public Health, Department of Health and Social
Services (HSS), stated that he is a general surgeon who has
dealt with colorectal cancer for many decades.
REPRESENTATIVE GARA inquired as to whether he could speak to
costs for colonoscopies. He stated that the Department of
Administration (DOA) takes the position that it costs more to
provide the screening than treatment.
DR. HURLBURT stated that he has not performed an analysis on the
screening. He said he could not comment since the fiscal note
is prepared by another department. He related that he is
speaking of colorectal cancer screening in the same sense that
Centers for Disease Control (CDC). The CDC colorectal cancer
screening for individuals ages 50 to 75. The screening tests
include a fecal occult blood test, a flexible sigmoidoscopy
every five years, or a colonoscopy every ten years. The
colonoscopy is the most expensive test but those in the public
health circles subscribe to early intervention for colorectal
cancer since early detection and intervention can make a big
difference. He recommended preventive efforts to identify
lesions such as benign polyps and remove them or identify an
early cancer while it is still localized since it greatly
increases the odds of survival. He did not have a specific
analysis on the immediate costs, but over the long term when
considering costs of end of life care it would balance out. He
suggested it is reasonable to think in the short run that a
program would incur costs but the savings would come "further
down the road."
4:52:42 PM
BRIAN SWEENEY, SR., Physician, Alaska Correctol Council, stated
that he is a member of the American College of Gastroenterology*
Alaska Correctol Council He is speaking today on behalf of his
son who is a member of the Alaska Correctol Council. He has
provided Representative Gara with the American College of
Gastroenterology guidelines. The guidelines cover all insurers
except the retired State of Alaska (SOA) employees. A number of
studies have shown the long term cost effectiveness of
colonoscopy cancer screening. One of the dilemmas is that
people 65 years and older become Medicare patients so any
specific entity making reimbursement payments may not see short
term cost effectiveness since the cost benefits accrue later on,
he said. Recent studies have shown a 30 percent decline in
colon cancer rates which has been attributed to the aggressive
screening procedures that began about eight years ago. He
reported that gastroenterologists nationwide have been taking a
more aggressive approach to screening. Patients identified as
high risk with cancerous polyps have had a 90 percent decline in
new cancer. The American Cancer Society has developed its
guidelines and the legislature has adopted their guidelines for
almost everyone in Alaska. He pointed out that patients often
know what they should do to maintain good health but if they
experience a financial hardship or the procedures are not
covered by insurance it makes it difficult. He has seen retired
state employees deny themselves their colonoscopy tests due to
lack of insurance coverage. He strongly supports coverage for
retired SOA employees so they may have parity with other
Alaskans. He urged members to pass HB 11.
4:56:16 PM
MOLLY MCCAMMON stated that in 1997 she was 45 years old and a
SOA employee diagnosed with Stage 1 colorectal cancer following
a colonoscopy paid for by her state insurance coverage. She
knew her grandfather had died of colon cancer at 45 years old
but a grandfather is a second degree relative so she was not too
concerned. However, her doctor recommended a colonoscopy. Her
symptoms were very minor and she felt confident she would have
ignored them if state insurance had not covered the procedure.
Fortunately, she was scoped and her tumor was discovered early
enough to be surgically removed so she was able to avoid
radiation and chemotherapy. She is now 59 and a SOA retiree and
screening colonoscopies are not covered under the SOA retiree's
health insurance. She said, "This seems totally absurd to me.
My body continues to want to make cancer as evidenced by
numerous precancerous polyps removed over the last 13 years. If
left in place these polyps would have developed into cancerous
tumors that would have required extensive treatment at a
substantial cost yet this is considered routine screening." She
reported that the American Cancer Society recommends routine
screening for colorectal cancer starting at age 50 unless a
person's family history indicates otherwise. She stated that
the ACS recommends that preventing colorectal cancer should be a
major reason for getting tested and the best way to test is the
colonoscopy. She pointed out that this cancer is so treatable
if caught early but the procedure is expensive enough that the
tendency is to postpone or avoid the test until a tumor is too
large to ignore or the cancer has spread. She concluded that
due to screening and improved treatment the U.S. has one million
survivors of colorectal cancer including her. She urged members
to support HB 11.
4:58:41 PM
EMILY NEENAN, Alaska Government Relations Director, American
Cancer Society Cancer Action Network, stated she has worked on
for six years. In 2006, the state law passed that required a
full range of colorectal cancer screening for all state-
regulated insurance plans many other plans followed suit for
colonoscopy screening including Providence Health Systems. The
active state employees already had this coverage. Some union
plans did not have coverage but have since added coverage. The
SOA retirees are the only group not covered for the 50-64 year
age group since Medicare has had coverage for some time for
those 65 years of age or older.
5:01:13 PM
The committee took an at-ease from 5:01 p.m. to 5:02 p.m.
5:02:25 PM
MS. NEENAN related that as of January 1, 2011, Medicare covers
screening, including colonoscopies at 100 percent with no
copayment. Screening can prevent cancer from ever developing,
which is unique to colorectal cancer. She expressed concern
with the 2007 Buck Consultants analysis including that the
consultant used the terms "screening" and "diagnostic"
interchangeably which indicates some confusion.
5:04:12 PM
REPRESENTATIVE SADDLER referred to information in members'
packets from Buck Consultants and to the relative tests
including fecal occult blood test, flexible sigmoidoscopy,
barium enema, and colonoscopy. He inquired as to whether it
fair to assume that it is a straight cost which is a less
effective strategy. He further inquired as to whether there is
a hierarchy for the screening tests.
MS. NEENAN responded that differences exist in the effectiveness
of the screening tests and the decision needs to be made patient
and the doctor dependent on the patient's comfort. She reported
that the colonoscopy is the most sensitive test since it screens
entire colon and can remove precancerous polyps. She recalled
earlier testimony that fecal occult blood testing poses some
problems in the Alaska Native population due to a high incidence
of a stomach lining infection that causes low grade bleeding and
should not be used in that population. She offered to provide
new facts and figures on colorectal cancer to members from the
Alaska Cancer Society.
5:06:45 PM
REPRESENTATIVE GARA stated that retired public employees are
only covered if the retiree shows symptoms. This is problematic
since the whole point of screening is to identify issues prior
to symptoms developing. Currently, retirees are eligible for
colonoscopies if they exhibit symptoms of cancer such as
bleeding. The colonoscopy will remove the polyp before any
bleeding exists. Once bleeding occurs it may be too late for
the patient to survive.
5:07:38 PM
REPRESENTATIVE SADDLER inquired as to whether other tests are
covered.
REPRESENTATIVE GARA answered that the tests are only covered
when symptoms are present.
CHAIR OLSON offered to provide additional information.
5:07:48 PM
RICHARD BENAVIDES stated that he has been a legislative aide for
Senator Bettye Davis. He is in Anchorage receiving cancer
treatment for Stage 4 colorectal cancer that metastasized to his
liver. His doctor recommended a colonoscopy in 2008 during a
routine physical, which he credits for saving his life. The
colonoscopy was covered under his state health plan so he had it
done. He did not experience any symptoms. He passed all the
tests. He was stunned to learn he had any cancer let alone
anything as serious as a stage four colorectal cancer. He was
told that the average survival rate for his cancer is two years.
Since diagnosis he has had two radiation treatments, two major
surgeries, five months of chemotherapy, and is now on oral
chemotherapy. The point is that without this coverage he would
not have known and he would not have had the test done since he
felt great. He stated that this bill would offer retirees the
same coverage that he attributed to saving his life. He offered
his belief that this bill would save thousands of dollars by
identifying colorectal cancer before it becomes more serious and
by preventing it before it is cancerous. He thought any
reduction in colon cancer is a good thing. He thought the bill
is a great idea. He urged members to pass HB 11.
5:11:06 PM
CHAIR OLSON related he has known Mr. Benavides for some time and
urged him to "keep up the battle."
5:11:22 PM
BOB DOLL, President, Retired Public Employees of Alaska (RPEA),
stated that the Retired Public Employees of Alaska (RPEA)
consists of 2,200 individuals who have retired from
municipalities and the SOA. He urged members to support HB 11.
Each year this issue emerges at the top of the RPEA's agenda.
Retirees are aware of the benefit for active employees but are
acutely aware of problem of not having it for retirees. It is
implied in the coverage for active employees that efficacy is
indicated and saves lives. It is a good thing to do. Its
absence has implications that dive it to the top of the list.
He offered his belief that this is a benefit that would not be
abused. No one would undergo the procedure except to maintain
good health. He referred to a letter of November 2007 from Buck
Consultants. He related that their letter states in four
instances that colonoscopy screening benefits is likely to
produce a positive return on investment. He referred to pages
1, 3, and 4 as references. He acknowledged that likely does not
mean certainty, but it does suggest a trial may be in order. He
observed that for us to bemoan the existence of an unfunded
liability and yet resist the adoption of a likely cost savings
procedure on at least a trial basis is inexplicable. It
suggests a bargaining position rather than address good health
care. He urged members to support HB 11.
5:14:50 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force,
referred to a letter from AARP in members packets. The AARP
fully supports HB 11. This bill could save money and save lives
for state employees and retirees.
[HB 11 was held over.]
5:16:22 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
5:16 p.m.