02/17/2012 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB266 | |
| HB314 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 266 | TELECONFERENCED | |
| *+ | HB 314 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
February 17, 2012
3:18 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Mike Chenault
Representative Steve Thompson
Representative Lindsey Holmes
Representative Bob Miller
MEMBERS ABSENT
Representative Craig Johnson, Vice Chair
Representative Dan Saddler
COMMITTEE CALENDAR
HOUSE BILL NO. 266
"An Act relating to the practice of naturopathy; and providing
for an effective date."
- HEARD & HELD
HOUSE BILL NO. 314
"An Act extending the time period for which the Alaska Railroad
Corporation may lease land without reserving the right to
terminate the lease; and providing for an effective date."
- MOVED HB 314 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 266
SHORT TITLE: PRACTICE OF NATUROPATHY
SPONSOR(s): REPRESENTATIVE(s) MUNOZ, TUCK, THOMPSON
01/17/12 (H) PREFILE RELEASED 1/13/12
01/17/12 (H) READ THE FIRST TIME - REFERRALS
01/17/12 (H) L&C
02/08/12 (H) L&C AT 3:15 PM BARNES 124
02/08/12 (H) Heard & Held
02/08/12 (H) MINUTE(L&C)
02/17/12 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 314
SHORT TITLE: ALASKA RAILROAD LAND LEASES
SPONSOR(s): LABOR & COMMERCE
02/06/12 (H) READ THE FIRST TIME - REFERRALS
02/06/12 (H) L&C
02/17/12 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
CHRISTOPHER CLARK, Staff
Representative Cathy Munoz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 266.
WARD B. HURLBURT, M.D., Chief Medical Officer;
Director, Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 266.
KRISTEN COX, Naturopathic Doctor (ND)
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 266.
MARY ALICE MCKEEN
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 266.
REBECCA VAN DE WATER, Certified Nurse Midwife (CNM);
Adult Nurse Practitioner (ANP);
Midwifery Director, Juneau Family Health and Birth Center
Juneau, Alaska
POSITION STATEMENT: Testified during the discussion of HB 266.
ASHLEY MAY, Naturopathic Doctor (ND)
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 266.
DIANE CRYER
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 266.
SCOTT LUPER, Naturopathic Doctor (ND)
Chief Medical Officer
Alaska Center for Natural Medicine
Fairbanks, Alaska
POSITION STATEMENT: Testified during the discussion of HB 266.
BILL KELLEY, Medical Doctor (MD)
Soldotna, Alaska
POSITION STATEMENT: Testified during the discussion of HB 266.
KATY SHERIDAN, Medical Doctor (MD)
Soldotna, Alaska
POSITION STATEMENT: Testified during the discussion HB 266.
MARY ANN FOLAND, Medical Doctor (MD);
President, Alaska State Medical Association (ASMA)
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion HB 266.
JIM JORDAN, Executive Director
Alaska State Medical Association (ASMA)
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 266.
ANNA LATHAM, Staff
Representative Kurt Olson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 314 on behalf of the sponsor,
the House Labor and Commerce Committee, Representative Kurt
Olson, Chair.
JON COOK, Chair
Real Estate Committee; Member, Board of Directors (BOD)
Alaska Railroad Corporation (ARRC)
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion HB 314.
ACTION NARRATIVE
3:18:06 PM
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 3:18 p.m. Representatives Miller,
Thompson, Chenault, and Olson were present at the call to order.
Representatives Holmes arrived as the meeting was in progress.
HB 266-PRACTICE OF NATUROPATHY
3:18:29 PM
CHAIR OLSON announced that the first order of business would be
HOUSE BILL NO. 266, "An Act relating to the practice of
naturopathy; and providing for an effective date."
3:19:02 PM
CHRISTOPHER CLARK, Staff, Representative Cathy Munoz, Alaska
State Legislature, on behalf of Representative Munoz, stated
that HB 266 is intended to place into statute existing
regulations for naturopaths to make it clear that legislative
intent for the language. He related that the sponsor is holding
ongoing discussions with various groups to address concerns of
physicians, particularly with respect to prescription drugs,
while still preserving what NDs can currently prescribe in their
practice.
3:20:42 PM
WARD B. HURLBURT, M.D., Chief Medical Officer; Director,
Division of Public Health, Department of Health and Social
Services (DHSS), stated that he had an opportunity to speak to
Dr. Jasper. He related his understanding that the naturopathic
doctors (NDs) intent is not to expand or change the scope of
naturopathic practice, but merely to clarify their practice. He
has learned that while the allopathic profession considers drugs
and medicines as one and the same, but from the naturopath's
perspective medicines refer to more naturally occurring
substances whereas drugs are more apt to be ones that are
synthesized. He suggested that some of the conflicts in the
bill may be due to definitional semantics. He expressed concern
that this bill would expand the practice of NDs to allow writing
prescriptions, even though it limits the ND to natural
substances. He explained that about 25 to 50 percent of
medications normally provided through a prescription are derived
from plants.
3:23:21 PM
DR. HURLBURT pointed out that pharmaceutical companies invest a
substantial amount on funguses, molds, and natural substances to
treat cancer and other diseases. He expressed concern that use
of drugs derived from funguses and molds can be risky. He also
expressed concern that the expanded prescription rights for
drugs that have historically been available over the counter
could increase costs for payors. He explained that 200
milligrams (mg) of Advil is normally available over the counter
and is not covered by payors, whereas the 800 mg strength is
covered. He recalled that Dr. Jasper gave an example of
capsicum, which is a tincture from the cayenne pepper used to
treat congestion although he cautioned that he is not an expert
in naturopathic medicines. He related his understanding that
this derivative has become less available to NDs since a
prescription is currently being required. He acknowledged he
did not know the details, but the pharmacist in the health care
service for the Medicaid program identified that the
manufacturer of the capsicum tincture decided to require a
prescription. Thus he did not think the prescription
requirement was mandated by the Food and Drug Administration
(FDA). He said he did not see any problem with the intent to
clarify the naturopathic practices since NDs have been licensed
since the 1980s. He offered his belief that the initial
language in the bill would have expanded the practice in a way
that would also increase health care costs.
3:27:02 PM
KRISTEN COX, Naturopathic Doctor (ND), provided a brief
background of her education and training. She explained that
she came to Juneau in 1985 as an AmeriCorps volunteer, but left
to attend naturopathic medical school. She spent one year in
Fairbanks for her residency at the Holistic Medical Clinic prior
to moving to Juneau. She has practiced safely under the current
statutes and regulations for the past ten years. She reported
that she has provided safe, effective, and affordable care to
over 564 patients. She acknowledged the issues with respect to
naturopathy surround language and definition.
CHAIR OLSON agreed.
3:28:33 PM
DR. COX recalled earlier testimony that the allopathic medicine
has origins in natural and botanical sources. She pointed out
medical doctors (MDs) are familiar with medicines that are
considered drugs, but that does not necessarily mean the only
medicine is drug related. She offered that NDs are experts in
non-drug medicine, including botanical extracts and other
medicines derived from natural substances. She said agreed
drugs can be toxic and dangerous, but that does not mean that
NDs should not be able to use the medicines. The NDs are
extensively trained and are the only practitioners adequately
skilled to dispense botanical preparations. She related that
MDs do not use naturopathic botanical preparations and she does
not want to dispense allopathic medicinal types of synthetic
prescription drugs. She identified one issue is that some of
the botanical therapies arbitrarily require a prescription.
3:29:57 PM
DR. COX stated that HB 266 would not expand the ND's practice.
She referred to an article she recently read in the Washington
Post which indicates by 2015 an estimated shortage of 30,000
general practitioners (GPs). She suggested one reason the
shortage exists is because in the U.S. the potential earnings
for general practitioners is about half of the earnings of
specialists, such as cardiologists. She offered her belief that
NDs willingly go into general practice, since they proudly
identify themselves as general practitioners. Additionally, the
NDs enter practice knowing their potential earnings will be
substantially less than MDs; however, NDs still provide valuable
services to people in communities who want alternatives to
conventional medicine. She highlighted that some people cannot
afford to see a medical doctor so they gravitate to NDs. She
further offered that NDs are in a unique position to triage
those patients and also care for those who have irrational fears
about medical doctors. She remarked that patients trust NDs to
advise them if they need additional care, such as emergency room
treatment or treatment by allopathic doctor.
3:32:07 PM
DR. COX expressed frustration that she must testify in order to
preserve her limited scope of practice as an ND. She offered
her belief that passing this bill would help ensure continued
access to health care options for patients and to increase
patient wellness and focus on prevention. She said, "I
guarantee you increasing access to naturopathic health care will
decrease health care costs and also free up time of the very
busy medical doctors to see their more seriously ill patients."
She suggested that members may be interested in a free
presentation on careers in Alaska's health care industry to
learn about the demand for trained health care workers in Alaska
to be held this weekend at the Bill Ray Center.
3:33:01 PM
CHAIR OLSON asked for the types of drugs she prescribes or
dispenses.
DR. COX responded that this is hard to answer since her practice
has not been terribly affected by the recent issues, but
expressed concern that the naturopath's scope of practice has
been diminished. She related that the legend for some
prescriptions is somewhat arbitrary. She pointed out that
professional product manufactures can place a label on their
product in an effort to market the product to MDs. She stated
NDs could lose the ability to dispense natural medicines if the
requirement is the medicine is restricted by prescription by
MDs. She commented other NDs in Alaska have been affected by
the changes.
3:34:46 PM
CHAIR OLSON related his understanding that the FDA is the agency
that restricts drugs.
DR. COX said she did not know. She was unsure of who determines
which products have a legend. She stated that it seemed to her
that it was somewhat arbitrary based on the manufacturer. She
said that NDs rely on manufacturers for high quality products
and these companies do not sell over the counter to patients,
but distribute products to practitioners. The manufacturer
decides whether the product will be restricted or if drug stores
can sell them. She reported that Ron's Apothecary used to honor
her prescriptions for natural substances that he would compound,
but at some point he stopped honoring them. She asked whether
an herbal compounded prescription for eczema should require a
prescription. She related that according to the compounded
pharmacist it does. She said she did not think her access to
the compound should be restricted simply because the statute
says that NDs may not write a prescription. She explained that
these are herbal compounded products. She suggested the
restriction is arbitrary and in doing so potentially eliminates
a gigantic scope of NDs' practice.
3:37:06 PM
REPRESENTATIVE HOLMES commented she is struggling to figure out
what NDs can and cannot do. Clearly, the definition in law and
in statute is not working since NDs are being denied the ability
to provide certain medicines NDs have always provided. She said
that she does not want to adopt new statutes only to find they
aren't any clearer and the changes don't provide relief. She
said, "I understand it's really frustrating and if someone were
coming after my livelihood I would feel the same way." She
emphasized that the committee wants to specifically identify
what is allowable and dispel any ambiguity.
3:38:34 PM
DR. COX said she appreciated the committee's efforts. She
acknowledged that the law is an antiquated law. The NDs have
not been successful in their efforts to revise their statutes.
She suggested the approach the NDs took was to model in statute
what has been in effect in regulation for 18 years. The NDs
thought taking this approach would be the least oppositional
approach to take since redefining the entire naturopathic
statute would be far more complicated.
3:39:57 PM
REPRESENTATIVE MILLER related that allopathic doctors have been
practicing medicine for years and other doctors have also
practiced naturopathic medicine for years. However, it seems as
though suddenly a new interpretation by pharmacists has arisen.
He offered his belief that hearing pharmacists' testimony is
crucial.
CHAIR OLSON agreed and offered to invite the FDA to participate
at a future meeting.
3:41:26 PM
MARY ALICE MCKEEN stated that she is an attorney and has been
licensed to practice law since 1978, but works as an
administrative judge for the federal government. However, she
said she is testifying today solely as a private citizen. She
and her husband, David Ottesen, also own Rainbow Foods, which is
a natural foods store located about a block from the Capitol
Building. She said she is testifying in support of HB 266, and
urged members to adopt the bill. She thanked members for
wrestling with the subject because this is a problem that only
legislators can solve. In 1986, the legislature made a policy
decision to license naturopaths so people could obtain care from
naturopathic doctors. She detailed that to receive a license in
Alaska, NDs either gain licensure through an ND license issued
to them in another jurisdiction, or they must pass a nationwide
naturopathic exam. She offered her belief that all NDs in
Alaska are licensed in another jurisdiction. In order to
receive a license, a naturopath must obtain 55 hours of training
in pharmacology, 1,639 hours of training in basic clinical
science, 132 hours of training in therapeutic nutrition in
naturopathic medical school. She commented that therapeutic
nutrition is an elective in medical schools. She emphasized
that the legislature realized that NDs are trained professionals
and the legislature previously made the policy decision to allow
them to practice. She stressed that this as an important
context to keep in mind while deliberating the issue. The
division interpreted the naturopathic [statute] and passed
[regulations] outlining what NDs could do since the statute
indicated that the NDs could not issue prescription drugs.
Naturopaths differentiate between the terms prescription
medicine and prescription drug. She said that this is clearly
authorized by [statute] since it defines prescription drug. She
said, "Prescription drug does not include a device or herbal or
homeopathic remedy in a form that is not a controlled
substance." She agreed that double negatives make this language
more difficult to understand, but she interpreted this to mean
that if the prescription drug is in a form that is a controlled
substance the naturopaths cannot prescribe it.
3:45:18 PM
MS. MCKEEN highlighted that the FDA clearly defines controlled
substances. She characterized that the definition of controlled
substance as a very clear term, noting it identifies what is a
controlled substance and what is not one. She offered her
belief the division's current interpretation is that the NDs
cannot prescribe or recommend their patients use natural
substances is an invalid interpretation of the regulation. She
suggested that patients could grind up their own capsicum or
produce butyric acid, which is found in butter. However, if the
patients want something standardized they cannot get it. She
offered her belief that is not the distinction that the
legislature and the department made in their definition of
prescription drug. She reminded members the [statute] says that
NDs cannot prescribe controlled substances. She offered her
belief patients should not be limited to grinding their own
medicine, but should be able to get these substances prescribed.
She was unsure what would increase the costs. She reiterated
that some substances are prescription medicine and some are not.
This bill would not increase overall medical costs since NDs
charge substantially less than medical doctors charge.
3:47:12 PM
MS. MCKEEN shared with members that her husband, Dave Ottesen,
is continually asked for medical advice since he owns a natural
food store; however, he does not give medical advice. This
illustrates her point that some people will not go to a
conventional doctor but will go to others for medical advice,
including a naturopath. She stated that her husband suggests
those not wishing to see an MD might prefer to see a naturopath,
with limited prescriptive authority who may be able to help
them. She recalled prior testimony that naturopaths also can
refer patients to medical doctors. She asked members to solve
this current problem and to implement the policy decision the
legislature adopted in 1986, which the NDs have been operating
under. She summarized that NDs have had limited prescriptive
authority for natural substances, but not to prescribe
controlled substances. She offered her belief that NDs have
been able to prescribe natural substances until recently.
3:48:16 PM
REPRESENTATIVE MILLER expressed his appreciation in hearing
someone who interprets statutes testify before the committee.
He asked whether she thought, from the perspective of an
administrative law judge, that HB 266 will clearly accomplish
the clarification for naturopaths.
3:49:55 PM
MS. MCKEEN said she was not sure if the question is whether HB
266, in the original form would address the issues clearly. She
pointed out she works on federal fisheries and issues of this
nature would not come before her in her judicial capacity, in
fact, she would not testify on any matter that might come before
her. She then offered her belief that HB 266 would improve the
situation. However, she was unsure whether an ND could
prescribe butyric acid under the definition in law.
REPRESENTATIVE MILLER said he is also unsure.
MS. MCKEEN stated that she thought the bill seemed reasonably
clear overall. She offered her belief it is almost impossible
to pass something with little question.
3:51:15 PM
REPRESENTATIVE MILLER said he hoped adopting current regulation
into statutes will clarify prescription authority for NDs.
MS. MCKEEN answered that she thought the bill would improve the
practice of naturopathy materially. She recalled that the
division previously testified that the statute trumps the
regulation, but she disagreed with that interpretation, since
licensed naturopaths should be able to rely on regulations. She
offered his belief the bill would solve the problem the division
holds that the regulation conflicts with the current statute.
She did not think the bill would eliminate every single question
of interpretation, but it would make the regulation conform to
the statute. She suggested that that it creates a bad situation
when the department does not hold that the regulation conforms
to statute.
MS. MCKEEN, in response to Chair Olson, answered she would be
happy to look at draft language or further testify. She
emphasized that she has a deep personal interest in this bill,
but she has not been involved in the discussions.
3:53:39 PM
CHAIR OLSON asked to place on the record that he is not an
expert. He said he appreciated her help.
3:54:37 PM
REBECCA VAN DE WATER, Certified Nurse Midwife (CNM);, Adult
Nurse Practitioner (ANP); Midwifery Director, Juneau Family
Health and Birth Center, stated that she is also a naturopathic
doctor's client and regularly refers her patients to NDs. She
said she hoped that some verbiage would make it abundantly clear
what NDs can do since she relies on them to fill in the gaps of
her own care. She stated that she was trained at Yale
University to prescribe medicine and in some instances to work
with natural herbal homeopathic remedies and plant-based
medicines; however, she will not work with things she is not
trained to use. Thus she relies on NDs to be the experts. She
reiterated that she hoped the committee could find a way to keep
their scope as broad and appropriate as possible.
3:55:55 PM
ASHLEY MAY, Naturopathic Doctor (ND), stated that this bill is
critical for the stability of naturopathic medicine in Alaska.
He characterized NDs as primary care providers that provide safe
and effective care. He emphasized that he has only practiced
naturopathy for two and one-half years in Alaska, which he found
can be frustrating since Alaska is a limited-scope state in
terms of naturopathy, while Washington state allows naturopaths
a broader scope of practice. He testified that it has been
harder and harder to obtain products he normally has been able
to get. He predicted that passing HB 266 would help attract
other NDs to Alaska. He also advised that NDs have a proven,
safe, track record in Alaska. He asked to lend his support for
HB 266.
3:57:58 PM
CHAIR OLSON asked what types of medicines he prescribes.
DR. MAY answered that his practice is primarily a family
practice. He dispenses multi-vitamins, fish oil, vitamin D,
natural thyroid, and adrenal extracts. He characterized these
substances as safe and effective medicines and that he does not
prescribe heavy narcotics or pain medications. He emphasized
that family practice entails a wide scope of medicines.
DIANE CRYER stated that she is a patient of naturopathic
medicine. She recommended the committee pass HB 266 since it
will clarify the practice of naturopathy and allow NDs to
continue to perform as they have previously been able to do in
Alaska. She also stated that NDs are filling a niche for
patients. She said that limiting NDs not only adds to the
frustration for NDs, medical doctors, and patients.
SCOTT LUPER, Naturopathic Doctor (ND), Chief Medical Officer,
Alaska Center for Natural Medicine, stated that he has practiced
in Alaska since 2000. He related a scenario in which in which a
patient came to see him for ulcerative colitis. He offered he
has often treated this condition by using sodium butyric acid,
which he has been able to obtain from Key Pharmacy in a
concentrated form, along with applicators. He related the
treatment will usually stop bleeding in one to two weeks. He
said that he was not able to purchase the butyric acid from Key
Pharmacy since the pharmacy had been instructed by the Alaska
Board of Pharmacy not dispense to the drug to NDs since it
required a prescription. He was unsure of how that happened;
however, the BOP did verify that they had contacted pharmacies.
DR. LUPER reiterated earlier testimony that one remedy would be
to adopt the naturopath's regulation into statutes. He agreed
the solution seems odd since the weight of law for regulations
is equal to statutes. He described his practice as one that
includes treating cancer patients, often working with a local
oncologist to prescribe intravenous therapy (IV) treatments to
mitigate the effects of chemotherapy or enhance the IV's
effects. Additionally, he has also used vitamin C to treat
ovarian cancer. He indicated that it has been more difficult to
obtain the IVs. He named several pharmacies, including Key
Pharmacy, who will not sell to him. He suggested that this bill
will help and by allowing NDs to continue to practice safely and
help patients. He related that the NDs he knows love Alaska,
even though they cannot fully practice their profession based on
their education. He said, "Unless this law passes we're going
to have the other hand tied behind our back - at least two or
three fingers - and keep us from doing things we've done safely
for 18 years here in Alaska, particularly with cancer patients,
particularly with the IV nutrients, and sodium butyric." He
expressed concern with the concept of developing a list of
medicines since medical science moves and shifts. Thus any list
would soon be out of date.
4:05:31 PM
BILL KELLEY, Medical Doctor (MD), stated that he is an
allopathic primary care physician who has worked in Alaska for
about 20 years. He stated he has found the testimony helpful.
He said in his community, that the allopathic physicians have a
great deal of respect for NDs for the reasons just mentioned.
He guessed if MDs and NDs sat down, little dispute would arise
as to which medicines can be prescribed. He heard testimony to
indicate a hope that this bill would not change the scope of
practice by NDs. He said, "My concern is the devil is in the
details in terms of semantics." He acknowledged that he did not
have a solution, but was worried since most allopathic medicines
historically are derived from botanical sources. He pointed out
cancer drugs, including Taxol, which is extracted from the bark
of the Pacific yew tree. He said the proposed statute literally
would allow NDs to prescribe Taxol. He said he realized this
statement may be ludicrous, but it captures his concern. He
supposed the FDA needs to be involved in terms of assisting the
committee with the semantics; however, he offered his belief
that the bill as currently written might allow for a significant
increase in the scope of practice for NDs.
4:07:53 PM
KATY SHERIDAN, Medical Doctor (MD), stated that she has
practiced family medicine for 16 years. She echoed what Dr.
Kelley just said, noting she also has a great respect for
complementary medicine and is open for her patients to have the
choice to select whatever care is best for them. She expressed
concern that this bill may open the opportunity for NDs to
prescribe outside their scope of practice, noting her belief
that most would not do so. She acknowledged the problem of
working outside the scope of their practice also happens in
allopathic medicine. She agreed with earlier testimony that the
words should be clearer. She noted a number of medications are
derived from natural plants that are incredibly potent
medications, including powerful cardiac medicines. She
suggested the committee revise the language to help protect
patients.
REPRESENTATIVE MILLER said the committee would welcome suggested
language. He offered his belief that people are in agreement
that the language needs to be worked on for clarity.
4:11:10 PM
MARY ANN FOLAND, Medical Doctor (MD); President, Alaska State
Medical Association (ASMA), offered some concerns about the
bill. She related that she is a family practice physician who
has practiced in Alaska since 1977. She said she is the past
president of the Alaska Academy of Family Physicians (AAFP).
She identified the primary concern of both groups is the health
of all Alaskans. She cautioned members to not misinterpret the
lack of letters and calls as disinterest in this bill. She
emphasized that the physicians have been following this issue
intently since this issue has the potential to have tremendous
and irreversible impact on patient safety. She stated that the
MDs have been working with the legislature to help clarify the
issue and reach a compromise.
DR. FOLAND said this is not an issue of turf protection. The
intent is not to change the scope, but is to clarify the scope
of practice of NDs. She stated that in prior years on similar
bills, the ASMA has presented testimony and data to support the
significant differences in training and supervised clinical
experience between physicians and naturopaths. She said that is
the basis for concern with respect to the scope of practice for
NDs. She highlighted that the goal of the bill to preserve the
status quo seems so simple; however it is not as straight
forward as it seems. She explained that the division apparently
has some details pertaining to current prescriptive practices of
some NDs. She offered her belief the reality of the bill is
that the language would expand prescriptive privileges beyond
what is currently legal and beyond nebulous limits.
MS. FOLAND offered that the legislature has the opportunity to
clarify and define those limits. She suggested that the phrase,
"any natural substance" is vague. She related that she asked
registered pharmacists which prescriptions this would include
and they responded that the list is far too expansive to list.
She reported that it would include substances already mentioned,
such as hormones, birth control pills, insulin, warfarin or
Coumadin, steroids, antibiotics, chemotherapy agents, biologics,
morphine and countless other drugs. She agreed it would be
helpful to get a list of medicines the ND's wish to prescribe so
the ASMA could evaluate them. She said the MDs she asked about
the requested vitamin B12, vitamin C, saline, capsicum
previously mentioned and they offered that those would be just
fine. However, medications listed by the FDA as prescription
drugs are defined by requiring a prescription by a licensed
physician would not be okay. It has never been the intent of
ASMA or the AAFP to shut down practices of NDs, but rather to
clarify what is allowed and what is not allowed.
4:15:25 PM
DR. FOLAND encouraged members to carefully consider this measure
carefully and set appropriate limits. In response to a prior
question, she enthusiastically supported having an entity
without a conflict of interest make a distinction between a list
of prescription drugs and a dietary supplement, an herbal
supplement, and an over-the-counter homeopathic supplement. She
identified the FDA as that entity since it is charged to review
prescription drugs for safety and efficacy and dietary
supplements for manufacturing and marketing standards.
4:16:29 PM
REPRESENTATIVE THOMPSON inquired as to whether as to the number
of lawsuits for NDs for miss prescriptions since they have
practiced in Alaska for 18 years. He further asked how many
malpractice suits have been brought against MDs in the state.
DR. FOLAND said she did not know.
4:17:14 PM
JIM JORDAN, Executive Director, Alaska State Medical
Association, (ASMA), suggested contacting the Alaska State
Medical Board to obtain any cases against physicians since MDs
must report any settlement to the board.
CHAIR OLSON related the committee would be interested in the
numbers and years, without names.
DR. JORDAN answered that names are included. He was unsure of
any reporting required of NDs.
4:18:23 PM
REPRESENTATIVE MILLER asked if the committee were to create a
list, whether they knew of any organization that could review
substances - new and old - and respond in a timely fashion as to
which ones are appropriate medicines for NDs or should be
reserved as allopathic drugs.
DR. FOLAND answered that the FDA's purpose is to review drugs.
4:19:58 PM
DR. JORDAN offered to provide background information on the
FDA's regulatory process. As a starting point, he suggested
using the definitions existing in the FDA laws. He reported the
FDA has definitions for the four basic categories, pointing out
the FDA considers anything not a food that impacts the body is
considered a drug. He listed the categories as prescription
drugs, listed or legend drugs, over-the-counter drugs,
homeopathic drugs, and dietary supplements. He elaborated that
the definition of dietary supplements includes herbal remedies,
herbal supplements, vitamins, botanicals, and other items. He
emphasized that it is important to have clear delineation. He
offered his belief that there is no single definitive list
prepared by the FDA. However, the FDA publishes a document
known as the "orange book," which is an electronic list of
approved drug products with therapeutic equivalency evaluation.
He reported that the current edition is the 32nd edition, which
is 1298 pages long and is updated daily. The orange book only
includes the current prescription drugs being marketed. In
order to get a definitive list it would be necessary to examine
all of the prior lists. He suggested this as a pathway to take.
Additionally, he recommended consistent definitions in statutes
such as the statutes for pharmacies to avoid any disconnect
between the two.
4:23:03 PM
CHAIR OLSON stated that public testimony would be held open.
4:23:26 PM
MS. MCKEEN, in response to a question by Representative
Thompson, answered that the main insurance company for
naturopaths is the NCMIC, [which was originally the National
Chiropractic Mutual Insurance Company]. She referred to a
letter from their litigation consultant, a naturopath, wrote
that they have provided liability insurance for NDs since 2001.
Since that time one professional liability claim was filed, but
the case resulted in the plaintiff dismissing the lawsuit. She
restated that since 2001 there has only been one claim brought
against NDs, but it was dismissed since it was found to have no
validity.
[HB 266 was held over.]
4:24:38 PM
The committee took an at-ease from 4:24 p.m. to 4:26 p.m.
HB 314-ALASKA RAILROAD LAND LEASES
4:26:16 PM
CHAIR OLSON announced that the final order of business would be
HOUSE BILL NO. 314, "An Act extending the time period for which
the Alaska Railroad Corporation may lease land without reserving
the right to terminate the lease; and providing for an effective
date."
4:26:29 PM
ANNA LATHAM, Staff, Representative Kurt Olson, on behalf of the
sponsor, the House Labor and Commerce Committee, introduced
herself.
MS. LATHAM stated that HB 314 would extend the maximum Alaska
Railroad Corporation (ARRC) property lease term from 55 to 95
years. She provided a brief overview of the ARC, such that the
state has owned the Alaska railroad since 1985. It has been
incorporated and operates as though it is a private business.
The corporation generates revenues through real-estate holdings,
year-round passenger service and freight service. Historically,
railroads have owned large parcels of land which they lease to
generate revenue. The railroad industry has been cyclical so
revenue generated from property leases have helped to carry
railroads through economic downturns.
MS. LATHAM related that the ARRC leases approximately 2,000 of
the 36,000 acres it owns and the corporation currently holds 260
long-term leases. She reported that 38 percent of the 36,000
acres is devoted to right-of-way, 12 percent is used for
operations, and the remaining 50 percent is available for lease.
As a state-owned entity, the ARRC is mandated to foster economic
development statewide and in communities along the Railbelt. An
extension of lease terms for up to 95 years would assist the
ARRC in meeting this directive. She explained that longer
leases encourage high-value building construction by assuring
developers and financiers the developments will retain their
value for future buyers. Quality developments retain their
value for a longer period of time and have a higher resale
value, which is good for the railroad, the state, and for
leaseholders.
MS. LATHAM cautioned that this does not mean the standard lease
will be 95 years, but the bill will give the ARRC Board of
Directors the option of extending a lease for up to 95 years at
their discretion. She highlighted that this bill has received
widespread support and members' packets contain letters of
support from the Municipality of Anchorage (MOA), the cities of
Valdez, Seward and Whittier, and from various leaseholders and
developers throughout the Railbelt. She noted that the sponsor
has not received any opposition to this bill.
4:29:06 PM
JON COOK, Chair, Real Estate Committee; Member, Board of
Directors (BOD), Alaska Railroad Corporation (ARRC), stated that
the genesis of the bill was explained by Ms. Latham. He said
that this bill was requested by existing tenants and potential
developers who indicated they would be interested in developing
projects on ARRC leased property if the 95-year lease term was
available. He explained that the 95-year leases would give the
tenants an opportunity to remarket the properties to ensure that
the owners the long-term leases are as close to fee simple as
one can get. He advised that another reason to extend the lease
terms is that the underwriting standards for obtaining loans has
tightened up pretty dramatically since 2008. Therefore, 55
years for very large project is insufficient. He suggested if
HB 314 passes the 95-year leases would not be the norm, but
would be an exception reserved for new, large development, or
existing businesses that plan to invest substantial amount of
capital in the property.
4:31:14 PM
CHAIR OLSON, after first determining no one else wished to
testify, closed public testimony on HB 314.
4:31:44 PM
REPRESENTATIVE HOLMES moved to report HB 314 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 314 was reported from the
House Labor and Commerce Standing Committee.
4:32:19 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
4:32 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB314 Supporting Documents-Assorted Letters.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 314 |
| HB314 Supporting Documents-Assorted Letters (2).pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 314 |
| HB314 Sponsor Statement.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 314 |
| HB314 Fiscal Note-DNR-MLW-2-10-12.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 314 |
| HB314 Fiscal Note-DCCED-ARRC-02-10-12.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 314 |
| HB266 Oppposing Documents-Letter Robin Cooke 2-6-12.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 266 |
| HB266 Supporting Documents-Assorted Letters and Emails for Feb 17 meeting.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 266 |
| HB314 ver A.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 314 |
| HB266 Supporting Documents-Copy of email from Dave Evans with NCMIC.pdf |
HL&C 2/17/2012 3:15:00 PM |
HB 266 |