02/10/2003 03:15 PM House L&C
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ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
February 10, 2003
3:15 p.m.
MEMBERS PRESENT
Representative Tom Anderson, Chair
Representative Bob Lynn, Vice Chair
Representative Nancy Dahlstrom
Representative Carl Gatto
Representative Norman Rokeberg
Representative Harry Crawford
Representative David Guttenberg
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 71
"An Act extending the termination date of the Board of Certified
Direct-Entry Midwives."
- MOVED HB 71 OUT OF COMMITTEE
HOUSE BILL NO. 73
"An Act extending the termination date of the State Medical
Board."
- MOVED HB 73 OUT OF COMMITTEE
HOUSE BILL NO. 74
"An Act extending the termination date of the Board of Nursing."
- MOVED HB 74 OUT OF COMMITTEE
PREVIOUS ACTION
BILL: HB 71
SHORT TITLE:EXTEND BOARD OF MIDWIVES
SPONSOR(S): STATE AFFAIRS
Jrn-Date Jrn-Page Action
01/31/03 0105 (H) READ THE FIRST TIME -
REFERRALS
01/31/03 0105 (H) L&C, FIN
02/10/03 (H) L&C AT 3:15 PM CAPITOL 17
BILL: HB 73
SHORT TITLE:EXTEND STATE MEDICAL BOARD
SPONSOR(S): REPRESENTATIVE(S)DAHLSTROM
Jrn-Date Jrn-Page Action
02/05/03 0130 (H) READ THE FIRST TIME -
REFERRALS
02/05/03 0130 (H) L&C, FIN
02/10/03 (H) L&C AT 3:15 PM CAPITOL 17
BILL: HB 74
SHORT TITLE:EXTEND BOARD OF NURSING
SPONSOR(S): REPRESENTATIVE(S)DAHLSTROM
Jrn-Date Jrn-Page Action
02/05/03 0130 (H) READ THE FIRST TIME -
REFERRALS
02/05/03 0130 (H) L&C, FIN
02/10/03 (H) L&C AT 3:15 PM CAPITOL 17
WITNESS REGISTER
REPRESENTATIVE BRUCE WEYHRAUCH
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As chair of the sponsoring committee,
presented HB 71, extending the term of the Board of Certified
Direct-Entry Midwives; he described his family's experience with
midwives at the birth of his three children.
PAT DAVIDSON, Legislative Auditor
Division of Legislative Audit
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified about the sunset reviews
conducted on the three the boards that would be extended in HB
71, HB 73, and HB 74; the audits concluded that the boards
should be extended, and in the case of the Alaska Medical Board
and the Board of Nursing, the auditor recommended extensions of
eight years rather than the typical four years.
KAYE KANNE, President
Midwives Association of Alaska;
Executive Director
Juneau Family Birth Center
Juneau, Alaska
POSITION STATEMENT: Spoke in support of HB 71, noting that high
fees have not limited entry into the midwife field; she answered
questions about midwife training and birthing techniques.
RICK URION, Director
Division of Occupational Licensing
Department of Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified in favor of HB 71, HB 73, and HB
74, saying the boards function well.
DANA BROWN, Chair
Board of Certified Direct-Entry Midwives;
Executive Director, Alaska Family Health and Birth Center
Fairbanks, Alaska
POSITION STATEMENT: Testified in favor of HB 71 and noted that
midwives strongly prefer having their own board.
KIMBERLY HANGER, Staff
to Representative Nancy Dahlstrom
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions about HB 73 and HB 74.
NANCY SANDERS, Chair
Board of Nursing
Anchorage, Alaska
POSITION STATEMENT: Spoke in favor of HB 74, which extends the
termination date for the Board of Nursing.
ACTION NARRATIVE
TAPE 03-7, SIDE A
Number 0001
CHAIR TOM ANDERSON called the House Labor and Commerce Standing
Committee meeting to order at 3:15 p.m. Representatives
Anderson, Lynn, Dahlstrom, Crawford, and Guttenberg were present
at the call to order. Representatives Gatto and Rokeberg
arrived as the meeting was in progress.
HB 71-EXTEND BOARD OF MIDWIVES
CHAIR ANDERSON announced the first order of business was a
hearing on HOUSE BILL NO. 71, "An Act extending the termination
date of the Board of Certified Direct-Entry Midwives."
Number 0077
REPRESENTATIVE BRUCE WEYHRAUCH, Alaska State Legislature,
speaking as chair of the House State Affairs Standing Committee,
sponsor of HB 71, explained that this legislation that extends
the Board of Certified Direct-Entry Midwives through June 30,
2007. He said the continuation of this board was handled in a
stand-alone bill because the profession is significantly
different from other health professions. The fiscal note is
zero. Fees from midwife licensing cover the administrative
costs of the board.
REPRESENTATIVE WEYHRAUCH explained his personal experience with
the midwife profession. His three children were born at home
with the assistance of midwives. Representative Weyhrauch's
wife selected this birthing option after researching what
midwives offer. Each time, the midwife carefully examined Mrs.
Weyhrauch, monitored her pregnancy, and evaluated her for risks
such as twins and Caesarian section birth. Both the Weyhrauchs
took prenatal classes from the midwife and the hospital and
developed contingency plans for emergencies. He described these
services, when conservatively handled, as a great asset both in
rural and urban Alaska. The board gives the state oversight
over who's practicing when, where, and how.
Number 0445
REPRESENTATIVE CRAWFORD noted that two of his three children
were born with the assistance of midwives, and he supports this
profession. He asked whether midwives would rather be separate
from related professionals and bear all the administrative cost
themselves or be combined with another board in order to keep
the cost of their licenses lower.
REPRESENTATIVE WEYHRAUCH suggested that a member of the midwife
board could better answer that question.
Number 0575
PAT DAVIDSON, Legislative Auditor, Division of Legislative
Audit, Alaska State Legislature responded to a question from
Representative Guttenberg about the legislative audit of the
Board of Certified Direct-Entry Midwives. The audit [Control
No. 08-20016-02] recommended a four-year extension of the
board's termination date. In a similar sunset audit four years
ago, the agency was concerned that the high cost of the
licensing fee was presenting a barrier to entry into the
profession. In this audit, staff found that those fees have
dropped, but the board is collecting sufficient fees to cover
their expenses. This audit did not examine whether the midwives
should consider joining another board. In answer to a question
from Representative Crawford, she noted that the biennial fee is
currently $950, down from $1,550 two years ago. Ms. Davidson,
in response to a comment by Representative Rokeberg, noted that
the Board of Certified Direct-Entry Midwives received a clean
audit.
Number 0675
KAYE KANNE, President, Midwives Association of Alaska; Executive
Director, Juneau Family Birth Center, told members that she has
practiced as a midwife in Juneau for 19 years. She testified in
support in HB 71. She said the Board of Certified Direct-Entry
Midwives board has done an excellent job of writing and
implementing regulations. She noted that she was a member of
the board from its inception in 1992 through 1999 and was its
chair for four of those years. The board strives for high
standards for CDMs [certified direct-entry midwives], and as a
result, she testified, midwives in Alaska are professional, well
trained, and provide safe, excellent care for women and
families.
MS. KANNE referred to data from the Office of Vital Statistics,
Division of Public Health, Department of Health and Social
Services, on the percentage of births in Alaska attended by
certified direct-entry midwives. She said they delivered almost
10 percent of the babies born in Alaska last year. The
percentage is even higher in some parts of the state, for
example, almost 25 percent in the Matanuska-Susitna Borough.
Alaska's figures are higher than the nationwide average, where
midwives attend approximately 5 percent of the births.
MS. KANNE opined that Alaska has one of the best midwifery laws
in the United States. Many other states look to Alaska as an
example when passing midwifery legislation. Some 21 states have
licensing for direct-entry midwives and 8 more have legislation
pending.
Number 0830
MS. KANNE answered Representative Rokeberg's questions from the
Legislative Audit report about why only 7 out of 30 apprentices
are still active. She described supervising apprentices during
her 20-year career. The long hours, low pay, and huge
responsibility discourage many students. She has supervised two
apprenticeships who finished their training and became licensed.
There's no requirement for a university degree in Alaska;
Alaska's direct-entry midwifery laws are based on the
apprenticeship model. There are several nationally credited
programs that instructors use when they supervise midwife
trainees; Ms. Kanne explained that she uses the National College
of Midwifery out of New Mexico, which is a degree program.
Number 0928
REPRESENTATIVE ROKEBERG noted his concern about high licensure
costs. He cited a recent disciplinary action by the board, the
cost of which must be covered by the midwife licensing fee. He
expressed concern that the fee would rise again. He noted it
was a key issue when the board was created because of its
potential barrier to entry; the amount of the licensing fee is
always a consideration in licensing an occupation.
MS. KANNE replied that the licensing fee was $1,300 for the most
recent renewal of December 31, so it has risen from $950,
probably because of the investigation. As the president of the
Midwives Association of Alaska, she reported that members feel
it is very important to have an independent board, and they do
not want to be merged with any other board. Members are willing
to pay the higher licensing fees, she said. They are continuing
to recruit midwives in the state. The Juneau Family Birth
Center and other nonprofit birth centers in Alaska pay their
midwives' licensing fees. They try to assure that no one is
prohibited from practicing because of the licensing fees.
Number 1085
MS. KANNE, in response to questions from Representative Rokeberg
about whether midwives can afford the fees, said midwifery
services pay for themselves and the midwives' salaries. She
said the total fees for a childbirth at the Juneau Family Birth
Center range from $3,000 to $5,000, which is about half the cost
of a normal delivery at the hospital.
Number 1127
REPRESENTATIVE LYNN asked if midwife services are covered by
insurance. He asked about the process, and timeframe, and the
cost of getting licensed as a certified direct-entry midwife.
MS. KANNE answered that midwife training in Alaska uses an
apprenticeship model. Students must finish an academic program
approved by the national accreditation program for midwives and
must finish clinical requirements under state law. Most
apprentices take three to four years because they must assist at
60 births. The cost of apprenticeship varies around the state.
At the Juneau birth center, for example, students pay $200 a
month and work at the center.
Number 1240
REPRESENTATIVE GUTTENBERG asked about the protocols to transfer
a patient from a midwife to a doctor in case of complications.
MS. KANNE replied that certified direct-entry midwives are
independent practitioners who do not practice under the
supervision of physicians. State law recommends - but does not
require - that patients see a physician for a complete physical
exam. She said she believes midwives and medical professionals
in Juneau and around the state have good working relationships.
Alaska law clearly defines what midwives can and cannot do.
REPRESENTATIVE GUTTENBERG asked whether there has been a
situation in which someone used a midwife instead of using a
physician.
MS. KANNE replied no, not to her knowledge.
Number 1360
MS. KANNE, in response to a question from Representative Lynn
about whether midwives administer pain medication during
childbirth, answered that no, midwives use natural techniques
such as massage and water to create a situation in which pain
medication isn't necessary.
MS. KANNE answered a question from Representative Gatto about
whether men are allowed to become midwives. She said that yes
they are, although there are none that she knows of practicing
in Alaska.
Number 1388
RICK URION, Director, Division of Occupational Licensing,
Department of Community & Economic Development, said the Board
of Certified Direct-Entry Midwives functions well and within its
budget. He urged the committee to pass HB 71.
Number 1430
DANA BROWN, Chair, Board of Certified Direct-Entry Midwives;
Executive Director, Alaska Family Health and Birth Center,
testified in favor of extending the board. She said the board
has been doing its work of maintaining high standards of care
for the public's safety. The midwives are able and willing to
pay the licensing fees required to maintain a separate board.
Number 1504
REPRESENTATIVE GATTO moved to report HB 71 out of committee with
individual recommendations and the attached fiscal note. There
being no objection, HB 72 was reported from the House Labor and
Commerce Standing Committee.
HB 73-EXTEND STATE MEDICAL BOARD
Number 1546
CHAIR ANDERSON announced a hearing on HOUSE BILL NO. 73, "An Act
extending the termination date of the State Medical Board."
REPRESENTATIVE DAHLSTROM, sponsor of HB 73, testified that the
bill extends the termination date of the State Medical Board for
four years. She described the membership of the eight-member
board, which is appointed by the governor. She also said:
The board serves the public interest by establishing
the minimum education and work-experience requirements
that individuals must meet to become licensed
physicians, osteopaths, podiatrists, paramedics, and
physician assistants. The board further serves the
public interest by investigating complaints against
licensed professionals and taking disciplinary action
when appropriate and necessary. The board has
consistently proven to be efficient; therefore I
recommend that the State Medical Board be extended to
June 30, [2007], and I urge you to vote for its
passage.
Number 1641
REPRESENTATIVE ROKEBERG asked why the sponsor didn't follow the
recommendation of the legislative audit report for an eight-year
extension.
KIMBERLY HANGER, Staff to Representative Nancy Dahlstrom, Alaska
State Legislature, quoted AS 08.03.020, which sets the four-year
extension for a board unless it is continued or reestablished
for a longer period.
REPRESENTATIVE ROKEBERG noted that the legislature can continue
the board longer than the four-year period if it chooses,
depending on the level of confidence the legislature has in the
board's work. The board has been in the headlines frequently,
holding disciplinary hearings, and perhaps, he surmised, that
means it's doing a good job. It's a judgment call how long to
extend the sunset provision. Often, the legislative audits
expose problems in the statute or the regulations of a board. A
shorter sunset period allows the legislature to review the
results of previous changes to the law.
Number 1811
PAT DAVIDSON, Legislative Auditor, Legislative Audit Division,
Alaska State Legislature, explained that the audit report [No.
08-20017-02] recommended an eight-year extension to 2011 for
several reasons. Auditors found that the board was actively
working on statutory and regulatory development of items in the
public interest. The board was functioning smoothly and there
were no financial problems with its operations. It's unusual
for her office to recommend such a lengthy extension of the
board, she said, and the statutes indicate a preference for
four-year extensions. She reminded legislators that they can
ask her agency to review a board if they see problems.
MS. DAVIDSON answered Representative Lynn's questions about the
details of board members' terms and appointments. She said the
eight members' terms are four-years and staggered; members are
appointed by the governor and approved by the legislature.
MS. DAVIDSON replied to Representative Rokeberg's query about
the statute controlling the extension of the boards, AS
08.03.020. She said the statute gives legislators leeway to put
whatever year they'd like on the termination date.
Number 1965
MS. DAVIDSON, as requested by Representative Rokeberg, explained
the one-year closeout period provided by state law if the
legislature chooses not to extend the termination date of a
board. She explained that the licensing function may remain and
be administered by the Division of Occupational Licensing even
if the board dissolves. When a board shuts down, the division
loses the voice of the professionals it is regulating. It is
more difficult to make changes in statute and regulations, which
as a result tend to get stale. Because a board only meets
several times a year, those activities would get shelved during
a wind-down year.
MS. DAVIDSON answered a question from Representative Guttenberg
about the State Medical Board's taking an active role in shaping
state laws and regulations. She said its members testify before
the legislature on bills and develop regulations to support the
statutes.
REPRESENTATIVE GUTTENBERG noted the board's 413 investigative
cases referenced in the audit and asked whether any resulting
legal challenges handled by the Department of Law have affected
the board's budget.
MS. DAVIDSON replied that most times when the Department of Law
does work associated with a licensing board, the department
charges the board for those services.
Number 2135
REPRESENTATIVE DAHLSTROM said that as the sponsor of the bill,
she favors the four-year period because the medical industry is
changing so rapidly, and this allows the legislature to review
the board again in four years.
MS. HANGER noted that the committee's bill packet includes a
letter from the former director of the Division of Occupational
Licensing, Catherine Reardon, agreeing with the audit's
recommended eight-year extension.
Number 2176
REPRESENTATIVE GATTO agreed with the sponsor's choice of a four-
year extension. He commented that a board might increase its
activities as it sees a termination date approaching. He has
followed the news of the board's investigations reported in the
newspaper. He has worked as a paramedic in Anchorage for 28
years and is familiar with some of the professionals being
investigated.
MS. DAVIDSON replied to Representative Guttenberg's question
about whether a board's activity increases as it nears its
termination date. She said it depends on the particular board.
Some boards prefer to have their sunset extension handled
separately from any changes to their governing statues. Other
boards may be going through growing pains and may be more active
before a sunset review.
Number 2355
RICK URION, Director, Division of Occupational Licensing,
Department of Community & Economic Development, said the
division supports HB 73 and asked the committee to pass it on.
He said the department has no problem with either a four-year or
eight-year extension of the board. Setting the term of the
board does not affect the four-year term of the members, and
he's not aware of any boards that become more active at the
approach of sunset.
TAPE 03-7, SIDE B
Number 2370
MR. URION said the Medical Board is extremely active and has
handled a number of disciplinary actions, which causes their
administrative costs to rise. He discussed how diplomacy
actions affect the licensing fees, and for professions with
fewer members, that can have a severe impact. He said the State
Medical Board is about $190,000 in the hole, and he predicted
next year will be a quieter year with less investigative
activity. The fee for physicians is $590 as of the beginning of
the year, and the next renewal is in 2004.
MR. URION replied to Representative Lynn's question about when
an investigation becomes public. He said under current division
policies, a complaint becomes public right away. But the
division is working on adding an intermediate step in which a
complaint would be screened for validity before beginning an
investigation.
Number 2139
REPRESENTATIVE GATTO asked how a patient can take action against
an incompetent physician. He also questioned whether the
medical profession is truly self-policing.
MR. URION replied that the patient can file a complaint about
the doctor with the Division of Occupational Licensing. He
added that it's easier for physicians to assess the competency
of their peers, now that they've been relieved of the liability
under a change in state law [AS 08.64.362] several years ago.
CHAIR ANDERSON invited Mr. Urion to brief the committee at a
future meeting about complaint procedures and the budget impact
of these procedures.
Number 1935
REPRESENTATIVE DAHLSTROM, in response to a question from
Representative Rokeberg, said she is not comfortable with
increasing the four-year extension, but she is willing to talk
to Senator Con Bunde, who is sponsoring a similar bill.
Number 1856
REPRESENTATIVE LYNN moved to report HB 73 out of committee with
individual recommendations and the accompanying fiscal note.
There being no objection, HB 73 was reported from House Labor
and Commerce Standing Committee.
HB 74-EXTEND BOARD OF NURSING
Number 1814
CHAIR ANDERSON announced that the final order of business would
be consideration of HOUSE BILL NO. 74, "An Act extending the
termination date of the Board of Nursing."
REPRESENTATIVE DAHLSTROM, as sponsor of HB 74, noted that it
extends the termination date of the Board of Nurses to June 30,
2007. She described the membership of the board and noted that
it establishes minimum education and work experience
requirements for licensed nurses and certified nursing aides.
The board also investigates complaints against licensed
professionals and takes disciplinary action when appropriate.
She said the board acts efficiently, and she urged the committee
to pass the bill.
Number 1753
KIMBERLY HANGER, Staff to Representative Nancy Dahlstrom, Alaska
State Legislature, testified that the Division of Legislative
Audit reviewed the operations of the Board of Nursing and
recommended the extension of the board. Each committee member's
packet includes a letter from the former director of the
Division of Occupational Licensing, Catherine Reardon,
recommending the extension of the board.
Number 1712
REPRESENTATIVE ROKEBERG asked whether the sponsor considered
adding statutory changes to the bill based on the
recommendations from the auditors report [No. 08-20018-02]. He
pointed out that the report highlighted two issues: notifying
the Board of Pharmacy of changes to the prescriptive authority
of nurse practitioners and nurse anesthetists and developing a
self-evaluation monitoring checklist for approved nursing aide
training programs.
MS. HANGER replied that these are regulatory matters that the
board can deal with internally.
Number 1630
PAT DAVIDSON, Legislative Auditor, Legislative Audit Division,
Alaska State Legislature, replied to Representative Rokeberg
that the two recommendations in the audit are operational, and
that the Board of Nursing responded to both issues with plans of
action.
REPRESENTATIVE ROKEBERG asked Ms. Davidson to explain why this
audit also recommends an eight-year extension on the Board of
Nursing and to explain to the committee the scheduling and cost
of sunset audits.
Number 1578
MS. DAVIDSON replied that while the board must cover the full
cost of its operations with license fees, it does not pay the
cost of legislative hearings or audits. An audit can cost
between $8,000 and $20,000, depending on the results. For
example, the State Medical Board and the Board of Nursing audits
are less expensive because the boards are well established and
function smoothly. Some of the controversial issues do not
relate to the board's operations. The Division of Occupational
Licensing conducts investigations, and its work must be
prioritized because it serves the boards across the occupations.
The boards do not have control over investigations, which in
some cases are controversial and hit the newspapers.
Number 1387
MS. DAVIDSON, in response to Representative Rokeberg, agreed
that the legislature would save one sunset audit if the board
were extended eight years instead of four. She said the
auditors would move to the next priority on their list and deal
with their backlog sooner. The length of board extensions is
completely up to the legislature. When the state adopted the
sunset law, the legislature wanted to keep tabs on what's
happening in the occupations, helping ensure that they are
operating in the public's best interest. The Division of
Legislative Audit does not lightly recommend eight-year
extensions.
Number 1268
RICK URION, Director, Division of Occupational Licensing,
Department of Community & Economic Development, testified that
his division favors HB 74, the extension of the Board of
Nursing. He reminded the committee that if legislators extend
the board for eight years, they always have the option to
request an audit.
Number 1109
NANCY SANDERS, Chair, Board of Nursing, spoke in support of HB
74 and said she was available to answer questions.
REPRESENTATIVE ROKEBERG recounted how he sponsored a budget bill
in 2000 which allowed the Board of Nursing licensees to raise
their own fees in order to replace lost grant money. He asked
about the outcome of that project.
MS. SANDERS answered that she was not on the Board of Nursing
when this event took place and so she was not familiar with the
project.
[SANDY PERRY-PROVOST, Lobbyist, Alaska Nurses Association, said
she did not know the answer to Representative Rokeberg's
question.]
Number 0960
REPRESENTATIVE LYNN moved to report HB 74 out of committee with
individual recommendations and the accompanying fiscal note.
There being no objections, HB 74 was reported from the House
Labor and Commerce Standing Committee.
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
4:40 p.m.
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