Legislature(2003 - 2004)

04/16/2003 01:35 PM Senate HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
          SENATE HEALTH, EDUCATION AND SOCIAL SERVICES                                                                        
                       STANDING COMMITTEE                                                                                     
                         April 16, 2003                                                                                         
                           1:35 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Fred Dyson, Chair                                                                                                       
Senator Gary Wilken                                                                                                             
Senator Bettye Davis                                                                                                            
MEMBERS ABSENT                                                                                                                
Senator Lyda Green, Vice Chair                                                                                                  
Senator Gretchen Guess                                                                                                          
COMMITTEE CALENDAR                                                                                                            
Confirmation Hearings:                                                                                                        
Board of Professional Counselors                                                                                                
 Anne Henry                                                                                                                     
 Stephanie Friese                                                                                                               
Board of Nursing                                                                                                                
 James Jurrens                                                                                                                  
 Cathy Giessel                                                                                                                  
CONFIRMATIONS ADVANCED                                                                                                          
SENATE BILL NO. 179                                                                                                             
"An Act allowing teacher certification for certain persons based                                                                
on a criminal history background check without fingerprints."                                                                   
     MOVED CSSB 179(HES) OUT OF COMMITTEE                                                                                       
SENATE BILL NO. 138                                                                                                             
"An Act annulling  a regulation relating to  use of collaborative                                                               
practice  authority  by  a  pharmacist  under  written  protocols                                                               
approved by persons licensed to  prescribe drugs; prohibiting the                                                               
Board  of Pharmacy  from  adopting a  similar  regulation in  the                                                               
future; and providing for an effective date."                                                                                   
     HEARD AND HELD                                                                                                             
PREVIOUS ACTION                                                                                                               
SB 179 - No previous action to consider.                                                                                        
SB 138 - No previous action to consider.                                                                                        
WITNESS REGISTER                                                                                                              
Mr. Zach Warwick                                                                                                                
Staff to Senator Therriault                                                                                                     
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT: Commented on SB 179 for the sponsor.                                                                      
Ms. Melinda Prusak                                                                                                              
PO Box 71827                                                                                                                    
Fairbanks AK 99707                                                                                                              
POSITION STATEMENT: Commented on SB 179.                                                                                      
Ms. Annie Carpeneti                                                                                                             
Criminal Division                                                                                                               
Department of Law                                                                                                               
PO Box 110300                                                                                                                   
Juneau, AK  99811-0300                                                                                                          
POSITION STATEMENT: Supported SB 179.                                                                                         
Ms. Diane Schenker                                                                                                              
Department of Public Safety                                                                                                     
PO Box 111200                                                                                                                   
Juneau, AK  99811-1200                                                                                                          
POSITION STATEMENT: Supported CSSB 179(HES).                                                                                  
Ms. Angie LeBoeuf, Past President                                                                                               
Pharmacy Association                                                                                                            
POSITION STATEMENT:  Opposed SB 138.                                                                                          
Ms. Laraine Derr, President                                                                                                     
Alaska Hospital and Nursing Home Association                                                                                    
426 Main Street                                                                                                                 
Juneau AK 99801                                                                                                                 
POSITION STATEMENT: Commented on SB 138.                                                                                      
Mr. Jim Jordan, Executive Director                                                                                              
Alaska State Medical Association                                                                                                
4107 Laurel Street                                                                                                              
Anchorage AK 99508                                                                                                              
POSITION STATEMENT: Commented on SB 138.                                                                                      
Dr. Paul Worrell                                                                                                                
Alaska State Medical Association                                                                                                
4107 Laurel Street                                                                                                              
Anchorage AK                                                                                                                    
POSITION STATEMENT: Commented on SB 138.                                                                                      
Dr. Michael Manuel, President                                                                                                   
Anchorage Medical Society and                                                                                                   
Alaskan Physicians and Surgeons                                                                                                 
3340 Providence Dr.                                                                                                             
Anchorage AK                                                                                                                    
POSITION STATEMENT: Supported SB 138.                                                                                         
Dr. Carolyn Brown                                                                                                               
No address provided                                                                                                             
POSITION STATEMENT: Opposed SB 138.                                                                                           
Dr. Colleen Murphy                                                                                                              
Anchorage AK                                                                                                                    
POSITION STATEMENT:  Opposed SB 138.                                                                                          
Ms. Cathy Giesel                                                                                                                
Anchorage AK                                                                                                                    
POSITION STATEMENT: Supported SB 138.                                                                                         
Dr. Terry Bab                                                                                                                   
Doctor of Pharmacy                                                                                                              
Valley Hospital                                                                                                                 
Palmer AK                                                                                                                       
POSITION STATEMENT: Opposed SB 138.                                                                                           
Dr. Elaine Reale                                                                                                                
Clinic Manager                                                                                                                  
Providence Alaska Medical Center Pharmacy                                                                                       
Anchorage AK                                                                                                                    
POSITION STATEMENT: Opposed SB 138.                                                                                           
Mr. Bill Altland                                                                                                                
Craig AK 99921                                                                                                                  
POSITION STATEMENT: Commented on SB 138.                                                                                      
Mr. Jerry Brown, President                                                                                                      
Alaska Pharmacist's Association                                                                                                 
4107 Laurel St. #101                                                                                                            
Anchorage AK 99508                                                                                                              
POSITION STATEMENT: Commented on SB 138.                                                                                      
ACTION NARRATIVE                                                                                                              
TAPE 03-22, SIDE A                                                                                                            
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services  Standing  Committee  meeting  to  order  at  1:35  p.m.                                                               
Present were  SENATORS WILKEN,  DAVIS and  CHAIR DYSON.  He asked                                                               
Ms.   Anne  Henry,   nominee  for   the  Board   of  Professional                                                               
Counselors, why she wanted to continue to serve on the board.                                                                   
MS. ANNE  HENRY, Board of  Professional Counselors, said  she had                                                               
been chairing the  board since its inception and  the board still                                                               
has  a great  deal to  do  regarding licensing  people. She  also                                                               
believes more regulations are needed.                                                                                           
CHAIR DYSON asked if the  legislature had done wrong by requiring                                                               
the [board] to pay for litigation out of licensing fees.                                                                        
MS. HENRY explained that it is a different way of doing things.                                                                 
CHAIR DYSON  thanked her for  her willingness to serve  and asked                                                               
Mr. Jurrens to comment on his nomination.                                                                                       
MR. JAMES  JURRENS, Board  of Nursing nominee,  said he  hopes to                                                               
have a positive influence on the nursing profession in Alaska.                                                                  
SENATOR GARY WILKEN  asked if he has participated  in the program                                                               
that began at the University four  years ago to bring more nurses                                                               
to  the state  and  would  he support  and  be  involved in  that                                                               
program if he were on the Board of Nursing.                                                                                     
MR. JURRENS  replied that  he didn't  have intimate  knowledge of                                                               
that  program, but  he  is in  favor of  any  program that  would                                                               
enhance nursing, both as a  professional practice and as a career                                                               
field for young people.                                                                                                         
MS. CATHY GIESSEL, Board of  Nursing, told members she knew there                                                               
was an opening on the board and wants to serve.                                                                                 
CHAIR DYSON  asked if she is  aware of anything that  needs to be                                                               
changed or problems that need to be solved.                                                                                     
MS.  GIESSEL said  the board  has already  discussed the  nursing                                                               
shortage  and she  has been  active  in promoting  SB 154,  which                                                               
addresses  the nursing  shortage.  She served  on the  governor's                                                               
transition advisory  council last fall that  promoted the nursing                                                               
shortage as a priority.                                                                                                         
SENATOR  WILKEN  asked  if  she  would  be  a  supporter  of  the                                                               
university program.                                                                                                             
MS. GIESSEL replied yes, definitely.                                                                                            
MS. STEPHANIE FRIESE, Board of  Professional Counselors, said she                                                               
is  interested  in  protecting the  public  from  incompetent  or                                                               
unethical counselors.                                                                                                           
SENATOR WILKEN moved to forward all  the names of the nominees to                                                               
the full body for consideration.  There were no objections and it                                                               
was so ordered.                                                                                                                 
           SB 179-TEACHER CERTIFICATION: FINGERPRINTS                                                                       
CHAIR FRED DYSON announced SB 179 to be up for consideration.                                                                   
MR.   ZACH  WARWICK,   staff  to   Senator  Therriault,   said  a                                                               
constituent who  is a teacher brought  the idea behind SB  179 to                                                               
Senator  Therriault's attention.  This  teacher  left Alaska  for                                                               
many years  and came back and  had to renew her  license. She was                                                               
required to submit fingerprints as  part of the process. Teaching                                                               
and  nursing  are  two  of  the  leading  professions  for  which                                                               
fingerprints get worn out to the  point of being unreadable. As a                                                               
result,  this  teacher,  who  is  currently  teaching,  has  been                                                               
resubmitting her fingerprints  for the past couple  of years. The                                                               
state  has  to   keep  reprocessing  the  prints   and  give  her                                                               
conditional certificates every three months.                                                                                    
The  Department of  Education and  Early  Development (DEED)  did                                                               
some  research and  found that  42  people have  had to  resubmit                                                               
three  sets  of  fingerprints  in nine  months.  This  bill  adds                                                               
language that says if a  person cannot submit legible fingerprint                                                               
cards due to  a permanent disability that  precludes the person's                                                               
ability to submit  fingerprints. A number of people  in the state                                                               
without fingers or hands are attempting to teach.                                                                               
MR. WARWICK said  that the DEED feels that the  language on lines                                                               
5  to  7, starting  with  "whenever"  and ending  with  "teacher"                                                               
should  be deleted,  because  that paragraph  does  not refer  to                                                               
fingerprints  in reference  to  a  teaching certificate.  Another                                                               
concern  expressed by  the  person  who does  the  hiring in  the                                                               
Palmer  school  district  said   that  the  district  never  gets                                                               
fingerprint  checks  back  within   three  months  and  suggested                                                               
changing to a five-month period.                                                                                                
The  Governor's Office  also said  that it  has some  issues with                                                               
fingerprints.  Supposedly, the  state is  not in  compliance with                                                               
federal law regarding fingerprint  background checks. He said the                                                               
Governor's  Office  did not  have  time  to prepare  a  committee                                                               
substitute before the meeting today.                                                                                            
CHAIR DYSON asked  Mr. Warwick if Senator  Therriault would agree                                                               
to  conceptual amendments  and if  it  is important  to get  this                                                               
legislation enacted this session.                                                                                               
MR. WARWICK  indicated the conceptual  amendments would be  up to                                                               
the  chairman, but  if  this legislation  passes  this year,  the                                                               
teachers would  not have  to go  through the  application process                                                               
again. The  Department of Administration  (DOA) has asked  for an                                                               
extension  until July  2004 to  bring the  fingerprint background                                                               
checks into compliance,  but if that request is  turned down, DOA                                                               
might not get federal help to do the background checks.                                                                         
SENATOR  GARY  WILKEN  said  he  had two  and  a  half  pages  of                                                               
conceptual amendments for the committee to look at.                                                                             
MS.  MELINDA  PRUSAK  said  she   tried  to  renew  her  teaching                                                               
credential in  December 2002 and her  fingerprints were rejected.                                                               
She reprinted two  more times in Fairbanks and then  had a public                                                               
safety  officer in  Anchorage  do the  printing.  She then  tried                                                               
going  to   the  FBI  and   others,  but  her   fingerprints  are                                                               
MS. ANNIE  CARPENETI, Criminal Division, Department  of Law, said                                                               
that several areas of state law  require a background check for a                                                               
person to get a license,  generally people who work with children                                                               
and vulnerable  adults. The FBI  requires states to  have certain                                                               
statutory provisions  to participate in its  national repository.                                                               
A  review  of  the  statute   in  2001  identified  a  number  of                                                               
inadequacies, but  without an extension  of the July  1 deadline,                                                               
the state  will be unable  to get national background  checks for                                                               
people like  teachers. She noted that  Senator Wilken's amendment                                                               
took care of her concerns and had been approved by the FBI.                                                                     
SENATOR  WILKEN  moved  to  adopt  Amendment  1.  There  were  no                                                               
objections and it was so ordered.                                                                                               
SENATOR  WILKEN  moved to  adopt  conceptual  Amendment 2,  which                                                               
would  change  three  months  to   five  months.  There  were  no                                                               
objections and it was so ordered.                                                                                               
SENATOR WILKEN  moved to delete  language on  page 1, line  5, to                                                               
the word  "teacher" in line  7. There  were no objections  and it                                                               
was so ordered.                                                                                                                 
SENATOR WILKEN  moved to pass  CSSB 179(HES) from  committee with                                                               
individual recommendations.  There were no objections  and it was                                                               
so ordered.                                                                                                                     
MR.   KEVIN   SWEENEY,   Department  of   Education   and   Early                                                               
Development,  said  the department  had  some  problems with  the                                                               
bill, but it would work them out with the sponsor.                                                                              
MS. DIANE  SCHENKER, Department of  Public Safety,  supported the                                                               
        SB 138-PHARMACIST/DOCTOR COLLABORATIVE PROTOCOLS                                                                    
CHAIR FRED DYSON,  sponsor of SB 138, explained  that most states                                                               
allow  for some  collaborative practices  that give  someone with                                                               
authority to prescribe medicines  without a doctor being present.                                                               
A couple of  years ago Alaska had no law  allowing the delegation                                                               
of  prescriptive   authority.  The   Board  of   Pharmacy  issued                                                               
regulations that have been in effect  for about one year, but the                                                               
Alaska  State Medical  Association  and the  State Medical  Board                                                               
took exception to those regulations  and encouraged some changes.                                                               
An   unintended    consequence   of   the    regulations   allows                                                               
prescriptions to be  delivered to a patient  with no relationship                                                               
at all to  any doctor, although Chair Dyson said  hadn't heard of                                                               
anyone being harmed.                                                                                                            
MS.  ANGIE LEBOEUF,  past President,  Pharmacy Association,  said                                                               
collaborative  practice  is  not  a  new  concept.  It  has  been                                                               
occurring  for 20  to  30  years, mostly  in  hospitals, and  was                                                               
previously  referred  to  as pharmaceutical  care.  Forty  states                                                               
currently have  collaborative care regulations with  oversight by                                                               
their  Boards  of  Pharmacy  and are  designed  as  an  agreement                                                               
between a  pharmacist and a  physician.   If a patient  meets the                                                               
criteria,  the protocol  is initiated  or adjusted  to meet  that                                                               
patient's needs.  Pharmacists are  normally qualified to  do such                                                               
an analysis.                                                                                                                    
She  informed the  committee  that the  U.S.  Center for  Disease                                                               
Control   (CDC)  requested   that  pharmacists   learn  to   give                                                               
immunizations  and   since  September  11,  2001,   the  National                                                               
Preparedness  Resource Group  is  assimilating 10  groups of  200                                                               
pharmacists  across   America  to  be  available   to  administer                                                               
immunizations  in  the  event of  a  biological  warfare  attack.                                                               
Collaborative  practice  is  also used  with  asthma  management,                                                               
diabetes and hypertension treatments.                                                                                           
MS.  LEBOEUF explained  that  pharmacists spend  six  years in  a                                                               
professional school  of pharmacy and it  is a huge waste  if they                                                               
are not  used to their  full potential. Her personal  research on                                                               
the Internet revealed 98,000  matches for collaborative practice,                                                               
but she couldn't  find anyone who was harmed  by participating as                                                               
a member of  a health care team in this  way. She concluded, "So,                                                               
therefore, I would respectfully request  that this not be pursued                                                               
through  statute and  be  brought before  the  Board of  Pharmacy                                                               
CHAIR DYSON clarified  that it was not his  intention to preclude                                                               
collaborative agreements  and asked  if her  association supports                                                               
collaborative agreements  on prescription drugs when  there is no                                                               
contact between the patient and a doctor.                                                                                       
MS. LEBOEUF  replied that usually  the protocol is set  between a                                                               
physician and  a pharmacist, but the  patient doesn't necessarily                                                               
see a doctor first. To her  knowledge, no one has participated on                                                               
any   medications   other   than  immunizations   and   emergency                                                               
MS. LARAINE  DERR, President of  the Alaska Hospital  and Nursing                                                               
Home Association  (ASHNA), said that protocols  are constantly in                                                               
use and allow more efficiency  within hospitals and nursing homes                                                               
as  physicians and  pharmacists alike  know what  is expected  of                                                               
them. The language in SB 138 would annul those activities.                                                                      
CHAIR  DYSON  asked  her  if hospitals  and  nursing  homes  were                                                               
operating efficiently  before the regulations came  out 18 months                                                               
ago. Ms. Derr indicated they were.                                                                                              
CHAIR  DYSON said  that annulling  those regulations  wouldn't do                                                               
any harm then.                                                                                                                  
MS. DERR  understood his  point but added  that five  states have                                                               
passed laws on collaborative practice.                                                                                          
MR.  JIM   JORDAN,  Executive  Director,  Alaska   State  Medical                                                               
Association (ASMA),  said the  ASMA felt  the Pharmacy  Board did                                                               
not have  the statutory  authority to  adopt the  regulation that                                                               
was adopted  a little over  one year  ago. The ASMA  is concerned                                                               
about  collaborative relationships  in  cases where  there is  no                                                               
physician/patient relationship. He maintained,  "We feel that the                                                               
cornerstone  to  good  medical  care  is  that  patient/physician                                                               
MR. JORDAN  said that collaborative relationships  have been used                                                               
in the hospital  setting for years. The  protocols and guidelines                                                               
are  established  through  the operations  of  committees  called                                                               
pharmaceutical and therapeutics committees.                                                                                     
DR. PAUL WORRELL set  out a sample of bottles he  had from an old                                                               
medicine collection from Nome in  the late 1800s. He related that                                                               
one of  the bottles had  contained a cure for  consumption, which                                                               
is tuberculosis,  for which there was  no cure back then.  In the                                                               
1900s, many medicines  were put in bottles with  claims that they                                                               
cured  all  sorts  of  diseases, but  those  claims  were  mostly                                                               
nonsense.  In 1903,  the Federal  Drug  Administration (FDA)  was                                                               
formed to  try to create  some sense  out of the  medical system.                                                               
One of the first things it did was  go to Coca-Cola and ask if it                                                               
wanted to  be a beverage  company or  a drug company  because the                                                               
FDA was  going to start  regulating drug companies.  If Coca-Cola                                                               
wanted to be  a beverage company, it had to  take the cocaine out                                                               
of Coca-Cola.                                                                                                                   
From those days  on, the FDA tried to find  medicines that really                                                               
were  effective in  treating the  human race's  problems. Now,  a                                                               
century later,  the FDA is part  of the whole team  - the medical                                                               
school   research  industry   and  the   pharmaceutical  research                                                               
industry. He thought the research  industries would not have made                                                               
as  much  progress if  the  FDA  hadn't  kept the  hucksters  and                                                               
hustlers out of  the mix. That is pertinent  because the pharmacy                                                               
protocols that were  passed last year appeared to  be designed to                                                               
get around the  FDA rules, which prohibited  medicines from being                                                               
given out over the counter  (OTC). He informed the committee that                                                               
the FDA would request 10 to  30 professors out of the 100 medical                                                               
schools to advise them on any  particular drug. He does not think                                                               
it is  wise to have the  state make decisions about  research and                                                               
TAPE 03-22, SIDE B                                                                                                            
DR. WORRELL  said the protocols  that were passed last  year were                                                               
totally different than  those that exist for in-patient  use in a                                                               
hospital or nursing home where  the doctor must visit the patient                                                               
every day. They allow for outpatient use of medicines.                                                                          
He  noted that  if  hospital protocols  went  away tomorrow,  the                                                               
hospitals would not stop functioning.  A doctor could just tell a                                                               
nurse to  do most of  those things.  To practice medicine  in the                                                               
state of Alaska a  doctor has to go to school  for 10 years; most                                                               
go  for 12  years.  If just  a simple  checklist  was needed,  it                                                               
wouldn't make  sense to have  to go to  school for that  long. He                                                               
accused the  protocols of being "phenomenally  vague." The recent                                                               
regulations  change  what most  people  normally  think of  as  a                                                               
prescription to almost anything a pharmacy board says it is.                                                                    
CHAIR DYSON asked  how children get vaccinated  in school without                                                               
a specific prescription from a doctor.                                                                                          
DR.  WORRELL  replied  that  some are  given  via  public  health                                                               
doctors' signatures to schools.  A private doctor authorized some                                                               
of the  immunizations given  at Carrs, but  some people  who were                                                               
giving them had no authority whatsoever.                                                                                        
CHAIR DYSON  said one collaborative  agreement that  concerns him                                                               
is the dispensing of emergency  contraception without the patient                                                               
having a  specific doctor prescribe  it. He asked Dr.  Worrell to                                                               
describe the potential dangers to  someone who receives emergency                                                               
contraception without seeing a physician.                                                                                       
DR.  WORRELL said  the FDA  felt  those medicines  were not  safe                                                               
without a doctor's prescription.  The recent pharmacy regulations                                                               
allow any  doctor in  the state  to sign a  protocol so  that the                                                               
pharmacist can dispense a prescription  OTC by asking the patient                                                               
eight questions. A  doctor has never taken  the patient's history                                                               
and  might even  live in  another city.  Drug reactions  and side                                                               
effects can't  be monitored. Morning-after pills  have associated                                                               
increased risk of  ectopic pregnancies, which could  be a problem                                                               
in Bush  communities because they require  surgical intervention,                                                               
sometimes quite quickly. Estrogen use  has many side effects with                                                               
the  biggest  being  blood clots.  Patients  can  have  different                                                               
syndromes and don't know they  have them; it is considered unsafe                                                               
to put them on any estrogen-type medications.                                                                                   
CHAIR DYSON asked him if that  family of drugs is not recommended                                                               
for people with high blood pressure and who are heavy smokers.                                                                  
DR. WORRELL  replied that people  over 35 who are  heavy smokers,                                                               
as well as some people who  are overweight, are in that category.                                                               
He explained whenever a physician  suggests a course of treatment                                                               
to a patient, he becomes involved  in the process of gaining that                                                               
patient's consent for doing the  treatment. Outside the hospital,                                                               
there is  a question  in the  association's mind  as to  how that                                                               
informed consent  takes place  if the  physician is  not involved                                                               
with prescribing  the drug. He  said a recent Supreme  Court case                                                               
increased the complexity of the question.                                                                                       
CHAIR DYSON said he understands  in some collaborative agreements                                                               
the only relationship between a  specific physician and a patient                                                               
is the informed consent form that  is sent to the physician every                                                               
90 days. He asked Dr. Worrell  if he thought that is good medical                                                               
DR. WORRELL  replied that  is not a  true informed  consent form,                                                               
but basically  a checklist that  the pharmacist asks  the patient                                                               
when  the  patient requests  the  medicine.  If the  patient  has                                                               
enough yes answers,  he or she is given the  medicine. That's the                                                               
form that  needs to be mailed  back to the doctor  within 90 days                                                               
so  the doctor  knows  how  many prescriptions  went  out on  his                                                               
signature. In  reality, that doesn't  tell the physician  how the                                                               
medicine is working or how  many complications occurred. It's not                                                               
a real follow-up.                                                                                                               
MR.  JORDAN  said with  informed  consent,  a patient  asks  more                                                               
questions  about  a  particular   course  of  treatment  and  the                                                               
standard of  the understanding and  explanation that  a physician                                                               
must go  through is  higher. He noted,  "Any question  raises the                                                               
CHAIR  DYSON  stated it  was  not  the committee's  intention  to                                                               
preclude   collaborative  agreements.   However,   he  wants   to                                                               
eliminate any  bad medical practices  and make sure  patients are                                                               
DR. MICHAEL  MANUEL, President of the  Anchorage Medical Society,                                                               
said  he   is  also  representing  the   Alaskan  Physicians  and                                                               
Surgeons. Both groups are strongly  supportive of SB 138. He said                                                               
the  way the  regulations  are  set up,  there  is potential  for                                                               
unbridled coverage  of patients without any  physician oversight.                                                               
That  is outside  of  the  intent for  which  the regulation  was                                                               
originally imposed.                                                                                                             
DR. CAROLYN BROWN said she  understands the chairman's intention,                                                               
but  the  bill's  current  language  gets  rid  of  collaborative                                                               
practice.  She thought  it is  an attempt  to stop  collaborative                                                               
practice   between    Alaska's   pharmacists    and   physicians,                                                               
specifically for the prevention  of emergency contraception. Over                                                               
40  states already  use  collaborative agreements  for  a lot  of                                                               
purposes. Thousands  of documents reveal no  adverse affects from                                                               
the  use of  emergency  contraception. She  took  issue with  Dr.                                                               
Worrell's   statements    about   the   damages    of   emergency                                                               
contraception and  said long-term oral contraception  has nothing                                                               
to do with emergency contraception  and the literature is replete                                                               
with documentation of that.                                                                                                     
Second, she  said there  is no  collaborative agreement  unless a                                                               
physician decides to participate and,  if a physician does decide                                                               
to participate, it would be in the best interest of the patient.                                                                
CHAIR DYSON asked  if she believes the FDA  should make emergency                                                               
contraception available OTC.                                                                                                    
DR. BROWN  replied absolutely and  said there  is quite a  bit of                                                               
literature to support that position.                                                                                            
CHAIR DYSON asked if  she had any idea if and  when the FDA might                                                               
rule on that.                                                                                                                   
DR. BROWN  replied that she didn't  know, but it takes  the FDA a                                                               
long time to do anything.                                                                                                       
CHAIR DYSON asked her  if it is her view that  there is no danger                                                               
in authorizing a pharmacist to dispense emergency contraception.                                                                
DR. BROWN  replied that is  her view and  also that of  Dr. David                                                               
Grimes  who  is one  of  the  leading  proponents  of it  in  the                                                               
country.  He has  clearly  stated  in a  number  of articles  and                                                               
studies that it's  safer than giving Bayer aspirin  to women. She                                                               
pointed  out  that  no lawsuits  have  been  adjudicated  against                                                               
physicians who provide emergency  contraception, nor is there any                                                               
substantial  literature  to support  that  it  is damaging  to  a                                                               
person who takes it.                                                                                                            
DR. COLLEEN  MURHPY, OB-GYN, urged  the committee to  support the                                                               
on-going practice  of collaborative  drug therapy  protocols. The                                                               
regulations that  were passed in  2001 have allowed  the practice                                                               
of medicine to  catch up with what has been  done for many years.                                                               
Health  care now  requires a  team and  the pharmacist  is a  key                                                               
member. She said using protocols makes therapy much safer.                                                                      
As  a medical  doctor, she  has heard  the physician  community's                                                               
concern  about  the regulation  and  the  possibility of  medical                                                               
doctors potentially  abusing the  pharmacy practice, but  she did                                                               
not  think  they  should  be  regulating  physician  behavior  by                                                               
striking  down the  regulation.  If the  Medical Association  has                                                               
concerns  about  use  of ambulatory  collaborative  drug  therapy                                                               
protocols, it  should address those  concerns in its  own medical                                                               
statutes  and  regulations.  She  repeated that  using  the  drug                                                               
protocol  has  helped her  improve  care  in both  inpatient  and                                                               
outpatient settings.                                                                                                            
CHAIR DYSON asked her if  she thought emergency contraception was                                                               
dangerous and if it should be OTC.                                                                                              
DR. MURPHY replied that the  OTC application was made on February                                                               
14, 2001 and over 16  other countries have that status. Emergency                                                               
contraception medication meets all  the criteria the FDA requires                                                               
for OTC  status. It's a  condition that is easily  diagnosed, the                                                               
medication is  safe and the  patient can follow  the instructions                                                               
easily. She added,  "Frankly, this is a huge  public health issue                                                               
that  does   not  require  direct   intervention  by   a  medical                                                               
MS. CATHY GIESEL supported Dr.  Worrell's comments and passage of                                                               
SB 138.                                                                                                                         
MR.  TERRY  BAB  concurred  with   Dr.  Brown  and  Dr.  Murhpy's                                                               
comments.  He is  concerned  that this  bill  will eliminate  all                                                               
collaborative practice agreements including  those performed in a                                                               
hospital  setting. It  will decrease  safety  and efficiency  and                                                               
ultimately increase  the cost of  health care. They would  not be                                                               
able  to   provide  time-sensitive  medications  or   to  act  on                                                               
immunizations. She offered:                                                                                                     
     I  would   share  that   the  American   Public  Health                                                                    
     Association, the  American Medical Association  and the                                                                    
     American College  of Obstetrics and  Gynecology support                                                                    
     the provision  of EC  [emergency contraceptives]  to an                                                                    
     OTC   status,  specifically   citing  the   safety  and                                                                    
     efficacy.  In due  respect to  Dr.  Worrell of  ectopic                                                                    
     pregnancy,  I   am  unsure   about  how   a  particular                                                                    
     physician may screen a woman  for ectopic pregnancy. It                                                                    
     occurs  with  or  without birth  control  pills.  I  am                                                                    
     concerned  with  the  limited  access  should  a  woman                                                                    
     request emergency contraception.  It's a time-sensitive                                                                    
     medication meaning  that delays  in treatment  may lead                                                                    
     to  more unintended  pregnancies with  associated risks                                                                    
     and  costs. There  are  many  physicians' offices  that                                                                    
     exclude  seeing  new  patients on  the  basis  of  just                                                                    
     seeing  their  established  patients. There  is  no  or                                                                    
     limited  access  on evenings  and  on  weekends and  my                                                                    
     concern  is   that  by  eliminating  this   ability  to                                                                    
     practice  collaboratively,  our   risk  for  unintended                                                                    
     pregnancies will rise.                                                                                                     
     In   1994,  50   percent   of   all  pregnancies   were                                                                    
     unintended.  Of  these,  50 percent  ended  in  induced                                                                    
     abortion,  specifically, 1.4  million. This  ability to                                                                    
     practice  collaboratively  issues   an  opportunity  to                                                                    
     reduce  the public  health burden  of these  unintended                                                                    
CHAIR DYSON asked him if he is a professional.                                                                                  
DR. BAB replied that he is a  Doctor of Pharmacy and is at Valley                                                               
Hospital in Palmer.                                                                                                             
CHAIR DYSON asked  if he thought regulations  should be tightened                                                               
so  that  not every  prescriptive  drug  could  be subject  to  a                                                               
collaborative agreement.                                                                                                        
DR. BAB  replied that he  didn't think that was  necessary, since                                                               
it is  a voluntary  agreement that  a medical  practitioner would                                                               
DR.  ELAINE REALE,  Clinical Manager,  Providence Alaska  Medical                                                               
Center Pharmacy,  opposed SB 138  and said that  Providence legal                                                               
counsel   advised  her   Providence  would   have  to   stop  its                                                               
collaborative  practice, which  would have  a negative  effect on                                                               
patient care. It  would cause delays and changes  to drug therapy                                                               
that physicians  have requested  and would  result in  more phone                                                               
calls, decreasing  efficiencies for both. It  would also increase                                                               
the costs  of some  medications to  patients. She  clarified that                                                               
Heperin  and alcohol  withdrawal  protocols  are not  pharmacist-                                                               
managed protocols  at Providence.  Passage of  SB 138  would also                                                               
stop  the worfren  (ph)  clinic at  the  Family Practice  Center.                                                               
Worfren  is an  anti-coagulant  that can  cause  bleeding if  not                                                               
dosed properly.                                                                                                                 
Physicians refer their  patients to her after  making a diagnosis                                                               
with the patient's full consent.  The pharmacist is able to focus                                                               
on  dosage monitoring  and can  intensively track  patients while                                                               
they are on the medication. There  have been no adverse events in                                                               
the one-year of the clinic's operation.                                                                                         
MS.  REALE also  pointed  out  that passage  of  this  bill is  a                                                               
statement that  the Board of  Pharmacy doesn't have the  right to                                                               
regulate its own  profession, a really bad precedent.  She said a                                                               
meeting  has been  scheduled with  the Medical  Board to  discuss                                                               
these issues.                                                                                                                   
CHAIR  DYSON  asked  if  she  was  also  speaking  on  behalf  of                                                               
Providence Hospital.                                                                                                            
MS. REALE  said she was not;  she was speaking on  her own behalf                                                               
as the director of Pharmacy.                                                                                                    
CHAIR DYSON asked when that meeting was going to take place.                                                                    
MS. REALE thought it would happen in two weeks.                                                                                 
CHAIR  DYSON  asked  if  she  currently  has  some  collaborative                                                               
agreements with physicians.                                                                                                     
TAPE 03-23, SIDE A                                                                                                            
MS. REALE said it has been going on  for 30 to 40 years and now a                                                               
regulation  supports  it. If  that  regulation  is repealed,  the                                                               
support will not be there.                                                                                                      
CHAIR DYSON asked  if her position is that they  wouldn't be able                                                               
to continue the kinds of  cooperative relationships they have had                                                               
for the last  30 years if the regulations are  repealed while new                                                               
ones are being promulgated.                                                                                                     
MS. REALE replied that is correct.                                                                                              
MR. BILL ALTLAND,  a resident of Craig, said he  and his wife run                                                               
a pharmacy  business in  a rural  area. His  main concern  is the                                                               
safety  of  the  patient  and   he  believes  that  collaborative                                                               
practice, whether  it's regulated  or not,  is something  that is                                                               
happening  a lot  in the  rural areas.  Many smaller  places will                                                               
never  have an  M.D.  and  there are  many  arrangements where  a                                                               
physician will never  see the patient. He believes SB  138 is way                                                               
too broad because  it does away with  Pharmacy Board regulations,                                                               
which are a step in the  right direction toward at least one part                                                               
of what is already happening.                                                                                                   
MR. JERRY BROWN, President,  Alaska Pharmacists Association, said                                                               
the  regulation  has  recognized collaborative  agreements  as  a                                                               
viable way  to conduct health  care in  Alaska and this  bill now                                                               
says  that is  not the  correct way.  He stated  that pharmacists                                                               
have six  years of  extensive education,  including two  and half                                                               
years  of pharmacology,  extensive clinical  training and  a year                                                               
and  a half  of disease  management.  They are  involved in  drug                                                               
disease management  processes, which  is what  collaborative care                                                               
is addressing. Pharmacists should  be allowed to do collaborative                                                               
care and,  if this bill  passes, current collaborative  care will                                                               
be at risk of failure.                                                                                                          
CHAIR DYSON interrupted to say that  no one wants to do away with                                                               
collaborative practices  and he  asked if  Mr. Brown  thought the                                                               
Pharmacy Board regulations are exactly what they should be.                                                                     
MR. BROWN replied that he  believes they are. He thought concerns                                                               
about  the  physician  patient   relationship  had  already  been                                                               
CHAIR DYSON asked him to clarify  whether he said things are just                                                               
fine the  way they are  - that  doctors may have  no relationship                                                               
with their  patients and  only know  about them  by name  90 days                                                               
MR.  BROWN  said  that  is  what he  is  saying.  Currently,  the                                                               
physician and  pharmacist in a collaborative  care agreement know                                                               
the patient.  The reports are  required in  90 days, which  is no                                                               
different than what  physician assistants are doing  right now in                                                               
places like Healy  or Cordova. In those  instances, the physician                                                               
never  sees  the patient.  A  physician  assistant has  far  less                                                               
educational background than a pharmacist does in drug therapy.                                                                  
CHAIR  DYSON thanked  all participants  for  their testimony  and                                                               
said he  would hold the  bill. He  adjourned the meeting  at 3:25                                                               

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