02/23/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB45 | |
| SB44 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 44 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 45 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 23, 2023
3:31 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator James Kaufman, Vice Chair
Senator Löki Tobin
Senator Forrest Dunbar
Senator Cathy Giessel
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 45
"An Act relating to insurance; relating to direct health care
agreements; and relating to unfair trade practices."
- MOVED CSSB 45(HSS) OUT OF COMMITTEE
SENATE BILL NO. 44
"An Act relating to the practice of naturopathy; establishing
the Naturopathy Advisory Board; relating to the licensure of
naturopaths; relating to disciplinary sanctions for naturopaths;
relating to the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 45
SHORT TITLE: DIRECT HEALTH AGREEMENT: NOT INSURANCE
SPONSOR(s): SENATOR(s) WILSON
01/25/23 (S) READ THE FIRST TIME - REFERRALS
01/25/23 (S) HSS, L&C
02/07/23 (S) HSS AT 3:30 PM BUTROVICH 205
02/07/23 (S) Heard & Held
02/07/23 (S) MINUTE(HSS)
02/09/23 (S) HSS AT 3:30 PM BUTROVICH 205
02/09/23 (S) Heard & Held
02/09/23 (S) MINUTE(HSS)
02/21/23 (S) HSS AT 3:30 PM BUTROVICH 205
02/21/23 (S) Scheduled but Not Heard
02/23/23 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 44
SHORT TITLE: NATUROPATHS: LICENSING; PRACTICE
SPONSOR(s): SENATOR(s) GIESSEL BY REQUEST
01/25/23 (S) READ THE FIRST TIME - REFERRALS
01/25/23 (S) HSS, L&C, FIN
02/23/23 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
JASMIN MARTIN, Staff
Senator David Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided a summary of changes from version S
to version U for SB 45.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 45
JANE CONWAY, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB 44.
NATALIE WIGGINS, ND
Alaska Association for Naturopathic Doctors
Juneau, Alaska
POSITION STATEMENT: Testified by invitation on SB 44.
MELANIE HENRIKSEN, ND, President
National University of Natural Medicine
Portland, Oregon
POSITION STATEMENT: Testified by invitation for SB 44.
CLYDE JENSEN, Ph.D.
Professor of Pharmacology
Rocky Vista University
Saint George, Utah
POSITION STATEMENT: Testified by invitation on SB 45.
SEAN HIGGINS, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation for SB 44.
JON LIEBERMAN, MD
Fairbanks, Alaska
POSITION STATEMENT: Testified by invitation on SB 44.
SCOTT LUPER, ND
Alaska Association of Naturopathic Doctors
Fairbanks, Alaska
POSITION STATEMENT: Answered questions on SB 44.
BRUCE CAMPBELL, representing self,
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of SB 44.
ANNETTE O'CONNELL, representing self
Nikiski, Alaska
POSITION STATEMENT: Testified in support of SB 44.
ACTION NARRATIVE
3:31:50 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 3:31 p.m. Present at the
call to order were Senators Tobin, Kaufman, Giessel, Dunbar, and
Chair Wilson.
SB 45-DIRECT HEALTH AGREEMENT: NOT INSURANCE
3:32:16 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 45
"An Act relating to insurance; relating to direct health care
agreements; and relating to unfair trade practices."
He noted that there was a committee substitute for the committee
to consider.
3:32:44 PM
CHAIR WILSON solicited a motion.
3:32:48 PM
SENATOR GIESSEL moved to adopt the committee substitute (CS) for
SB 45, work order 33-LS0211\U, as the working document.
3:32:59 PM
CHAIR WILSON found no objection and CSSB 45 was adopted.
3:33:11 PM
JASMIN MARTIN, Staff, Senator David Wilson, Alaska State
Legislature, Juneau, Alaska, presented the summary of changes
from version S to version U of SB 45.
[Original punctuation provided.]
"An Act relating to insurance; relating to
insurance; relating to direct health care
agreements; and relating to unfair trade
practices."
Version S to U
5 changes from first V.S to V.U:
1) Technical changes, non-substantive:
a) Language is rearranged for clarity.
b) Definition of "direct health care agreement"
is moved to the definitions section.
c) Language is adjusted for consistency though
out.
2) Page 2, line 15-18: Language is added
requiring that a direct health care agreement
must identify a contact person for a
representative of the health care provider that
is responsible for receiving requests to amend
the agreement, in addition to the person
responsible for receiving complaints.
3) Page 3, line 2-12: Language allowing a
provider to immediately terminate the agreement
if a patient does not comply with a treatment
plan is removed from this section. A provider may
still cancel and agreement with 30 days' notice.
4) Page 3, line 16-22: In version S, a health
care provider may raise the periodic fee no more
than once a year and must provide the patient 45
days' notice that they plan to do so. Version U
has language added that allows the patient to
cancel with no penalties if they decided to not
continue an agreement when the provider raises
the fees.
5) Page 6, line 9-21: A "false advertising"
clause was added. This section prohibits a
provider from false advertising regarding a
direct health care agreement. It specifically
prohibits advertising these agreements as
insurance or as an alternative to insurance.
3:35:17 PM
SENATOR KAUFMAN arrived at the meeting.
3:35:29 PM
SENATOR TOBIN asked whether the complaint process should remain
in the Attorney General's office or if it should be moved to the
Division of Insurance.
3:36:06 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community & Economic Development, Juneau, Alaska,
stated that the division has worked on SB 45 for several years
and realizes consumer protection is a concern. She said there
had been good discussion regarding the overlap between insurance
and contracts. She stated she was upfront during discussions and
said if oversight came to her division, it would not have a
fiscal note. The division would handle contracting and insurance
complaints in the same manner.
3:37:30 PM
CHAIR WILSON found no further questions and solicited a motion.
3:37:34 PM
SENATOR GIESSEL moved to report the CS for SB 45, work order 33-
LS0211\U, from committee with individual recommendations and
attached zero fiscal note(s).
3:37:57 PM
CHAIR WILSON found no objection and CSSB 45(HSS) was reported
from the Senate Health and Social Services Standing Committee.
3:38:10 PM
At ease
B 44-NATUROPATHS: LICENSING; PRACTICE
3:41:02 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 44 "An Act relating to the
practice of naturopathy; establishing the Naturopathy Advisory
Board; relating to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to the
Department of Commerce, Community, and Economic Development; and
providing for an effective date."
3:41:24 PM
SENATOR CATHY GIESSEL, District E, sponsor of SB 44 spoke to the
following sponsor statement:
[Original punctuation provided.]
"An Act relating to the practice of naturopathy;
establishing the Naturopathy Advisory Board; relating
to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to
the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
Senate Bill 44 establishes a clear scope of practice
for Alaska naturopathic doctors and will allow these
primary healthcare providers to practice consistent
with their education and training.
The state's nearly 50 licensed naturopaths provide
valuable healthcare services to thousands of Alaskans
and can play an important role in helping address our
current primary care provider shortage. However, our
outdated statutes contain vague language that dictate
the authorities of naturopaths; consequently, this
lack of clarity and interpretation has led to the
adoption of some of the most restrictive naturopathic
medicine regulations in the nation.
Senate Bill 44 would set clear statutory guidelines,
including, among other things, allowing licensed
naturopathic practitioners to perform minor office
procedures and to prescribe vitamins, minerals and
other non-controlled substance medications.
Naturopathic doctors practice safely in other states
under the same scope of practice that this bill would
allow.
Naturopathic medicine can provide valuable and
complementary care in the Alaska health care setting
for many Alaskans who struggle to find an accessible
primary care physician. The ability for naturopaths to
practice the scope of medicine consistent with their
training would immediately expand the availability of
primary care in Alaska.
Many Alaskans face challenges with chronic diseases
like obesity, diabetes and hypertension that are
issues for which Naturopaths are very equipped to
treat. Their education focuses on disease prevention,
rather than just treating symptoms and prescribing
medications. In the long run, Naturopathic care will
provide cost savings and improved health outcomes for
patients, insurers and the state, while allowing
Alaskans to choose the style of health care most
suitable to them.
Please join me in support of Senate Bill 44.
3:45:15 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis
for SB 44 as follows and noted a correction to Section 3 stating
it amends AS 08.45.020:
[Original punctuation provided]
"An Act relating to the practice of naturopathy;
establishing the Naturopathy Advisory Board; relating
to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to
the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
Section 1 Amends AS 08.02.010(a) Professional
designation requirements
Requires naturopathic practitioners to use
appropriate letters, titles and specialist
designations.
Section 2 Amends AS 08.45.015 and adds a new
section:
Establishes a five-person Naturopathy Advisory
Board for the purpose of making recommendations
on adoption of regulations and other matters
relating to the functions of the department under
AS 08.45.
3:46:27 PM
Section 3 Amends AS 05.45.020 Application for
license
Requires applicants applying for licensure to use
a form provided by the department; to submit
fingerprints for purposes of a criminal history
background check for licensure; and pay a fee
established by the department.
Section 4 Amends AS 08.45.030 Issuance of license
Requires an applicant to:
• have graduated with a doctoral degree from
an accredited naturopathic college
• complete a 2-year externship program
• have passed a pharmaceutical examination
approved by department
• have passed the Naturopathic Physicians
Licensing Examination • is not subject to
an unresolved disciplinary action in
another jurisdiction
• comply with application requirements; and
• have not been convicted or, or pled
guilty, or no contest to a crime that
adversely reflects on the applicant's
ability to practice or jeopardizes the
safety of a patient.
Removes outdated language requiring that to be issued
a license to practice naturopathy in Alaska, if an
individual graduated before 1988, they must also have
been issued a license to practice in another state
previously.
Section 5 Amends and adds a new section under AS
08.45.032 Documentation of license refusals
and revocations
Requires the department to provide in writing, a
concise statement for refusal to issue licenses
or for license revocation.
3:47:59 PM
Section 6 Amends AS 08.45.035(a) Temporary licenses
Allows the department to issue a temporary
license to a naturopath if they are signed up to
take a licensing exam at the next available date
after the date of the application and meets all
the other licensing requirements.
Section 7 Amends and adds new sections under AS
08.45
08.45.037 Continuing Education Requirements:
• applicant must submit evidence that
education requirements have been met set
under regulations, equivalent to those of a
physician assistant, and has received
education in pain management and opioid
use/addiction within 2 years of application
renewal date
the department may exempt applicant from
this requirement due to extenuating
circumstances
• department will require over 15 hours of
continuing education every 5 years as well
as education in pain management and opioid
use/addiction
08.45.038 Standards for License Renewal:
• applicant must pay required fee, meet
continuing education requirements, has not
been convicted of a crime that proves
incompetency or jeopardizes safety of the
patient; applicant has current CPR
certification, has submitted to
fingerprinting and paid fees to meet
Public Safety for purposes of background
check within previous 6 years.
Section 8 Amends and adds new section AS 08.45
Practice of naturopathy
08.45.045 Allows naturopaths to:
• practice within the standards and scope
of their education and training
• prescribe natural and therapeutic
substances, natural therapies, and
contraceptive devices
• prescribe allowed drugs only if the
Naturopath has passed the Naturopathic
Physicians Licensing Examination
pharmacology portion and
• perform minor surgeries and order
diagnostic procedures
• Defines "naturopathic physical
application"
3:49:10 PM
Section 9 Amends AS 08.45.050 Restrictions on
practice of naturopathy
• Removes the prohibition for prescribing
drugs, performing minor surgeries
• Prohibits Naturopaths from giving,
recommending or prescribing cancer drugs
and controlled substances
Section 10 Amends and adds new sections under AS
08.45
08.45.053: Public health duties: Requires
Naturopaths to abide by duties followed by
licensed physicians regarding public health laws,
reportable and communicable diseases, recording
of vital statistics, health exams and laws
outlined by municipal boards of health
AS 08.45.055 Duty of naturopaths to report: If
treating another naturopath who is being treated
for alcoholism or other mental health disorders
and who may constitute a danger to themselves or
others, they must report individual with name and
address of that person. Upon receipt of report
the department shall investigate and may appoint
a committee to examine and report on its
findings. The department has authority to suspend
the person prior to appointing the committee and
receipt of its report. The department shall
suspend, revoke or limit the Naturopath's license
if it finds the reported is unable to continue
with reasonable safety for patients/public. A
Naturopath may not refuse to report or withhold
information disclosed in patient relationship or
under a confidentiality agreement under AS
18.23.030. An action cannot be taken against the
reporting Naturopath or other investigating
agency, administrator or judicial entity.
AS 08.45.058 Naturopaths to report certain
injuries. This section imposes the same public
health duties on naturopaths as other physicians
such as 3rd degree burns, bullet wounds, firearm
discharge wounds, knife or other blade wounds,
life-threatening wounds, unless incidences were
purely accidental; protects the Naturopath from
civil liability for making the report.
3:50:55 PM
Section 11 amends AS 08.45.060 Grounds for
suspension, revocation, or refusal to
issue a license
Amends and applies the same suspensions, license
revocation, or refusal to issue a license grounds
on naturopaths as other physicians
Section 12 Amends and adds a new subsection under AS
08.45.060 Grounds for suspension,
revocation, or refusal to issue a
license.
Adds a new subsection to clarify the authority of
the entity taking disciplinary action against a
license under AS 08.45.060(a)(14) which states
that a Naturopath can have licensed
revoked/suspended if he/she has had license
revoked/suspended in another state or Canada for
violations of practice or failure to pay fees.
Section 13 amends AS 08.45.070(a) Disciplinary
sanctions
Clarifies that disciplinary sanctions apply for
AS 08.45 and imposes a limit of $25,000 for civil
penalties.
Section 14 Amends and adds new subsection under AS
08.45.070
Allows department to reinstate a license if
applicant is deemed able to practice safely,
allows suspension of license if department
received proof of license revocation or
suspension in another state or Canada; requires
department to report to the National Practitioner
Data Bank any licensure refusals, suspensions and
fines.
3:52:18 PM
Section 15 Amends 08.45 by adding new sections
08.45.105 Automatic suspension for mental
incompetency: License is automatically revoked if
Naturopath is found to be mentally incompetent by
a judicial proceeding or voluntary commitment.
License can be restored with court finding of
restored competency, or restorative opinion
issued by a psychiatrist approved by the
department.
08.45.110 Voluntary surrender: The department can
accept a voluntary surrender of a license and can
reinstate the licensee if department deems them
competent to resume practice, but cannot
reinstate license if the license was surrendered
because of a civil or criminal charge against the
licensee.
08.45.115 Medical and psychiatric examinations:
the department may require a drug or alcohol test
as part of an investigation of a licensee, with
the test to be paid by the department
08.45.120 Reports relating to malpractice action
and claims: A licensee must report to the
department any malpractice or civil claim brought
against them within 30 days after resolution or
termination of civil action.
08.45.125 Penalty for practicing without a
license: Makes it a class A misdemeanor to
practice without a license, and each day of
unauthorized practice is a separate offense.
08.45.130 Prohibited use of title: a Naturopath
cannot use or advertise as a naturopath unless
licensed by the state.
3:53:18 PM
Section 16 Repeals and reenacts AS 08.45.200(3)
Definitions
Repeals and replaces definition for "naturopathy"
Section 17 Amends and adds new paragraphs under AS
08.45.200(4) & (5)
Definitions Defines "approved naturopathic
medical school" and "naturopath"
Section 18 Amends AS 12.62.400(a) National criminal
history record checks for employment,
licensing, and other noncriminal justice
purposes.
Adds Naturopaths to list of other professions
requiring them to submit fingerprints to complete
the national criminal history record check
Section 19 Transitional Language for current
licensees
Allows currently licensed naturopaths to continue
to practice under current law until licensee's
normal renewal period, under which they must
comply with language contained in this
legislation.
3:54:06 PM
Section 20 Transitional Regulations
Allows the Department to adopt transitional
regulations immediately following passage and
prior to the bill's effective date.
Section 21 Effective date
Establishes immediate effective date for Section
20
Section 22 Effective date
Establishes effective date for Sections 1 19 as
January 1, 2024
3:54:37 PM
CHAIR WILSON began invited testimony on SB 44.
3:55:18 PM
NATALIE WIGGINS, ND, Naturopathic Physician Alaska Association
for Naturopathic Doctors, Anchorage, Alaska, said she works in
an integrative clinic with two nurse practitioners and a
physician assistant. Voting in favor of SB 44 is in the best
interest of Alaskan residents because Alaska is experiencing a
healthcare crisis. Alaska needs more providers living in the
state to take care of residents. Access to care contributes to
Alaska's ranking as the state with the highest medical care
costs in the nation. Areas with low numbers of medical care
providers experience more expensive care. Naturopathic doctors
(NDs) are available and ready to support community needs.
However, naturopaths must be allowed to practice medicine to the
full extent of their training to help. SB 44 would update the
scope of practice to reflect the training naturopaths receive.
The need for an update has yet to occur out of concern for
safety. SB 44 requires the legislature to decide if naturopathy
is safe. She spoke about the following key points regarding
safety:
• All licensed naturopathic doctors in Alaska have completed
a four-year bachelor's degree program, including pre-
medical training.
• All licensed naturopathic doctors in Alaska have completed
a four-year doctoral program at a naturopathic medical
school.
• The Council on Naturopathic Medical Education accredits
naturopathic schools under the US Department of Education.
• Medical training includes approximately 140 hours of
pharmacology training.
• 1,200 hours of clinical training, including prescriptive
management and instruction in minor office procedures
3:57:32 PM
MS. WIGGINS said naturopathic training is commensurate with
nurse practitioners and physician assistants, yet the scope of
practice for naturopathic doctors is less. The updated scope in
SB 44 is like what other states have safely allowed for a long
time. She said she had a DEA (Drug Enforcement Agency) number
and prescriptive authority, which included scheduled drugs when
she worked in Arizona. Also, Arizona state permitted her to
perform sutures and administer vaccines. The ability to perform
such tasks is necessary for primary care providers. Naturopaths
are well-trained in the use of such tools. Alaskan patients need
naturopaths that are allowed to practice. Ironically, in
Arizona, she was a physician who oversaw physician assistants at
the clinic where she worked. Now she must refer to her physician
assistant colleague for medication management. Patients learn to
trust their established medical provider and want their
medication managed by them. Duplicative appointments are costly
and time-consuming for patients and contribute to the state's
healthcare burden. She said she returned to Alaska to raise her
children, but it came at the considerable cost of surrendering
her ability to practice medicine in accordance with her
training. Alaska has 50 licensed naturopath doctors who can
safely prescribe medications and perform office procedures, just
like colleagues safely do in other states. Voting in favor of SB
44 is a safe step in the right direction toward reducing
healthcare costs and providing patient choice.
4:00:26 PM
At ease
4:01:09 PM
CHAIR WILSON reconvened the meeting.
4:01:20 PM
SENATOR DUNBAR referred to page 7 of the handout Senate Bill 44
Naturopaths; Licensing; Practice, and asked for an explanation
of the gray areas of the map.
4:01:58 PM
MS. CONWAY stated her belief that the gray areas represent
states where the naturopath profession is under-regulated. She
deferred the question.
4:02:45 PM
SENATOR DUNBAR wondered how a naturopath's four years of
training at medical school relates to prescriptive authority. He
asked why Schedule I and cancer drugs are exempt if naturopaths
received training.
4:03:38 PM
DR. WIGGINS replied that some drugs, like cancer drugs, fall
into a specialty category, so although naturopaths know of them,
they should be prescribed by a specialist. A naturopath's
pharmacology training is very similar to that of a nurse
practitioner or physician assistant. The training includes
pharmacokinetics, side effects, and drug/herb interactions.
4:04:35 PM
SENATOR DUNBAR asked if nurse practitioners and physician
assistants could prescribe Schedule I drugs and why naturopaths
could not prescribe Schedule I drugs if they have the same
training.
4:04:47 PM
DR. WIGGINS replied that Schedule I drugs are not for medical
use. The drugs that nurse practitioners and physician assistants
prescribe are listed on Schedules II - V. There are many
medications in those categories, including pain medication. She
said she does not know the reason for pushing against
naturopaths' ability to prescribe.
4:05:46 PM
SENATOR GIESSEL stated that Dr. Wiggins testified that she had a
DEA number and controlled substances authority in Arizona. She
asked what DEA stands for, what controlled substances are, the
different schedules, and what a person does to obtain a DEA
number.
4:06:16 PM
DR. WIGGINS responded that DEA stands for Drug Enforcement
Agency, which regulates high-risk abuse medications, which is
why Schedule II drugs include opioids. There are medications in
that category suited for family practice, such as testosterone.
However, because of the risk of abuse, it is a scheduled
medication.
4:06:58 PM
SENATOR GIESSEL asked what Dr. Wiggins did to get a DEA number
and authorization to prescribe medication.
4:07:05 PM
DR. WIGGINS said that to receive a DEA number, an individual has
passed the education and training requirements set by the DEA.
4:07:30 PM
SENATOR GIESSEL commented that the DEA is a federal agency and
authorization renewal is required. She asked Dr. Wiggins to
elaborate more about the DEA.
4:07:42 PM
DR. WIGGINS stated she was unsure what more to elaborate about.
4:07:56 PM
SENATOR GIESSEL said the agency scrutinizes who receives an
authorization number and requires renewal every five years,
which means authorized individuals must prove their credentials
and ability to be safe. A single violation results in a
permanent banning of one's controlled substance prescriptive
authority.
4:08:19 PM
SENATOR TOBIN said she noticed that SB 44 contains mandated
reporting. She asked Dr. Wiggins to expound on what naturopathic
doctors are required to report as it is important to ensure
people report the signs of abuse to the proper authority.
4:08:55 PM
DR. WIGGINS answered that naturopaths are trained mandatory
reporters.
4:09:16 PM
SENATOR TOBIN asked if SB 44 states that naturopaths are
mandatory reporters.
4:09:30 PM
SENATOR GIESSEL said the language in SB 44 is uniform across the
healthcare and education professions.
4:09:42 PM
SENATOR KAUFMAN asked if there is a book that defines all minor
surgeries.
4:10:12 PM
DR. WIGGINS said she did not know if there was a list.
4:10:22 PM
At ease.
4:10:30 PM
CHAIR WILSON reconvened the meeting.
DR. WIGGINS said the definition of minor surgery is "limited to
superficial repair." Minor would refer to superficial structures
such as skin repair. The definition would not include body
cavities.
4:10:59 PM
SENATOR KAUFMAN said a minor repair would refer to skin damage
but not spleen damage.
4:11:15 PM
SENATOR KAUFMAN asked if a four-year bachelor's degree and four-
year naturopathic medical degree constitute a Ph.D. program.
4:11:36 PM
DR. WIGGINS stated it equates to a doctoral degree. The degree
is a doctorate in naturopathic medicine.
4:11:45 PM
SENATOR DUNBAR said the fiscal note is almost zero and would
establish a new board to make regulations. He presumed there
would be licensing fees and expressed concern that with only 50
naturopathic doctors in Alaska, the fees to cover the cost of
the board would be high.
4:12:25 PM
MS. CONWAY said Dr. Luper could answer. However, she opined that
the fee increase might be smaller than anticipated.
4:13:00 PM
SENATOR DUNBAR asked if naturopaths already pay a licensure fee.
MS. CONWAY replied yes. The increased fee will depend on the
department's cost to construct the advisory board and promulgate
the regulations.
4:13:44 PM
SENATOR TOBIN said on page 5, lines 2-9, that there is direction
regarding education on pain management and opioid use. She asked
about mandatory reporting concerning opioids.
4:14:21 PM
MS. CONWAY said she did not understand the question.
4:14:34 PM
SENATOR GIESSEL stated the reason for the education requirement
in SB 44 was that clinicians that have DEA numbers and prescribe
opioids are required to complete two hours of training every two
years. Naturopaths provide care to people that are on opioids.
By requiring the same training as other clinicians, naturopaths
will have the same ability when providing care. If someone
appears to have an addictive behavior, they could order a urine
drug screen and then contact that person's prescriber or even
the board of pharmacy that manages the prescription drug
monitoring program.
4:16:03 PM
MELANIE HENRIKSEN, ND, President, National University of Natural
Medicine, Portland, Oregon, provided her work history and stated
that she comprehensively understands both conventional and
integrated care requirements and expectations. She highlighted
the following details of the naturopath program:
• 5,047 hours of education for the four-year graduate
training program
• 1,254 hours of direct clinical exposure, which is
comparable to the education requirements for many types of
medical providers.
• Graduation from an accredited four-year college with a
bachelor's degree
• Science and social science prerequisites are nearly
identical to other medical doctorate programs
• Two years of biomedical sciences diagnostic training and
human sciences diagnostic training including: anatomy,
physiology, biochemistry, pathology, embryology,
microbiology, physical examination, laboratory diagnosis
and diagnostic imaging.
• Successful completion of the Biomedical Science National
Board Exam
• Two years of clinical application that is anatomy specific
to organ systems and courses on teaching disease management
and prevention through therapeutic modalities such as
nutrition, botanical medicine, physical medicine, lifestyle
counseling, minor office procedures, and pharmacology.
• Participation in clinical skills rotations.
4:18:46 PM
DR. HENRIKSEN said all faculty must have terminal degrees in
their teaching disciplines. Curriculums are updated and assessed
regularly through the curriculum committee as mandated by
federal accreditors. The Council for Naturopathic Medical
Education is the accrediting agency that monitors naturopathic
medical programs according to federal guidelines. The rigorous
accreditation process requires annual reports, self-studies, and
site visits. Regional accreditors also oversee colleges.
4:19:55 PM
DR. HENRIKSEN said that 26 US states license naturopathic
physicians. The scope of licensure varies widely. Some states
have comprehensive prescriptive authority, while others are
limited. All naturopath students must complete two different
sets of exams to graduate. Residencies are available in all the
naturopathic colleges in the country and some individual medical
sites. Unfortunately, they are not covered through federal
programs like medical doctors (MDs) and osteopathic doctors
(DOs), which limits the number of students that complete
residency. Residency is not a requirement for licensure except
in one state. She said the educational program of naturopathic
medical colleges prepares graduates to be competent, safe, and
effective healthcare providers who can assess primary care
needs, particularly in medically underserved states.
4:21:36 PM
CLYDE JENSEN, Ph.D., Professor of Pharmacology, Rocky Vista
University, Saint George, Utah, stated he teaches pharmacology
to medical doctors (MDs), osteopathic physicians (DOs), and
naturopathic physicians (NDs). The amount of pharmacology and
the topics within the subject of pharmacology taught in
naturopathic medical schools are identical to those taught in
osteopathic and allopathic schools.
4:22:51 PM
DR. JENSEN said training in all health sciences institutions
includes training in clinics and hospitals. If there were any
difference in the pharmacology and pharmaceutical training
between naturopaths, osteopaths, and allopaths, it would be that
DOs and MDs receive training in hospitals. NDs are trained in
the basic sciences of drugs but devote more of their time in
naturopathic medicine to treating patients on an outpatient
basis and utilizing alternative forms of therapy like nutrition
and herbal medicines. He opined that NDs prefer to use those
forms of therapy and are inclined to use fewer drugs than MDs.
NDs are responsible for continuing medical education in the same
number of hours and on similar topics as MDs and DOs. He stated
that as a person who has led and taught continuing medical
education programs, he knows that the pharmacology training that
naturopathic physicians receive is virtually identical to that
of MDs and DOs. He stated that his purpose in testifying is to
encourage all healthcare professionals to be allowed to practice
to the limit of their scope. Many individuals are seeking health
care, and it's wasteful not to allow NDs, DOs, and MDs to
practice and use all the skills they have learned. He stated his
belief that naturopathic physicians are sufficiently trained and
have sufficient skills to dispense and utilize pharmaceutical
products, especially those listed in SB 44.
4:26:12 PM
SENATOR DUNBAR asked if there were specialized drugs other than
cancer drugs. He said he is trying to understand why the
prescriptive authority was formulated in this precise way.
4:27:01 PM
DR. JENSEN said he does not know why Alaska excluded particular
drugs from SB 44. NDs in other states can use the excluded
drugs. Cancer drugs are more dangerous and are intravenously
administered. The nature of naturopathic medicine makes using
cancer drugs less common in the profession. He opined that
opioids were probably excluded as a means of compromise in
aiding the passage of SB 44. He said no other drugs needed
excluding. There are other dangerous drugs, but MDs, ODs, and
NDs have the training, know the dangers, and avoid them.
4:29:18 PM
SEAN HIGGINS, representing self, Anchorage, Alaska, provided a
brief work history and stated he is an emergency room (ER)
physician at Alaska Regional Hospital. Washington permits NDs a
work scope that represents their skill sets and training. The US
is experiencing many barriers to primary care access,
particularly in Alaska. Primary care doctors cannot see their
patients promptly, resulting in more ER trips for primary care-
related issues. He said that as an ER doctor, he sees an
increase in patients visiting the ER for reasons that primary
care providers should manage, such as medication refills and
contraception. He estimated that 30 percent of the patients he
sees should be seeing a primary care doctor. Visiting the ER is
more expensive and strains ER staff and resources. It creates a
lack of consistency and follow-up that is detrimental to a
patient's primary care management, especially for chronic
illness. He stated that he has worked with NDs and agrees that
their training is comparable to the coursework and exams he
received. He said he was baffled to learn that NDs in Alaska
must refer their patients to physician assistants and nurse
practitioners for medication management because he knows NDs
receive more rigorous and lengthy training. In addition, NDs
emphasize prevention, which reduces chronic disease
complications that lead to emergencies such as heart attacks. He
opined that NDs are thoughtful, deliberate, and forward-
thinking. Allowing them to practice to the full extent of their
training will help Alaskans receive needed primary and
preventative care.
4:33:03 PM
JON LIEBERMAN, Retired, Washington, stated he spent most of his
career as a medical doctor (MD) in Fairbanks. He opined that
there is an evolution in medicine, so legislators are trying to
figure out how to keep the public safe. History shows that
doctors were primarily MDs at the turn of the century, with
osteopaths (DOs) beginning to practice manipulative therapy.
Osteopaths became a strong group and now perform brain and
cardiac surgery. Many DOs are family practitioners. DOs are on
par with MDs. Nurse Practitioners and Physician Assistants who
provide valuable healthcare experienced an uphill battle to have
their abilities recognized. The government must focus on
outcomes to protect the public instead of creating roadblocks.
4:35:41 PM
DR. LIEBERMAN stated that society should not categorically fear
naturopaths (NDs) and their professional duties. Surgeons and
other medical professionals who think naturopaths are trying to
take over their practice are unwittingly fearful and
shortsighted. If all roadblocks had been historically
successful, society would not have the benefit of osteopaths,
nurse practitioners, midwives, and others. Monitoring outcomes
and problems is the answer, not barring the door and failing to
identify bad actors. There are standards for professional ethics
that doctors are trusted to follow. Society needs to trust that
naturopaths will be good doctors. If society is not going to
trust them, it should be done based on evidence and not knee-
jerk fear. He opined that society needs to be nonprejudicial as
it opens the door to naturopathic services and evaluates them
based on outcomes.
4:37:44 PM
CHAIR WILSON asked Dr. Lieberman if he disagrees with the
following portion of a letter:
Surgeons will train as much as four times as long as
naturopaths. The education and training of a
naturopath is no way comparable to that of a medical
doctor. It is dishonest to refer to naturopaths as
naturopathic doctors, naturopathic physicians.
4:40:58 PM
DR. LIEBERMAN replied that the statement is very specious and he
does not believe it truthful. Naturopaths achieved a doctorate
level of knowledge in their field. Although naturopathic
medicine is evolving, naturopathic physicians know to work
within the scope of the practice. A naturopath is not going to
perform neurosurgery in their office. A family practitioner,
general surgeon, any specialty field, or MD can open a practice
and do what they want in their office until complaints occur and
authorities investigate. He stated that the person who would
write that letter is unwittingly fearful because they do not
know the outcome. He said he would ask the author of the letter
to show him the evidence. Naturopaths do not want to be plastic
surgeons. He opined that there are too many stipulations in SB
44. The stipulations bow down to a fear that naturopaths will
step over the line. Naturopaths are a very important part of
evolution, and the public should not miss out on the good they
could do because of fear.
4:42:38 PM
SCOTT LUPER, ND, Alaska Association of Naturopathic Doctors,
Fairbanks, Alaska, gave a brief history of his work background
and said he would like to answer questions the committee asked.
He said he loves practicing in Fairbanks but is irked that he
cannot practice to the full extent of his training. He said the
crux of the opposition to SB 44 is fear of change. Some think
naturopathic medicine is weeds, beads, seeds, and feathers when
naturopathic medicine is safe, and the doctors are well trained.
Naturopathy has been on the West Coast for a long time, so there
is a cumulative record of malpractice suits and complaints. The
overall complaint record for naturopaths is 10 - 20 percent of
MDs and DOs; admittedly, MDs and DOs do more risky procedures
and surgeries. However, the rate of complaints and malpractice
for naturopaths is low. Malpractice insurance rates for
naturopaths are also 10 - 20 percent of the medical profession.
Malpractice rates are not political. Companies set the rates by
determining actual risk, which speaks to the safety of
naturopathy.
4:46:05 PM
DR. LUPER said political expediency answers Senator Dunbar's
question regarding the reason for the lockout of controlled
substances and chemotherapy from SB 44. Pushback from the
medical profession focuses on prescriptions. Naturopathic
doctors are making others feel better by taking away the most
dangerous drugs. It is easy for naturopathic doctors not to
include them in SB 44 because they are not inclined to use them.
Naturopathic doctors are a group of sensible people. They are
people who have gone through rigorous application and interview
processes and training programs. Like any professional,
naturopaths must be smart, earn good grades, and have moral
character. MDs and ODs do not use everything at their disposal;
they self-regulate because that is what professionals do.
4:47:51 PM
DR. LUPER said Alaska statute does define minor surgery and
summarized it as superficial procedures. He said the definition
excludes body cavities, plastic surgery, and general or spinal
anesthetics. Minor surgery excludes anything that a doctor would
need special surgery training to perform. A naturopath's
training is to be a primary care provider, not a surgeon. They
have the skill and training to sew a laceration, but in Alaska
must direct patients to the emergency room for care, which is
very expensive.
DR. LUPER said the last question was regarding naturopath
licensing fees. The fee amount is $1,800 every two years because
the profession is small.
4:49:57 PM
CHAIR WILSON opened public testimony on SB 44.
4:50:11 PM
BRUCE CAMPBELL, representing self, Fairbanks, Alaska, testified
in support of SB 44. He stated that he uses a naturopath as his
primary care provider and finds the doctor's insights and
expertise invaluable. He stated his belief that fear comes from
confusing a naturopath with an herbalist or other similar
professions. He encouraged the passage of SB 44.
4:51:49 PM
ANNETTE O'CONNELL, representing self, Nikiski, Alaska, testified
in support of SB 44. She stated there was a point when she
became extremely ill and saw three medical doctors who did not
take her symptoms seriously. Finally, a naturopathic doctor
diagnosed and treated her for chronic Lyme disease. She stated
that naturopathic doctors are needed in Alaska and urged the
passage of SB 44.
4:53:41 PM
CHAIR WILSON closed public testimony on SB 44.
4:53:50 PM
SENATOR KAUFMAN asked what relationship naturopathy has with
private and government health insurance.
4:54:08 PM
DR. LUPER said Alaska law requires insurance to cover
naturopathic care. Insurance covers approximately 75-85 percent
of his work. Federal policies supersede state policies, so
naturopaths are not covered by Medicare, Tricare, or any federal
policy because the naturopath profession is small, and many
states have no licensing. He hopes political will changes as the
profession grows.
4:55:46 PM
SENATOR DUNBAR referred to a letter the committee received from
Dr. Vainio, which stated:
[Original punctuation provided.]
Section 3 does not allow a naturopath to practice in
the state unless they seek prescribing authority.
(contradicted in Sec.08.45.045 (2) (D). The
overwhelming majority of naturopaths are not seeking
expanded scope of practice, per the discussions of our
2021 working group. At that time 3 of the approximate
50 naturopaths in the state were seeking expanded
scope of practice.
He asked Senator Giessel whether most naturopaths do not seek
prescriptive authority and if she agrees with Dr. Vainio's
interpretation of SB 44.
4:56:46 PM
SENATOR GIESSEL replied that Section 3, page 3, lines 1 - 10
discusses the application for licensure. The application is on a
form provided by the department and requires fingerprints, a
criminal background check, and an application fee. These
requirements are uniform across the healthcare professions. She
stated she does not understand how Section 3 requires someone to
apply for prescriptive authority.
SENATOR DUNBAR responded that the letter states the
contradiction occurs in Section 2(d).
SENATOR GIESSEL said Section 2(d) is on page 2, line 26.
4:57:49 PM
SENATOR DUNBAR interjected his belief that the letter referred
to a different version of SB 44 and withdrew his question.
4:57:58 PM
SENATOR DUNBAR said Dr. Vainio's letter references a
collaborative agreement with naturopaths to achieve an expanded
scope. He asked if a naturopath could speak to the
collaboration, especially regarding prescriptive authority.
4:58:31 PM
DR. LUPER stated that previously naturopathic doctors in
California had to form relationships with prescribers. It sounds
good in theory, but finding a prescriber willing to donate their
time to work with other practitioners was difficult. He stated
that collaboration is fabulous unless it gets in the way of
providing care, which happens when relationships are mandated.
4:59:57 PM
SENATOR GIESSEL said nurse practitioners had not had the
physician oversight requirement since 1980 and opined that
requiring physician oversight of naturopaths would be
inappropriate.
5:00:27 PM
CHAIR WILSON held SB 44 in committee.
5:02:02 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 5:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB44 version B.PDF |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Sponsor Statement 02.02.23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Sectional Analysis 02.02.23.pdf |
SHSS 2/23/2023 3:30:00 PM SL&C 4/3/2024 1:30:00 PM |
SB 44 |
| SB 44 FN DCCED.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB 44 FN DPS.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Emails 02-20-23_Redacted.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Kruger 02-20-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Lenger 02-18-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Waller 02-21-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Mosley 02-21-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Campbell 02-21-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Huntington 02-21-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Wiggins 02-21-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Sagan 02-21-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Support Emails 02-21-23_Redacted.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB 44 Support Mitchell.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB-44-WA-SenHSS_022023 Alderhold.pdf |
SHSS 2/23/2023 3:30:00 PM |
|
| SB 44 Tsigonis.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB 44 Letter Vainio.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Letter Merkouris.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB 44 ASPS NWSPS opposition 2.22.23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Naturopathic Medicine Presentation SHSS.3.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| CS SB 45 v U 2.22.23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 45 |
| SB 45 Explanation of Changes v. S-U 2.23.23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 45 |
| SB44 Support Luper 02-21-23.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB44 Supporting Document FAQs.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |
| SB 44 Supporting Document - Comparison.pdf |
SHSS 2/23/2023 3:30:00 PM |
SB 44 |