Legislature(2019 - 2020)BELTZ 105 (TSBldg)

03/14/2019 01:30 PM LABOR & COMMERCE

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01:31:13 PM Start
01:31:42 PM Confirmation Hearing(s):
02:13:02 PM SB44
02:40:20 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Consideration of Governor's Appointees: TELECONFERENCED
-- Public Testimony on All Appointees--
- Board of Dental Examiners - Dr. Jonathan P.
Woller
-Board of Veterinary Examiners - Dr. Scott
Flamme
- Board of Nursing - Emily Nicole Henry
- Workers' Compensation Board - Kimberly C.
Ziegler, Bradley S. Austin, Diane Margaret
Thompson, Sara Faulkner
- Alaska Labor Relations Agency - Dennis Moen
*+ SB 44 TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS TELECONFERENCED
Heard & Held
-Invited Testimony Followed by Public Testimony-
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
          SENATE LABOR AND COMMERCE STANDING COMMITTEE                                                                        
                         March 14, 2019                                                                                         
                           1:31 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Lora Reinbold, Chair                                                                                                    
Senator Mia Costello, Vice Chair                                                                                                
Senator Click Bishop                                                                                                            
Senator Chris Birch                                                                                                             
Senator Elvi Gray-Jackson                                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
Board of Dental Examiners                                                                                                     
Dr. Jonathan P. Woller - Fairbanks                                                                                              
                                                                                                                                
     CONFIRMATION ADVANCED                                                                                                      
                                                                                                                                
Board of Veterinary Examiners                                                                                                 
Dr. Scott Flamme - Fairbanks                                                                                                    
                                                                                                                                
     CONFIRMATION ADVANCED                                                                                                      
                                                                                                                                
Board of Nursing                                                                                                              
Emily Henry - Anchorage                                                                                                         
                                                                                                                                
     CONFIRMATION ADVANCED                                                                                                      
                                                                                                                                
Workers' Compensation Board                                                                                                   
Kimberly Ziegler - Cordova                                                                                                      
Bradly S. Austin - Juneau                                                                                                       
Diane M. Thompson - Anchorage                                                                                                   
Sara Faulkner - Homer                                                                                                           
                                                                                                                                
     CONFIRMATIONS ADVANCED                                                                                                     
                                                                                                                                
Alaska Labor Relations Agency                                                                                                 
Dennis Moen - Anchorage                                                                                                         
                                                                                                                                
     CONFIRMATION ADVANCED                                                                                                      
                                                                                                                                
SENATE BILL NO. 44                                                                                                              
"An Act relating to the prescription of drugs by a physician                                                                    
assistant without physical examination."                                                                                        
                                                                                                                                
     HEARD AND HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 44                                                                                                                   
SHORT TITLE: TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS                                                                            
SPONSOR(s): SENATOR(s) GIESSEL BY REQUEST                                                                                       
                                                                                                                                
02/04/19       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/04/19       (S)       L&C                                                                                                    
03/14/19       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
DR. JONATHAN P. WOLLER, Appointee                                                                                               
Board of Dental Examiners                                                                                                       
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the Board of                                                                    
Dental Examiners.                                                                                                               
                                                                                                                                
EMILY HENRY, Appointee                                                                                                          
Board of Nursing                                                                                                                
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the Board of                                                                    
Nursing.                                                                                                                        
                                                                                                                                
KIMBERLY C. ZIEGLER, Appointee                                                                                                  
Workers' Compensation Board                                                                                                     
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the Workers'                                                                    
Compensation Board.                                                                                                             
                                                                                                                                
BRADLEY S. AUSTIN, Appointee                                                                                                    
Workers' Compensation Board                                                                                                     
Department of Labor and Workforce Development (DOLWD)                                                                           
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified as appointee to the Workers'                                                                    
Compensation Board.                                                                                                             
                                                                                                                                
DIANE M. THOMPSON, Appointee                                                                                                    
Workers' Compensation Board                                                                                                     
Department of Labor and Workforce Development (DOLWD)                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the Workers'                                                                    
Compensation Board.                                                                                                             
                                                                                                                                
SARA FAULKNER, Appointee                                                                                                        
Workers' Compensation Board                                                                                                     
Department of Labor and Workforce Development (DOLWD)                                                                           
Homer, Alaska                                                                                                                   
POSITION STATEMENT: Testified as appointee to the Workers'                                                                    
Compensation Board.                                                                                                             
                                                                                                                                
DR. SCOTT FLAMME, DVM, Appointee                                                                                                
Board of Veterinary Examiners                                                                                                   
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the Board of                                                                    
Veterinary Examiners.                                                                                                           
                                                                                                                                
DENNIS MOEN, Appointee                                                                                                          
Alaska Labor Relations Agency                                                                                                   
Department of Labor and Workforce Development (DOLWD)                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the Labor                                                                       
Relations Agency.                                                                                                               
                                                                                                                                
SENATOR CATHY GIESSEL                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified as sponsor of SB 44.                                                                            
                                                                                                                                
JANE CONWAY, Staff                                                                                                              
Senator Cathy Giessel                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided a sectional analysis of SB 44.                                                                   
                                                                                                                                
CHERISE HUG, Physician Assistant                                                                                                
Orion Behavioral Health                                                                                                         
Eagle River, Alaska                                                                                                             
POSITION STATEMENT: Testified in support of SB 44.                                                                            
                                                                                                                                
SHIGONE BEIGHLE, Physician Assistant                                                                                            
Orion Behavioral Health                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 44.                                                                            
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:31:13 PM                                                                                                                    
CHAIR  LORA  REINBOLD  called  the   Senate  Labor  and  Commerce                                                             
Standing Committee meeting  to order at 1:31 p.m.  Present at the                                                               
call  to order  were Senators  Gray-Jackson, Costello,  Birch and                                                               
Chair Reinbold. Senator Bishop arrived shortly thereafter.                                                                      
                                                                                                                                
^CONFIRMATION HEARING(S):                                                                                                       
                    CONFIRMATION HEARING(S):                                                                                
                   Board of Dental Examiners                                                                                
                 Board of Veterinary Examiners                                                                              
                        Board of Nursing                                                                                    
                  Workers' Compensation Board                                                                               
                 Alaska Labor Relations Agency                                                                              
                                                                                                                              
1:31:42 PM                                                                                                                    
CHAIR REINBOLD announced  that the first order  of business would                                                               
be Confirmation Hearings  for the Board of  Dental Examiners, the                                                               
Board  of  Veterinary  Examiners,   the  Board  of  Nursing,  the                                                               
Workers'  Compensation  Board,  and the  Alaska  Labor  Relations                                                               
Agency.                                                                                                                         
                                                                                                                                
1:32:43 PM                                                                                                                    
JONATHAN P.  WOLLER, DMD, Appointee,  Board of  Dental Examiners,                                                               
Division of  Corporations, Business, and  Professional Licensing,                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED), Fairbanks  clarified that  his father is  Timothy Woller                                                               
and they work  together in the same dental offices.  He said that                                                               
he was  born and raised  in Fairbanks. He holds  an undergraduate                                                               
degree in physiological sciences  from the University of Arizona.                                                               
He  earned  his   Doctor  of  Dental  Medicine   (DDM)  from  the                                                               
University  of   Louisville  in  2004.   He  said  that   he  has                                                               
continuously practiced dentistry since  2004. During 2004-2007 he                                                               
practiced  medicine in  Minneapolis,  Minnesota,  at a  nonprofit                                                               
organization that  served immigrant and underserved  children. He                                                               
returned to Fairbanks  in 2007 and entered  into private practice                                                               
with his  father. In  2010, he  purchased his  father's business,                                                               
which he currently operates.                                                                                                    
                                                                                                                                
He said that he firmly believes  in public service and has served                                                               
in  voluntary  positions  with the  Alaska  Dental  Society,  the                                                               
American Dental Association, and  twice has provided services via                                                               
the Alaska  Mission of  Mercy. He  said he  views serving  on the                                                               
Board of Dental Examiners as a means  for him to give back to the                                                               
state. He  offered his  belief that  dental professionals  have a                                                               
duty  to  hold themselves  to  the  highest ethical,  moral,  and                                                               
clinical standards. Helping dental  providers will help to ensure                                                               
that all Alaskans  are in good hands when they  seek the services                                                               
of licensed dentists and dental  hygienists. He has served on the                                                               
executive  council  and  on  committees  for  the  Alaska  Dental                                                               
Society.  He would  like the  profession to  have clear  and fair                                                               
legislation  that  reflects the  values  expected  of the  dental                                                               
community.  He said  he  looks forward  to  serving all  Alaskans                                                               
beyond his own patient population.                                                                                              
                                                                                                                                
1:35:55 PM                                                                                                                    
CHAIR REINBOLD opened public testimony  and after ascertaining no                                                               
one   wished  to   testify,  closed   public  testimony   on  the                                                               
confirmation  hearing for  Dr. Jonathan  P. Woller,  appointee to                                                               
the Board of Dental Examiners.                                                                                                  
                                                                                                                                
1:37:15 PM                                                                                                                    
EMILY   HENRY,  Appointee,   Board   of   Nursing,  Division   of                                                               
Corporations,  Business, and  Professional Licensing,  Department                                                               
of   Commerce,  Community   and  Economic   Development  (DCCED),                                                               
Anchorage, stated  she is thrilled  to be a  part of the  team of                                                               
nurses  at the  Providence  Extended Care  where  she has  worked                                                               
since 2018.  She said  that she is  originally from  Delaware and                                                               
graduated from Delaware Technical  Community College in 2001. She                                                               
later worked as a home care  nurse and continued to take courses.                                                               
She later had  an opportunity to work in Alaska.  She said she is                                                               
excited to promote and uphold  the standards in nursing care. She                                                               
believes  in compassion  for residents.  She has  participated in                                                               
organizations, including  the Future Farmers of  America (FFA) in                                                               
Delaware  and  conservation  organizations, including  the  Rocky                                                               
Mountain  Elk Foundation,  the National  Rifle Association  (NRA)                                                               
and the National Wild Turkey Federation.                                                                                        
                                                                                                                                
1:40:17 PM                                                                                                                    
CHAIR REINBOLD opened public testimony  and after ascertaining no                                                               
one   wished  to   testify,  closed   public  testimony   on  the                                                               
confirmation hearing for  Emily Henry, appointee to  the Board of                                                               
Nursing. She noted that Ms. Henry participated in the FFA.                                                                      
                                                                                                                                
MS. HENRY responded  that she has been part of  the FFA since she                                                               
was a girl. She said she  hopes to promote healthy lifestyles for                                                               
better health.                                                                                                                  
                                                                                                                                
1:41:44 PM                                                                                                                    
KIMBERLY  C.  ZIEGLER,  Appointee, Workers'  Compensation  Board,                                                               
Division of  Corporations, Business, and  Professional Licensing,                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED),  Anchorage, stated  she has  worked in  the construction                                                               
industry in  training and apprenticeship. She  currently works in                                                               
the seafood industry at Copper  River Seafoods. She is interested                                                               
to serve on the Workers'  Compensation Board (WCB) because public                                                               
service is  integral to personal  and professional  growth. After                                                               
viewing workers'  compensation from  the employers' side,  she is                                                               
interested in  seeing it  from another side  of the  process. She                                                               
said she  hope to work on  policy issues to improve  the workers'                                                               
compensation system in Alaska.                                                                                                  
                                                                                                                                
1:43:19 PM                                                                                                                    
CHAIR   REINBOLD  mentioned   that   the   legislature  will   be                                                               
considering workers' compensation bills.                                                                                        
                                                                                                                                
1:43:43 PM                                                                                                                    
SENATOR  BIRCH asked  how  many employees  work  at Copper  River                                                               
Seafoods and if she has experienced any issues.                                                                                 
                                                                                                                                
MS. ZIEGLER  responded that during  the off-season,  Copper River                                                               
Seafood employs 120  fulltime employees and beginning  in May the                                                               
company employs  up to 900  seasonal employees. She  covers 40-50                                                               
workers' compensation claims  each year, and in some  years up to                                                               
70  claims.  She  said  that  the  seafood  industry  is  a  very                                                               
dangerous  profession  with   significant  workers'  compensation                                                               
usage. She said  that she is interested in  helping address these                                                               
issues.                                                                                                                         
                                                                                                                                
1:44:59 PM                                                                                                                    
CHAIR  REINBOLD acknowledged  that commercial  fishing is  one of                                                               
the highest risk jobs.                                                                                                          
                                                                                                                                
1:45:36 PM                                                                                                                    
BRADLEY  S.  AUSTIN,   Appointee,  Workers'  Compensation  Board,                                                               
Department of  Labor and  Workforce Development  (DOLWD), Juneau,                                                               
stated he  works with the  Plumbers and Pipefitters,  Local Union                                                               
262.  He serves  on the  joint apprenticeship  training committee                                                               
and  is  the  training  coordinator   and  instructor  for  their                                                               
apprentices.                                                                                                                    
                                                                                                                                
He  said his  family moved  to Alaska  in 1970  and that  his dad                                                               
worked as a  plumber. He attended Juneau-Douglas  High School and                                                               
owned his  own plumbing contractor  business. He also  has worked                                                               
for local  shops in Juneau. He  said that he holds  a certificate                                                               
for  industrial  training  and   holds  an  associate  degree  in                                                               
industrial training.  He was appointed  to the labor seat  of the                                                               
Workers' Compensation Board (WCB) in  2010, that this will be his                                                               
fourth appointment  to the  WCB. He characterized  the WCB  as an                                                               
important board  and serving on the  board gives him a  chance to                                                               
give back to  Alaska. The board provides  three functions. First,                                                               
the board  is involved in  hearings, often  including complicated                                                               
medical   or   legal   matters.  Second,   the   board   develops                                                               
regulations, he said. Finally, the  board approves companies that                                                               
apply  for  self-insurance  through  workers'  compensation.  Two                                                               
members  serve Southeast  Alaska. He  serves in  the labor  seat,                                                               
another board member  serves in the industry seat,  and they have                                                               
a hearing officer.                                                                                                              
                                                                                                                                
1:48:10 PM                                                                                                                    
SENATOR COSTELLO said  about a third of the WCB  members are new.                                                               
She asked how he will mentor new members.                                                                                       
                                                                                                                                
MR. AUSTIN responded that the  WCB members work well together and                                                               
he hopes that  he will be able to mentor  new members. In further                                                               
response, he elaborated that the  WCB holds two hearings a month.                                                               
He  said  that new  members  must  be  prepared to  read  lengthy                                                               
settlement agreements  and spend considerable time  preparing for                                                               
meetings since it is an active board.                                                                                           
                                                                                                                                
SENATOR BIRCH  said that Mr.  Austin has a tremendous  resume. He                                                               
asked if  he has seen  safety practices improve or  change during                                                               
the 40  years he has served  in his profession. He  further asked                                                               
about the types of on the job injuries he has encountered.                                                                      
                                                                                                                                
MR.  AUSTIN  acknowledged  that   safety  records  have  improved                                                               
greatly  over  time.  His  organization  and  trade  unions  have                                                               
instituted  safety programs  for apprentices  and journeymen.  He                                                               
mentioned that  North Slope employees  also go  through extensive                                                               
safety training programs. The trend  has been to provide enhanced                                                               
safety programs to lower the number of injuries, he said.                                                                       
                                                                                                                                
1:53:05 PM                                                                                                                    
SENATOR BISHOP  said the Workers' Compensation  Board falls under                                                               
the  Department  of Labor  and  Workforce  Development. From  his                                                               
perspective  as   the  former  commissioner  of   the  DOLWD,  he                                                               
acknowledged that a  lot of work is involved for  this board. The                                                               
department started a focused campaign  to assist employers on the                                                               
importance   of  workplace   safety.   He   said  that   workers'                                                               
compensation continues  to be  a tenuous  conversation and  it is                                                               
hard  to make  improvements in  the industry.  The Department  of                                                               
Labor  and Workforce  Development (DOLWD)  Worker Safety  Account                                                               
receives  a  2.75  percent  stipend  from  workers'  compensation                                                               
insurance premiums. Last  year, the legislature passed  a bill to                                                               
address the multiplier, because  workplace accidents were reduced                                                               
to the  point that  the Division  of Insurance  needed a  bill to                                                               
increase  it. "We're  moving  the  needle in  the  right way  and                                                               
thanks, Brad, for reapplying," he said.                                                                                         
                                                                                                                                
CHAIR REINBOLD expressed  hope that Mr. Austin would  weigh in on                                                               
workers' compensation bills coming before the committee.                                                                        
                                                                                                                                
1:55:46 PM                                                                                                                    
DIANE  M.  THOMPSON,   Appointee,  Workers'  Compensation  Board,                                                               
Department   of   Labor   and  Workforce   Development   (DOLWD),                                                               
Anchorage, stated she  has lived in Anchorage since  1981 and has                                                               
worked  in  the  restaurant  business  for  over  30  years.  She                                                               
currently is  the owner/manager  for Firetap  Ale House  in South                                                               
Anchorage  and she  previously has  owned  Humpy's Great  Alaskan                                                               
Alehouse, which she sold in 2000.  She serves as the president of                                                               
the  Alaska  Hospitality  Retailer's  Association  (AHRA),  which                                                               
represents  the entire  hospitality  industry in  the state.  The                                                               
AHRA currently has  about 200 members, she said.  She has handled                                                               
all the workers' compensation claims  for her restaurants, so she                                                               
understands the  system. She currently employs  about 70 workers.                                                               
She said  that she is interested  in observing the other  side of                                                               
the  workers'  compensation  equation. However,  her  restaurants                                                               
have  not had  many  workers' compensation  claims. She  recalled                                                               
that  she has  had  three  claims in  10  years,  mostly for  cut                                                               
fingers, which  was addressed by providing  employees with better                                                               
gloves.                                                                                                                         
                                                                                                                                
1:59:35 PM                                                                                                                    
SARA   FAULKNER,   Appointee,    Workers'   Compensation   Board,                                                               
Department  of Labor  and Workforce  Development (DOLWD),  Homer,                                                               
stated she  has lived in Alaska  since 1980. She stated  that she                                                               
and her  husband have owned and  operated Lands End in  Homer for                                                               
over  30 years.  During that  time,  they also  owned Van  Gilder                                                               
Hotel in  Seward and Kenai Landing  in Kenai. She said  she would                                                               
like  to serve  on  the Workers'  Compensation  Board to  address                                                               
employee  safety  and  health,   which  are  priorities  for  her                                                               
businesses.  She   would  like  to  learn   more  about  workers'                                                               
compensation issues and use her  knowledge and experience to help                                                               
others.  Secondly,  since  medical costs  have  skyrocketed,  she                                                               
would like to help control  the workers' compensation program and                                                               
ultimately  reduce  workers'  compensation  insurance  rates  and                                                               
costs. She hoped  she would be a good board  member. She said she                                                               
will bring her broad experience  across many industries. She also                                                               
has experience with workers' compensation  audits and claims. She                                                               
is also good  with numbers and is a good  listener. She said that                                                               
she  will   do  her  best   to  properly  execute   the  workers'                                                               
compensation laws of Alaska.                                                                                                    
                                                                                                                                
SENATOR BISHOP  said she has  a well-rounded background.  He said                                                               
he liked that she started her career  as a bull cook working on a                                                               
neighbor's NANA  camp in Deadhorse.  He said  she will be  a good                                                               
fit for the board.                                                                                                              
                                                                                                                                
2:02:12 PM                                                                                                                    
CHAIR REINBOLD opened public testimony  and after ascertaining no                                                               
one   wished  to   testify,  closed   public  testimony   on  the                                                               
confirmation  hearings for  Kimberly Ziegler,  Bradly S.  Austin,                                                               
Diane  M. Thompson,  Sara Faulkner,  appointees  to the  Workers'                                                               
Compensation Board.                                                                                                             
                                                                                                                                
2:02:59 PM                                                                                                                    
SCOTT  FLAMME, DVM;  Appointee,  Board  of Veterinary  Examiners,                                                               
Division of  Corporations, Business, and  Professional Licensing,                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED),  Fairbanks,  stated  he   has  been  a  veterinarian  in                                                               
Fairbanks for  17 years. He  grew up on  a farm and  has multiple                                                               
experiences  serving  on  boards.  He worked  for  Pfizer  Animal                                                               
Health  as student  advisor. He  said  that veterinary  practices                                                               
have changed dramatically  in recent years due  to technology. In                                                               
part,  due  to  these   technology  changes,  veterinarians  have                                                               
experienced  increased  legal   responsibilities,  especially  in                                                               
terms of recordkeeping and the  use of online technology. He said                                                               
that he  is well versed  in "tech" and would  like to serve  on a                                                               
state board. Most veterinarians  are hard-working individuals and                                                               
he works hard, he said.                                                                                                         
                                                                                                                                
SENATOR BISHOP offered  his belief that Mr. Flamme  is the "right                                                               
guy for the  job" at this time.  He said he was  floored that Mr.                                                               
Flamme has  time to serve  on the board,  but that the  state can                                                               
use him.                                                                                                                        
                                                                                                                                
2:05:23 PM                                                                                                                    
CHAIR REINBOLD opened public testimony  and after ascertaining no                                                               
one   wished  to   testify,  closed   public  testimony   on  the                                                               
confirmation hearing for Scott Flamme,  appointee to the Board of                                                               
Veterinary Examiners.                                                                                                           
                                                                                                                                
2:05:56 PM                                                                                                                    
DENNIS   MOEN,   Appointee,   Alaska  Labor   Relations   Agency,                                                               
Department   of   Labor   and  Workforce   Development   (DOLWD),                                                               
Anchorage,  stated that  he came  to Alaska  in the  mid-70s, and                                                               
that  he has  lived  in Fairbanks,  Anchorage,  and in  Southeast                                                               
Alaska.  He  has   over  40  years  of   experience  with  public                                                               
employees, including  working as  a public employee  and managing                                                               
public employees for the Department  of Transportation and Public                                                               
Facilities  (DOTPF),  and  as  a   business  manager  for  Public                                                               
Employees,  Local 71,  he  said. He  has  experience in  contract                                                               
negotiations,   contract  interpretation,   conflict  resolution,                                                               
letters  of agreement,  grievance  resolutions, arbitration,  and                                                               
employee training and safety. He  recently retired on March 1 and                                                               
would  like to  continue to  serve Alaskans  as a  member of  the                                                               
board.                                                                                                                          
                                                                                                                                
2:07:18 PM                                                                                                                    
SENATOR BISHOP  said Mr. Moen  is qualified and  acknowledged his                                                               
focus  has been  on safety  and health.  He said  that he  really                                                               
appreciated  the leadership  on the  "Kids Don't  Float" program,                                                               
which is a good program.                                                                                                        
                                                                                                                                
2:08:24 PM                                                                                                                    
SENATOR GRAY-JACKSON  said she  knows Mr.  Moen. She  thanked him                                                               
for his  years of service as  an employee who has  represented so                                                               
many  public service  employees  that provide  many services  for                                                               
members'  constituents. She  said  he brings  a  lot of  workers'                                                               
compensation experience to the board.                                                                                           
                                                                                                                                
2:09:27 PM                                                                                                                    
CHAIR REINBOLD opened public testimony  and after ascertaining no                                                               
one   wished  to   testify,  closed   public  testimony   on  the                                                               
confirmation  hearing for  Dennis Moen,  appointee to  the Alaska                                                               
Labor Relations Agency.                                                                                                         
                                                                                                                                
2:09:58 PM                                                                                                                    
At-ease.                                                                                                                        
                                                                                                                                
2:10:40 PM                                                                                                                    
CHAIR  REINBOLD  reconvened  the  meeting.  She  stated  that  in                                                               
accordance  with  AS 39.05.080,  the  Senate  Labor and  Commerce                                                               
Standing  Committee reviewed  the  following  and recommends  the                                                               
appointments be forwarded to a joint session for consideration:                                                                 
                                                                                                                                
Board of Dental Examiners                                                                                                     
Dr. Jonathan P. Woller - Fairbanks                                                                                              
                                                                                                                                
Board of Veterinary Examiners                                                                                                 
Dr. Scott Flamme - Fairbanks                                                                                                    
                                                                                                                                
Board of Nursing                                                                                                              
Emily Henry - Anchorage                                                                                                         
                                                                                                                                
Workers' Compensation Board                                                                                                   
Kimberly Ziegler - Cordova                                                                                                      
Bradly S. Austin - Juneau                                                                                                       
Diane M. Thompson - Anchorage                                                                                                   
Sara Faulkner - Homer                                                                                                           
                                                                                                                                
Alaska Labor Relations Agency                                                                                                 
Dennis Moen - Anchorage                                                                                                         
                                                                                                                                
Signing  the   reports  regarding  appointments  to   boards  and                                                               
commissions in  no way reflects  individual members'  approval or                                                               
disapproval  of  the  appointees;   the  nominations  are  merely                                                               
forwarded to the full legislature for confirmation or rejection.                                                                
                                                                                                                                
2:11:24 PM                                                                                                                    
At-ease.                                                                                                                        
                                                                                                                                
         SB 44-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS                                                                      
                                                                                                                                
2:13:02 PM                                                                                                                    
CHAIR  REINBOLD reconvened  the meeting.  She announced  that the                                                               
final order  of business  would be  SENATE BILL  NO. 44,  "An Act                                                               
relating to  the prescription of  drugs by a  physician assistant                                                               
without physical examination."                                                                                                  
                                                                                                                                
2:13:05 PM                                                                                                                    
SENATOR  COSTELLO clarified  the original  version of  SB 44  was                                                               
before  the committee.  Senator  Bishop  objected for  discussion                                                               
purposes.                                                                                                                       
                                                                                                                                
2:13:15 PM                                                                                                                    
SENATOR CATHY  GIESSEL, Alaska State Legislature,  Juneau, stated                                                               
that this  bill relates to  telehealth and  physician assistants.                                                               
She said  that while she  is a  health care professional,  she is                                                               
not a  physician assistant (PA)  and derives no benefit  from the                                                               
bill. She  described this  bill as  a "clean  up bill"  that will                                                               
increase access  to care throughout Alaska.  She paraphrased from                                                               
her sponsor statement for SB 44, which read:                                                                                    
                                                                                                                                
     The  2016   Medicaid  Reform  bill  (Senate   Bill  74)                                                                    
     provided for  the use of telehealth  by revising Alaska                                                                    
     statutes  to require  the Alaska  Board of  Medicine to                                                                    
     adopt   regulations  and   guidelines  for   physicians                                                                    
     rendering   a   diagnosis,  providing   treatment,   or                                                                    
     prescribing,    dispensing,    or    administering    a                                                                    
     prescription  drug to  a  person  without conducting  a                                                                    
     physical examination under AS 08.64.364.                                                                                   
                                                                                                                                
2:14:19 PM                                                                                                                    
     Consequently,  the omission  of PAs  from the  Medicaid                                                                    
     Reform  bill   has  led  to   them  being   subject  to                                                                    
     limitations on  the use of  telemedicine. Specifically,                                                                    
     the  Medical  Board  released guidelines  stating  that                                                                    
     physician  assistants could  not  treat  a patient  via                                                                    
     telemedicine  without  first  conducting  an  in-person                                                                    
     examination   personally,  or   with  a   collaborating                                                                    
     physician  or  other  practitioner in  the  same  group                                                                    
     practice.                                                                                                                  
                                                                                                                                
2:14:54 PM                                                                                                                    
SENATOR GIESSEL  said that physician  assistants (PAs)  have been                                                               
prohibited  from  practicing  telemedicine.  She  explained  that                                                               
physician  assistants  are a  type  of  clinician that  developed                                                               
during the  Vietnam War.  These were medics  who went  to Vietnam                                                               
and had to practice very  high-level medical care. Actually, they                                                               
replaced doctors in the war field.  They came back to the US with                                                               
these skills.  Physicians realized that these  medics were highly                                                               
skilled.                                                                                                                        
                                                                                                                                
She referred  to a document  in members' packets  labeled "AAPA."                                                               
The  American Academy  of Physician  Assistants (AAPA)  discusses                                                               
the  education and  experience of  physician assistants.  PAs are                                                               
required  to have  27 continuous  months of  education, including                                                               
classroom  education   in  medical   sciences,  and   to  perform                                                               
rotations in  medical and surgical disciplines,  family medicine,                                                               
internal medicine,  general surgery, pediatrics,  and obstetrics.                                                               
These medical  professionals must  have at  least 2,000  hours of                                                               
clinical practice  in various settings  and almost  all physician                                                               
assistant  programs are  master's  degree programs.  In fact,  it                                                               
will be  required by the  year 2020. After graduation,  they must                                                               
pass  the physician  assistant national  certifying  exam and  be                                                               
licensed by  the state.  Every two years  they must  complete 100                                                               
hours of  continuing medical education  and every ten  years they                                                               
must  take   an  exam  to  recertify.   She  characterized  these                                                               
physician  assistants as  medical professionals  with substantive                                                               
education.                                                                                                                      
                                                                                                                                
2:17:02 PM                                                                                                                    
SENATOR  GIESSEL   referred  to  medical  board   guidelines  for                                                               
collaborating  physicians and  physician  assistants in  members'                                                               
packets. She  said that physician assistants  (PAs) must practice                                                               
under  the supervision  of a  collaborating physician.  They must                                                               
have an active collaborative plan,  which describes the nature of                                                               
the  relationship, the  scope  of practice,  where  they will  be                                                               
practicing, and  what controlled  substances they  can prescribe.                                                               
Physician assistants have  the authority and ability  to apply to                                                               
the Drug  Enforcement Administration  to obtain  authorization to                                                               
prescribe controlled  substances. They may  or may not  choose to                                                               
do so,  but if  they do,  their collaborating  physicians oversee                                                               
the prescribing authority.                                                                                                      
                                                                                                                                
2:18:12 PM                                                                                                                    
SENATOR  GIESSEL  related  the  controlled  substances  physician                                                               
assistants  are authorized  to prescribe,  including schedule  II                                                               
through schedule  V drugs. She  offered to provide  the document,                                                               
but basically explained  that schedule II includes  drugs such as                                                               
oxycodone  and  morphine, schedule  III  includes  drugs such  as                                                               
codeine, schedule IV includes drugs  such as Darvon, and Schedule                                                               
V includes drugs such as Robitussin with codeine.                                                                               
                                                                                                                                
2:19:01 PM                                                                                                                    
SENATOR   GIESSEL   explained   that  the   bill   would   expand                                                               
telemedicine  to physician  assistants  (PAs).  She continued  to                                                               
review her sponsor statement, as follows:                                                                                       
                                                                                                                                
     SB 44 amends  the law, aligning with the  intent of the                                                                    
     Medicaid  Reform   bill,  to  clarify   that  physician                                                                    
     assistants can provide telemedicine  in the same manner                                                                    
     as  physicians. Under  SB 44,  the physician  assistant                                                                    
     would  be subject  to the  same statutory  oversight as                                                                    
     physicians regarding  the practice of  telemedicine, as                                                                    
     well   as   the   same  disciplinary   sanctions   when                                                                    
     appropriate                                                                                                                
                                                                                                                                
     Senate Bill  44 will  increase patient access  to care,                                                                    
     particularly   for   rural  and   medically-underserved                                                                    
     areas.  The bill  will allow  PAs to  use telemedicine,                                                                    
     extending the  reach of medicine to  underserved areas.                                                                    
     This  is particularly  important in  Alaska, with  vast                                                                    
     geographical  challenges and  limited  access to  vital                                                                    
     healthcare.                                                                                                                
                                                                                                                                
She referred to HRSA document in members' packets. Alaska                                                                       
is a health professional shortage area.                                                                                         
                                                                                                                                
2:20:40 PM                                                                                                                    
SENATOR  BIRCH asked  for further  clarification on  whether this                                                               
would cover nursing and nurse practitioners.                                                                                    
                                                                                                                                
SENATOR GIESSEL  said that  nurse practitioners  have independent                                                               
practice in  Alaska and can  open their  own clinics and  have no                                                               
limitations  on  prescriptive  authority. They  can  obtain  Drug                                                               
Enforcement  Administration  (DEA)  numbers that  allow  them  to                                                               
prescribe controlled  substances, which  has been in  place since                                                               
1983.  They often  practice with  physician  assistants (PA)  and                                                               
often perform the same work, but  PAs are under the state medical                                                               
board and require supervision.                                                                                                  
                                                                                                                                
2:21:44 PM                                                                                                                    
SENATOR COSTELLO  appreciated the history  of PAs. She  watched a                                                               
Vietnam War  documentary and can  see many individuals  came back                                                               
from that  war with an  arsenal of  experience in the  field. She                                                               
said  "patient" is  replaced with  "person" However,  on page  3,                                                               
line  13  of the  bill  relates  to the  term  "physician-patient                                                               
relationship." She  asked whether  the term "patient"  is defined                                                               
in statute or if it is a commonly-understood term.                                                                              
                                                                                                                                
SENATOR  GIESSEL  said  that  law  uses  the  term  "person"  and                                                               
"patient"  as medical  terminology and  often refers  to them  as                                                               
clients. She characterized it as a  term of art whereas person is                                                               
a legal term. However, physician-patient  relationship in used in                                                               
other places in the medical statutes.                                                                                           
                                                                                                                                
2:23:32 PM                                                                                                                    
JANE  CONWAY,   Staff,  Senator   Cathy  Giessel,   Alaska  State                                                               
Legislature,  Juneau, paraphrased  the sectional  analysis, which                                                               
read as follows:                                                                                                                
                                                                                                                                
           Senate Bill 44 Sectional Analysis (vsn U)                                                                            
            Telehealth: Physician Assistants; Drugs                                                                             
                                                                                                                                
     Section 1:  Amends AS 08.64.101(a)(6) by  requiring the                                                                    
     board to  adopt regulations  for a  physician assistant                                                                    
     practicing telehealth under AS  08.64.364, and that the                                                                    
     regulations must  use a  recognized national  model for                                                                    
     standards of telehealth care.                                                                                              
                                                                                                                                
        Section 2: Amends AS 08.64.364(a) by saying that                                                                        
        disciplinary action cannot be directed toward a                                                                         
     physician   assistant   for   prescribing   drugs   via                                                                    
     telehealth if the drugs  are not controlled substances,                                                                    
     if  follow up  care can  be provided  from its  medical                                                                    
     group, and  if consent  has been  given by  the patient                                                                    
     for care  and sharing  of records  to the  primary care                                                                    
     provider.                                                                                                                  
                                                                                                                                
     Section  3: Amends  AS 08.64.364(b)  by  saying that  a                                                                    
     physician  assistant  may  administer  botulinum  toxin                                                                    
     (Botox) if  they meet all  the requirements set  out in                                                                    
     08.64.364 and is supervised  by an appropriate licensed                                                                    
     health care provider                                                                                                       
                                                                                                                                
     Section 4:  Amends AS  08.64.364(c) by  renumbering and                                                                    
     adds that  a physician  or physician assistant  may not                                                                    
     prescribe, dispense  or administer a  prescription drug                                                                    
     via an Internet questionnaire  or email message without                                                                    
     having a prior patient/doctor relationship.                                                                                
                                                                                                                                
2:25:47 PM                                                                                                                    
SENATOR  COSTELLO said  that it  seems that  the guidelines  that                                                               
were written  by the  board just  need to  be updated  to include                                                               
PAs.  she asked  whether  the sponsor  has  considered adding  an                                                               
immediate effective date.                                                                                                       
                                                                                                                                
MS. CONWAY said  that this bill would become  effective after the                                                               
governor signs the bill.                                                                                                        
                                                                                                                                
2:26:21 PM                                                                                                                    
SENATOR BIRCH asked whether administering Botox is a change.                                                                    
                                                                                                                                
SENATOR GIESSEL  answered that Botox  requires the presence  of a                                                               
licensed  health care  provider who  is authorized  to administer                                                               
that medication. This is current  law for physicians and the bill                                                               
adds  PAs. Currently,  physicians  can  prescribe, dispense,  and                                                               
administer  a controlled  substance  or botulinum  toxin when  an                                                               
appropriate  licensed health  care provider  is present  with the                                                               
person.  This language  is listed  separately  because these  are                                                               
heavy duty medications being administered.                                                                                      
                                                                                                                                
2:27:43 PM                                                                                                                    
CHAIR REINBOLD opened public testimony on SB 44.                                                                                
                                                                                                                                
2:29:38 PM                                                                                                                    
CHERISE HUG,  Physician Assistant  (PA), Orion  Behavioral Health                                                               
Network, Eagle River,  stated she is a PA in  Anchorage and works                                                               
in child  and adolescent  psychiatry. About half  of her  time is                                                               
spent  in   person  and  the   other  half  is   spent  providing                                                               
telemedicine  to remote  communities  throughout  the state.  She                                                               
said PAs  are allowed  to provide  telemedicine, but  they cannot                                                               
prescribe    medications    without   having    a    face-to-face                                                               
relationship. She said  this has created a  burden and difficulty                                                               
for patients in  rural communities to access care.  She said that                                                               
the  delay can  be  detrimental to  families.  Currently, if  she                                                               
provides  an  initial  evaluation via  telemedicine,  she  cannot                                                               
start  any medication.  This causes  delays  and hinders  patient                                                               
care. It requires patients to  travel and adds significant travel                                                               
costs to patient care.                                                                                                          
                                                                                                                                
2:31:33 PM                                                                                                                    
SENATOR  BIRCH  asked for  her  experience  with audio  or  video                                                               
transmission and if it is an effective means of providing care.                                                                 
                                                                                                                                
MS. HUG  answered that  she uses  an Internet-based  service that                                                               
has a video  connection. She said they have good  cameras, but it                                                               
depends on  what patients have  at their end. She  explained that                                                               
the quality of  the video tends to be pretty  good. She said that                                                               
she  often works  with other  clinics and  patients can  go to  a                                                               
community health office for the telehealth appointment.                                                                         
                                                                                                                                
SENATOR BIRCH asked how patients receive their prescriptions.                                                                   
                                                                                                                                
DR. HUG answered that patients  use mailout pharmacy services via                                                               
Walgreens  and Southcentral  Foundation.  The patient's  provider                                                               
ships the medication directly to the patient.                                                                                   
                                                                                                                                
2:34:19 PM                                                                                                                    
SHIGONE  BEIGHLE,  Physician  Assistant  (PA),  Orion  Behavioral                                                               
Health  Network,  Anchorage,  echoed  Ms.  Hug's  testimony.  She                                                               
stated  that  about 50  percent  of  her patients  are  pediatric                                                               
psychiatric patients  in rural communities.  She was raised  in a                                                               
rural community  of 500  in Aniak.  She said that  at age  13 she                                                               
lost three  peers to suicide. Her  school had a population  of 50                                                               
between  7th-12th  grades.  She  said  that  the  loss  of  three                                                               
students in  one year was  significant. She said that  Alaska has                                                               
the highest  rate of  teen suicide and  Alaska Natives  and rural                                                               
communities have the highest rates.                                                                                             
                                                                                                                                
She said  that her organization  provides care via  telehealth to                                                               
children throughout  the state,  including Barrow and  King Cove.                                                               
This  service   provides  opportunities   she  wished   had  been                                                               
available to  depressed teens during  her high school  years. She                                                               
related a patient  experience, in which a child under  the age of                                                               
10 had  three depressive stints  at North Star  Behavioral Health                                                               
(North  Star) with  limited out-patient  care and  delayed access                                                               
stabilization and care. Although  North Star provided the initial                                                               
care,  the  child  will  face  delays  for  stabilized  care  and                                                               
maintenance  if  she cannot  not  write  prescriptions until  she                                                               
meets  face-to-face  with  the  child. She  said  that  in  these                                                               
situations,  the parents  and medical  staff are  already dealing                                                               
with  an unstable  child  or a  child in  need.  She said  adding                                                               
travel is expensive  and adds undue burdens for  those working to                                                               
help children in crisis. She said  that she got into the field of                                                               
medicine and psychiatry  because of the great need  in Alaska and                                                               
her  desire   to  serve  the  rural   population.  She  expressed                                                               
gratitude  for the  services that  her organization  provides and                                                               
the telehealth  services it provides. She  expressed concern that                                                               
medical professionals  see patients and then  cannot do anything,                                                               
which  is detrimental  to patients.  She said,  "Maybe not  being                                                               
seen and doing nothing is almost the same."                                                                                     
                                                                                                                                
2:37:20 PM                                                                                                                    
CHAIR  REINBOLD  recalled a  friend's  experience  at a  hospital                                                               
emergency  room, with  very high  costs for  services. She  hoped                                                               
that telemedicine would  help reduce costs. She  hoped to further                                                               
discuss emergency room costs and  the trauma psychiatric patients                                                               
experience in those situations.                                                                                                 
                                                                                                                                
2:38:56 PM                                                                                                                    
CHAIR REINBOLD held public testimony open on SB 44.                                                                             
                                                                                                                                
2:39:19 PM                                                                                                                    
SENATOR  GIESSEL   referred  to  six  letters   of  support  from                                                               
physician  assistants  in  rural  Alaska  that  are  in  members'                                                               
packets.                                                                                                                        
                                                                                                                                
[SB 44 was held in committee.]                                                                                                  
                                                                                                                                
2:39:47 PM                                                                                                                    
CHAIR REINBOLD reviewed upcoming committee announcements.                                                                       
                                                                                                                                
2:40:20 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair Reinbold  adjourned the Senate Labor  and Commerce Standing                                                               
Committee meeting at 2:40 p.m.                                                                                                  

Document Name Date/Time Subjects
L&C Dental Examiners Resume - Woller.pdf SL&C 3/14/2019 1:30:00 PM
L&C Veterinary Examiners Resume - Flamme.pdf SL&C 3/14/2019 1:30:00 PM
L&C Nursing Resume - Henry.pdf SL&C 3/14/2019 1:30:00 PM
L&C Labor Relations Agency Resume - Moen.pdf SL&C 3/14/2019 1:30:00 PM
L&C Workers Comp Resume - Ziegler.pdf SL&C 3/14/2019 1:30:00 PM
L&C Workers Compensation - Faulkner.pdf SL&C 3/14/2019 1:30:00 PM
L&C Workers Compensation Resume - Austin.pdf SL&C 3/14/2019 1:30:00 PM
L&C Workers Compensation Resume - Thompson.pdf SL&C 3/14/2019 1:30:00 PM
SB44 version U 2-14-19.PDF SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Sponsor Statement 2-17-19.pdf SFIN 4/9/2019 9:00:00 AM
SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Sectional Analysis vsn U.pdf SFIN 4/9/2019 9:00:00 AM
SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Fiscal Note DCCED-CBPL 3-8-19.pdf SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Fiscal Note DOA-HPA 3-8-19.pdf SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Letters of Support.pdf SFIN 4/9/2019 9:00:00 AM
SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Supporting Document AK State Medical Bd Roster 3-13-19.pdf SFIN 4/9/2019 9:00:00 AM
SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Supporting Document HRSA -HPSA Underserved Primary Care Areas.pdf SFIN 4/9/2019 9:00:00 AM
SL&C 3/14/2019 1:30:00 PM
SB 44
SB44 Supporting Document Medically Underserved Areas HRSA 3-13-19.pdf SFIN 4/9/2019 9:00:00 AM
SL&C 3/14/2019 1:30:00 PM
SB 44