Legislature(2019 - 2020)BELTZ 105 (TSBldg)
03/14/2019 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): | |
| SB44 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 44 | TELECONFERENCED | |
| + | 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.