HB 91-NATUROPATHS: LICENSING; PRACTICE  3:18:32 PM CHAIR SPOHNHOLZ announced that the first order of business would be HOUSE BILL NO. 91, "An Act relating to the practice of naturopathy; relating to the licensure of naturopaths; relating to the Department of Commerce, Community, and Economic Development; and providing for an effective date." 3:19:05 PM ERIN SHINE, Staff, Representative Jennifer Johnston, Alaska State Legislature, presented HB 91 on behalf of Representative Johnston, prime sponsor and provided a presentation entitled, "House Bill 91 Naturopathic Medicine Reform." She directed attention to slide 2 to highlight the definition of a naturopathic doctor. Naturopathic medicine, she said, is a distinct medical practice that emphasizes prevention and self- healing processes to treat each person holistically and improve outcomes while lowering costs. Naturopathic doctors are educated and trained at accredited naturopathic medical colleges. They diagnose, prevent, and treat acute and chronic illness, as well as restore and establish optimal health by supporting the person's inherent self-healing process. Rather than just suppressing symptoms, naturopathic doctors work to identify underlying causes of illness and develop personal treatment plans to address them. Ms. Shine went on to paraphrase slide 3 entitled, "What Education do Naturopathic Doctors Receive," which read in its entirety as follows [original punctuation provided]: Education  4-Year Medical School Program accredited by the Council of Naturopathic Medical Education; including: • 2 years of medical sciences (anatomy, physiology, microbiology, immunology, etc.) • 2 years of clinical sciences and treatment methods Prerequisites  • 4 year undergraduate degree and additional pre- medical coursework Residencies  • 1-3 year residency options throughout the country; however, there are not enough residency opportunities for every graduate  Licensing  • Naturopaths must pass the two-part Naturopathic Physicians Licensing Examination (NPLEX) before being licensed to practice MS. SHINE continued with slide 4 entitled, "Who is not a Naturopathic Doctor?" She said, unfortunately, "naturopath" has become a catch-all term for many non-naturopathic doctors that get lumped together with the practicing physicians who are licensed in this state. In other states, naturopaths have title protections so that people can't use their name without being licensed and going through the same educational process. She turned attention to slide 5 entitled, "Legislative History of Naturopath Statutes in Alaska," and paraphrased the following [original punctuation provided]: ESTABLISHING STATUTES  1986: AS 08.45 (Naturopaths) established LEGISLATION PASSED  2004: SB 306 - Established a Naturopathic Medicine Task Force 2005: SB 42 - Extended Task Force one year and updated membership 2005: SB 52 - Updated statutes to correct "division" to "department" LEGISLATION ATTEMPTS  2007: SB 107 2008: HB 363 2010: HB 282 & SB 70 2011: HB 122 2012: HB 266 & SB 175 2013: HB 7 2017: HB 326 & SB 120 2019: HB 91 MS. SHINE directed attention to two maps on slides 6-7 to discuss licensing and prescriptive authority for naturopaths in America. Prescriptive authority is one of the contentious issues in HB 91. She explained that there are varying degrees of prescriptive authority, as the map on slide 7 illustrates. She pointed out that Vermont is the only state with full prescriptive authority. Alaska, in contrast, is one of 10 states where naturopaths are regulated and have no prescriptive authority. She noted that naturopathic doctors complete a rigorous education in pharmacology during their 4-year science- based medical education. Naturopathic doctors believe that natural medicine and conventional medicine are not mutually exclusive and recognize that there are times when both approaches can be utilized together for patients' benefits. She addressed slide 8 entitled, "House Bill 91," and read the following [original punctuation provided]: Modernizes statutes for Naturopaths by cleaning up outdated language, requiring continuing education every 2 years, and imposing the same public health duties on Naturopaths as other medical providers Updates scope of practice for Naturopaths to include limited prescriptive authority and allowing minor office procedures Removes the need for duplicative office visits and improves access to care for patients in Alaska MS. SHINE concluded by preemptively addressing forthcoming testimony that will "undoubtedly" be given on HB 91. She said the testimony will come from several providers who share personal anecdotes about frightening stories and substandard medical care provided by naturopaths; however, the stories have never been substantiated or linked to any licensed naturopath in Alaska. More importantly, she said, the Division of Corporations, Business and Professional Licensing has received no reports alleging the kinds of ethical and medical breaches purported in these accounts. She added that in the 20 years that naturopaths have been licensed there have been a total of 33 complaints that have been investigated, albeit not necessarily sanctioned. 3:29:01 PM REPRESENTATIVE STORY sought clarification on limited prescriptive authority. MS. SHINE explained that each state allows different approaches to prescriptive authority for naturopathic doctors. HB 91, for example, would be exclusionary [prescriptive authority] because it excludes controlled substance and chemotherapeutic agents. 3:29:57 PM MS. SHINE provided a sectional analysis of HB 91 [included in the committee packet], which she read in its entirety as follows [original punctuation provided]: Section 1 AS 08.02.010(a) Professional designation  requirements. (Amended)  Requires naturopathic practitioners to use appropriate letters, title and specialist designations Section 2 AS 08.45.030 Issuance of license.  (Amended)  • Establishes that, to be issued a license, an applicant must be of good moral character, have graduated from an accredited naturopathic college and have passed a licensing examination. • Removes outdated language requiring that to be issued a license to practice naturopathy in Alaska, if an individual graduated before 1988, they must also have been issued a license to practice in another state previously. Section 3 AS 08.45.035(a) Temporary licenses.  (Amended)  Allows the department to issue a temporary license to a naturopath if they are signed up to take licensing exams at the next available date after the date of the application and have not previously failed the licensing exam. Section 4 AS 08.45.045 Practice of naturopathy. (New  section)  • Allows naturopaths to practice within the scope of their education and training • Allows naturopaths to prescribe natural and therapeutic substances, natural therapies, drugs and contraceptive devices • Allows naturopaths to perform minor surgeries and perform or order diagnostic procedures • Defines "naturopathic physical application" Section 5 AS 08.45.050 Restrictions on practice of  naturopathy. (Amended)  • Removes prohibition for prescribing drugs, performing minor surgeries, and using the word "physician" in titles • Prohibits naturopaths from giving, recommending or prescribing cancer drugs and controlled substances Section 6 AS 08.45.053 & 08.45.057 Public health  duties and renewal of license. (New sections)  • Imposes same public health duties on naturopaths as other physicians • Requires naturopaths to complete 24 hours of continuing education every two years for license to be renewed Section 7 AS 08.45.200(3) Definitions. (Repealed and  reenacted)  Repeals and replaces definition for "naturopathy" Section 8 AS 08.45.200(4) & (5) Definitions. (New  paragraphs)  Defines "approved naturopathic medical school" and "naturopath" Section 9 Transitional Language (Uncodified law)  Transitional language allowing currently licensed naturopaths to practice under the new law Section 10 Transitional Regulations (Uncodified law)  Allows the Department to adopt transitional regulations immediately following passage and prior to the bill's effective date. Section 11 Effective date. (Uncodified law)  Establishes immediate effective date for section 10 Section 12 Effective date. (Uncodified law)  Establishes effective date for sections 1 - 9 as January 1, 2020 3:32:44 PM REPRESENTATIVE STUTES, referencing Section 5, asked if "minor surgeries" is defined in the bill. MS. SHINE explained that sutures, punch biopsies, and the removal or insertion of an IUD [intrauterine device] are all examples of what would constitute a minor surgery. REPRESENTATIVE STUTES asked if the word "minor" is defined in HB 91. 3:35:48 PM MS. SHINE directed attention to page 4, lines 1-7, which read as follows: perform procedures in the office using operative, electrical, or other methods, including the use of antiseptics and local anesthetics, for the surgical repair and care of superficial lacerations and abrasions, superficial lesions, and the removal of foreign bodies located in the superficial tissues of the human body; the procedures may not include general or spinal anesthetics, major surgery, surgery of the body cavities, plastic surgery, surgery involving the eyes, or surgery involving tendons, ligaments, nerves, or blood vessels; and REPRESENTATIVE RASMUSSEN questioned whether the pharmacology classes that naturopathic doctors take during their 4-year college education align with the material that a physician learns in school. MS. SHINE offered her understanding that over the first two years, [naturopaths] follow the same track as a medical doctor with pharmacology learned throughout most of their courses. She offered to follow up with a cross-comparison. CHAIR SPOHNHOLZ, in response to Representative Rasmussen, added that naturopaths are "naturopathic doctors (NDs"), just like medical doctors. She explained that the term "doctor" is generally used in short for medical doctor (MD), but also applies to anyone that has received a doctorate degree. 3:36:30 PM CHAIR SPOHNHOLZ announced that HB 91 was held over.