SB 38-NATUROPATHS: LICENSING; PRACTICE  1:36:07 PM CHAIR WILSON announced the consideration of SENATE BILL NO. 38 "An Act relating to the practice of naturopathy; establishing the Naturopathy Advisory Board; relating to the licensure of naturopaths; relating to disciplinary sanctions for naturopaths; relating to the Department of Commerce, Community, and Economic Development; and providing for an effective date." 1:36:46 PM JOE HAYES, Staff, Senator Scott Kawasaki, Juneau, Alaska, stated he had no additional comments. 1:37:01 PM SENATOR HUGHES moved Amendment 1. AMENDMENT 1  32-LS0318\A.2 Fisher 4/12/21 OFFERED IN THE SENATE BY SENATOR HUGHES TO: SB 38 Page 4, following line 3: Insert "(2) has completed a three-year naturopathic  residency program;" Renumber the following paragraphs accordingly. Page 4, line 21: Delete "AS 08.45.030(1)(A) and (2) - (4)" Insert "AS 08.45.030(1)(A) and (2) - (5)" CHAIR WILSON objected for purposes of discussion and restated the Amendment being offered is Amendment 1 [A.2]. 1:37:39 PM SENATOR HUGHES stated naturopaths are a great asset to the field of healthcare. The scope of a naturopath practice is expanded by SB 38. The bill includes prescriptive rights. Amendment 1 adds a three-year residency licensing prerequisite. This prerequisite mirrors the clinical hours and oversight that physicians experience and that is embedded in the training of physician assistants and nurse practitioners. She stated she is in favor of naturopathic doctors having prescriptive authority if they have extra supervision. SENATOR REINBOLD stated that committee members were informed that naturopaths would not be available to testify. This amendment undermines the naturopaths' prior testimony. Physician assistants, nurse practitioners, physical therapists, and chiropractors do not complete residencies. She suggested naturopaths could work three years in an externship. A three- year residency is unconscionable, as naturopaths have thirty- five years of established safe practice. 1:40:13 PM SENATOR BEGICH asked why there are not enough residencies available. MR. HAYES replied that there are more students than naturopaths and hospitals pay for the residency of medical doctors. They do not pay for naturopathic doctors. 1:40:41 PM SENATOR BEGICH asked for the sponsor's view of this amendment. MR. HAYES replied that Senator Kawasaki has concerns about fiscal ramifications and who will fund the residencies. There are fifty-two naturopaths practicing in Alaska. Senator Kawasaki has concerns about how the amendment will affect them. Alaska would be the first state to require residency. 1:41:49 PM SENATOR HUGHES explained that Amendment 1 does not prescribe how residency would be crafted. She is open to the idea of grandfathering. There are a variety of ways to accomplish supervision. Students coming out of school could be paired with existing naturopaths or primary care providers. MDs and DOs sometimes have residencies lasting eight to ten years. A three- year residency is a minimum requirement. Chiropractors and physical therapists do not prescribe medications. Physician assistants have clinical hour requirements and after being licensed are supervised by a physician. She concluded that a wider scope of practice should require an equivalent amount of training. SENATOR REINBOLD offered Conceptual Amendment 1 to Amendment 1. On page 1 line 3 of the amendment, replace the language in paragraph (2) and insert "has completed two-years of naturopathic externship program At the Chair's request she restated the conceptual amendment. SENATOR HUGHES asked the difference between an internship and externship. 1:44:49 PM SENATOR REINBOLD replied an externship is working in a clinical setting under supervision and earning money. SENATOR HUGHES stated residents are interns that earn money. She is open to the two-year adjustment but has reservations about the appropriate terminology to use regarding residency. SENATOR REINBOLD answered that an externship offers supervised hands-on clinical training in doctor's offices versus hospitals. SENATOR HUGHES stated she is agreeable to the conceptual amendment. SENATOR BEGICH read the definition of externships as, Experiential learning opportunities, similar to internships, provided by partnerships between educational institutions and employers to give students practical experiences in the field of study." 1:46:25 PM CHAIR WILSON asked if there was objection to Conceptual Amendment 1 to Amendment 1. SENATOR COSTELLO asked if Amendment 1 is intended to make SB 38 more stringent because it offers prescriptive authority to naturopaths. She noted that in SB 38 the pharmacological portion of the exam is elective. This amendment would include those who are not interested in having prescriptive authority. She asked if the residency requirement is intended for them. SENATOR HUGHES replied that the residency requirement pertains to the prescriptive authority and outpatient procedures that naturopaths will be allowed to perform. She suggested that the amendment could be changed to exclude office procedures depending on how it will be defined. 1:48:20 PM At ease 1:51:02 PM CHAIR WILSON reconvened the meeting. He found no further objection and Conceptual Amendment 1 to Amendment 1 passed. 1:51:33 PM CHAIR WILSON withdrew his objection. Finding no further objection, Amendment 1, as amended, passed. 1:51:57 PM SENATOR HUGHES moved Amendment 2 [A.5]. AMENDMENT 2  32-LS0318\A.5 Fisher 4/12/21 OFFERED IN THE SENATE BY SENATOR HUGHES TO: SB 38 Page 4, following line 3: Insert "(2) has passed a pharmaceutical  examination approved by the department that is  equivalent to any examination of pharmaceutical  knowledge required under AS 08.64.210 or 08.64.220;" Renumber the following paragraphs accordingly. Page 4, line 21: Delete "AS 08.45.030(1)(A) and (2) - (4)" Insert "AS 08.45.030(1)(A) and (2) - (5)" CHAIR WILSON objected for purposes of discussion. 1:52:14 PM SENATOR HUGHES stated this amendment requires naturopaths to pass a pharmaceutical exam equivalent to what medical and osteopathic doctors pass to acquire a license. If naturopaths are to be called physicians their training, examinations and continuing education should be on par with other doctors who are called physicians. The Alaska Association of Naturopathic Physicians uses the word physicians on their website. It is important to commensurate the requirements of a naturopath with the average Alaskan's expectation of a physician. SENATOR REINBOLD stated there is a need to address naturopaths using the word physician. 1:54:22 PM At ease 1:59:15 PM CHAIR WILSON reconvened the meeting and resumed discussion on Amendment 2. 1:59:21 PM SENATOR HUGHES stated that her legislative intern could address statute references. RILEY NYE, Intern, Senator Shelley Hughes, Alaska State Legislature, Juneau, Alaska, explained that Amendment 2 deletes AS 08.45.030(1) (A) and (2) (4) and inserts the same statute but with a change that includes (2) (5). SENATOR COSTELLO stated that the statutes listed in Amendment 2 clarify that "the board" is the medical board. SENATOR BEGICH asked whether the medical board or the department would set policy regarding pharmaceutical examinations. He offered his belief that Senator Hughes intended the department to set policy and asked for confirmation from Ms. Chambers. 2:01:42 PM SARA CHAMBERS, Director, Division of Corporations, Business, and Professional Licensing, Juneau, Alaska, stated that the department is to review examination requirements under AS 08.64 and then approve an equivalent exam. The medical board would not be involved unless advice was needed. There are standard examinations that the medical board approves. The department would be looking for an equivalent exam that is accessible to naturopaths. SENATOR REINBOLD offered a conceptual amendment to Amendment 2. On page 4, line 3 add, If a naturopath seeks increased prescriptive authority and. 2:03:26 PM CHAIR WILSON announced SB 38 will be held for further consideration. SENATOR COSTELLO stated that the next committee of referral for SB 38 is Senate Labor and Commerce. She was committed to working with Senator Kawasaki's office on a committee substitute. If it is held in the Health and Social Services committee, parties should work together to rectify issues that the amendments address. There is a lot of interest in crafting a successful bill. SENATOR HUGHES stated this bill has been fourteen years in the making. She offered her belief that it is important to get the bill right. She supports Chair Wilson holding it so parties can work together. 2:05:10 PM CHAIR WILSON clarified that the bill is being held so the sponsor and members of the committee can work through language in the amendments and produce a better bill. SENATOR REINBOLD stated the remaining amendments would not consume as much time and the members should keep working to move the bill out of committee. CHAIR WILSON stated it would be better to get a CS from the sponsor than to keep amending amendments. SENATOR HUGHES stated she is willing to work with the sponsor on her amendments. 2:06:38 PM SENATOR REINBOLD expressed her dislike for committee substitutes. She prefers to work through an open process in committee rather than two people working behind closed doors. Working through the amendments in committee is difficult but it is what the committee is for. CHAIR WILSON replied he understands. SENATOR BEGICH commented that amendments are in committee member's hands. Members should offer suggestions before Tuesday so the bill can be moved out of committee. 2:07:45 PM [CHAIR WILSON held SB 27 in committee.]