Legislature(2015 - 2016)BARNES 124
02/13/2015 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB49 | |
| HB26 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 26 | TELECONFERENCED | |
| *+ | HB 49 | TELECONFERENCED | |
HB 26-EXTEND CERT. DIRECT-ENTRY MIDWIVES BOARD
4:11:44 PM
CHAIR OLSON announced that the final order of business would be
HOUSE BILL NO. 26, "An Act extending the termination date of the
Board of Certified Direct-Entry Midwives; and providing for an
effective date."
4:11:59 PM
LAURA STIDOLPH, Staff, Representative Kurt Olson, Alaska State
Legislature, on behalf of the prime sponsor, stated that HB 26
would extend the sunset date for the Board of Certified Direct-
Entry Midwives to June 30, 2017. The Division of Legislative
Audit conducts audits to determine if state boards and
commissions should be reestablished. The division reviewed the
activities of the Board of Certified Direct-Entry Midwives to
determine if there is a demonstrated public need for the board's
continued existence and whether it has been operating in an
effective manner. She directed attention to a copy of the
legislative audit in members' packets. The auditors recommended
that the board be extended two years until June 30, 2017.
MS. STIDOLPH explained that auditors found the Board of
Certified Direct-Entry Midwives has been serving the public's
interest by effectively licensing certified direct-entry
midwives (CDM) and apprentices. In addition, it was found that
the board continues to improve the profession by modifying and
adopting midwifery regulations to conform to current standards
of care.
MS. STIDOLPH highlighted that the auditors had four findings and
recommendations, including the Department of Commerce, Community
& Economic Development (DCCED) should immediately pursue
disciplinary sanctions for CDM cases when warranted; increase
licensing fees to eliminate the board's operating deficit; that
the board should communicate certificate requirements to
continuing education providers to facilitate compliance with
centralized licensing regulations; and the board should approve
apprentice permit applications in accordance with statute. In
response to a question, she reiterated the chair of Board of
Certified Direct-Entry Midwives (CDM) is Cheryl Corrick.
4:15:15 PM
REPRESENTATIVE JOSEPHSON referred to page 10 of the audit. He
expressed concern about the failure of the certified direct-
entry midwives (CDM) respondents to sign consent orders (CAs).
He asked whether the committee should be concerned about
anything in terms of the nature of the reason the CDMs wouldn't
sign. He said he was concerned about this given that the
legislature removed the statute and gave the board the liberty
to create its own regulations.
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
Legislative Agencies and Offices, answered that the division
doesn't see any correlation or cause and effect related to last
legislature's Senate Bill 136, which moved the requirement for
what the profession could do from statute to regulations to give
the board more flexibility. At the end of an investigation if
any problems are found and sanctions are necessary,
investigators draft consent agreements and ask the respondents
to voluntarily agree to the sanctions. If that does not occur,
the investigators can use standard procedures to elevate the
matter to the commissioner, file an accusation, and move forward
with civil licensing action through the Office of Administrative
Hearings (OAH). However, it is not uncommon for respondents to
refuse to sign consent agreements, she said.
4:17:45 PM
REPRESENTATIVE JOSEPHSON suggested that he felt less secure when
the process changed. He read page 10, paragraph 2, as follows,
"By not pursing licensing action, the respondents were allowed
to continue practicing, and the public's safety was placed at
risk." He went on to say that this referred to 4 of 52
providers, but he wanted to be sure a pattern wasn't developing
that the legislature should be concerned about.
MS. CURTIS answered that the audit period covered four years.
There were 28 complaints filed and investigated, with all
addressed timely except for these four cases. She reported that
the four investigations involved two people and investigators
concluded the disciplinary sanctions should occur, but were not
pursued timely. She explained that two of the four cases were
forwarded to the Department of Law's Office of Special
Prosecutions and Appeals (OSPA) for criminal action. At the
time of the audit the cases had been at OSPA for over a year
without action. OSPA regarded these cases as the lowest
priority due to the cases being classified as class B
misdemeanors. She stated that due to turnover, the auditors
were not able to determine why the investigators did not pursue
a civil licensing action, which at a minimum, should have been
pursued concurrently with criminal action to ensure the public
safety is protected. Auditors characterized this as a fairly
serious deficiency which is why the audit only recommend a two-
year extension. She said it is unusual for the auditors to give
such a short extension, but auditors felt it was important for
the division to follow up on this matter to ensure that
corrective action has been taken.
4:20:17 PM
REPRESENTATIVE COLVER assumed these cases were not simple
licensing actions, but were due to cases driven by mothers or
families who experienced problems with the midwifes. He asked
for further clarification on the cases without breaching
anything that is confidential.
MS. CURTIS answered that one or two of the consent agreements
asked for voluntary license revocation, which would indicate
severe problems were encountered. She recalled that another
consent agreement asked for continuing education, which is a
common outcome for an investigation. She declined to provide
any details about the cases.
4:21:38 PM
REPRESENTATIVE COLVER related his understanding that some
direct-entry midwives practice at a birthing center and others
assist with home births. He said that he and his wife used
midwives with the birth of both of his children, and the births
went very well. In their experience, the midwives were very
professional. He asked whether the mother or child endangered
by the procedures or care since, at some point, he has found
that midwives are very clear to determine when the mother needs
to go to a hospital. He thought it would be helpful for the
committee to have a better understanding of what happened.
MS. CURTIS responded that the audit does not comment on the
profession as a whole, but does comment on investigative
practices, which are in place to protect the public and to
ensure quality of care. She said that the allegations were
pretty serious and the auditors found the lack of timely
disciplinary sanctions as fairly significant. In response to a
question, she reiterated that there were four cases that
involved two people.
4:23:30 PM
REPRESENTATIVE KITO referred to page 10 of the audit and read,
"A year after the cases were forwarded to OSPA, no action had
been taken." He asked whether it was the board's responsibility
or of OSPA.
MS. CURTIS stated that board members were asking for and
receiving updates on the investigations. Thus, there isn't
anything in the auditor recommendations on the board not taking
appropriate action. She stated that the board must recuse
themselves since the board must weigh in later as an
adjudicative entity. Therefore the board typically is not
furnished details. The board was advised that the cases had
been referred to the Department of Law. She described the
typical process is that cases are referred to the Department of
Law for review of sufficiency of evidence prior to an accusation
being filed for civil licensing action. However, the cases were
at OSPA, in an effort to pursue a criminal case.
4:25:05 PM
REPRESENTATIVE TILTON referred to page 10, to recommendation 2
in the audit. She related her understanding that this board has
a small number of people who pay a large licensing fee, but face
a deficit. She acknowledged that she personally used midwives
when she gave birth to her children, so her questions are not
about care, but relate to the fiscal impact. Recommendation 2,
which read, "DCBPL, in consultation with the board, should
increase licensing fees to eliminate the board's operating
deficit." She asked whether there is a plan for that action.
MS. CURTIS answered that the license fees for certified direct-
entry midwives have been a continual problem. In 2006, during
the sunset review, the licensing fees were over $2,000 and they
paid the highest fees of any occupation. Thus this issue is not
new to the occupation. She directed attention to the table on
page 15 that lists license fees. She stated that in fiscal year
[FY] 10, the initial certification fee was $500. Fees were
increased in FY 11 and again in FY 13, at which time fees were
$1,450. However, the fees were not sufficient enough to cover
increased costs, which were associated with regulation changes
and investigative costs. As of March 2014, the number of
licensees was 35, plus 13 apprentices. Thus to shoulder the
cost for such a small group of licensees results in higher
license fees. In terms of the future plan, the department would
need to address how it plans to reduce the deficit.
4:27:15 PM
CHAIR OLSON stated that the Legislative Budget and Audit
Committee (LB&A) started a year ago to grapple with the issue.
He recalled one board had $150,000 in legal costs and other
boards have large numbers of licensees to spread out the costs.
He explained the difficulty in establishing standards that can
be applied to all of the boards. He said the LB&A committee and
the division spent the interim working on these issues.
4:28:24 PM
REPRESENTATIVE TILTON expressed thanks for the work the
Legislative Budget & Audit (LB&A) and the division have done on
this matter.
4:28:31 PM
REPRESENTATIVE HUGHES asked for the typical extension time for
boards.
MS. CURTIS answered that the statutes provide a maximum
extension of eight years.
4:28:57 PM
REPRESENTATIVE HUGHES related her understanding that the
auditors questioned why the board didn't pursue civil action
simultaneously with the referral of cases to OSPA and that the
board wasn't criticized because OSPA didn't take action.
MS. CURTIS said she expected to see civil licensing action to be
taken to be sure a negligent or incompetent practitioner isn't
allowed to practice.
REPRESENTATIVE HUGHES asked for further clarification on who
would initiate the civil action.
MS. CURTIS answered that it would be filed by the commissioner
in conjunction with the board. The respondents are allowed to
file a response to the accusation, and the Office of
Administrative Hearings (OAH) has 120 days to conduct their
hearings after which the board has time to make a decision.
4:30:17 PM
CHAIR OLSON remarked that two years is short extension time. He
recalled that the Alaska Bar Association was extended for three
years in a row.
MS. CURTIS replied that she did not specifically recall.
4:31:06 PM
REPRESENTATIVE JOSEPHSON referred to the repeal of AS 08.65.140
since he was unsure of what fills that gap. He asked for
further clarification on part of the statutes that at a minimum
the regulations must require that the certified direct-entry
midwife not knowingly deliver a woman with certain types of
health conditions, prior history or complications as specified
by the board. He suggested that the language was ambiguous. He
asked for clarification that safeguards are in place before he
could vote to extend the board. He said he was curious about
the status of the regulations. He asked for an explanation
since the legislature deferred to the board to make the rules.
SARA CHAMBERS, Acting Director, Division of Corporations,
Business, and Professional Licensing, Department of Commerce,
Community, & Economic Development (DCCED), answered that the
board has been conscientious in working to adopt its new
regulations. The department has been working with the board to
minimize the window between the statutory repeal and the
effective date of new regulations. The Board of Certified
Direct-Entry Midwives (CDM) met over the past two days. She
related her understanding that the board planned to continue to
work on regulations and if they adopted the regulations, the
division would expedite the public comment within the next
month. She said Ms. Corrick could provide more details but the
board and division are very aware of the concern.
4:34:12 PM
CHAIR OLSON pointed out that Representative Josephson
participated this summer during the Legislative Budget and Audit
Committee hearings on the board issues.
4:34:51 PM
REPRESENTATIVE JOSEPHSON asked about the status of the
regulations. He further asked what part of the prohibited
statutes that was particularly unfair that the board wanted the
authority over regulations for prohibited actions.
CHERYL CORRICK, Chair, Board of Certified Direct-Entry Midwives
(CDM), Department of Commerce, Community & Economic Development
(DCCED), replied she serves as one of two midwifes on the board
that also includes a certified nurse midwife and a physician who
practices in obstetrics/gynecology. She said the board felt the
prohibitions were somewhat out of date, particularly since they
had not been addressed in over 20 years. She reported that the
board just finished its regulations project today that will
further guide midwives. Up until that point, the board has made
it clear to practitioners through board actions that the old
regulations still apply until the new ones were promulgated.
4:36:28 PM
MS. CORRICK recalled one in terms of prohibitions for treating
with women with gestational diabetes. The new regulation will
allow midwives, in consultation with a physician, to manage a
woman as long as she can be managed without medication,
basically through diet and exercise, and can deliver the baby.
Midwives can now co-manage the patients with the physician, but
the physician will deliver the baby.
REPRESENTATIVE JOSEPHSON related that she has provided enough
information that gives him comfort and he appreciated her time.
4:38:35 PM
CHAIR OLSON, after first determining no one wished to testify,
closed public testimony on HB 26.
4:38:49 PM
REPRESENTATIVE COLVER deferred to the Chair, but he wondered
whether it might be possible to extend the board for three
years. He expressed a concern that the legislature will have to
revisit this again.
CHAIR OLSON deferred to the legislative auditor on the extension
time and said he completely trusts her judgment. He could not
think of any time that he disagree with the auditor's judgment
on extension times.
4:40:42 PM
REPRESENTATIVE HUGHES commented that she personally has had
wonderful experiences with midwifes and was grateful that the
state has very competent midwives who provide wonderful services
to families. She viewed the two-year extension for the board
was more a reflection on the division and not the midwives as a
profession. She commended the midwives who provide a very
wholesome and wonderful experience delivering babies.
CHAIR OLSON commented that most of the boards the committee will
review request a four to eight year extension, but this
represents an exception. He acknowledged the importance of
protecting Alaskans.
4:42:11 PM
REPRESENTATIVE COLVER echoed earlier comments that midwifery
provides a valuable service that allow families to make choices.
He emphasized the importance of allowing families to make
choices, especially since this is their baby and their family.
He offered his belief that it is important in medical care that
government does not mandate women must to go to a hospital to
have her baby. He stressed that it is up to the family to
decide what works for them. He imagined that using a midwife
also has an economic role since women can have their babies at
home, which is especially important for the uninsured. He said
that it is important to help families. He hoped that there
won't be any complications that will cause an expensive birth,
but again, it offers a means to deliver health care without an
expensive trip to the hospital. He offered that this bill will
accomplish a number of goals and objectives in our society. He
said he is very supportive of the profession and he hoped the
punitive issues would soon be resolved.
4:43:55 PM
CHAIR OLSON remarked that boards are comprised of volunteers and
most of the time things go well. The only time the legislature
hears about it is when something goes wrong and in those
instances often the whole profession is blamed. He commended
the volunteers who serve on boards, stating his "hat goes off"
to them.
4:44:44 PM
REPRESENTATIVE HUGHES moved to report HB 26 out of committee
with individual recommendations and the accompanying fiscal
note. There being no objection, HB 26 was reported from the
House Labor and Commerce Standing Committee.