04/03/2019 03:15 PM House LABOR & COMMERCE

            HB  91-NATUROPATHS: LICENSING; PRACTICE                                                                         
                                                                                                                                
3:43:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL announced  that the  next 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."                                                                              
                                                                                                                                
3:44:47 PM                                                                                                                    
                                                                                                                                
ERIN  SHINE,  Staff,  Representative  Jennifer  Johnston,  Alaska                                                               
State Legislature,  presented HB  91 on behalf  of Representative                                                               
Johnston, prime  sponsor.  She  paraphrased parts of  the sponsor                                                               
statement [included in  the committee packet], which  read in its                                                               
entirety as follows [original punctuation provided]:                                                                            
                                                                                                                                
     House  Bill  91,  by  establishing  a  clear  scope  of                                                                    
     practice for naturopathic doctors,  aims to allow these                                                                    
     primary  health care  providers in  Alaska to  practice                                                                    
     consistent with their education and training.                                                                              
                                                                                                                                
     Alaska's   nearly  60   licensed  naturopaths   provide                                                                    
     valuable  health   care  services   and  can   play  an                                                                    
     important  role  in  helping address  Alaska's  primary                                                                    
     care provider  shortage. However, current  state statue                                                                    
     is   vague   as   to  the   specific   authorities   of                                                                    
     naturopaths, which has  led to the adoption  of some of                                                                    
     the most restrictive  naturopathic medicine regulations                                                                    
     in the nation.                                                                                                             
                                                                                                                                
     For example,  despite being trained to  perform a range                                                                    
     of  minor  office  procedures, such  as  sutures,  wart                                                                    
     removal,  IUD placement  and  removal, naturopaths  are                                                                    
     prohibited  from   performing  any  of   these  routine                                                                    
     procedures in Alaska.  Similarly, many naturopaths have                                                                    
     accredited pharmacological training,  yet under current                                                                    
     regulation  are prohibited  from writing  prescriptions                                                                    
     and  must instead  refer patients  to other  providers                                                                     
     even  though those  providers  may  have less  advanced                                                                    
     training.  These  overly  restrictive  regulations  are                                                                    
     causing  many  naturopaths  to  rethink  practicing  in                                                                    
     Alaska.                                                                                                                    
                                                                                                                                
     HB 91  would correct this by  outlining clear statutory                                                                    
     guidelines,  including,  among other  things,  allowing                                                                    
     licensed  naturopathic practitioners  to perform  minor                                                                    
     office procedures and  to prescribe vitamins, minerals,                                                                    
     and  other non-controlled  substance medications.  This                                                                    
     same scope  is being  practiced safely in  other states                                                                    
     and by other healthcare  providers in Alaska with equal                                                                    
     or lesser training.                                                                                                        
                                                                                                                                
     Naturopathic   medicine   can  provide   valuable   and                                                                    
     complementary care  in the Alaska health  care setting.                                                                    
     Many Alaskans  struggle with basic health  care access.                                                                    
     The ability  for naturopaths to  practice the  scope of                                                                    
     medicine   consistent   with   their   training   would                                                                    
     immediately expand the availability  of primary care in                                                                    
     the state.                                                                                                                 
                                                                                                                                
     Many  Alaskans face  challenges  with chronic  diseases                                                                    
     like  obesity, diabetes,  and  hypertension. These  are                                                                    
     the sorts  of issues  for which naturopaths  have clear                                                                    
     tools to  assist their patients.  Naturopathic training                                                                    
     focuses on disease prevention,  rather than symptom and                                                                    
     medication  management  alone.  In the  long-run,  this                                                                    
     type  of care  can  provide  cost-savings and  improved                                                                    
     health  outcomes  for   consumers,  insurers,  and  the                                                                    
     state. HB 91 aims to  let naturopathic medicine live up                                                                    
     to  this promise  by allowing  naturopathic doctors  to                                                                    
     practice  within  the  scope   of  their  training  and                                                                    
     education,  thereby   increasing  competition   in  the                                                                    
     healthcare sector  and ensuring Alaskan's have  a range                                                                    
        of options when choosing the style of healthcare                                                                        
     that's right for them.                                                                                                     
                                                                                                                                
3:51:14 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL asked for clarification on state regulation.                                                                      
                                                                                                                                
MS. SHINE replied  that in a regulated state,  the governing body                                                               
sets a criterion  of qualifications that must be  met; whereas in                                                               
an unregulated  state, it's  possible for  individuals to  set up                                                               
practices as  naturopathic doctors  (NDs) without  oversight from                                                               
the state.                                                                                                                      
                                                                                                                                
CO-CHAIR WOOL  asked if NDs  in unregulated states  can prescribe                                                               
drugs or do minor office procedures.                                                                                            
                                                                                                                                
MS. SHINE  answered no.   She offered her understanding  that NDs                                                               
must  be registered  or licensed  within a  state to  be able  to                                                               
prescribe medications.  Nonetheless, she  noted that a ND who has                                                               
set  up practice  in  an unregulated  state  could be  performing                                                               
minor procedures without oversight from the state.                                                                              
                                                                                                                                
3:52:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  LEDOUX asked  if NDs  in Alaska  are regulated  even if                                                               
they currently can't write prescriptions.                                                                                       
                                                                                                                                
MS.  SHINE answered  yes,  they are  regulated  and cannot  write                                                               
prescriptions.                                                                                                                  
                                                                                                                                
CO-CHAIR LEDOUX questioned whether  the current statute prohibits                                                               
NDs from prescribing.                                                                                                           
                                                                                                                                
MS. SHINE affirmed that.                                                                                                        
                                                                                                                                
3:52:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS indicated  that there  is an  advantage in                                                               
state  regulation in  terms of  transparency for  consumers.   He                                                               
asked  Ms.  Chambers if  there  is  currently adequate  authority                                                               
within   the   Division    of   Corporations,   Businesses,   and                                                               
Professional  Licensing for  someone who  sets up  a naturopathic                                                               
practice without any knowledge or proficiency in the field.                                                                     
                                                                                                                                
3:53:33 PM                                                                                                                    
                                                                                                                                
SARA  CHAMBERS, Director,  Division of  Corporations, Businesses,                                                               
and Professional  Licensing, Department of Commerce,  Community &                                                               
Economic  Development,  explained  that,  currently,  NDs  are  a                                                               
licensed profession in Alaska which  gives the division authority                                                               
to enforce the existing statutory  and regulatory restrictions on                                                               
NDs and to regulate unlicensed practices.                                                                                       
                                                                                                                                
REPRESENTATIVE  FIELDS   established  a  scenario  in   which  an                                                               
individual insists on advertising themselves  as a ND even though                                                               
he or  she doesn't  have the  proper training.   He asked  if the                                                               
division would have the ability to shut down that business.                                                                     
                                                                                                                                
MS. CHAMBERS replied that they  typically have that authority for                                                               
all  their  licensed  programs  and  professions;  however,  it's                                                               
individualized within each  statute.  She stated that  there is a                                                               
process for those  who practice any of  their professions without                                                               
a  license and  if it  extends  beyond their  civil authority  it                                                               
would include law enforcement for criminal authority if needed.                                                                 
                                                                                                                                
3:55:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN inquired  as to  how long  naturopathy has                                                               
been a licensed profession in the state.                                                                                        
                                                                                                                                
MS. CHAMBERS answered since 1986.                                                                                               
                                                                                                                                
REPRESENTATIVE HANNAN  questioned the  level of  consumer concern                                                               
and frequency of complaints about the practice of NDs.                                                                          
                                                                                                                                
MS. CHAMBERS said  there has been 33 complaints over  the last 20                                                               
years,  adding  that  most  of  those  have  been  low  level  or                                                               
ultimately found to be unsubstantiated.                                                                                         
                                                                                                                                
3:57:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  sought  clarification on  the  prescriptive                                                               
authority that the current bill is seeking to grant NDs.                                                                        
                                                                                                                                
MS. SHINE  replied that the  prescriptive authority  being sought                                                               
is  noncontrolled  substances  and nonchemotherapeutic  agents  -                                                               
everything  else  that  would require  a  prescription  would  be                                                               
allowed for NDs under their scope.                                                                                              
                                                                                                                                
3:58:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  LEDOUX  offered her  understanding  that  the focus  of                                                               
naturopathic  medicine was  nature-based.   She  asked  why a  ND                                                               
would need to write prescriptions  for antibiotics or things that                                                               
aren't "natural."                                                                                                               
                                                                                                                                
MS.  SHINE  acknowledged  that NDs  focus  on  holistic  healing;                                                               
however, they  are still  trained to  be able  to prescribe  as a                                                               
last  resort.   She  noted  that as  the  number of  naturopathic                                                               
primary  care  providers  increases,  this would  allow  them  to                                                               
address their patients  concerns if it gets to the  point that an                                                               
antibiotic or a birth control prescription would be warranted.                                                                  
                                                                                                                                
4:00:12 PM                                                                                                                    
                                                                                                                                
ABBY LAING,  ND, Thrive  Integrative Medicine;  President, Alaska                                                               
Association  of  Naturopathic  Physicians, added  that  sometimes                                                               
antibiotics  are needed.   A  child  with an  ear infection,  for                                                               
example, is situational - sometimes  the infections don't need to                                                               
be  treated with  antibiotics and  others do.   If  someone would                                                               
prefer  to treat  things naturally,  there's also  the "wait  and                                                               
watch approach," in  which case they would get a  supplement or a                                                               
nutraceutical as well  as an antibiotic prescription  in case the                                                               
infection doesn't  get better.   She also  pointed out that  if a                                                               
woman wanted to  get a refill on her  birth control prescription,                                                               
she would have to do that through a different provider.                                                                         
                                                                                                                                
4:02:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX questioned whether  there is a difference between                                                               
NDs and medical doctors (MDs).                                                                                                  
                                                                                                                                
MS. SHINE  offered her understanding  that both MDs and  NDs have                                                               
four-year degrees;  however, completing  a residency  is required                                                               
of physicians and optional for NDs.   She further noted that they                                                               
take different approaches to medicine.                                                                                          
                                                                                                                                
DR. LAING,  in response to Representative  LeDoux, explained that                                                               
MDs are trained in specialties,  while NDs focus on primary care.                                                               
She also  affirmed that  a residency  is required  of all  MDs in                                                               
order to be licensed, except for  those working at an urgent care                                                               
facility.                                                                                                                       
                                                                                                                                
MS.  SHINE  pointed  out  that   nurse  practitioners  (NPs)  and                                                               
physician's  assistants (PAs)  are  practicing  within a  greater                                                               
scope  than  what's  being  requested by  NDs  because  they  can                                                               
prescribe controlled substances.                                                                                                
                                                                                                                                
4:06:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL  offered his  understanding that  PAs and  NPs only                                                               
prescribe under  the direct  supervision of  a MD.   He  asked if                                                               
this was correct.                                                                                                               
                                                                                                                                
MS. SHINE confirmed  that PAs are under the supervision  of a MD,                                                               
while NPs are not.                                                                                                              
                                                                                                                                
CO-CHAIR WOOL asked  if hormone therapy, steroids,  or high blood                                                               
pressure  medicine   would  all   fall  under   the  prescriptive                                                               
authority of a ND if this bill were to pass.                                                                                    
                                                                                                                                
DR.  LAING  explained  that  testosterone   is  classified  as  a                                                               
controlled   substance   and   therefore   excluded   from   NDs'                                                               
prescriptive authority  under HB 91.   She noted  that controlled                                                               
substances  are   contentious  and  not  necessary   to  practice                                                               
effectively.                                                                                                                    
                                                                                                                                
4:09:34 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL announced that HB 91 was held over.