Legislature(2019 - 2020)BARNES 124
05/03/2019 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB91 | |
| HB24 | |
| HB127 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 91 | TELECONFERENCED | |
| += | HB 24 | TELECONFERENCED | |
| *+ | HB 127 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 91-NATUROPATHS: LICENSING; PRACTICE
3:26:03 PM
CO-CHAIR WOOL 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."
3:26:20 PM
CO-CHAIR WOOL opened public testimony.
3:27:09 PM
ROSS TANNER, Alaska State Medical Association, informed the
committee that he is an internal medical physician in Anchorage
and has practiced for the last 30 years. He recounted a patient
with Type 1 diabetes and liver failure who was instructed to
discontinue all medications, including insulin, by a
naturopathic doctor (ND), which resulted in a prolonged
hospitalization and near death. He opined that NDs show a lack
of clinical experience that put patients in harm in Alaska. He
continued by saying that Naturopaths tend to prescribe numerous
supplements that lack "therapeutic efficacy and any kind of
data." He concluded by stating that a lack of residency, lack
of insurance, personal experience, and no improvement to access
of care are his primary [objections].
3:29:50 PM
REPRESENTATIVE HANNAN asked how Mr. Tanner's comments relate to
the extended scope of practice that the bill proposes.
MR. TANNER said it's one example that illustrates lack of
competence due to lack of clinical training, knowledge and
expertise. He added that "even non-medical people would know
not to discontinue medication."
REPRESENTATIVE HANNAN asked if Mr. Tanner's objection is to NDs
practicing medicine period, not just this bill's proposal to
give them a scope of practice that includes prescription and
minor surgery.
MR. TANNER offered his belief that NDs should stay in their
scope of practice, adding that they're trained to be
complementary to physicians. He continued by saying that less
than 5 percent of naturopaths do residencies and that to call
NDs doctors is misleading to patients and harmful to Alaska's
communities.
3:33:57 PM
MELINDA RATHKOPF, MD, Alaska State Medical Association, informed
the committee that she is a board-certified allergist
immunologist who has practiced in Alaska for 13 years. She
shared her educational background, which included 4 years of
medical school, 3 years of a pediatric residency training, and 2
years of allergy and immunology fellowship. She discussed her
experience with patients who received misinterpreted allergy
testing from naturopaths. She explained her opposition to the
bill, saying that increasing ND's scope of practice would
increase the number of patients that seek their care and think
they are equivalent to MDs.
3:36:00 PM
LAURIE MONTANO, Alaska State Medical Association, shared several
experiences with patients who had previously been mistreated by
NDs, adding that they were not backed by science. She expressed
major concern and strongly opposes HB 91.
3:37:49 PM
STEVE SIVILS, Alaska State Medical Association, stated that he
is a pediatric anesthesiologist in Anchorage and expressed his
opposition to the bill, especially including surgery in the
increased scope of practice. He offered his understanding that
NDs don't receive any formal surgical training which would put
Alaskans at risk.
3:39:49 PM
IRINA GRIMBERG, Alaska State Medical Board, stated her
opposition to HB 91. She opined that it is potentially
dangerous when naturopaths act as a legitimate MD. year after
year, she said, naturopaths are pushing measures for
prescriptive authority. She offered her belief that they should
be an alternative option to conventional medicine.
3:44:14 PM
TONYA CAYLOR, Alaska State Medical Board, informed that
committee that she is opposed to HB 91 and credited her many
encounters with poor judgement made by naturopathic providers.
She gave a brief summary of two such encounters. She offered
her belief that naturopaths lack clinical knowledge in
pathophysiology and clinical judgement that is needed to
practice medicine. She said they should not be granted the
ability to prescribe medication.
3:47:31 PM
MARY ANN FOLAND, Alaska State Medical Board, voiced her
opposition to HB 91. She alleged that the state medical board
also opposes the bill and considers these changes "the practice
of allopathic medicine." She stated that physicians require
12,000-15,000 more hours of training than NDs and shared two
stories of patients who were mistreated by naturopaths. She
added that all the examples being shared today reflect the lack
of education in pharmacology. She continued by saying that
naturopaths don't need to have prescriptive and surgical
privileges and instead, can continue to practice within the
definition of naturopathy.
CO-CHAIR LEDOUX asked if, theoretically, a medical school
graduate would be licensed to perform brain surgery.
MS. FOLAND answered yes. She offered her belief that she
possesses a medical surgical license, which would theoretically
allow her to do that; however, she said that her credentials
don't allow her to [perform brain surgery] and if she were to
practice outside the scope of her training she would have to
answer to the state medical board.
3:53:17 PM
CO-CHAIR WOOL pointed out that nurse practitioners (NPs) have
prescriptive powers and questioned how Ms. Foland justifies
that.
MS. FOLAND offered her understanding that NPs and physician
assistants' training is allopathic, adding that naturopathic
training is completely different content.
3:54:41 PM
ALEXANDER VON HAFFTEN, Alaska State Medical Board, said he
opposes HB 91. Nonetheless, he noted that he supports the
values of naturopathy and the wholistic approach to preventing
disease and optimizing wellness. he further noted that he has
discussed naturopathy during lessons as a teacher in the WHAMI
medical program and has referred patients to NDs when
naturopathy offers a viable or better alternative to allopathic
or osteopathic medicine. However, he said, "the proposed
changes eliminate the prerequisites for a person to be
considered qualified as a position and have little adherence to
the core values of naturopathy." He questioned whether NDs are
qualified to prescribe and offered his belief that HB 91 would
change the standard for disclosure, change the standard of care,
and communicate that "truth in advertising is irrelevant." He
concluded by reiterating that, while he values naturopathy as an
alternative to allopathic medicine, physicians possess expertise
in judgement in accordance with minimum nationally established
requirements for education, training, and skill-competencies.
4:02:04 PM
REPRESENTATIVE FIELDS asked if Mr. Von Hafften would support
allowing "some degree" of prescriptive authority for naturopaths
who went through a residency equivalent to that of an MD.
MR. VON HAFFTEN said no, "the devil is in the details." He
added that a scope of practice already exists in statute and he
sees no reason to change that.
REPRESENTATIVE FIELDS asked if there are any types of medicine
that would be appropriate for naturopaths to have prescriptive
authority for.
MR. VON HAFFTEN stated, "I'm regarding prescriptive
responsibility."
4:04:17 PM
PATRICK NOLAN, Alaska State Medical Board, informed the
committee that he is a board certified endocrinologist and a
member of the American Association of Clinical Endocrinologists,
the American College of Endocrinology, and the International
Endocrine Society; as well as a member of the American College
of Physicians and a fellow with the American Association of
Clinical Endocrinology. He also served as a former state
Medical Board member for four years. He expressed his
opposition to HB 91 "for many of the reasons that were already
stated." He reflected on cases that, in his opinion, were
misdiagnosed by NDs.
4:09:07 PM
CAMERON O'CONNELL, ND, expressed her support for HB 91. She
said she would not take up the committee's time by relating some
of the patients she has treated that were under the care of
Medical Doctors and were overprescribed medication and "had bad
outcomes from medication they were given." Instead she
addressed the ways in which a limited scope of practice
influences her day-to-day care of patients. She concluded by
asking the members to consider updating [indisc.] to a more
modern scope, noting that naturopathic medicine has grown a lot
as a profession and the legislation should reflect that.
4:11:57 PM
CO-CHAIR WOOL asked if residency was a required part of her
degree program in Portland, Oregon.
MS. O'CONNELL said, currently, they don't have the funding and
there aren't enough residencies for the amount that would be
needed for every ND to go. She added that completing a
residency is highly encouraged and competitive.
CO-CHAIR WOOL asked if Ms. O'connell's residency was
naturopathic, allopathic, or some combination of the two.
MS. O'CONNELL replied that it was a combination of both.
4:13:24 PM
DAVID SCHLEICH, MD, Alaska Association of Naturopathic
Physicians, informed the committee that is the president of the
National University of Natural Medicine, the oldest federally
and regionally and state accredited university in the U.S. that
prepares naturopathic physicians for clinical practice and
careers. He shared his background and experience working for
many different universities and colleges across the U.S. and
Canada and expressed his support for HB 91. He noted that the
professional preparation of NDs has been referenced erroneously
and often. He said it translates into four years of fulltime
study beyond a bachelor's degree. He states that his colleagues
in the allopathic profession who have said that the content and
learning objectives of naturopathy are different, are mistaken.
He added that the clinical record of NDs is more substantial
than their colleagues would suggest. He concluded by
encouraging the members to endorse the current bill.
CO-CHAIR WOOL said there has been reference to a philosophy or
underlying statement behind naturopathy and asked Mr. Schleich
to speak to that.
DR. SCHLEICH replied that his University has recently published
12 volumes, 6,000 pages, on the history, philosophy, and
derivation of naturopathic practice. He added that the
underlying philosophies are not that different.
4:23:17 PM
JOHN CULLEN, American Academy of Family Physicians, stated that
he is the president of the American Academy for family
Physicians and expressed his opposition to "the extent of this
bill." He said he would like to see the data to that
naturopaths are capable of prescribing medication safely. He
opined that this bill will not solve the solution to rural
healthcare problems and objected to the "naming of naturopaths
as physicians." He encouraged members to vote no on this bill.
4:26:42 PM
KRISTIN MITCHELL, American College of Physicians, offered her
belief that the training for naturopaths is not equivalent to
scientific medical training and should be complementary. She
expressed concern about a lack of sufficient evidence showing
that it is safe for patients to receive care from naturopaths in
terms of prescribing pharmaceuticals and performing surgery,
which in her opinion, they are not trained for. She said
patients have a difficult time distinguishing between licensed
practitioners and it is the state's role to protect the safety
of patients.
4:30:45 PM
The committee took a brief at-ease.
4:31:28 PM
JOSEPH RETH expressed his opposition to HB 91, offering his
belief that naturopaths don't have the training needed to
prescribe medicine and perform minor surgeries effectively and
safely. He addressed the concept of residency. He argued that
physicians are required to complete a 3-year residency after 4
years of medical school, during which they are taught how to
safely and effectively prescribe medicine along with performing
surgical procedures. In contrast, he said, naturopaths have 4
years of schooling and no residency requirement. He mentioned
the placebo affect and pointed out that it can account for more
than 50 percent of positive outcomes. He said that he and his
colleagues have had too many interactions with naturopaths where
it was clear that they did not adequately and sufficiently
understand the science of medicine and as a result have put
patients health and their lives at risk.
4:35:39 PM
REPRESENTATIVE REVAK sought clarification on the placebo effect.
MR. RETH stated that it is very powerful and can occur up to 80
percent of the time.
4:36:35 PM
CO-CHAIR WOOL pointed out that many naturopaths do clinical
residency after medical school in states that grant prescriptive
authority to NDs. He asked if some go get the proper training
to prescribe drugs, given that they came from that background.
MR. RETH replied that there are significantly more residencies
available for naturopaths now than there were years ago. He
described naturopathic residencies as "going to someone else's
office and hanging out with them," adding that it wasn't
consistent. He said one year of residency is not enough to
learn how to safely prescribe medication.
CO-CHAIR WOOL pointed out that NPs have prescriptive ability and
do not complete the same amount of school as physicians. He
asked how Mr. R justifies that.
MR. RETH said that NPs are trained in allopathic medicine as
opposed to "natural substances."
4:39:23 PM
CO-CHAIR LEDOUX asked if both PAs and NPs work under a doctor.
MR. RETH said he was unsure. He offered his understanding that
PAs work under a "collaborative agreement" and, although
oversight is present, they are free to do what they need to do.
CO-CHAIR LEDOUX equated NDs to osteopaths, regarding their
history, specifically their desire to be recognized as
physicians.
4:42:37 PM
REPRESENTATIVE FIELDS referenced previous comments about
naturopathy being complementary to MDs as opposed to
interchangeable and asked if that is true.
MR. RETH opined that they are not interchangeable, adding that
NDs and MDs have divergent approaches to the human body. He
said he was surprised that naturopaths want prescriptive
authority for medicine that isn't "natural."
REPRESENTATIVE FIELDS asked if the two practices are
complementary.
MR. RETH opined that it comes back to the placebo affect;
meaning that if an individual believes and trust in someone, he
or she will get a lot of benefit from that person. He further
stated that "going to a naturopath for some people is the way to
go." However, he added that a patient with a serious problem
will need the addition of allopathic medicine.
REPRESENTATIVE FIELDS asked if there could be a sufficiently
rigorous process of residency for naturopaths that would prepare
them for prescriptive authority.
MR. RETH acknowledged that a more limited or "restrictive"
prescriptive ability could be considered, while reiterating his
concern about granting NDs complete prescriptive authority.
4:46:30 PM
REPRESENTATIVE FIELDS asked if the medical association has ever
considered the idea of a more regular and regulated residency
process for NDs.
MR. RETH related that the medical associate has never discussed
residency, as it is a newer concept for naturopaths.
4:47:40 PM
REPRESENTATIVE HANNAN said many of the doctors who testified
today spoke broadly in opposition to naturopaths rather than
against the specifics of HB 91, which is prescriptive authority.
She questioned whether the Alaska Medical Association is opposed
to all naturopathic medicine or if their objection is just in
response to the surgical and prescriptive authority that this
bill addresses.
MR. RETH affirmed that the AMA specifically opposes the
prescriptive authority. He noted that they have no problem with
NDs being licensed in Alaska.
REPRESENTATIVE HANNAN pointed out that pharmacists don't
complete a residency for the administration of drugs and more
specifically vaccines. She asked if the Medical Association
opposes that.
MR. RETH countered with the assumption that pharmacists know how
to administer drugs, adding that he was unsure if the AMA
opposes that. He clarified that the AMA's opposition to
Naturopath's prescriptive authority is not about the ability to
prescribe vaccines, but that it would allow them to prescribe
anything apart from scheduled controlled substances and
chemotherapeutic agents.
REPRESENTATIVE HANNAN asked if the Alaska Medical Association
has a position on midwives and doulas and their treatment of
patients.
MR. RETH said he was unsure if the AMA has a formal policy on
midwives.
4:51:10 PM
The committee took a brief at-ease.
4:51:13 PM
ANNETTE O'CONNELL, reflected on being diagnosed with celiac
disease. She said she was misdiagnosed by MDs until finally
going to an ND who retested her and figured out that she was
allergic to gluten. She noted that she has been better ever
since that diagnoses as long as she follows her NDs suggestions.
She offered her belief that the American Medical Association is
campaigning to discredit NDs and blamed MDs for the opioid
epidemic. She concluded that Alaska needs both naturopathic and
medical doctors and expressed hope that NDs will be given the
right to exercise within their full scope of practice.
4:55:26 PM
DANIEL YOUNG, ND, Center for Natural Medicine, expressed his
support for HB 91 and, referencing the previous testifiers,
indicated that MDs are not the experts on naturopathic medicine.
He offered that NDs are not trying to be MDs, instead they are
providing a different model of healthcare that is very affective
and works for their patients. He said the fact that NDs still
exist is testament to that. He stated that naturopathic medical
and clinical training consists of more than 2 years of
supervised care with patients. The goal, he said, is to provide
effective care for patients and added that the state has
recently taken away their ability to provide things with
prescription labels, such as B12, B-Complex, and homeopathic
medicine, which is all medicine they regularly use. He
reiterated that the previous testifiers' comments are anecdotal,
some of which, he said he has before which makes him question
their validity.
4:58:38 PM
WAYNE ADERHOLD, Board of Chiropractic examiners, stated that he
fully supports HB 91 as a clear, concise and comprehensive
statute that will give naturopaths the structure needed to
practice to the full extent of the training level they choose
within a scope of practice defined by the profession. He
continued by praising his experience using naturopaths as his
primary care doctor since 1993. He offered his belief that this
committee has the duty to promote a free market that maximizes
competition by properly trained professionals. He added that
the tools used by professionals, including prescriptive
authority, should be determined by the regulated profession
itself, not the competing profession. He pointed out that he
has had numerous instances in his treatment history where a
prescriptive drug was considered a necessary part of a larger
treatment plan, adding that he deserves the option of receiving
the maximum level of treatment. He requested that the members
pass HB 91 out of committee and increase healthcare competition
in Alaska, adding that consumers deserve nothing less.
5:01:16 PM
STEVE FRANK noted that he has been seeing a naturopath for many
years as a primary healthcare provider and received excellent
care. He pointed out that his ND has referred him to MDs, such
as an internist and cardiologist, when appropriate. He added
that the opposition to this bill seems to be characterized by
anecdotal fearmongering and implored members to stick to the
facts and make fact-based decision. He continued by saying he
would like to see this bill moved out of committee.
5:04:34 PM
The committee took a brief at-ease.
CO-CHAIR WOOL closed public testimony on HB 91.
[HB 91 was held over.]
5:05:10 PM