Legislature(2023 - 2024)DAVIS 106
04/11/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB115 | |
| HB96 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 115 | TELECONFERENCED | |
| += | HB 96 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 115-NATUROPATHS: LICENSING; PRACTICE
3:05:02 PM
CHAIR PRAX announced that the first order of business would be
HOUSE BILL NO. 115, "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."
[CHAIR PRAX passed the gavel to Vice Chair Ruffridge.]
3:06:54 PM
CHAIR PRAX moved to adopt Amendment 1 to HB 115, labeled 33-
LS0631\A.1, Bergerud, 4/7/23, to HB 115, which read as follows:
Page 3, line 4, following "department;":
Insert "and"
Page 3, lines 5 - 9:
Delete all material.
Renumber the following paragraph accordingly.
Page 5, line 24, following "patient;":
Insert "and"
Page 5, line 25:
Delete "; and"
Insert "."
Page 5, lines 26 - 30:
Delete all material.
Page 14, line 6, through page 16, line 10:
Delete all material.
Renumber the following bill sections accordingly.
Page 16, line 14:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 15:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 17:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 18:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 25:
Delete "20"
Insert "19"
Page 16, line 26:
Delete "sec. 21"
Insert "sec. 20"
CHAIR PRAX explained that Amendment 1 would remove the
requirement for naturopaths to have criminal background checks
and fingerprints taken. He stated this requirement is imposed
on naturopaths but not on other practitioners under Title 8.
3:08:01 PM
The committee took an at-ease from 3:08 p.m. to 3:12 p.m.
3:12:37 PM
REPRESENTATIVE FIELDS questioned whether the amendment would
delete the fingerprint and fees required by the Department of
Public Safety (DPS).
SYLVAN ROBB, Director, Division of Corporations, Business and
Professional Licensing (CBPL), Department of Community,
Commerce, and Economic Development (DCCED), concerning Amendment
1 to HB 115, responded that for background checks DCCED would
collect fingerprint cards and send them to DPS. She stated that
entities which are subjected to background checks are listed in
the DPS statute. She stated that [HB 115] required this [for
naturopaths], but the amendment would be taking it out.
3:13:19 PM
REPRESENTATIVE FIELDS questioned whether collecting fingerprints
is standard for occupations like naturopaths. He requested some
context about the process as a safety mechanism.
MS. ROBB responded that currently naturopaths are not required
to provide fingerprints to be licensed. She stated that only a
handful of professions require fingerprint-based background
checks, with nurses being the largest group.
MS. ROBB, in response to a series of follow-up questions,
answered that advanced nurse practitioners are required to be
licensed registered nurses, and registered nurses would require
a fingerprint-based background check. She answered that
physician assistants are not required to have a fingerprint-
based background check. In response to the final follow-up
question, she answered that licensee applications have questions
concerning an individual's criminal record. She stated that
occasionally background checks have revealed things which were
not disclosed on the application, but this is rare.
3:15:49 PM
REPRESENTATIVE SUMNER questioned whether professions with
prescriptive authority would typically have fingerprint-based
background checks. He questioned whether physician assistants
would have prescriptive authority.
MS. ROBB responded that the professions covered by the State
Medical Board would not be required to have background checks,
and this would include physicians and physician assistants.
3:16:19 PM
REPRESENTATIVE MINA questioned whether physicians, osteopaths,
and physician assistants would have other background-check
mechanisms which do not require fingerprints.
MS. ROBB responded that there is no background check required
for these providers.
3:16:49 PM
VICE CHAIR RUFFRIDGE suggested that requiring background checks
could add time to the licensing process. Concerning which
health care professions are required to have a background check,
he suggested that it "seems to be split."
MS. ROBB responded that currently professions which require
background checks include nurses, nursing assistants, massage
therapists, and registered guide outfitters. She stated that
the majority of the professions licensed by the division do not
require fingerprint-based background checks.
3:18:04 PM
REPRESENTATIVE SADDLER, for clarification, stated that only a
few professions require a fingerprint-based background check,
and all licenses governed by the State Medical Board to not
require a fingerprint-based background check.
MS. ROBB responded in the affirmative.
3:18:33 PM
VICE CHAIR RUFFRIDGE removed his objection. There being no
further objection, Amendment 1 to HB 115 was adopted.
[Vice Chair Ruffridge passed the gavel to Chair Prax.]
3:19:08 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 2 to HB 115,
as amended, labeled 33-LS0631\A.2, Bergerud, 4/10/23, to HB 115,
as amended, which read as follows:
Page 1, line 1:
Delete "Advisory"
Page 2, line 16:
Delete "Advisory"
Delete "Advisory"
3:19:21 PM
CHAIR PRAX objected for the purpose of discussion.
3:19:27 PM
The committee took a brief at-ease at 3:19 p.m.
3:19:43 PM
REPRESENTATIVE RUFFRIDGE, speaking to Amendment 2, stated that
it is a simple amendment; however, it may have further reaching
consequences. In the realm of medical practice, he said, every
medical care profession with prescriptive authority has a board
governing its actions. He stated that the proposed bill calls
for an advisory board. He offered the understanding that an
advisory board would be middle ground between an actual board
and not having a board at all. He stated that the amendment
would create an "actual" board for naturopaths. He named the
seven license types with boards, as the amendment would align
naturopaths with these.
3:21:24 PM
REPRESENTATIVE RUFFRIDGE, in response to Representative Saddler,
stated that the meeting schedule for boards is set through
regulation or statute. He stated that the newly created board
would have regulations to pursue; however, he expressed the
opinion that the language [in HB 115, on page 1], lines 18-21,
requiring the board to meet one time per year, would be
unnecessarily prescriptive.
3:23:07 PM
REPRESENTATIVE SADDLER questioned the effect of removing the
word "advisory" from the description of the proposed Naturopathy
Advisory Board.
MS. ROBB responded that it would not be an advisory board. She
continued that most regulatory boards have statutory language
which delegates the duties for the board. She recognized that
there is interplay between the amendments being offered to HB
115, and the duties delegated would depend on which amendments
are passed.
3:24:25 PM
CHAIR PRAX stated this would be different for naturopaths, as
opposed to others regulated by the State Medical Board. He
questioned whether [an advisory board] would work.
MS. ROBB responded that all of the state's 21 boards are
regulatory, and there are no advisory boards. She stated that
regulatory boards have some expense for the licensees. She
explained that a profession with a small number of licensees
would spread the expense across a small pool of people, and this
could raise some concern. She reasoned, in this case, having an
advisory board would be a good middle ground; the board would be
a standing panel of experts to offer advice without having an
extra cost to the licensees.
3:26:05 PM
CHAIR PRAX questioned the number of individuals regulated under
a board.
MS. ROBB answered this would vary by profession. She stated
that, for example, there are over 20,000 licensed nurses, over
6,000 licensed pharmacy facilities, and the State Medical Board
covers 8,200 licensees. She stated that there are several small
boards, such as the Board for Direct-Entry Midwives, which has
less than 30 licensees. She stated that this board has found
challenges with the costs and the small pool for board
appointees.
3:28:02 PM
REPRESENTATIVE MINA questioned whether naturopaths with
prescriptive authority in other states would be under a
governing board or an advisory board.
SCOTT LUPER, ND, Alaska Association of Naturopathic Doctors,
responded that they would be under a board, but not an advisory
board. He expressed the opinion that no other state has an
advisory board for neuropathy. He stated that there has been
discussion in other states, and he expressed the belief that
North Dakota may have recently adopted an advisory board. He
reiterated that most states use a regulatory board.
3:29:26 PM
REPRESENTATIVE RUFFRIDGE, in response to Representative Saddler,
stated that the amendment is the mechanism for the discussion
concerning whether or not the proposed Naturopathy Advisory
Board would be an advisory board or a [regulatory] board. Once
this is decided, he said, in conjunction with naturopaths and
the department, the board's makeup would be determined. He
suggested that this may need some clarifying amendments. He
expressed uncertainty concerning the sustainability of the cost
of having a full regulatory board. He expressed the opinion
that if the discussion results in a full regulatory board for
naturopaths, all other entities with prescriptive authority
should have a full regulatory board. He said, "What we heard in
testimony was the desire for naturopathic providers ... to be on
somewhat of an equal playing field, and already it seems like in
this legislation we are treating them a little differently."
3:32:36 PM
REPRESENTATIVE SADDLER moved to table Amendment 2 until after
the discussion of Amendment 14. There being no objection,
Amendment 2 was tabled.
3:32:58 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 14 to HB 115,
as amended, labeled 33-LS0631\A.14, Bergerud, 4/10/23, which
read:
Page 1, line 1:
Delete "Advisory"
Page 2, line 16:
Delete "Advisory"
Delete "Advisory"
Page 2, lines 18 - 21:
Delete all material.
Reletter the following subsections accordingly.
Page 2, lines 22 - 23:
Delete "and serve at the pleasure of the
commissioner"
Insert "the governor"
Page 2, lines 29 - 30:
Delete all material.
Page 6, lines 15 - 17:
Delete all material and insert:
"(E) drugs under a collaborative agreement
adopted under AS 08.45.057, except as prohibited under
AS 08.45.050, if the naturopath has passed the
elective pharmacology examination portion of the
Naturopathic Physicians Licensing Examination;"
Page 7, line 4, following "(1)":
Insert "notwithstanding AS 08.45.057,"
Page 8, following line 17:
Insert a new section to read:
"Sec. 08.45.057. Naturopath collaborative
practice authority. (a) The State Medical Board and
the Naturopathy Board may jointly approve a
collaborative agreement between a naturopath and an
authorizing health care provider who is authorized to
prescribe drugs under AS 08 if the agreement meets the
requirements of (b) of this section and the agreement
is submitted to both boards.
(b) A collaborative agreement must include
(1) an authorization by the authorizing
health care provider for the naturopath to initiate or
modify drug therapy in accordance with the terms of
the collaborative agreement;
(2) a statement identifying each health
care provider and naturopath who is a party to the
collaborative agreement;
(3) the time period of the collaborative
agreement, not to exceed two years;
(4) the types of decisions that a
naturopath is authorized to make, including
(A) the types of diseases a naturopath may
treat, the types of drugs or drug categories that the
naturopath may administer or dispense, and the types
of care decisions the naturopath may make; and
(B) procedures, decision criteria, or plans
a naturopath must follow when making therapeutic
decisions;
(5) activities a naturopath must follow in
the course of exercising collaborative authority,
including documenting decisions made by the
naturopath, and a plan for communicating with and
receiving feedback from the authorizing health care
provider concerning specific decisions made by the
naturopath;
(6) a list of the specific types of
patients eligible to receive services under the
collaborative agreement;
(7) a plan for the authorizing health care
provider to review the decisions made by the
naturopath at least once every three months;
(8) a plan for providing the authorizing
health care provider with each patient record created
under the collaborative agreement;
(9) a prohibition on the administration or
dispensing of a schedule I, II, III, or IV controlled
substance by a naturopath; and
(10) an acknowledgment that the authorizing
health care provider will not receive any compensation
from a naturopath as a result of the care or treatment
of a patient under the collaborative agreement.
(c) To enter into a collaborative agreement
under this section, an authorized health care provider
must be licensed and in active practice, and the
authority granted to the naturopath under the
collaborative agreement must be within the scope of
the health care provider's license and practice.
(d) Before approving a collaborative agreement,
the State Medical Board and the Naturopathy Board
shall ensure that the naturopath has been adequately
trained in the procedures outlined in the
collaborative agreement. If the naturopath is not
adequately trained, the boards shall specify and
require completion of additional training that covers
those procedures before issuing approval of the
collaborative agreement.
(e) The State Medical Board and the Naturopathy
Board shall maintain documentation related to a
collaborative agreement for at least two years.
(f) A collaborative agreement may be terminated
upon written notice by the authorizing health care
provider or the naturopath. The naturopath shall
notify the State Medical Board and the Naturopathy
Board in writing within 30 days after the
collaborative agreement is terminated.
(g) Any modification to a collaborative
agreement must be jointly approved by the State
Medical Board and the Naturopathy Board as required by
this section for a new collaborative agreement.
(h) A signed copy of the approved collaborative
agreement must remain at the naturopath's practice
location at all times."
REPRESENTATIVE FIELDS objected for the purpose of discussion.
3:33:10 PM
REPRESENTATIVE RUFFRIDGE, speaking to Amendment 14, said it
would add the same language [as Amendment 2], but it would
accomplish more. He stated the amendment would remove the word
"advisory" and create a full board, which would be appointed by
the governor. He pointed out it would make substantive changes
beginning on page 6 of the bill, and a new section would be
added on page 8 addressing collaborative authority for
naturopaths. He explained that the amendment would address the
continuing education language in the proposed legislation. He
directed attention to page 5, line 4, which relates that the
continuing education requirements for a naturopath must be
equivalent to those of a physician assistant. He stated that
physician assistants have collaborative practices for their
prescriptive authority. He reasoned that since they have
similar requirements, the prescriptive authorities should match.
In other words, a naturopath wishing to prescribe medications
would need to have a collaborative agreement between the State
Medical Board and the proposed Naturopathy Advisory Board.
3:35:26 PM
REPRESENTATIVE MINA questioned a breakdown between licensed
providers who have prescriptive authority under a collaborative
agreement and those who practice by themselves.
REPRESENTATIVE RUFFRIDGE expressed the understanding that a
collaborative practice agreement is in place for physician
assistants, while pharmacists have a limited collaborative
practice authority for prescriptions.
3:36:20 PM
REPRESENTATIVE RUFFRIDGE, in response to Representative Saddler,
explained that collaborative practice authority allows a
licensed individual to obtain written permission for
prescriptive authority from another individual who is, for
example, licensed through the medical board. He stated that the
written agreement would determine the prescriptive authority,
and, depending on what the boards agree to, the agreement could
be versatile. He conveyed that naturopaths have said they would
have few prescription requests. He gave examples of antibiotics
and hormone replacement. Because there has to be a relationship
with the individual with authority, he said, the practice would
have limitations. The providers giving the authority would have
oversight, which fits with the limited amount of prescribing a
naturopath would do. He advised that naturopaths are not
requesting the ability to prescribe an abundance of medications,
rather they are requesting the option of having a collaborative
practice with an overseeing provider. He stated that this is
the reason he brought the amendment forward.
REPRESENTATIVE SADDLER compared the collaborative practice with
someone cosigning on a loan.
REPRESENTATIVE RUFFRIDGE responded that the analogy is
reasonable. He continued that both parties would have some sort
of authority, but ultimately there would be the discussion of
what is being prescribed and why. He stated that the agreement
can be narrow or broad.
3:39:56 PM
REPRESENTATIVE FIELDS withdrew his objection.
3:40:13 PM
CHAIR PRAX objected. He expressed the understanding that
naturopaths receive the equivalent training in pharmacology as
other medical providers who have prescriptive authority. He
reasoned that because of this the amendment is not necessary.
He suggested that medical professionals with prescriptive
authority would not collaborate with a naturopath unless the
naturopath had training. Furthermore, he expressed the opinion
that naturopaths would not rely on allopathic medications, as it
would be inconsistent with their philosophy of practice. He
expressed the opinion that because naturopaths are required to
go to an accredited institution, there would be fewer risks.
3:42:58 PM
REPRESENTATIVE RUFFRIDGE responded that these are valid points;
however, he explained, because allopathic providers regularly
prescribe pharmaceutical-grade medications, they would have a
higher level of understanding and proficiency than a
naturopathic provider. He stated that his concern is not with
the training, rather his concern is that naturopaths do not use
pharmaceutical-grade medications on a regular basis. In
addition, he argued that in the construction of the advisory or
regulatory board there would be different types of providers.
He suggested that two naturopaths, one pharmacist, and one
physician would be a "strange makeup" of a board. He stated
that a board typically is made up of one group; for example, a
nursing board would be made up of all nurses. He stated that a
concession is being made with the design of the proposed
Naturopathy Advisory Board, as it would be a collaborative
effort.
3:45:53 PM
REPRESENTATIVE SUMNER moved to adopt Conceptual Amendment 1 to
Amendment 14, to delete all material on page 6, line 7, [as
numbered on Amendment 14], and insert "(B) a poison".
3:46:13 PM
REPRESENTATIVE FIELDS objected.
3:46:24 PM
The committee took an at-ease from 3:46 p.m. to 3:56 p.m.
3:56:08 PM
REPRESENTATIVE SUMNER withdrew the motion to adopt Conceptual
Amendment 1 to Amendment 14.
3:56:35 PM
REPRESENTATIVE MINA pointed out the collaborative authority for
pharmacists and physician assistants are defined by regulation,
not statute. In consideration of aligning authority, she
suggested that the collaborative authority for the naturopathy
board should be in regulation. She requested that CBPL speak to
this.
REPRESENTATIVE RUFFRIDGE concurred with the assessment. He
advised that a conversation needs to be had concerning the board
type.
3:57:51 PM
GLENN SAVIERS, Deputy Director, Division of Corporations,
Business and Professional Licensing, Department of Commerce,
Community, and Economic Development, for clarification,
questioned whether the State Medical Board or the proposed
Naturopathy Advisory Board would establish the regulations.
3:58:10 PM
REPRESENTATIVE MINA responded that it would be the naturopathy
board.
3:58:18 PM
GLENN SAVIERS commented that anytime something is put into
regulation, it is easier for the board to make the amendment,
but this would be a policy call.
3:58:31 PM
MS. SAVIERS, in response to Representative Saddler, stated that
she could speak only to the boards under CBPL, and these would
all be appointed by the governor. She said she would follow up
as to whether the language in statutes say, "serve at the
pleasure of the governor".
3:59:48 PM
REPRESENTATIVE SUMNER questioned whether the prescription of
controlled substances would be disallowed [for naturopaths] in a
collaborative agreement.
REPRESENTATIVE RUFFRIDGE responded that the question is "tough"
[to answer]. He expressed the belief that the prescription of
controlled substances would not need to be restricted, as a U.S.
Drug Enforcement Administration license would need to be
obtained. He expressed uncertainty that naturopaths would be
able to obtain this, and he suggested this should be addressed.
4:00:58 PM
REPRESENTATIVE SADDLER requested an explanation of the origins
of the language on pages 2-4 of Amendment 14. He questioned
whether the language is similar to language elsewhere in state
statute.
REPRESENTATIVE RUFFRIDGE responded that the language came from
Legislative Legal Services and is a blend from the current
collaborative-practice authority language for pharmacy licensees
and physician assistants.
4:02:15 PM
REPRESENTATIVE MINA related that the regulation for pharmacists
is found in 12 AAC 52.240, and the regulation for physician
assistants is found in 12 AAC 40.410.
REPRESENTATIVE RUFFRIDGE clarified that there is corresponding
language for the State Medical Board, as well.
4:03:01 PM
REPRESENTATIVE MINA directed attention to page 2, line 11, of
Amendment 14, which authorizes a health care provider to
prescribe drugs. She questioned whether this would concern
physicians, physician assistants, and nurse practitioners, or
just physicians.
REPRESENTATIVE RUFFRIDGE responded that all of the mentioned
licensed types would be included. Addressing Representative
Sumner's earlier question, he stated that the amendment would
prohibit naturopaths from dispensing scheduled drugs. He
suggested that if the conversation needs to happen at a later
time, this will need to be taken out of the amendment.
4:04:09 PM
REPRESENTATIVE SADDLER pointed to page 3, lines 17-22 of
Amendment 14. He stated that this would give the State Medical
Board and the proposed Naturopathy Advisory Board the authority
to require adequate training before approving a collaborative
agreement. He expressed concern that [training] could be
"limitless." He suggested that the ability of naturopaths to
practice could be narrowed "if they have to chase an undefined
standard of training." He requested a comment to ensure this
would not be an impediment.
REPRESENTATIVE RUFFRIDGE responded that he has been in a
collaborative practice agreement, and from this experience he is
able to have a conversation at a "little higher level." He
stated that Representative Saddler's assessment is "astute." As
far as training is concerned, he stated that this language would
prevent any type of licensee in a collaborative practice
agreement from engaging in activities outside their scope of
practice. In example, he stated that under a collaborative
practice agreement [without a training requirement] a pharmacist
may decide to do surgery. He offered the opinion that a
training requirement would not be an insurmountable barrier. He
reiterated that the training requirement would narrow the
ability of "carte blanche" authority.
4:07:15 PM
CHAIR PRAX maintained his objection. He expressed the opinion
that in practice, care providers would go beyond the minimum
requirement. He argued that training and testing are the same
for naturopaths as other medical professionals. He went on to
say specialists tend not to prescribe drugs outside of their
specialty. He said, "I think we're more concerned at the
governing level than we need to be. I think that this works
itself out in practice without being overly prescriptive or
overly restrictive." He added that this would need approval
from both the State Medical Board and the proposed Naturopathy
Advisory Board. He suggested that scheduling the board meetings
would be a significant barrier.
4:09:20 PM
REPRESENTATIVE RUFFRIDGE pointed out that the amendment is
large. He questioned whether committee members had time to
fully vet the amendment.
4:10:16 PM
A roll call vote was taken. Representatives McCormick,
Ruffridge, Saddler, Sumner, and Fields voted in favor of
Amendment 14 to HB 115, as amended. Representatives Mina and
Prax voted against it. Therefore, Amendment 14 was adopted by a
vote of 5-2.
4:11:24 PM
The committee took an at-ease from 4:11 p.m. to 4:12 p.m.
4:12:30 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 7 to HB 115,
as amended, labeled 33-LS0631\A.7, Bergerud, 4/10/23, which read
as follows:
Page 5, lines 8 - 15:
Delete all material.
CHAIR PRAX objected for the purpose of discussion.
4:12:43 PM
REPRESENTATIVE RUFFRIDGE [rhetorically] questioned why the
proposed legislation would have the department exempt
naturopaths from continuing education requirements. He
questioned the intention of this section in the proposed
legislation, arguing that if there is continuing education, a
standard should be set. He added that this is the reason for
the amendment.
4:13:45 PM
REPRESENTATIVE SUMNER stated that he supports the amendment;
however, he expressed confusion concerning educating naturopaths
in pain management when they are unable to prescribe these
drugs.
REPRESENTATIVE RUFFRIDGE responded that Amendment 15 would
address the question.
4:14:43 PM
CHAIR PRAX, in reference to the proposed Naturopathy Advisory
Board being a regulatory board, questioned whether DCCED would
be required to make any decisions concerning naturopaths.
REPRESENTATIVE RUFFRIDGE responded that the department would
not. He stated that the board would establish the continuing
education requirements licensees would have to meet. He
continued that the department would play a major role in the
renewal of licenses, which would ensure continuing education
requirements are met. He stated that he cannot speak to the
exact mechanism for the continuing education aspect.
4:16:25 PM
MS. SAVIERS, in response to Chair Prax, stated she would need to
look at each program to understand whether there are [continuing
education] exemptions for other professions. She stated this is
not a common practice, but she would research and provide a
follow-up answer to the committee.
4:17:27 PM
REPRESENTATIVE SADDLER questioned whether requiring continuing
education for naturopaths would be difficult, as opposed to
physician assistants.
MS. SAVIERS responded that because naturopaths currently do not
have continuing education, she cannot speak to this. She stated
that the proposed legislation, in its current form, would set
the same medical board standards for naturopaths as for
physician assistants.
REPRESENTATIVE SADDLER expressed the concern that translating
the requirements from physician assistants to naturopaths would
be difficult.
4:18:56 PM
CHAIR PRAX objected to Amendment 7. He expressed the opinion
that statutes should not be overly prescriptive, as extenuating
circumstances cannot be known. He expressed trust in both the
department and the board to make good judgments.
4:19:43 PM
A roll call vote was taken. Representatives Mina, McCormick,
Ruffridge, Saddler, Sumner, and Fields voted in favor of
Amendment 7 to HB 115, as amended. Representative Prax voted
against it. Therefore, Amendment 7 was adopted by a vote of 6-
1.
4:20:24 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 8 to HB 115,
as amended, labeled 33-LS0631\A.8, Bergerud, 4/10/23, which read
as follows:
Page 5, line 24, following "patient;":
Insert "and"
Page 5, line 25:
Delete all material.
Renumber the following paragraph accordingly.
4:20:32 PM
CHAIR PRAX objected for the purpose of discussion.
REPRESENTATIVE RUFFRIDGE stated that the current version of HB
115 would require naturopaths to have a current cardio pulmonary
resuscitation (CPR) certification when renewing licenses. He
voiced that naturopaths are well-trained care providers and
would not need a requirement in statute in order to be trained
in CPR. He stated that Amendment 8 would remove this language.
4:21:30 PM
MS. SAVIERS, in response to Representative Mina, stated that
dentists are required by statute to be trained in CPR; however,
dentistry is a different type of profession. She stated that
there are no other requirements in statute for health care
professionals of this type.
4:22:37 PM
CHAIR PRAX removed his objection. There being no further
objection, Amendment 8 was adopted.
4:23:16 PM
The committee took an at-ease from 4:23 p.m. to 4:24 p.m.
4:24:23 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 9 to HB 115,
as amended, labeled 33-LS0631\A.9, Bergerud, 4/10/23, which read
as follows:
Page 6, line 8:
Delete "whole gland substances,"
CHAIR PRAX objected for the purpose of discussion.
REPRESENTATIVE RUFFRIDGE stated that Amendment 9 would delete
"whole gland substances" in regard to prescribing and
administering preventative treatment in the practice of
naturopathy. He requested an explanation of this language for
the committee.
4:25:16 PM
DR. LUPER responded that whole gland medications are glands
which were processed in their entirety, then incapsulated. He
gave the example of Armor Thyroid. He stated that a thyroid
gland from a pig is processed, and a dosage is standardized. He
stated that this is used to treat hypothyroidism.
4:26:16 PM
REPRESENTATIVE RUFFRIDGE stated that removing "whole gland
substances" would clean up the language in HB 115, better
aligning the collaborative practice agreements for
prescriptions.
4:26:59 PM
REPRESENTATIVE SADDLER suggested that if Amendment 15 were
passed, the language would not present a problem. He questioned
whether glandular medications are esoteric or standardized
medicine.
REPRESENTATIVE RUFFRIDGE responded that Section 8 of the
proposed bill lists some of the things which would not fall
under a collaborative practice agreement for naturopaths. He
stated that if the language "whole gland substances" stays, it
would not be included in the collaborative authority language in
Amendment 15. Since whole gland substances and other examples
are not prescription drugs, he said, if Amendment 15 moves
forward, then these nonprescription medications should be
stricken from being under authority, instead of having a special
distinction.
4:29:16 PM
REPRESENTATIVE SADDLER, seeking confirmation of the reasoning,
surmised that "whole gland substances" would be covered under
other prescriptive authority, so they would not need to be
pointed out.
REPRESENTATIVE RUFFRIDGE responded in the affirmative.
4:29:50 PM
CHAIR PRAX questioned the distinction between whole gland
substances from a live animal and the prescription drug version.
REPRESENTATIVE RUFFRIDGE responded that while Armor Thyroid is
an example, the whole gland of a pig thyroid can be used in a
number of ways. It can be used as a prescription tablet or in
powder form in pharmaceutical compounding.
4:32:01 PM
A roll call vote was taken. Representatives Fields, Mina,
McCormick, Ruffridge, Saddler, and Sumner voted in favor of
Amendment 9 to HB 115, as amended. Representative Prax voted
against it. Therefore, Amendment 9 was adopted by a vote of 6-
1.
4:32:38 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 10 to HB 115,
as amended, labeled 33-LS0631\A.10, Bergerud, 4/10/23, to HB
115, as amended, which read as follows:
Page 6, line 13, following "vaccines;":
Insert "and"
Page 6, line 14:
Delete all material.
Reletter the following subparagraph accordingly.
REPRESENTATIVE FIELDS objected for the purpose of discussion.
REPRESENTATIVE RUFFRIDGE pointed out that, following the same
reasoning as the previous amendment, Amendment 10 would remove
the language "devices for contraception" from the proposed
legislation.
4:33:45 PM
REPRESENTATIVE RUFFRIDGE, in response to Representative Fields,
stated that "devices for contraception" would be covered under
shared authority.
4:34:46 PM
REPRESENTATIVE FIELDS removed his objection.
CHAIR PRAX objected to Amendment 10. He expressed disagreement
with using statutes to make requirements. He maintained that
the manufacturer of the contraceptive would require training,
and this control, along with other training, would be adequate.
4:35:48 PM
REPRESENTATIVE SADDLER questioned what would constitute a
contraceptive device.
REPRESENTATIVE RUFFRIDGE responded that the most common example
would be an intrauterine device (IUD). He stated that there can
be a variety of types, which can be prescribed in an office
setting or through a pharmacy.
REPRESENTATIVE SADDLER clarified that this would be a mechanical
device, as opposed to a biological treatment. He expressed the
opinion that naturopaths would not need to prescribe this, so it
should not be excluded.
REPRESENTATIVE RUFFRIDGE responded that it is not the intent of
any of the amendments to prohibit naturopaths from the ability
to prescribe. He stated that collaborative practice agreements
may narrow their ability; however, he reiterated that the
authority can be broad or narrow, whatever the agreement
determines. He stated that if this is included in the
collaborative practice agreement, then it would stand.
4:37:58 PM
REPRESENTATIVE SADDLER expressed the opinion that if every
aspect of practice is going to be governed by the collaborative
agreement, then the discussion would never end. He gave the
example of vaccines.
REPRESENTATIVE RUFFRIDGE responded that a few things can already
be prescribed, administered, and dispensed by naturopaths. He
stated that vaccines are an interesting dilemma. Although
vaccines are prescribed, he explained that in many cases they
are under a large collaborative practice. He stated that
vaccines are different from a true-prescriptive entity, and
Representative Saddler's argument is a valid one.
4:39:29 PM
REPRESENTATIVE FIELDS pointed out that naturopaths do
"superficial" procedures. He voiced that an IUD insertion would
not be considered "superficial." He stated that if this is not
within the scope of a naturopath's practice, then it should be
eliminated.
4:40:04 PM
REPRESENTATIVE MINA commented that Nexplanon is superficially
inserted in the arm. She stated that IUD manufacturers do not
allow unlicensed individuals to do the insertion. She stated
that naturopath training includes gynecological training, which
would be the same for other care professionals who do IUD
insertions. She offered the opinion that a collaborative
agreement would create a middle ground for this.
4:41:17 PM
REPRESENTATIVE FIELDS withdrew his objection.
CHAIR PRAX objected to Amendment 10.
4:41:31 PM
A roll call vote was taken. Representatives Sumner, Fields,
Mina, McCormick, Ruffridge, and Saddler voted in favor of
Amendment 10 to HB 115, as amended. Representative Prax voted
against it. Therefore, Amendment 10 was adopted by a vote of 6-
1.
4:42:07 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 12 to HB 115,
as amended, labeled 33-LS0631\A.12, Bergerud, 4/10/23, which
read as follows:
Page 7, lines 1 - 10:
Delete all material.
Renumber the following bill sections accordingly.
Page 16, line 14:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 15:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 17:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 18:
Delete "secs. 1 - 18"
Insert "secs. 1 - 17"
Page 16, line 25:
Delete "Section 20"
Insert "Section 19"
Page 16, line 26:
Delete "sec. 21"
Insert "sec. 20"
CHAIR PRAX objected for the purpose of discussion.
REPRESENTATIVE RUFFRIDGE stated that Amendment 12 would delete
Section 9 of the proposed legislation. He stated that if there
is a collaborative practice agreement in place, the section
would not be needed.
4:43:12 PM
REPRESENTATIVE MINA questioned the elimination of the
restriction on the use of the word "physician" in the proposed
legislation.
REPRESENTATIVE RUFFRIDGE responded that this is in the proposed
legislation for no reason other than "there is already, through
some of these amendments, a large number of somewhat naturally
occurring restrictions." He stated that if there is a
particular concern about the use of the word "physician" in the
amendment, this could be changed.
4:44:30 PM
REPRESENTATIVE FIELDS moved to adopt Conceptual Amendment 1 to
Amendment 12. He stated that the conceptual amendment would
address line 1 of Amendment 12, changing the language "page 7,
lines 1 10" to "page 7, lines 1 9". He expressed support
for the amendment, in that it achieves conformity with
previously adopted amendments; however, for clarity to
consumers, physicians have voiced support for the prohibition of
the use of the term "physician", and Conceptual Amendment 1
would leave this prohibition in the proposed legislation.
REPRESENTATIVE SUMNER objected to Conceptual Amendment 1. He
recommended that to achieve this intent, lines 1-3 should not be
deleted.
REPRESENTATIVE FIELDS interjected that Conceptual Amendment 1
would instead change "page 7, lines 1 10" to "page 7, lines 4
9". He opined that this would have the effect of applying
restrictions only on the practicing naturopaths, disallowing the
word "physician" in their title. He continued that the
remainder of the language would be stricken in conformity with
previously adopted amendments.
4:46:09 PM
REPRESENTATIVE SADDLER pointed out the "double negatives" in the
language. He stated that currently the language in the proposed
legislation directs that a naturopath is prohibited from
engaging in surgery. By deleting this language, he questioned
whether naturopaths would be allowed to engage in surgery.
REPRESENTATIVE RUFFRIDGE, in response, pointed out that what a
naturopath is allowed to do is listed on page 6, line 18 of the
proposed legislation. He continued that line 21 relates the
procedures naturopaths are not allowed to do. He stated that
the language in the new section already includes the language
from amended Section 9. In response to a follow up, he stated
that on line 8 of Amendment 14, controlled substances are
prohibited in a collaborative agreement.
4:49:18 PM
REPRESENTATIVE SUMNER withdrew his objection. There being no
further objection, Conceptual Amendment 1 to Amendment 12 was
adopted.
4:49:49 PM
CHAIR PRAX withdrew his objection to Amendment 12, as amended.
There being no further objection, Amendment 12, as amended, was
adopted.
4:50:15 PM
The committee took an at-ease from 4:50 p.m. to 4:51 p.m.
4:51:23 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 15 to HB 115,
as amended, labeled 33-LS0631\A.15, Bergerud, 4/10/23, which
read as follows:
Page 5, lines 3 - 7:
Delete "Continuing education requirements must be
equivalent to the continuing education requirements of
a physician assistant under AS 08.64.107 and must also
include a requirement that not less than two hours of
education in pain management and opioid use and
addiction be completed not more than two years before
the application for renewal"
Insert "The continuing education requirements
adopted by the department must include a requirement
that a licensee complete not less than 50 hours of
continuing education approved by the department within
the two-year period immediately preceding the
application for renewal"
CHAIR PRAX objected for the purpose of discussion.
REPRESENTATIVE RUFFRIDGE stated that Amendment 15 addresses the
continuing education requirements for naturopaths. He stated
that currently the continuing education requirements in the
proposed legislation are equivalent to the requirements for
physician assistants. He stated that the amendment would align
this with language adopted by the State Medical Board. He
stated that the licensee would be required to complete not less
than 50 hours every 2 years in continuing education. He stated
that the amendment would direct the department to adopt these
requirements.
4:52:55 PM
REPRESENTATIVE RUFFRIDGE, in response to Representative Saddler,
stated that continuing education requirements were discussed in
regard to [Amendment 7]; however, Amendment 15 would remove the
language concerning the education in pain management and opiate
use and insert new language concerning the education
requirements. In response to a follow-up question, he expressed
the understanding that the effect would increase the education
requirements.
4:54:17 PM
REPRESENTATIVE MINA questioned the continuing education
requirements for other relevant health care providers. She
questioned whether these requirements would be in statute or
regulation.
MS. SAVIERS responded that the continuing education requirements
are set by the board in regulation. Because the advisory board
was changed to a regulatory board, the continuing competency
requirements would be in regulation, as with the Board of
Nursing. She stated that the statute directs the board to
establish these in regulation.
4:55:28 PM
CHAIR PRAX referenced the statute on continuing education
standards for physician assistants. He stated that there is no
set amount of hours of education established in regulation,
rather it is left to the National Commission on Certification of
Physician Assistants.
REPRESENTATIVE SADDLER clarified that the effect of the
amendment would be to establish 50 hours of continuing education
for naturopaths. He stated that the department would set this
regulation. He questioned whether opioid use, pain management,
and addiction issues would be part of the continuing education.
REPRESENTATIVE RUFFRIDGE responded that, through this amendment
process, naturopaths would not be prescribing controlled
substances. He stated that the intent in the amendment "was to
say exactly as you said earlier, 'Why would we have someone
trained in opiates that does not prescribe opiates?'" However,
he stated that a "great" point was brought up regarding the
difference between an advisory and regulatory board, as some
things are better suited to be handled by regulation. He
suggested that the committee look at a regulatory board versus
an advisory board in regard to this amendment and potentially
other changes to HB 115, as amended.
4:58:18 PM
REPRESENTATIVE MINA questioned the requirements for continuing
education for the American Association of Naturopathic
Physicians.
DR. LUPER responded that the State of Oregon requires 35 hours a
year of continuing education. He stated that Arizona and
Washington require less than this. He continued that the hours
being discussed for Alaska are close to what these states
require.
4:59:16 PM
CHAIR PRAX proffered that Arizona has a 30-hour requirement.
4:59:56 PM
REPRESENTATIVE SADDLER questioned whether the language "adopted
by the department" in the amendment would imply regulations. He
acknowledged an affirmative response from Ms. Saviors.
5:00:25 PM
REPRESENTATIVE MINA commented that continuing education
requirements would be more appropriate in regulation, not
statute.
5:01:07 PM
REPRESENTATIVE MINA objected to Amendment 15.
5:01:12 PM
A roll call vote was taken. Representatives Saddler, Sumner,
Fields, McCormick, Ruffridge, and Prax voted in favor of
Amendment 15. Representative Mina voted against it. Therefore,
Amendment 15 was adopted by a vote of 6-1.
5:02:10 PM
CHAIR PRAX observed that Amendment 2 was "no longer needed."
[Amendment 2 was withdrawn.]
5:02:29 PM
CHAIR PRAX announced that HB 115, as amended, was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 115 A.1.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.2.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.3.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.5.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.7.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.8.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.9.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.10.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.11.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.12.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.13.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 A.15.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 96 Amendment_96_1.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 96 |
| HB 115 A.14.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |
| HB 115 CS Version S.pdf |
HHSS 4/11/2023 3:00:00 PM |
HB 115 |