Legislature(2023 - 2024)ANCH LIO DENALI Rm
12/05/2023 02:00 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB119 | |
| HB186 | |
| HB115 | |
| HB100 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 115 | TELECONFERENCED | |
| += | HB 100 | TELECONFERENCED | |
| *+ | HB 186 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 119 | TELECONFERENCED | |
HB 115-NATUROPATHS: LICENSING; PRACTICE
2:25:00 PM
CHAIR SUMNER announced that the next 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."
2:25:51 PM
REPRESENTATIVE PRAX, as prime sponsor, stated that the purpose
of HB 115 is to allow naturopaths to practice to the scope of
their training. He stated that currently they are trained to
prescribe drugs and do minor, in-office surgeries; however, they
are not allowed to do these things in Alaska. He explained that
the discussion to allow naturopaths to practice in this way in
the state has been ongoing for ten years. He pointed out that
in other states this is allowed, and evidence suggests that this
practice is viable. He deferred to the invited testimony.
2:27:40 PM
NATALIE WIGGINS, ND, Alaska Association of Naturopathic Doctors
(AKAND), gave invited testimony on HB 115. She stated that she
is representing AKAND in support of HB 115. She expressed the
opinion that this is in the best interest of Alaskan residents,
as medical costs are rising, which is directly affected by the
accessibility of care and the shortage of medical providers.
She said that naturopaths are ready to address this shortage;
however, their practice is hindered by limitations in the state.
She addressed the concerns of their qualifications by discussing
naturopaths' educational requirements. She stated that after
completing a bachelor's degree, a naturopath in the state would
then complete an accredited four-year doctoral program. She
stated that the training includes 140 hours of pharmacology and
1,120 hours of clinical training, which includes prescriptive
management and minor office procedures. She stated that this
training is commensurate with nurse practitioners, who have a
less restrictive scope of practice in the state, and it is more
training than physician assistants receive. She pointed out
that both nurse practitioners and physician assistants have
prescriptive authority. She argued that these restrictions
prohibit naturopaths from fully using their skills in the state.
She pointed out that HB 115 mirrors legislation in other states,
adding that she had practiced for many years in Arizona in the
full scope of her training. She stated that in Arizona she also
provided training to medical students and nurses and oversite to
physician assistants.
DR. WIGGINS stated that she returned to Alaska to raise her
family; however, this meant that she had to give up her practice
to the extent of her training. She argued that when she moved
back to Alaska, her certified medical experience did not go
away. She stated that in Alaska she is forced to refer patients
when they need medications. Because of the limited availability
of providers, she pointed out the long wait time for patients
before being seen, and she argued that this is an unnecessary
burden to the state's health care infrastructure. She argued
that the patients of naturopaths in the state need their doctors
to have the ability to prescribe medications and perform minor
office procedures; otherwise, these patients would need
duplicative office appointments. She reiterated that the
proposed legislation would help cushion the overwhelming health
care burden. In summary, she stated that there are about 45
licensed naturopathic doctors in the state who are qualified and
trained for prescriptive needs and minor office procedures.
2:35:34 PM
REPRESENTATIVE SADDLER questioned who trains the naturopaths.
DR. WIGGINS explained that clinical training is led by medical
doctors and naturopathic doctors.
2:37:08 PM
REPRESENTATIVE WRIGHT questioned whether there were any
instances during her work in Arizona which required another
doctor.
DR. WIGGINS stated that in Arizona her prescriptive authority
did not include chemotherapy. In response to a follow-up
question, she stated that in a primary care setting, there are
always times when patients need to be referred to other
specialists.
2:39:01 PM
CARRIE BALDWIN-SAYRE, ND, Director of Advanced Community
Engagement, National University of Natural Medicine (NUNM), gave
invited testimony on HB 115. She addressed the education and
training completed by naturopathic physicians at NUNM. To
become a licensed naturopathic physician, she said that an
individual must attend an accredited naturopathic medical school
overseen by the US Department of Education. She added that NUNM
is overseen by both programmatic accreditors and a regional
institutional accreditor. She stated that this regional
institutional accreditor sets the standards for curriculum
delivery, performance outcomes, financial stability of the
institution, and more. She added that this is the same
accreditor which oversees the University of Alaska's program.
DR. BALDWIN-SAYRE stated that the naturopathic medical program
at NUNM is a four-year graduate program, and it includes
approximately 5,047 hours of education and 1,254 hours of direct
clinical exposure. She said that this program is comparable to
the education requirements for many other medical providers, and
admissions requirements are nearly identical to the
prerequisites for any other medical doctor program in the
country.
DR. BALDWIN-SAYRE described the first two years of academic
education at NUNM for naturopaths, which includes a foundation
in human sciences and extensive study in diagnostic methods and
procedures. She stated that students are measured by the
biomedical science national board exam. She stated that the
second two years of the program focuses on clinical
applications, with courses providing a framework for developing
graduates into primary care physicians. Students also take
courses on disease management and prevention using nutrition,
lifestyle counseling, botanical medicine, pharmaceutical
prescribing, and minor surgery. Students complete nearly 1,300
hours of direct clinical training and must pass three hands-on
clinical examinations to graduate, and this includes a full year
with their own patient load. In addition to graduation from an
accredited institution, to become eligible for licensure, all
candidates must pass two national board examinations.
DR. BALDWIN-SAYRE, in summary, highlighted that naturopathic
medical colleges prepares graduates to be competent, safe, and
effective healthcare providers who can assess the primary care
needs of their patients, particularly in medically underserved
states. She advised that allowing naturopaths to have
prescriptive authority and the ability to perform minor office
procedures would be a low risk in relation to the existing scope
of their practice, as this is well within the confines of their
training. She added that this would help keep the cost for
patients down, as it avoids multiple office visits.
2:45:32 PM
CLYDE JENSEN, PhD, MS, Professor of Pharmacology, College of
Osteopathic Medicine, Rocky Vista University, provided invited
testimony on HB 115. He shared his credentials, which includes
being a professor of naturopathic medicine. He said he was
present today to offer his expertise. He explained that
pharmacology is the study of how drugs work, when the drugs
should be used, and any side effects the drugs may have. He
stated that medical professional study pharmacology in
preparation for prescribing drugs. He testified that the
pharmacology taught to medical doctors, naturopaths, and
osteopaths is identical in quality, hours, and intensity. From
his experience, he stated that he has an overview of not only
the instruction but how the instruction will be utilized.
2:48:36 PM
SEAN HIGGINS, MD, Emergency Room Physician, Alaska Regional
Hospital, provided invited testimony on HB 115. He shared that
before his practice in Alaska he had worked in Seattle, where
naturopaths are permitted to work in a broader scope which
better represents their skill set and training. He addressed
the shortage in health providers in Alaska, and he advised that
this results in more trips to the emergency room. He stated
that about 30 percent of cases seen in emergency rooms should be
handled by a primary care physician, and he listed many of these
conditions. He pointed out that this equates to expensive and
unnecessary bills for patients and a strain on emergency room
resources and staff. He argued that this is forcing emergency
room doctors to practice primary care, which is outside of their
scope of practice. He continued that allowing naturopaths to
practice to the extent of their training would increase the
number of primary care givers in Alaska. He reiterated the
qualifications of naturopaths. He noted that he has witnessed
naturopaths prescribe medications and perform minor procedures
safely and effectively in Washington, and he said that he is
"baffled" that they cannot do this in Alaska. He referenced the
preventative medicines that naturopaths provide.
2:53:19 PM
ROB DOWNEY, MD, Seaworthy Functional Medicine, South Peninsula
Hospital, provided invited testimony on HB 115. He shared that
he has worked alongside many naturopathic doctors for the past
17 years, and he conveyed respect in speaking on behalf of these
doctors. He reiterated naturopaths are properly trained to
administer prescription drugs and perform minor procedures. He
recommended that the proposed legislation be passed. He shared
that he has been a medical doctor with 23 years of experience in
family practice and 17 years of experience providing functional
medicine, which is like naturopathic medicine for medical
doctors. He added that he has also been a medical facility
administrator. He expressed respect for his colleagues who are
naturopaths in Alaska. He noted the irony in withholding these
privileges from naturopaths, as these doctors tend to be more
careful in recommending the use of medication.
DR. DOWNEY estimated that only 35 percent of existing medical
care needs are being met in Alaska. Referencing the 65 percent
of medical needs in communities not being met, he provided
examples of how naturopaths could help. He expressed
understanding why members of the conventional medical community
could be alarmed by the proposed legislation, as this medical
community culture is philosophically conservative and "feel the
safest protecting the status quo." However, he continued that
this attitude is leaving needs unmet, failing to match available
resources with qualified providers. He expressed the opinion
that the medical community would be "relieved" once this service
is witnessed. He argued that it is time for naturopathic
doctors to be able to prescribe medicine and to do the minor
procedures that they are trained for.
2:59:49 PM
SCOTT LUPER, ND, Alaska Association of Naturopathic Doctors,
provided invited testimony on HB 115. He stated that he has
been practicing for 35 years in the state. In reference to
students studying naturopathic medicine, he said that these
students are required to be supervised by licensed naturopathic
doctors and medical doctors. He argued that the passage of HB
115 would bring the practice of naturopaths in line with their
training and education, which is in primary care, and this is
important because of the need of primary care doctors in Alaska.
He expressed the opinion that the competency of naturopaths is
reflected in the low rate of complaints across the nation and
the low cost of malpractice insurance in licensed states. He
said that the opposition to the proposed legislation comes from
the Alaska State Medical Association. He pointed out that other
medical providers, such as nurse practitioners and osteopaths,
have all stood in this same position against the medical
association in the state. He urged the passage of HB 115.
3:03:23 PM
REPRESENTATIVE PRAX thanked the committee. He said work was
done to provide documentation around the legislation, and he
encouraged members to review these materials.
3:04:35 PM
CHAIR SUMNER announced that HB 115 was held over.