Legislature(2023 - 2024)BARNES 124
01/22/2024 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB143 | |
| HB115 | |
| HB192 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 115 | TELECONFERENCED | |
| *+ | HB 192 | TELECONFERENCED | |
| += | HB 143 | TELECONFERENCED | |
| += | HB 159 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 115-NATUROPATHS: LICENSING; PRACTICE
3:28:47 PM
[Due to technical difficulties, some audio following the call
back to order was not captured on the recording but information
from the secretary's log notes was provided.]
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."
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 1 to HB 115,
labeled 33-LS0631\A.2, Bergarud, 4/10/23, which read as follows:
Page 1, line 1:
Delete "Advisory"
Page 2, line 16:
Delete "Advisory"
Delete "Advisory"
REPRESENTATIVE PRAX objected for purposes of discussion.
3:33:22 PM
REPRESENTATIVE RUFFRIDGE spoke to Amendment 1. He explained
that a full-fledged board would better suit the ability of
naturopaths to function in line with other medical providers in
the state. The amendment simply would remove the word
"advisory" and would propose establishing a full functioning
board for naturopaths.
3:33:59 PM
CHAIR SUMNER noted that the Director of Division of
Corporations, Business, and Professional Licensing, Sylvan Robb,
was available to answer questions.
3:34:16 PM
REPRESENTATIVE CARRICK asked whether Ms. Sylvan could enumerate
some of the differences between an advisory and a full board.
She queried Representative Ruffridge regarding whether there are
any professional boards in the state of Alaska that are of this
type that are advisory right now and where this board would fall
with this amendment in relation to other boards of this type.
3:34:59 PM
REPRESENTATIVE RUFFRIDGE deferred to Director Robb but commented
that advisory boards are within her capacity to manage.
However, as far as medical provider status, there is no advisory
board that allows full prescriptive authority.
3:35:28 PM
SYLVAN ROBB, Director of Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community, and
Economic Development, in answer to Representative Carrick's
question stated that her division currently did not have any
advisory boards in the division.
REPRESENTATIVE CARRICK requested that Ms. Robb enumerate the
differences between an advisory board and a full board in terms
of authority that is granted.
MS. ROBB explained that the division has 21 regulatory boards
invested with the powers that are given to them in statute. She
provided examples of the powers granted by statute. An advisory
board on the other hand, is less of a policy making body and
more of an advisory body.
3:36:59 PM
REPRESENTATIVE SADDLER pointed out the amendment proposes
changing the name, but there apparently are no other changes in
function, so it is unclear what changing the name actually
accomplishes.
MS. ROBB deferred to the maker of the amendment.
3:37:47 PM
REPRESENTATIVE PRAX asked whether the department has any opinion
or recommendation regarding the advisability of a policy making
board as opposed to an advisory board. He questioned whether
the department can take on the regulatory power of the board.
3:38:22 PM
MS. ROBB explained that currently there are 21 different
programs covering approximately 80 professions where there is no
board, and the division provides regulatory oversight. This
would be similar, but it would be an enhanced situation because
there would be a formal advisory board. She discussed concerns
with a board in a small profession. In 2023 there were only 56
licensed naturopaths in Alaska. The expenses incurred by the
board would fall on the members of the profession. She
commented that although Alaska is a large area, it is like a
small town where people in a particular profession know each
other. She gave an example of a board of similar size where the
members "conflicted out" of a disciplinary matter because they
all knew each other.
REPRESENTATIVE PRAX asked whether decisions get delayed because
of lack of a quorum.
MS. ROBB explained that some boards have struggled to achieve a
quorum, so business is delayed. Licensing and discipline
matters are similarly delayed.
REPRESENTATIVE PRAX questioned whether that would generally be
weeks or months.
MS. ROBB stated that the frequency depends on the composition of
the board and changes in the board over time. A meeting can't
be scheduled for the next day because of the Open Meetings Act.
REPRESENTATIVE PRAX asked whether the department is accountable
to the governor, an elected official, and to the legislature, a
group of elected officials, whereas boards are less accountable.
MS. ROBB replied in the affirmative.
3:42:07 PM
REPRESENTATIVE RUFFRIDGE asked whether there are any professions
with prescriptive authority in the state that do not have a
regulatory board.
MS. ROBB said there are none.
3:42:44 PM
REPRESENTATIVE SADDLER explained that he was still not sure that
changing the name from advisory board to board imparts any
regulatory authority and at this point seems like window
dressing.
REPRESENTATIVE RUFFRIDGE stated that there were big differences
between an advisory board and a naturopathy board. Moving
forward, depending on the wishes of the committee, they could
clean up language in section B regarding the commissioner having
oversight.
REPRESENTATIVE SADDLER asked Ms. Robb whether there was a
definition of board versus advisory board. He mentioned that he
did not see a change in the function of the two boards.
3:44:19 PM
MS. ROBB explained that without giving the board powers, the
board would remain mostly advisory.
REPRESENTATIVE SADDLER reiterated that it seemed there was no
real effect to the amendment.
3:44:49 PM
REPRESENTATIVE PRAX commented that he supposed the answer was
literally "no," but if someone starts to think about this
somewhere in the future, the intent needs to be clear. He
explained his real concern is that boards could make it more
difficult to get into the profession. He doesn't mind seeing a
board advising an official that works for the government that
works for elected officials. He reiterated his concern that a
board would, to some degree, have a conflict of interest with
people who might want to get into the profession.
3:46:00 PM
REPRESENTATIVE FIELDS pointed out that if the legislature were
to create a board with real powers, then the intent would be
clear. If it is a board, then implicitly the costs would be
user fees rather than coming from the general fund.
3:46:28 PM
REPRESENTATIVE RUFFRIDGE explained that the intent is to make
this a full regulatory board with prescriptive authority similar
to other medical professions in the state. In response to
Representative Saddler's questions, he suggested the possibility
of adding to the amendment a removal of the language in
[subsection](b) which would clarify that. Then in
[subsection](c), changing the language from, serving "at the
pleasure of the commissioner" to, serving "at the pleasure of
the Governor". He added he thought this was an appropriate
place to have the discussion of what is an advisory board versus
what is a full-fledged regulatory board.
3:47:40 PM
REPRESENTATIVE FIELDS said the bill significantly expands the
scope of naturopathy as it overlaps with doctors and
pharmacists. Therefore, it seems that creating a more
expansive, almost new profession, it would seem strange to have
regulatory authority over two professions but not over
naturopaths who in some cases do the same procedures. For that
reason, he supports Amendment 1.
3:48:19 PM
The committee took an at-ease from 3:48 p.m. to 4:01 p.m.
4:01:41 PM
REPRESENTATIVE RUFFRIDGE moved Conceptual Amendment 1 to
Amendment 1, to delete [subsection (b) in Section 2 on page 2
line 18-21 and inserting the following: "The board may adopt
regulations necessary to carry into effect the provisions of
this chapter." Then, on page 2, line 23, delete "commissioner"
and insert "governor". The intent would be to form a
naturopathy board as a regulatory board instead of an advisory
board.
4:02:37 PM
REPRESENTATIVE SUMNER asked about making conforming changes.
REPRESENTATIVE RUFFRIDGE replied that it would be open to
Legislative Legal Services to make any conforming changes as
needed.
4:02:53 PM
REPRESENTATIVE PRAX objected to Conceptional Amendment 1 to
Amendment 1. He did not think spending only five minutes
considering the issue in a committee hearing was a good idea.
As a matter of process, if the committee or someone else wants
to make these changes, they could be considered in the House
Rules Standing Committee. He opined that it should be the
elected officials or somebody under the authority above the
elected officials that should be making the rules, not a
specific group which "the boards end up being." He suggested
that a group of citizens could advise, but it should be the
commissioner or the director who have the legal authority to do
this. He noted that the governor has sent the legislature
several executive orders to get rid of boards which, he opined,
are slowing down opening Alaska for business and protect their
own interest first. That is not necessarily in the public's
interest. He advocated limiting the board to an advisory
function rather than giving regulatory authority.
4:05:50 PM
REPRESENTATIVE SADDLER spoke to his colleague's objection,
explaining that his reading of the statutes is that other boards
that are regulatory boards have fully defined powers and duties.
This rather expansive bill purports to expand the scope and
practice for naturopaths. He suggested that there should be
some side boards regarding the duties and responsibilities for
this board rather than simply allowing it to adopt regulations.
He explained that was the source of his discomfort for this
bill.
4:06:35 PM
A roll call vote was taken on Conceptual Amendment number 1 to
Amendment 1. Representatives Ruffridge, Wright, Carrick,
Fields, and Sumner voted in favor of Conceptual Amendment 1 to
Amendment 1. Representatives Prax and Saddler voted against it.
Therefore, Conceptual Amendment 1 to Amendment 1 was adopted by
a vote of 5-2.
4:07:34 PM
A roll call vote was taken on Amendment 1 as amended.
Representatives Carrick, Fields, Ruffridge, Wright, and Sumner
voted in favor of Amendment 1, as amended. Representatives Prax
and Saddler voted against it. Therefore, Amendment number 1, as
amended, was adopted by a vote of 5-2.
4:08:03 PM
CHAIR SUMNER opened public testimony on HB 115, as amended.
4:08:50 PM
BRUCE CAMPBELL, representing self, spoke in support of HB 115.
He explained that he values naturopathic care and believes the
bill is an important update to statutes allowing naturopathic
doctors (NDs) to practice at their level of training. He
described a personal experience regarding using pre- and post-
surgery supplements following the instructions of an ND.
4:10:14 PM
WAYNE ADERHOLD, representing self, spoke in support of support
HB 115. He explained that he has used NDs in collaboration with
other licensed medical providers since 1993. He also served on
the state chiropractic board. He is a strong advocate of
patient-centered care. He described the process for
applications and the statutes regulating naturopathic doctors.
He opined that HB 115 is in the public's interest.
4:12:48 PM
MARY ANNE FOLAND, MD, representing self, Alaska State Medical
Association, explained that she is a family practice physician,
and she opposes this expansion of scope of practice. She said
that the Alaska State Medical Association, the Alaska Academy of
Family Physicians, and the American Medical Association (AMA)
all oppose expansion, but there has never been an effort to
restrict collaborative use. It is about patient safety. An
apprenticeship is not the same as a post-graduate residency.
She gave three scenarios in which naturopathy had negative
results. She described HB 115 as a Pandora's box with
irreversible impact on patient safety.
4:15:38 PM
ANNETTE O'CONNELL, representing self, spoke in support of HB
115. She explained that NDs are trained in the use of
prescriptive drugs and referenced several states that use this
format. She also pointed out the opioid epidemic was brought
about by well-trained MDs. She shared her personal experiences
regarding when physicians didn't help but naturopaths did.
4:18:03 PM
4:18:41 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, explained that the association opposes the
expansion of naturopath scope of practice in HB 115 to include
minor office procedures and prescriptive authority. She
compared the number of hours and types of training and residency
of physicians versus naturopathic doctors. She noted the lack
of specifics in the bill regarding what constitutes minor office
procedures. She questioned the safety of patients under a
naturopath's care.
4:20:29 PM
LISA MARTSOLF, representing self, explained that her family's
naturopath has been their primary care physician for 25 years.
She is confident of this model as a standard of care. She
appreciates the therapeutic care and wealth of information her
ND provides as well as the proactive care and treatment as
opposed to more invasive models of care.
4:21:39 PM
CHRISTINE SAGIN, representing self, described her work as a
family nurse practitioner for 17 years. She collaborates with
naturopaths and finds them to be competent and great primary
care physicians for their patients. She pointed out that there
are different personalities and different types of medicine for
different people. She finds that people who want naturopathic
medicine aren't getting what they need from traditional
medicine. She said HB 115 would allow more access to care.
4:23:36 PM
CHAIR SUMNER, after ascertaining there was no one else who
wished to testify, closed public testimony on HB 115, as
amended.
4:23:39 PM
REPRESENTATIVE RUFFRIDGE moved to report HB 115, as amended, out
of committee with individual recommendations and the
accompanying fiscal notes, and to allow Legislative Legal
Services to make any conforming changes, as necessary. There
being no objection, CSHB 115(L&C) was reported out of the House
Labor and Commerce Standing Committee.