Legislature(2011 - 2012)BARNES 124
03/11/2011 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB118 | |
| HB122 | |
| HB155 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 155 | TELECONFERENCED | |
| += | HB 122 | TELECONFERENCED | |
| += | HB 118 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 122-NATUROPATHS
3:53:13 PM
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 122, "An Act relating to naturopaths and to the
practice of naturopathy; establishing an Alaska Naturopathic
Medical Board; authorizing medical assistance program coverage
of naturopathic services; amending the definition of 'practice
of medicine'; and providing for an effective date."
3:53:34 PM
TOM GOODE stated he has been treated by a Naturopathic Doctor
(ND) for the past eight years and expressed his preference for
the naturopathic approach to medicine. He related that
scientific research has been discovering the role nutritional
deficiencies plays in disease. The ND is one who has
extensively studied nutrition whereas 50 percent of medical
schools do not require any nutritional courses to graduate as a
medical doctor (MD). The other 50 percent of medical schools
only require one semester in nutrition, he said. The ND uses
prescription drugs as a last resort, but if all else fails and
they are necessary he would prefer the drugs were prescribed by
his ND. He related a scenario in which he went to the doctor
but was treated by a physician's assistant. He finds it ironic
that physician assistants can treat and prescribe drugs whereas
NDs cannot. He suggested an independent board consisting of
skilled NDs should govern the practice of Naturopathic
profession in Alaska.
3:55:17 PM
KATY SHERIDAN, Physician; Member, Alaska Academy of Family
Physicians (AKAFP), stated she is a lifelong Alaskan who has
practiced family practice medicine in Soldotna for 15 years and
also represents the AKAFP today. She identified three areas she
would address, including patient safety, issues raised during
the prior hearing, and the future of health care in Alaska. She
advised that the AKAFP opposes HB 122, primarily due to concerns
for patient safety and quality of care in Alaska. She recalled
in medical school the saying, "You won't make the diagnosis if
you don't think of the disease." He expressed concern with the
limited training that Naturopaths receive especially in disease
process and treatment of chronic disease. She said it is one
thing to optimize health with nutrition and exercise but it is
another to be ruling out serious disease and planning treatment
for chronic problems. While she would be the first to admit
that allopathic medicine does not have all the answers and
complementary and alternative medicine also have a place, she
thought this bill goes too far to empower naturopaths to
practice beyond their training. She referred to a graph in
members' packets that shows the different in training between
family physicians and naturopaths. She pointed out that family
physician's training is similar to pediatricians and internists,
who also practice primary care medicine. She expressed
significant concern since the bill would allow naturopaths to
prescribe medications, perform preventative and screening
physicals, all of which are opportunities to identify diseases
and develop protocols for preventive care for patients. She
related that the lack of hours of education in disease process
and chronic disease management limits the naturopaths' ability
to provide comprehensive care.
3:58:08 PM
DR. SHERIDAN offered her belief that HB 122 would compromise
health care in Alaska. She recalled earlier testimony on the
bill suggesting that other states have similar bills pending to
allow for NDs to prescribe medicine. She clarified that only
eight states have policies for prescribing and only for natural
substances pursuant to a physician's protocol. Several states
do allow NDs with "birth privileges" to administer some that
deliver can prescribe pitocin and antihemorrhagic drug drugs
pursuant to protocols. In fact, only a few states allow
prescription ability for NDs and then only with limited
guidelines. She recalled testimony that naturopaths focus on
preventive care. As a family physician, she spent considerable
hours of training and continues to provide many hours providing
preventive care counseling and education for her patients. She
recalled testimony that some patients did not have good
experiences with allopathic medicine, but she did not think this
is the norm. The future of health care and the concept of
health care homes necessitate the care that must be given when
considering dispensing rights. She stressed the importance of
considering what constitutes a quality provider to provide full
spectrum health care home needs. She emphasized that empowering
health who are only qualified to care for a portion of a
person's health and not necessarily all aspects could set
ourselves up for reduced levels of health care homes for the
future. She urged members to examine who they would want caring
for their families.
DR. SHERIDAN summarized that the AKAFP strongly oppose the bill
as written primarily on the basis of patient safety and quality
care issues and for the future of health care systems that will
be established for the health care delivery system in Alaska.
4:01:43 PM
REPRESENTATIVE MILLER asked how much training a medical doctor
has in pharmacology or prescribing drugs in the market.
DR. SHERIDAN answered that the number of classes in medical
school addressing pharmacology and medications varies but
medical school also addresses diseases and medications.
Physicians frequently address medical management during their
residency, experience, and continuing education. She related
that medications continually change in health care so MDs must
keep current on the latest medications and potential side
effects. She reported that medical doctors must have 50 hours
of continuing education each year to keep their medical license
current and spend a large portion of their time reviewing
medications.
4:03:15 PM
REPRESENTATIVE MILLER asked for clarification on the source of
information that MDs use to keep current on medications.
DR. SHERIDAN related that the sources of information physicians
use varies but many physicians use electronic sources and pocket
information with the latest downloads. Many physicians confer
with pharmacies and keep current on medications through ongoing
continuing education. She also performs research at the bedside
using technology since medications continually change. She
concluded that the reality is that physicians spend a lot of
time addressing medications.
4:04:47 PM
REPRESENTATIVE MILLER asked where the "body of information
resides" and whether that information would also be available to
all MDs or NDs.
DR. SHERIDAN answered probably much of the information is
available to the public. Many MDs subscribe to UpToDate, which
is an electronic scientific information resource. However, she
stressed the importance that the person reading the information
must have some understanding of how a medication works on the
body or on a particular disease process. Some of this
information can be pretty difficult and challenging to
understand, she said.
REPRESENTATIVE MILLER asked for clarification on the source of
information.
DR. SHERIDAN answered that some scientific forum called
"UpToDate" collects and compiles it.
4:06:28 PM
REPRESENTATIVE SADDLER asked for clarification on the current
standard of care for MDs and NDs in society. He asked how this
would change under the bill.
DR. SHERIDAN answered that would happen through peer pressure.
She related a scenario in which in which someone has a stroke in
Soldotna and ends up in the hospital. The standard of care
would be that the physician would perform an appropriate stroke
work up, including disease modifying treatment for that patient,
depending on the findings. If the patient resides in a more
remote place in Alaska it may be that the standard of care may
also be different. She explained that some communities may have
certain tests readily available or not available, such as a CAT
scans. Thus, the standard of care depends on the resources
available in a community and the other physicians available.
DR. SHERIDAN elaborated that if someone did not provide the
standard of care, mechanisms are available in the hospital to
review and address the matter. She stated that NDs are not lay
midwives. In Soldotna, some people practice midwifery and their
standards may be different from physicians delivering babies in
hospital settings. She highlighted her concern that if NDs are
empowered to prescribe and provide preventive screening the
standard may be lowered since the NDs may provide a different
level of care. She said she has observed this happen with lay
midwives since treatment is given that would not be considered
medically appropriate by MDs, but the physicians have limited
recourse over midwifery practice. She said, "That's a very
serious concern of those of us practicing medicine, especially
in smaller communities in Alaska."
4:09:20 PM
REPRESENTATIVE SADDLER related his understanding that the
standard of care is a community-based descriptive rather than an
objective standard.
DR. SHERIDAN agreed. She stated that Americans have developed a
level of care based on television and the Internet so they have
expectations for a higher level of care. However, it can be
community dependent, she said.
REPRESENTATIVE SADDLER asked whether the standard of care as
practiced by NDs would be factored in to the overall standard of
care and would possibly tend to dilute the level of the standard
of care.
DR. SHERIDAN agreed that would be the AKAFP's concern.
4:10:23 PM
MARION GRANDHOME, Physician, Family Practice Physician, related
that she wanted to echo Dr. Sheridan's comments. She stated
that she is speaking in opposition to HB 122. She expressed
concern about patient safety. She said, "We support
supervision. We support naturopaths but we also strongly
believe in aligning medical providers' scope of practice
appropriately to their training." She indicated that
naturopaths and family physician's training are different in
volume and substance. The average family physician has
completed approximately 21,000 hours of training prior to
practice whereas naturopaths have only completed approximately
6,000 hours. The typical family physician has had five years of
clinical practice in the clinic, hospital, and emergency room
ordering, interpreting labs and X-rays, performing procedures,
and prescribing medication. The typical naturopath spends a
year or less in clinical training, which is necessarily focused
on naturopathic treatments. She questioned whether they have
experience to safely order intravenous therapy or IV therapy or
X-rays. This bill would leave the door open to prescribing
medications which she also questioned. She related that her
specific concerns surround pre-employment school and workplace
physicals, since someone without adequate training could miss
risks. She highlighted that bus drivers and pilots may have
deficits in vision or hearing or low-blood sugar caused by
diabetes or seizures from an uncontrolled seizure disorder. She
pointed out that school sports physicals must evaluate students
for heart disease before sports participation. She remarked on
the tuberculosis outbreak in Southwest Alaska and questioned
whether NDs could identify these risks for personal and public
safety.
4:12:42 PM
DR. GRANDHOME stated that she received five years of training in
IV therapy. She related that starting IVs, prescribing IV
therapy, has serious potential and could easily kill a person by
giving IV saline solution at too high a concentration or too
fast a rate. She referred to a letter from the Osteopaths in
members' packets that indicated 93 percent of the public prefer
the term physician to be limited to licensed medical doctors.
She indicated that it is critical patients know the
qualifications of the person treating them. She concluded by
stating that traditional and naturopathic practices can be
complementary can coexist. However, it is critical for public
safety that all providers are appropriately limited to the scope
of practice consistent with their training.
4:13:35 PM
CHAIR OLSON, after first determining no one else wished to
testify, closed public testimony on HB 122.
[HB 122 was held over.]
4:13:55 PM
The committee took an at-ease from 4:13 p.m. to 4:15 p.m.