05/13/2025 03:15 PM House HEALTH & SOCIAL SERVICES

                 HB 147-PRACTICE OF NATUROPATHY                                                                             
                                                                                                                                
3:27:27 PM                                                                                                                    
                                                                                                                                
CHAIR MINA  announced that  the next order  of business  would be                                                               
HOUSE  BILL  NO.  147,  "An  Act  relating  to  the  practice  of                                                               
naturopathy."                                                                                                                   
                                                                                                                                
CHAIR MINA opened public testimony on HB 147.                                                                                   
                                                                                                                                
3:27:56 PM                                                                                                                    
                                                                                                                                
AMBER FIGUEROA,  DO, representing  self, stated that  her younger                                                               
sister was  diagnosed with colon  cancer and died at  42, leaving                                                               
behind three children.  Her  sister's primary care provider was a                                                               
naturopath who  attributed her  anemia to a  heavy period.   When                                                               
her  sister sought  help through  traditional medicine  during an                                                               
emergency room visit, she was told  to follow up with her primary                                                               
care  provider,  whom Dr.  Figueroa  said  did  not know  how  to                                                               
navigate her  into the  Western medicine  system to  have various                                                               
procedures  related  to  the  cancer  performed.    According  to                                                               
Figueroa DO,  by the time her  sister's cancer was found,  it had                                                               
metastasized into  her liver and  abdomen.  Dr. Figueroa   stated                                                               
that while  her testimony was  not related  to whether or  not to                                                               
prescribe  naturopathy, it  highlighted  two points:   those  who                                                               
seek  naturopathy are  not looking  for prescription  medication;                                                               
and  she  does  not  prescribe these  remedies  not  because  she                                                               
doesn't think that  they work, but because she is  not trained in                                                               
naturopathy,  as   she  is  a   licensed  family   physician.  To                                                               
illustrate her second point, she  stated that despite having over                                                               
twenty  years  of training  in  pharmacology,  she is  constantly                                                               
looking   up  new   medicines   and   consulting  her   colleague                                                               
pharmacologist on them,  as pharmacology is "a  huge and changing                                                               
world, even for those of us  who have extensive education in it."                                                               
She stated  that if naturopaths  wanted to  prescribe traditional                                                               
medicine, they  should be trained  in Western medicine,  as there                                                               
exist several paths  of them to attain  the relevant credentials.                                                               
She  acknowledged  that  while there  is  a  healthcare  provider                                                               
shortage,  she does  not think  naturopaths offer  a solution  to                                                               
said  shortage.   She attributed  this belief  to losing  someone                                                               
whom she  says was untrained  in the medical profession,  and she                                                               
doesn't wish the same on anyone.                                                                                                
                                                                                                                                
3:30:18 PM                                                                                                                    
                                                                                                                                
SEAN HIGGINS, MD,   had his written testimony regarding HB 147                                                                  
read by Gene Therriault, as follows:                                                                                            
                                                                                                                                
     Good afternoon,  my name  is Sean Higgins,  I am  an ER                                                                    
     physician working in Alaska  Regional Hospital.  Before                                                                    
     becoming  an  Alaskan,  I  worked  in  several  medical                                                                    
     communities   in  Washington   State,  where   licensed                                                                    
     naturopaths were  permitted to work with  a broad scope                                                                    
     of practice.                                                                                                               
                                                                                                                                
     As an  ER doctor,  I am seeing  more and  more patients                                                                    
     come in for things that  should be managed by a primary                                                                    
     care  provider.    These  include  medication  refills,                                                                    
     antibiotics  for urinary  tract infections,  management                                                                    
     of  chronic ...  conditions such  as diabetes  and high                                                                    
     blood  pressure.   During a  typical shift,  I estimate                                                                    
     that around 30 percent of the  patients I see in the ER                                                                    
     are  for primary  care  related  medical concerns,  not                                                                    
     emergencies.                                                                                                               
                                                                                                                                
     This not only equates  to expensive and uncertain bills                                                                    
     for the  patient, but is  putting a huge strain  on our                                                                    
     staffing  and resources  in the  emergency  room.   Our                                                                    
     wait  times have  increased  tremendously and  patients                                                                    
     with  emergencies are  not  always  getting the  prompt                                                                    
     attention  they need.   The  shortage  of primary  care                                                                    
     providers  ...  forces  emergency medicine  doctors  to                                                                    
     practice on  the fringes or  even outside our  scope of                                                                    
     expertise.   Patients receiving primary care  in the ER                                                                    
     from  providers who  are not  trained  in primary  care                                                                    
     receive  a disservice.   The  lack  of consistency  and                                                                    
     follow-up  they  receive in  this  scenario  is not  in                                                                    
     alignment with ... the goals  and principles of primary                                                                    
     care.   This is all  detrimental to the patient  and to                                                                    
     Alaska.                                                                                                                    
                                                                                                                                
     Allowing  naturopathic  doctors   to  practice  to  the                                                                    
     extent of  their training will  increase the  amount of                                                                    
     primary  care  providers  in  Alaska.    It  will  give                                                                    
     patients more  access to  primary care,  thus relieving                                                                    
     the pressure on  emergency rooms.  I  have many working                                                                    
     professional relationships  with naturopathic providers                                                                    
     from   Alaska  and   Washington.     As  you've   heard                                                                    
     previously,  pharmaceutical   curriculum  at  four-year                                                                    
     doctoral   programs   for  naturopathic   medicine   is                                                                    
     comparable, or  maybe even identical, to  the courses I                                                                    
     took at the UVA  medical school for allopathic doctors.                                                                    
     These  providers  use  the  same  textbooks  and  study                                                                    
     programs ...  for their license  exams as I did.   I've                                                                    
     previously  witnessed  naturopathic  colleagues  manage                                                                    
     prescriptive  medication  safely   and  effectively  to                                                                    
     promote  primary  care  in Washington  patients.    I'm                                                                    
     baffled  that here  in  Alaska, naturopathic  providers                                                                    
     need  to  refer  their  patients  to  a  PA  [physician                                                                    
     assistant]  or  a  nurse  practitioner  for  medication                                                                    
     management when  I know that naturopathic  doctors have                                                                    
     more  rigorous and  lengthy training.   This  situation                                                                    
     defies logic.                                                                                                              
                                                                                                                                
     In my experience,  naturopathic doctors are thoughtful,                                                                    
     deliberate,   and  forward   thinking.     By  allowing                                                                    
     naturopathic doctors to practice  to the full extent of                                                                    
     their training,  you are  helping Alaskans  receive the                                                                    
     primary and  preventative care they need,  keeping them                                                                    
     healthier and out of the emergency room.                                                                                   
                                                                                                                                
     Thank You.                                                                                                                 
                                                                                                                                
3:34:06 PM                                                                                                                    
                                                                                                                                
COURTNEY BOWERS,  ND, Vermont  Naturopathic Doctors,  stated that                                                               
Vermont  and Alaska  were  similar  in that  both  suffer from  a                                                               
shortage  of  primary  care  providers.    In  response  to  this                                                               
shortage,  the Vermont  State Legislature  passed a  law allowing                                                               
naturopaths to prescribe medication  according to their training.                                                               
Prior to this action, naturopaths  had a limited formulary.  With                                                               
the  new  bill, naturopathic  doctors  are  required to  pass  an                                                               
additional  board examination  that consists  of their  first 100                                                               
prescriptions or first year of  prescriptions to be reviewed by a                                                               
supervising licensed medical provider  in good standing, licensed                                                               
naturopathic doctor,  or naturopathic  doctor with at  least five                                                               
years   of  prescribing   experience   under  full   prescription                                                               
authority.     She   drew  upon   her  own   experience  of   the                                                               
certification process  for illustration  purposes.   According to                                                               
her testimony, the  passage of the bill did not  correspond to an                                                               
increase   in    complaints   to   medical    doctors   regarding                                                               
prescriptions, which she attested to  as the appointed advisor to                                                               
her  state's Office  of Professional  Regulation, which  oversees                                                               
her profession.  She continued,  stating that she  has not  had a                                                               
problem finding  a physician  that oversees  prescription review.                                                               
She  said  that  the  bill  had  been  incredibly  successful  in                                                               
providing primary  care to patients,  as services allowed  by the                                                               
bill  provided a  means by  which  patients could  be matched  to                                                               
appropriate medication  and for naturopathic doctors  to practice                                                               
to their fullest scope of expertise.                                                                                            
                                                                                                                                
3:36:59 PM                                                                                                                    
                                                                                                                                
NATALIE WIGGINS, ND, Alaska  Association of Naturopathic Doctors,                                                               
began  her  testimony  by  expressing   her  condolences  to  Dr.                                                               
Figueroa  over  the death  of  her  sister.   She  expressed  her                                                               
concerns  with testimonies  like Dr.  Figueroa,   as  there is  a                                                               
misnomer between  someone who is  a licensed  naturopathic doctor                                                               
and  someone who  refers  to  themselves as  a  naturopath.   The                                                               
difference between the  two is that naturopaths do  not have much                                                               
in the  way of  rigorous course  of study  or oversight  and that                                                               
naturopathic  doctors  by  contrast   are  trained  primarily  as                                                               
primary care providers.  This  gives the latter the knowledge and                                                               
experience  to  navigate  the  healthcare  system,  make  careful                                                               
diagnoses, and  thus prescribe medication.   She further  went on                                                               
to  say that  prescribing authority  is not  a "Western  medicine                                                               
modality, but it is a primary  care modality."  Thus, due to this                                                               
modality, and  that licensed naturopathic doctors  are trained in                                                               
pharmacology  in  ways  like  MDs, the  concerns  raised  by  Dr.                                                               
Figueroa testimony would not apply to this bill                                                                                 
                                                                                                                                
DR.  WIGGINS   stated  that   another  misnomer   in  discussions                                                               
surrounding  the prescribing  authority  of naturopathic  doctors                                                               
that nurse  practitioners (NPs) are  trained in  Western medicine                                                               
and   naturopaths  are   not.     Further,   there  are   various                                                               
similarities  between  NP  training  and  naturopathic  training,                                                               
especially  because   neither  requires   the  completion   of  a                                                               
residency and  that in  Alaska, nurse  practitioners have  a very                                                               
broad  scope  of practice  without  a  required residency.    She                                                               
continued, saying  that both Alaska  nurse practitioners  and NDs                                                               
have  faced  similar opposition  from  "a  very selective,  small                                                               
group  of MDs  in the  state  that have  a loud  voice" over  the                                                               
practices of each respective group.   She further stated that the                                                               
views  are  not representative  of  the  medical paradigm  within                                                               
Alaska  and that  the situation  has resulted  in a  "nonsensical                                                               
turf  war" between  both  naturopathic doctors  and  MDs and  has                                                               
taken from  efforts to address  the needs of patients  in Alaska.                                                               
She expressed support for the  expansion of prescribing authority                                                               
within  the  bill,  stating  that  it was  simply  an  update  to                                                               
existing   law  that   reflected  the   scope  of   training  for                                                               
naturopathic  doctors.  Drawing  on her  comparison  between  the                                                               
opposition  faced by  NPs and  NDs from  "some of  the select  MD                                                               
community," Dr. Wiggins  stated that when the  former group asked                                                               
for similar  authorities 24  years prior it  resulted in  NPs now                                                               
serving an  important role in  the health care system  in Alaska.                                                               
Thus, indicating the  evidence presented by both  Dr. Higgins and                                                               
Dr. Bowers,  as well as her  own work experience in  Arizona, Dr.                                                               
Wiggins stated  that naturopathic  doctors could serve  a similar                                                               
role.                                                                                                                           
                                                                                                                                
3:42:09 PM                                                                                                                    
                                                                                                                                
CHAIR  MINA,  after  ascertaining  that no  one  else  wished  to                                                               
testify, closed public testimony on HB 147.                                                                                     
                                                                                                                                
3:42:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GRAY commented that  since the state currently has                                                               
a shortage of  primary care providers, "rather  than having these                                                               
turf wars and saying, you  know, that this particular provider is                                                               
better  than  that  particular  provider,"  many  Alaskans  would                                                               
prefer to  see a naturopath  and that  their four year  course of                                                               
training was adequate for the  authorities the bill would provide                                                               
them.  Thus, he supported HB 147.                                                                                               
                                                                                                                                
3:43:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX, as prime sponsor of  HB 147, asked to hear a                                                               
question indicated by Representative Mears for Dr. Bowers.                                                                      
                                                                                                                                
3:43:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MEARS asked Dr. Bowers  a question pertaining to a                                                               
state agency providing oversight in Vermont.                                                                                    
                                                                                                                                
DR. BOWERS responded  that the agency that provided  that was the                                                               
Office  of Professional  Regulation  under the  authority of  the                                                               
Vermont Secretary of State that  oversees many professions, as it                                                               
provides licenses to said professions  when appropriate.  The way                                                               
these professions are managed leans  towards an advisor model, as                                                               
the secretary  of state overseeing  said office  appoints various                                                               
people  from  those  professions  to  a  committee  dealing  with                                                               
complaints  and concerns  over public  safety  specific to  their                                                               
profession.   Dr. Bowers  herself has been  serving on  the board                                                               
for  three  years and  has  not  had  one complaint  regarding  a                                                               
prescribing situation.                                                                                                          
                                                                                                                                
REPRESENTATIVE  MEARS  asked  Dr.  Bowers  a  follow-up  question                                                               
pertaining  to how  much of  a parallel  current State  Boards of                                                               
Medicine,  Midwives,  and Nurse  Practitioners  would  be to  the                                                               
board Dr.  Bowers is  describing or  if the  board Dr.  Bowers is                                                               
describing includes other professions.                                                                                          
                                                                                                                                
DR.  BOWERS  answered  that there  are  parallels  between  board                                                               
structures in  both states,  that this  structure is  provided by                                                               
the State  of Vermont, and  that she serves  on said board  as an                                                               
appointed volunteer.   She currently  serves alone on  the board,                                                               
though  others  could  serve  on it  later  should  resources  be                                                               
allocated by the legislature.                                                                                                   
                                                                                                                                
3:47:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX  asked if Rob  Sylvan was present and  if she                                                               
could  explain  how  naturopathic  doctor  prescribing  authority                                                               
could work with a supervisory board.                                                                                            
                                                                                                                                
3:48:01 PM                                                                                                                    
                                                                                                                                
SYLVAN ROBB,  Director, Division  of Corporations,  Business, and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic  Development, stated  that naturopathy  is a  profession                                                               
not  regulated  by the  board  but  rather  is regulated  by  the                                                               
division.   In response  to a  follow-up question,  she explained                                                               
that such  a complaint against naturopaths  would be investigated                                                               
by   division  affiliated,   certified  investigators,   and  the                                                               
division  would  assign  an appropriate  course  of  disciplinary                                                               
action  should a  violation be  found.   If such  action required                                                               
naturopathic knowledge, the board  would engage with a naturopath                                                               
to determine specific disciplinary action.                                                                                      
                                                                                                                                
3:49:57 PM                                                                                                                    
                                                                                                                                
CHAIR  MINA  asked  Ms.  Robb  which  other  professions  receive                                                               
similar regulatory oversight from  the division rather than their                                                               
own board.                                                                                                                      
                                                                                                                                
MS.  ROBB  answered  that there  are  several  professions  under                                                               
similar    oversight,    including   acupuncturist,    behavioral                                                               
analysist,   dietitians,    nutritionists,   athletic   trainers,                                                               
audiologists, and speech language pathologists.                                                                                 
                                                                                                                                
CHAIR  MINA  asked  Ms.  Robb  if  any  of  the  professions  she                                                               
mentioned  in  her  answer   to  Representative  Mears'  original                                                               
question have prescribing authority.                                                                                            
                                                                                                                                
MS. ROBB answered they do not.                                                                                                  
                                                                                                                                
3:51:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MEARS asked Ms. Robb  how the disciplinary process                                                               
for professions overseen directly by the division would work.                                                                   
                                                                                                                                
MS. ROBB answered that there  was no specific individual assigned                                                               
to each  case because of  a need  to avoid conflicts  of interest                                                               
with each  induvial case.   Beyond  those concerns,  the division                                                               
would then look for someone  with expertise in a specific subject                                                               
matter regarding  the case.   As  an example,  since the  bill in                                                               
question  concerns  the  prescribing  authority  of  naturopathic                                                               
doctors, investigators  assigned to a case  regarding a complaint                                                               
against   a  naturopathic   doctor   would   have  expertise   in                                                               
pharmacology.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  MEARS,  in follow-up,  asked  Ms.  Robb how  such                                                               
expertise would be  determined, and if a process for  doing so is                                                               
already in place or would need to be created.                                                                                   
                                                                                                                                
MS.  ROBB  replied  that  such  records  are  maintained  by  the                                                               
licensing  agency   and  that   investigators  are   referred  to                                                               
individual  cases by  other  professionals  within the  licensing                                                               
agency's database.                                                                                                              
                                                                                                                                
3:53:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX,   regarding  testimony  of   Dr.  Figueroa,                                                               
expressed his condolences  to Dr. Figueroa, stating  that both he                                                               
and his  wife were "shopping  around" for primary  care providers                                                               
when his wife  became interested in naturopathic  medicine.  They                                                               
were able to  find someone that was best suited  to both of their                                                               
needs, he emphasized  there can be, in both  naturopathic and the                                                               
"licensed medical"  profession, a great deal  of variability when                                                               
it  comes to  professional  ethics.   Representative Prax  stated                                                               
that  he hopes  that the  passage of  HB 147  provides a  "better                                                               
guideline" for  practitioners and  that the  public would  have a                                                               
greater  sense of  trust in  someone  who has  been certified  in                                                               
contrast to someone  who hasn't been certified.  In  doing so, he                                                               
argued that  the state medical  profession would be able  to "get                                                               
over some  of what really are  turf wars in many  of these cases"                                                               
and thus help the public access primary care.                                                                                   
                                                                                                                                
3:55:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRAY,   speaking  of   the  concerns   raised  by                                                               
Representative  Mears regarding  oversight,  stated  that he  had                                                               
several  questions as  to why  a  separate board  could not  have                                                               
oversight  over naturopathic  doctors.    He elaborated,  stating                                                               
that  various medical  boards  don't want  to  have oversight  of                                                               
naturopathic professionals.    Further, he stated  that there are                                                               
currently not  enough naturopathic doctors  in the state  for the                                                               
creation of  a separate board  to be created for  naturopathy. He                                                               
stated  that by  passing  HB  147, the  state  would  be able  to                                                               
attract more  qualified naturopaths,  and a  board could  thus be                                                               
created  later.   At such  a point,  the legislation  surrounding                                                               
naturopathy could be revisited in the future.                                                                                   
                                                                                                                                
3:56:51 PM                                                                                                                    
                                                                                                                                
CHAIR MINA  asked Ms. Robb  to confirm that  naturopathic doctors                                                               
were   currently  being   regulated  through   the  Division   of                                                               
Corporations, Business, and Professional Licensing                                                                              
                                                                                                                                
MS. ROBB responded that it is correct.                                                                                          
                                                                                                                                
CHAIR  MINA asked  how  many complaints  there  had been  against                                                               
naturopathic doctors  since naturopathic the profession  has been                                                               
under regulatory oversight.                                                                                                     
                                                                                                                                
MS. ROBB  answered that  she did  not have  a specific  number of                                                               
complaints  made against  naturopathic  doctors  since they  were                                                               
under such  regulatory oversight but could  give accurate figures                                                               
for the past  several fiscal years, which could be  sent to Chair                                                               
Mina later.                                                                                                                     
                                                                                                                                
CHAIR MINA  asked for the  specific number of complaints  for the                                                               
past fiscal year.                                                                                                               
                                                                                                                                
MS. ROBB stated that she would provide that information.                                                                        
                                                                                                                                
3:57:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SCHWANKE  expressed support for the  bill, stating                                                               
that  there   were  some  good   comments  made.     She  thanked                                                               
Representative Gray for pointing out  that there aren't that many                                                               
naturopathic  doctors in  Alaska,  and that  HB  147 offered  the                                                               
state  "an opportunity  to move  forward in  a positive  manner."                                                               
She further  expressed support for the  physician oversight, exam                                                               
requirements,  and the  continuing  education  provisions in  the                                                               
bill, that  similar provisions  existed in  other states  with no                                                               
complaints,  and that  many  of the  state's  residents have  had                                                               
positive interactions with  naturopaths, herself included, siting                                                               
her personal  experience where  her medical  provider recommended                                                               
exploratory  surgery when  a naturopath  did not  think this  was                                                               
necessary.                                                                                                                      
                                                                                                                                
3:59:39 PM                                                                                                                    
                                                                                                                                
CHAIR  MINA  noted  that  she  had  received  an  amendment  from                                                               
Representative Prax.                                                                                                            
                                                                                                                                
                                                                                                                                
3:59:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX said  he did not want to  offer the amendment                                                               
now.                                                                                                                            
                                                                                                                                
4:00:09 PM                                                                                                                    
                                                                                                                                
CHAIR MINA announced that HB 147 was held over.