Legislature(2017 - 2018)BARNES 124
03/09/2018 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| HB147 | |
| HB326 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 147 | TELECONFERENCED | |
| += | HB 309 | TELECONFERENCED | |
| *+ | HB 329 | TELECONFERENCED | |
| + | HB 264 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| += | HB 326 | TELECONFERENCED | |
| += | HB 89 | TELECONFERENCED | |
HB 326-NATUROPATHS: LICENSING; PRACTICE
CHAIR KITO announced that the next order of business would be
HOUSE BILL NO. 326, "An Act relating to the practice of
naturopathy; relating to the licensure of naturopaths; relating
to the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
3:38:10 PM
The committee took a brief at ease from 3:38 p.m. to 3:38 p.m.
3:38:56 PM
REPRESENTATIVE GERAN TARR, Alaska State Legislature, presented
HB 326 as prime sponsor. She explained the proposed bill would
outline a clear scope of practice for naturopaths across Alaska.
3:39:43 PM
The committee took an at-ease from 3:39 p.m. to 3:40 p.m.
3:40:55 PM
REPRESENTATIVE TARR said the proposed bill addresses three
issues: access, cost, and allowing professionals to practice at
the whole scoped of their training. She indicated slide 1
showed a map of healthcare costs around America.
3:41:55 PM
REPRESENTATIVE TARR moved to slide 2, "Restrictive Regulations
Create a Significant Gap Between Naturopathic Training and
Allowed Scope":
• Shortage of primary care remains in Alaska
despite the presence of NDs trained to provide it
• NDs qualify for Indian Health Service's national
loan repayment program aimed at increasing
healthcare access in remote Alaska, but are
unable to make use of this program due to the
limited scope of practice.
• This decreases competition, drives up costs and
limits access for healthcare consumers
3:43:29 PM
REPRESENTATIVE TARR moved to slide 3, "Solution: Allow
Naturopaths to Practice What They are Educated to Do":
• Immediately enables dozens of new primary care
providers (~57)
• This scope is being practiced safely in many
other states
3:44:01 PM
REPRESENTATIVE TARR spoke to slide 4, "What Are Naturopathic
Doctors (NDs)?"
• Training to provide evidence-based primary care,
with a patient-centered focus that prioritizes
disease prevention over symptom management and
drug therapies
• Emphasis on longer office visits (~60-90 min.)
• This approach tends to reduce need for healthcare
utilization, as well as long-term costs
3:45:16 PM
REPRESENTATIVE TARR spoke to slide 5, "Education":
4-Year Accredited Medical School Program
• 2 Years of basic sciences; 2 years clinical
sciences and treatment methods
• Regulated by the Council of Naturopathic Medical
Education, which is overseen by the US Department
of Education - same as other medical schools
• NDs must pass the two-part Naturopathic
Physicians Licensing Examinations (NPLEX), before
being licensed to practice
3:46:57 PM
REPRESENTATIVE TARR addressed slide 6, "ND Therapeutic Order
Progresses From Minimal to Higher Levels of Intervention as
Necessary":
• Clinical Nutrition / Diet
• Counseling / Behavior Change
• Hydrotherapy & Others
• Herbal Medicine
• Physical Manipulation
• Pharmaceuticals (Not allowed in AK)
• Minor Surgery (Not allowed in AK)
3:47:28 PM
REPRESENTATIVE TARR moved to slide 7, "HB 326: Key Provisions":
HB 326 defines a clear scope of practice for
naturopathic doctors which
reflects their education and training
• Cleans up outdated language
• Allows NDs to perform minor office procedures
(minor surgeries)
• Allows issuance of vitamins, minerals and other
non-controlled substance prescription medications
• Requires 24 hours of continuing education every 2
years
3:48:55 PM
REPRESENTATIVE TARR spoke to slide 8, "Key Provision: "Minor
Office Procedures":
• Allows repair of superficial lacerations & skin
biopsies (e.g. stitches, wart removal, punch
biopsies)
• Does NOT include any sort of major, internal or
plastic surgery, or those involving the eyes,
tendons, ligaments, nerves, or blood vessels
• NDs complete an avg. of 100 hour of training in
this area
• Being practiced safely in many other states
3:49:41 PM
REPRESENTATIVE TARR addressed slide 9, "Key Provision:
Prescriptive Authority":
• Applies only to Non-Controlled Substance
medications (excluding Testosterone & Ambien)
• Alaska already allows prescriptive authority for
other healthcare providers with equal or lesser
pharmacological training
• This is being practiced safely in in many other
states
3:51:10 PM
REPRESENTATIVE WOOL asked for clarification regarding the color
code on slide 9. He asked what the grey represents.
REPRESENTATIVE TARR answered that she did not have an answer and
would have to get back to him.
3:51:46 PM
REPRESENTATIVE TARR moved on to slide 10, "HB 326 offers one
clear, safe and tangible step towards better healthcare in
Alaska":
• Increases competition and drives down healthcare
costs
• Improves healthcare access
• Provides clear guidance to state regulators
• Allows healthcare professionals to do what they
are educated to do
3:53:05 PM
REPRESENTATIVE TARR pointed out the relative comparison to
letters of support and one letter of opposition. She added the
answer to the map question was that grey represents
"unlicensed."
3:54:09 PM
ABBY LAING, President, Alaska Association of Naturopathic
Physicians, testified in the hearing on HB 326. She said
naturopathic doctors (NDs) want to provide the best healthcare
possible. She said Alaska has highly restrictive regulations.
She said the proposed bill would drive down healthcare costs and
would allow greater freedom to better access to healthcare. She
added the proposed bill is straightforward and would remove
outdated language.
3:57:43 PM
REPRESENTATIVE JOSEPHSON asked whether the grey states on the
map are unregulated.
MS. LAING answered in the affirmative.
CHAIR KITO mentioned one of the provisions was proposing to
change the prescription authority of NDs. He pointed out one of
the items being removed from prohibition is a poison. He asked
whether the request was for the ability to prescribe poisons.
MS. LAING answered the aim is to clear up some language. She
emphasized there is no intention or desire to prescribe poison.
3:59:20 PM
REPRESENTATIVE WOOL asked whether the grey states on the map do
not have naturopaths.
MS. LAING deferred to Dr. David Schleich. She said that some
states do not have naturopaths, and in some states NDs are just
not regulated.
4:01:05 PM
MELINDA RATHKOPF, Medical Doctor, Board of Alaska Medical
Association, testified in opposition to HB 326. She talked
about her experience in medical school. She stated it's not
uncommon to do additional testing on patients who come from
naturopathic care providers. She addressed the claim that
naturopaths can help bring down healthcare costs. She
underlined that for some patients it drives up healthcare costs.
She further addressed the question of access to the controlled
substances database should prescription privileges be granted.
She shared her concerns about preventative health. She said
that traditionally, NDs haven't embraced vaccination. She spoke
to a 2009 study stating children are significantly less likely
to be vaccinated against preventable diseases if they are in the
care of a naturopath. Alaska is still below the national
average in childhood immunization, and she said she is afraid
that with more naturopaths practicing, there will be fewer
children with vaccinations. She relayed her experience as a
general pediatrician and stated it would be impossible to
maintain 90-minute appointment times. She shared her concerns
about training. She said family practice physicians get
anywhere from 9,000 to 10,000 hours of residency training, where
naturopaths generally get under 1,00 hours of training, which
she said is often optional. She added she has concerns about
oversight. She queried who would monitor patient care issues to
ensure patient safety.
4:05:46 PM
REPRESENTATIVE JOSEPHSON stated HB 426 says that the naturopaths
are not seeking to prescribe controlled substances. He asked
whether she was suggesting there was a way around that in the
proposed bill.
DR. RATHKOPF stated naturopaths were asking to be able to
prescribe testosterone and zolpidem. She underlined if she
wanted to prescribe similar substances, she would have to
consult the controlled substances database before prescribing.
4:06:46 PM
REPRESENTATIVE JOSEPHSON asked whether zolpidem is a sleep
sedative.
DR. RATHKOPF answered in the affirmative. She said Ambien was a
common name for it.
4:07:00 PM
REPRESENTATIVE JOSEPHSON declared he believes that young people
need vaccinations. He asked Dr. Rathkopf whether it is the
culture of naturopathy to "frown on" immunization.
DR. RATHKOPF said she is not the best person to answer what is
taught in a naturopathic school. She said she does find that
the patient population that goes to naturopaths seems to be less
likely to be immunized.
4:08:16 PM
MS. LAING said it is a paradox because naturopaths are unable to
provide vaccines. She added it is standard of care to provide
US Centers for Disease Control and Prevention (CDC) guidelines
for vaccines to patients.
4:09:23 PM
REPRESENTATIVE WOOL asked Dr. Rathkopf whether she supports
nurse practitioners having prescriptive powers.
DR. RATHKOPF answered she has been in Alaska for 12 years. She
said she was trained in states where nurse practitioners were
not allowed prescriptive powers. She added a rebuttal to an
early statement. She spoke to a study in Washington state
regarding child immunization by naturopaths. She specified that
in that state, naturopaths were allowed to administer
vaccinations and the statistics still showed low immunization
rates.
4:11:00 PM
REPRESENTATIVE WOOL asked whether Dr. Rathkopf supports nurse
practitioners having prescriptive powers now that they are in
place.
DR. RATHKOPF answered she works with a lot of nurse
practitioners and she has not had issues with nurse
practitioners. She added most are trained in similar medical
backgrounds and philosophies as allopathic doctors.
4:12:37 PM
REPRESENTATIVE JOSEPHSON mentioned his father represents the
naturopaths on the issue of the scope of their license. He
asked Ms. Chambers whether there is anything in the request in
the legislation that seems outside the scope of practice for
states that allow more robust forms of naturopathy.
4:12:50 PM
SARA CHAMBERS, Division Operations Manager, Division of
Corporations, Business, and Professional Licensing, Department
of Commerce, Community, & Economic Development (DCCED), answered
questions in the hearing on HB 326. She answered the only
primary area the department is concerned with is the
administration of testosterone, a schedule 3, federally
scheduled drug product. She indicated the department has
requested some changes to the proposed bill.
REPRESENTATIVE WOOL asked how long Alaska has been a state which
licenses NDs.
MS. CHAMBERS said she would confirm that the answer is 1986.
4:15:23 PM
CHAIR KITO opened public testimony on HB 326.
4:15:45 PM
KAILA BUERGER testified in support of HB 326. She said that HB
326 would allow NDs to practice their extensive knowledge by
issuing vitamins, minerals, and non-controlled substance
prescription medication, as well as performing minor office
procedures. She spoke to treating the root of the issue versus
the symptoms. She said it was time all doctors took a holistic
approach, rather than handing out prescription drugs and
antibiotics. She shared some personal experience with NDs. She
gave some statistics regarding diabetes.
4:25:29 PM
CLYDE JENSEN, PhD, National University of Natural Medicine,
testified in the hearing on HB 326. He gave his qualifications
and background in teaching pharmacology. He opined that
naturopaths are well trained at professional degree level and
said he sees no reason they should be as restricted as they have
been in Alaska.
4:27:07 PM
SCOTT LUPER, Medical Director, Alaska Center for Natural
Medicine, testified in the hearing on HB 326. He described his
practice and underlined that he is the father of five children
who are all vaccinated.
4:28:33 PM
JODY OAKES testified in support of HB 326. She shared a
personal story of migraines and how an ND helped her manage her
pain. She said she feels safe in the care of her ND.
4:30:21 PM
BARON GLASSGOW, Executive Director, Arizona Naturopathic Medical
Association, testified in the hearing on HB 326. He gave the
history of the Arizona Naturopathic Medical Association. He
said naturopathic doctors in Arizona are considered primary care
providers. He added they complete pediatric course work on how
and when to administer vaccinations. He stated NDs can perform
vaccinations in the state of Arizona.
4:32:03 PM
ANNETTE O'CONNELL testified in support of HB 326. She shared
she was diagnosed with celiac disease as a young woman and
compared the treatment she received from a medical and a
naturopathic doctor. She said she is forced to go out of state
to get her care.
4:34:08 PM
ROB DOWNEY, MD, testified in the hearing on HB 326. He shared
his qualifications and background. He said he has shared
patients with NDs in trauma and mental health. He said he thinks
the minor surgical procedures requested in the legislation are
extremely safe and limited and will help Alaskans.
4:36:41 PM
ALAN GROSS, MD, testified in support of HB 326. He said he
believes the regulatory interpretations on naturopaths are too
restrictive. He opined naturopaths coming from accredited
facilities should be allowed to perform minor procedures and
prescribed non-controlled substances. He spoke to his
experience working with naturopaths. He said the proposed bill
would lower the cost of healthcare in the state.
4:38:26 PM
GARY FERGUSON testified in support of HB 326. He shared he works
primarily in public health with Alaska Native communities. He
said naturopaths help reduce the medicines that elders are on.
4:40:54 PM
STEVE GEDDES testified in the hearing on HB 326. He shared his
personal experience with naturopathic care. He said he thinks
it is reasonable for naturopaths to treat health conditions.
4:43:26 PM
DAVID SCHLEICH, PhD, President, National University, testified
in support of HB 326. He said National University is the
longest-standing accredited university of naturopathic medicine
in the United States. He gave his qualifications and
background. He highlighted that the accreditation of
naturopathic programs is "exactly consistent with" allopathic
programs and the accrediting bodies come from the Department of
Education. He spoke to the concern about residencies. He said
naturopathy students are prevented from access to residency
match by federal practice. He commented on immunization. He
said the program at his organization has extensive immunization
training, meeting all requirements in those states in which
vaccination is approved. He stated in Oregon naturopathic
doctors are considered primary care providers. He stated that
the comment regarding 1,000 hours of naturopathic residency is
not accurate.
4:48:59 PM
REPRESENTATIVE JOSEPHSON referred to a comment that
"there is lots of teaching about immunology," that did not say
what is taught.
DR. SCHLEICH answered what is taught is the same thing that is
taught in standard allopathic medical schools. He added that
the prerequisites for entering his program are virtually
identical to those for medical schools.
4:50:20 PM
JENNIFER YOUNG shared that she is a cardiac nurse, married to a
naturopathic doctor. She said she comes across many patients who
want to be treated naturally. She referred to a comment by Dr.
Rathkopf regarding immunization. She opined it is not a
reflection of the naturopathic doctors, but that people choose
for themselves not to be immunized.
4:52:37 PM
DANIEL YOUNG, Naturopathic Doctor, testified in support of HB
326. He stated he has practiced naturopathic medicine for 26
years. He said naturopathic providers are trained in ambulatory
care. He stated he had been in practice with another medical
doctor. He said he thinks naturopathic doctors should all be
able to practice how they are trained and communicate with each
other. He underlined the patient is the primary importance.
4:55:09 PM
MICHAEL DANZ testified in support of HB 326. He said he thinks
NDs should be allowed to give the type of care they have been
restricted from [administering].
[CHAIR KITO held over HB 326.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB147 Summary of Changes ver A to ver J 2.13.18.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 147 |
| HB147 Sponsor Statement ver J 2.5.18.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 147 |
| HB147 Sectional Analysis ver J 2.13.18.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 147 |
| HB147 version A.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 147 |
| HB147 version J.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 147 |
| HB147 Fiscal Note DCCED-CBPL 2.22.18.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 147 |
| HB147 Letters of Support 2.13.18.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 147 |
| HB326 Letters of Support 3.10.18.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 326 |
| HB326 Letters of Opposition 3.10.18.pdf |
HL&C 3/9/2018 3:15:00 PM |
HB 326 |