Legislature(2023 - 2024)BELTZ 105 (TSBldg)
03/24/2023 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| SB51 | |
| SB93 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 89 | TELECONFERENCED | |
| + | SB 51 | TELECONFERENCED | |
| *+ | SB 93 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 51-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
2:10:14 PM
CHAIR BJORKMAN reconvened the meeting and announced the
consideration of SENATE BILL NO. 51 "An Act exempting
veterinarians from the requirements of the controlled substance
prescription database; and providing for an effective date."
2:10:43 PM
SENATOR LÖKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 51, paraphrased the following
sponsor statement:
[Original punctuation provided.]
In 2008, in response to the nationwide opioid
epidemic, the Alaska State Legislature created the
Prescription Drug Monitoring Program (PDMP). This
program created a database of prescriptions for
controlled substances in Alaska, with the stated
intent was to place obstacles in front of individuals
seeking opioids from multiple providers. In 2016, the
Legislature expanded the program to include
veterinarians. Unfortunately, the program failed to
account for the major differences between the practice
of human medicine and veterinary medicine. SB 51
addresses this conflict by exempting veterinarians
from the Prescription Drug Monitoring Program.
Eliminating the requirement for veterinarians in
Alaska to use the PDMP does not cause deregulation.
Veterinarians will continue to be covered by federal
statutes and regulated by the Drug Enforcement Agency
(DEA) and the Alaska Board of Veterinary Examiners.
Additionally, provisions in state statute will
continue to limit the number of opioids a veterinarian
can prescribe to a seven-day prescription, with two
exceptions. Those exceptions are if the prescription
is part of long-term chronic care, or if there is
logistical or travel barrier to returning within seven
days.
Prescription drug monitoring is not unique to Alaska.
All 50 states have some variation of prescription drug
monitoring, with over 30 states exempting
veterinarians. Previously, 10 of those states mandated
veterinarians be part of prescription drug monitoring
efforts; however, those states soon realized that
including veterinarians had no clear benefit. Instead,
these states found that including veterinarians in
their prescription drug monitoring programs placed
unnecessary time-consuming barriers on those who
practice veterinary medicine. In Alaska, the PDMP
fails to be effective because animal patients do not
have identifiers such as social security numbers. As a
result, veterinarians must try to get the private
health data of those who seek care for their animals
prior to treating the animal. This is both inefficient
and an invasion of privacy.
Senate Bill 51 seeks to correct an overexpansion of
the Prescription Drug Monitoring Program to ensure
continued access to veterinary care in Alaska.
2:13:51 PM
TREVOR BAILLY, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis
for SB 51.
[Original punctuation provided.]
Senate Bill 51
"Controlled Substances Data Exemption for
Veterinarians"
Version: 33-LS0339\A
Section 1
Deletes the requirement that the Board of Veterinary
Examiners to notify the Board of Pharmacy when a
practitioner registers with the controlled substance
prescription database.
Section 2
Creates a new subsection in the controlled substance
prescription database statutes that exempts
veterinarians from the requirements of the controlled
substance prescription database.
Section 3
Repeals the subsection that requires veterinarians
register with the controlled substance prescription
database.
Section 4
The act takes effect immediately upon passage.
2:15:30 PM
CHAIR BJORKMAN invited Dr. Berngartt to put herself on the
record and begin her presentation.
2:15:42 PM
DR. RACHEL BERNGARTT, Chair, Board of Veterinary Examiners,
Juneau, Alaska, presented a slideshow on exempting veterinarians
from the prescription drug monitoring program during the hearing
on SB 51.
DR. BERNGARTT displayed slides 2 and 3 and paraphrased the
following:
SB 51: AN ACT EXEMPTING VETERINARIANS FROM THE
REQUIREMENTS OF THE CONTROLLED SUBSTANCE PRESCRIPTION
DATABASE.
THE ALASKA STATE VETERINARY MEDICAL ASSOCIATION
(AKVMA) SUPPORTS SB 51.
THE ALASKA BOARD OF VETERINARY EXAMINERS (BOVE)
SUPPORTS SB 51.
THE ALASKA BOARD OF PHARMACY SUPPORTS EXEMPTING
VETERINARIANS FROM PARTICIPATING IN THE PDMP
2.18.2022 Board of Pharmacy Meeting
Voted and Passed Motion to Support
2:17:19 PM
DR. BERNGARTT reviewed slide 4, Background: The PDMP." It read:
2008: Alaska's PDMP established by SB 196.
2017: In reaction to growing opioid epidemic, the PDMP
was amended by via HB 159 to include all DEA permit
holders, including veterinarians.
Neither AKVMA nor BOVE were consulted regarding this
amendment.
PDMP reporting is required for all actively licensed
practitioners who hold a Federal Drug Enforcement
Agency registration number and who prescribe,
administer, or dispense federally scheduled II IV
controlled substances in the state.
DR. BERNGARTT reported that the Alaska State Medical
Association expressed that it did not oppose exempting
veterinarians from the Prescription Drug Monitoring Program
(PDMP).
2:18:25 PM
DR. BERNGARTT spoke to the following points on slide 5, Why It
Makes Sense to Exempt." It read:
The PDMP is not an effective database for
veterinarians or our patients.
The PDMP was established for human medicine.
Querying of PDMP data for animals is not possible
with the PDMP (and reported drugs for an animal are
not visible in the PDMP database).
A query is made on the individual(s) that bring the
animal to the veterinarian and human data is
obtained, not animal data.
Human data obtained from the PDMP query is not
usable for the veterinarian. Veterinarians are not
trained in human medicine to understand what the
dosages mean.
2:20:31 PM
DR. BERNGARTT spoke to the following points on slide 6, Why It
Makes Sense to Exempt." It read:
Querying of human PDMP information is invasion into an
individual's medical privacy.
Clients find it intrusive when the veterinarian is
required to query their private health data in the
PDMP.
An individual's private medication information
becomes known to the veterinarian for certain drugs,
such as narcotics, sedatives, and stimulants.
Examples of some common medications seen include,
but are not limited to: Adderall, Ritalin, anabolic
steroids such as testosterone, postpartum depression
medications, sex hormones, Xanax, Klonopin, Valium,
Ativan, Domar, and sleep aids like Ambien and Lunesta.
2:21:58 PM
DR. BERNGARTT spoke to the following points on slide 7, Why It
Makes Sense to Exempt." It read:
Veterinarians are monitored by the Drug Enforcement
Agency and must adhere to controlled substance
regulations.
Veterinarians who prescribe or dispense controlled
substances are licensed through the Drug Enforcement
Agency (DEA). There is already a significant level
of accountability, record keeping, and medication
storage requirements that veterinarians must adhere
to.
Distributors of controlled substances monitor
utilization patterns of veterinarians. The
Suspicious Order Monitoring System is in place and
data is gathered by distribution companies who are
required by the DEA to monitor and report unusual
purchase patterns a veterinarian may have.
Distributors are required to flag purchases that
fall outside of norms for either previous purchase
history or the norms for practices of similar
size/type. DEA oversight is to control/prevent
diversion from licensed professionals to drug
dealers and users.
2:23:24 PM
DR. BERNGARTT spoke to the following points on slide 8, Why It
Makes Sense to Exempt." It read:
33 other states have exempted veterinarians from
participating in the PDMP.
10 states formerly mandated veterinary reporting but
repealed their inclusion due to the problems
experienced, lack of identified benefits to
veterinary participation, and demonstration that
exempting veterinarians does not decrease protection
of public health and safety. These states are
Alabama, Arizona, Idaho, Illinois, Kansas, Kentucky,
Louisiana, New Mexico, West Virginia (2021), and
Wyoming.
Missouri was the last state to implement a PDMP in
2021 and did not require veterinarians to
participate.
2:23:50 PM
DR. BERNGARTT spoke to the following points on slide 9, Why It
Makes Sense to Exempt." It read:
Veterinarians are not a source of the drugs of primary
concern.
Synthetic opioids excluding methadone overdose deaths
increased 97-fold
Psychostimulants with abuse potential (primarily
methamphetamine) overdose deaths increased 59-fold
Cocaine increased 6.4-fold
Rx opioid deaths increased 4.9-fold
Opioid medications prescribed by veterinarians
(728,223) were only 0.34% of the total opioid
prescriptions (214 million) that were dispensed by
U.S. retail pharmacies in 2017.
2:24:53 PM
DR. BERNGARTT spoke to the following on slide 10, Why It Makes
Sense to Exempt." It read:
The unwieldy PDMP leads to costly and burdensome
investigations of veterinarians by the Alaska Board of
Veterinary Examiners.
Costly and onerous requirements for monitoring
veterinarians have been placed on the board of
veterinary examiners (BOVE).
2:25:39 PM
DR. BERNGARTT spoke to the following points on slide 11, Why It
Makes Sense to Exempt." It read:
Licensing fees for veterinarians will likely increase
as a result of the cost to conduct needless
investigations of veterinarians with DEA licenses. The
cost of doing business will be passed on to consumers.
Alaska has the highest licensing fees for
veterinarians in the country.
Licensing fees are expected to increase in the State
of Alaska as a result of the cost of PDMP
investigations.
Charging veterinarians for the cost of enforcement of
an unusable PDMP system, and regulations with which
they are unable to comply, is not responsible
stewardship of resources.
2:26:20 PM
DR. BERNGARTT reviewed the following summary of SB 51 on slide
12:
AKVMA and BOVE ASK FOR SUPPORT of SB 51
An Exemption of Veterinarians from participating in
the PDMP:
Will allow veterinarians to provide the
appropriate, timely, medical management
appropriate for each patient.
Will increase the efficiency of the PDMP system
for its intended purpose, by allowing for
accurate interpretation of data and trends in
human medicine.
Will allow continued judicious use of controlled
substances that is already practiced by
veterinarians.
Will eliminate unnecessary and disproportionate
business burdens for veterinarians.
2:27:23 PM
SENATOR BISHOP moved to adopt the committee substitute (CS) for
SB 51 as the working document.
2:27:38 PM
CHAIR BJORKMAN objected for purposes of an explanation.
2:27:45 PM
At ease.
2:28:07 PM
CHAIR BJORKMAN reconvened the meeting.
2:28:09 PM
SENATOR BISHOP restated his previous motion and moved to adopt
the committee substitute (CS) for SB 51, work order 33-LS0339\B,
as the working document.
CHAIR BJORKMAN objected for the purpose of explanation. He
invited Ms. Achee to walk through the changes in the CS.
2:28:42 PM
LAURA ACHEE, Staff, Senator Jesse Bjorkman, Alaska State
Legislature, Juneau, Alaska, reviewed the explanation of changes
from version A to version B for SB 51. In addition to issues
related to the PDMP, the Alaska Board of Veterinary Examiners
has asked that the statute be expanded to include additional
means by which qualified veterinarians can be certified. Like
many industries in Alaska, veterinary medicine has shortages;
these changes could even help in the important task of
attracting veterinarians to the state.
CHAIR BJORKMAN asked Ms. Achee to review the changes in the CS.
MS. ACHEE reviewed the following changes in the CS for SB 51:
Section 1 would amend AS 08.98.050(b) to authorize the Board of
Veterinary Examiners to adopt a certification process for
veterinarians to become licensed to practice in Alaska.
Section 2 would amend AS 08.98.165(a) to allow the board to
accept certification through the Program for the Assessment of
Veterinary Education Equivalence in place of attending an
accredited program in the United States. The language in this
section would also allow the boards the discretion to approve
other certification processes.
Section 3 would amend AS 08.98.184 to contain the same changes
as in Section 2.
The remainder of the sections are unchanged.
2:31:47 PM
DR. CIARA VOLLARO, Member, Alaska Board of Veterinary Examiners,
Anchorage, Alaska, provided invited testimony on SB 51. She
paraphrased from the following prepared testimony:
In order to improve the quality and availability of
veterinary services in the state of Alaska, the board
is requesting statutory changes to licensing
requirements for foreign veterinary graduates.
Currently the Alaska statutes mandate educational
commission for foreign veterinary graduate
certification. This program is the original program
developed in 1971 by the American Veterinary Medical
Association to ensure competency equivalent to
graduates of American and Canadian veterinary schools.
The American Association of Veterinary State Boards
(AAVSB) created a similar certification program
entitled PAVE, Program for the Assessment of
Veterinary Education Equivalence in 2001. The AAVSB
supervises the veterinary state boards of all states
and is an organization Alaska actually utilizes in the
veterinary licensing process. Forty-six United States
states and territories, all Canadian provinces and
territories, Australia and New Zealand recognize this
newer program. The two programs, the educational
commission for foreign veterinary graduates
certification and PAVE are very similar in their
requirements and require years to complete the many
phases to prove competency. Furthermore, like any
student from an American credited veterinary school,
Canadians still have to pass the National American
Veterinary Licensing Exam, which is mandatory for
veterinary licensing throughout the United States.
Most state veterinary legislations only specify the
educational commission for veterinary graduate
certification in their statutes and regulations
initially, resulting in having to go through
legislative updates to add PAVE. When making this
change, states have adopted different strategies and
wording. The Board of Veterinary Examiners are
requesting the amendment to these statutes to include
PAVE or another certification approved by the board to
prevent the need to provide statutes again in the
future. The wording requested mimics 23 other states.
In conclusion, the outdated statute unnecessarily
creates a barrier to Alaska increasing the ability of
veterinarians to provide care to the public. To date,
at least two veterinary internal medicine specialists
are known who are licensed in other US states that did
not apply for an Alaskan license because they
graduated from a foreign veterinary college and have
received certification from PAVE. That means it is
unknown exactly how many veterinarians Alaska has
missed out on licensing because state requirements are
outdated by not including PAVE.
2:34:50 PM
CHAIR BJORKMAN removed his objection. He found no further
objection and the CS for SB 51, work order 33-LS0339\B, was
adopted as the working document.
CHAIR BJORKMAN said the committee would hear public testimony
during the next hearing of the bill. He reminded the public that
written testimony may be submitted to [email protected].
CHAIR BJORKMAN held SB 51 in committee.