Legislature(2015 - 2016)SENATE FINANCE 532
03/16/2016 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB69 | |
| SB124 | |
| SB196 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 69 | TELECONFERENCED | |
| + | SB 124 | TELECONFERENCED | |
| *+ | SB 196 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 69
"An Act relating to the Board of Chiropractic
Examiners and the practice of chiropractic."
9:03:04 AM
Senator Dunleavy disclosed that he had a financial interest
in a chiropractic office.
9:03:26 AM
SENATOR BILL STOLTZE, SPONSOR, hoped to work as a conduit
for better access to medical services by increasing access
for high school physicals. He relayed that the Alaska
School Activities Association had lamented their limited
access to physicals for children, not only availability,
but also efficiency and affordability. He said that schools
had not used chiropractors for physicals due to ambiguity
in statute. He believed that the bill would provide the
guidance needed in order to expend access to physicals.
9:06:57 AM
Co-Chair MacKinnon requested a sectional analysis.
9:07:00 AM
BRANDON BREFCZYNSKI, STAFF, SENATOR BILL STOLTZE, discussed
the sectional analysis (copy on file):
Section 1: Amends AS 08.20.055 by adding new language
that allows the board to adopt regulations for the
following:
- Training and scope of practice of chiropractic
interns and chiropractic preceptors;
- Designation of a nationally recognized
certification program for chiropractic clinical
assistants;
- Performance of patient examinations.
Section 2: Amends AS 08.20.100(b) clarifying how
chiropractors can accept referrals, authorizes
chiropractors to perform school physicals, and allows
the employment of certified chiropractic clinical
assistants, chiropractic interns, and chiropractic
preceptors.
Section 3: Amends AS 08.20.100 by adding a new
subsection (d) that exempts chiropractic interns from
this section.
Section 4: Amends AS 08.20.160 regarding the
requirements for temporary permits.
Section 5: Amends AS 08.20 by adding a new section (AS
08.20.168) regarding chiropractic clinical assistants.
Section 6: Amends 08.20.185 by changing name of "peer
review committee" to "utilization review committee" to
better reflect the purpose of the committee. Also, the
change is intended to assist in determining what
complaints warrant a referral to investigative staff.
Section 7: Amends AS 08.20.200 by updating penalties
for unlicensed practice.
Section 8: Amends AS 08.20.210 by updating penalties
for fraudulent licenses and certificates.
Section 9: Amends definition of "chiropractic
examination" located in AS 08.20.900(7).
Section 10: Amends AS 08.20.900 by adding new
definitions for "chiropractic clinical assistant,"
chiropractic intern," and "chiropractic preceptor."
9:10:09 AM
Senator Hoffman looked at Section 2, and wondered whether
the referrals were for chiropractic treatment or physical
exams.
Mr. Brefczynski deferred the question to Mr. Barrington.
9:11:13 AM
Senator Olson asked whether other medical providers were
able to sign off on a sports physical.
Senator Stoltze responded that he did not know the answer.
9:11:51 AM
Co-Chair MacKinnon noted that there were several experts
waiting to testify, as well as were available to respond to
questions.
9:12:25 AM
Senator Stoltze noted that other practitioners that were
able to perform physicals under statute were medical
doctors, doctors of osteopathic medicine, advanced nurse
practitioners, and physician's assistants.
9:12:52 AM
Senator Olson queried the most common reason for a person
to fail a sports physical exam.
Mr. Brefczynski responded that he could not speak to
disqualifying factors for sport physical exams.
9:13:19 AM
Senator Olson understood that cardiovascular issues were a
main disqualifying factor. He expressed concern that
chiropractic care was generally related to muscular and
skeletal expertise, and not cardiovascular issues.
JANEY HOVENDEN, DIRECTOR, CORPORATIONS, BUSINESS AND
PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY
AND ECONOMIC DEVELOPMENT (DCCED), testified that the bill
would add layers to the existing chiropractic program. She
solicited specific questions on the legislation.
9:15:24 AM
Co-Chair MacKinnon stated that medical questions would be
held for the medical professionals.
Co-Chair MacKinnon wondered whether the administration was
in favor of the legislation.
Ms. Hovenden replied that the Board of Chiropractic
Examiners had come out in support, but that the division
did not have a position on the bill.
Co-Chair MacKinnon asked whether the division had any input
on the bill.
Ms. Hovenden replied that she did not believe so.
9:16:00 AM
Senator Olson asked whether the bill faced any opposition.
Ms. Hovenden replied that she was not aware of any
opposition to the legislation.
9:16:05 AM
Senator Olson probed whether the State Medical Board and
Board of Nurse Practitioners supported the bill.
Ms. Hovenden responded that those groups had not taken a
position on the legislation.
9:16:20 AM
Vice-Chair Micciche aske Ms. Hovenden to explain the fiscal
note, specifically the way in which boards and commissions
were of no cost to the state.
Ms. Hovenden replied that the division received supported
services, which meant that the licensees paid for all of
the expenses for their program within the division.
9:16:52 AM
Co-Chair MacKinnon understood that the bill would require
the addition of one, part-time position.
Ms. Hovenden replied in the affirmative, and stated that
there would also be a regulations project.
9:17:31 AM
DR. EDWARD BARRINGTON, LEGISLATIVE CHAIRMAN, ALASKA
CHIROPRACTIC SOCIETY AND BOARD, testified in support of the
legislation. He said that the proposed changes outlines in
SB 69 were in the public interest. He stated that allowing
the Board of Examiners to set standards for chiropractic
clinical assistance was essential so that any employee that
had direct patient care contact was fully qualified. He
relayed that authorizing and setting standards for doctors
that were already practicing who wished to host new
graduates, or students who had completed all of the
requirements but had not fully graduated, to acquire more
clinical experiences. He shared that the law currently
allowed for chiropractic physicians to examine children for
student physicals and to write excuses to keep them from
participating in sports activities. He relayed that rural
districts in the state currently used chiropractic services
for sports examinations. He believed that other areas of
the state did not use chiropractors in the same way because
the law was not specific enough. He noted that the statute
had not been addressed since 1988, and that a utilization
review would be a step toward clarification. He stated that
the board had brought penalties for fraudulent practice up
to par with other disciplines.
9:21:53 AM
Senator Olson wondered how many chiropractors were licensed
in the state.
Dr. Barrington responded that there were 300 currently
licensed chiropractors; 265 actively practicing.
9:22:05 AM
Senator Olson queried any type of licensing action taken
against licensees over the past 3 years.
Dr. Barrington replied that no suspension of license had
been undertaken. He said that investigations did occur, but
that the board did not hear of those until a determination
had been reached. He relayed that within the last year, the
board had recommended additional classes for a practitioner
that had made an error in chart keeping.
9:23:20 AM
Vice-Chair Micciche queried how the legislation served the
public interest.
Dr. Barrington replied that public interest was best served
by the qualifications of chiropractor physicians, and by
the ability for parents to select the practitioner
performing their child's physical. He said that in many
cases the availability of other practitioners might be
scarce.
9:24:31 AM
Vice-Chair Micciche asked whether a chiropractor could
recommend that a student avoid a sporting activity for a
cardiovascular reason.
Dr. Barrington replied in the affirmative. He stated that
the scope of chiropractic practice was limited, but their
diagnostic and examination abilities were unlimited.
9:26:16 AM
Vice-Chair Micciche understood that currently chiropractors
could not write letters allowing for participation, but
could write letters recommending non participation.
Dr. Barrington replied in the affirmative.
9:26:47 AM
Senator Hoffman reiterated his question about referrals.
Dr. Barrington replied that anyone who walked into a
chiropractic office of their own volition was considered a
self-referred patient. He thought that word "referral" in
Section 2 was related to a person who walked in off the
street, or was referred by another practitioner or entity.
Co-Chair MacKinnon OPENED public testimony.
9:28:16 AM
DR. JENNIFER JOZWIAK, MEMBER, ALASKA CHIROPRACTIC SOCIETY
AND BOARD, JUNEAU, spoke in support of the legislation.
9:29:13 AM
Senator Olson queried the expertise of chiropractors as
related to disqualifying issues pertaining to sports
physicals, such as cardiovascular disease, rheumatoid
arthritis, or diabetes.
Dr. Jozwiak replied that in her training a Palmer College
of Chiropractic she had also been a diagnostic teaching
assistant. She shared that in that training she was taught
to recognize red flags for the aforementioned issues. She
asserted that patient history was a major factor in
diagnosing medical conditions, and that there was always
more than one indicator observed.
9:30:38 AM
Senator Bishop referred to a letter in member's packets
Palmer College (copy on file). He pointed out to the
committee the section related to United States Department
of Transportation physicals:
Doctors of Chiropractic are included as eligible
health care providers to provide physical examinations
by the United States Department of Transportation
(DOT). In fact, two faculty clinicians at the Palmer
Chiropractic Clinics in the Quad Cities (Davenport and
Bettendorf, Iowa, and Moline and Rock Island, Ill.)
are listed on the National registry as certified to
provide DOT "Fit for Duty" physical exams.
The DOT physical is a comprehensive evaluation
covering all systems of the body, including a
comprehensive health history and review along with a
urinalysis screening. All of these examination aspects
are taught and tested as part of Palmer's Doctor of
Chiropractic curriculum, in both the academic and
clinical portion of the education.
9:31:22 AM
Vice-Chair Micciche recalled that sports exams had been
fairly simple in his experience.
Dr. Jozwiak responded that she had a copy of the exam that
she could share with the committee.
9:32:32 AM
Senator Olson surmised that chiropractors did not check for
inguinal hernias.
Dr. Jozwiak stated that she had patients lay down on the
table with their knees bent while she palpated the area.
She explained that anything abnormal was investigated
further.
Senator Olson argued that there was no direct examination
for an inguinal hernia.
Dr. Jozwiak responded that a check would be done if other
red flags were observed.
9:34:24 AM
DEBBIE RYAN, ALASKA CHIROPRACTIC SOCIETY, ANCHORAGE (via
teleconference), noted that she did not wish to testify on
the record.
Co-Chair MacKinnon CLOSED public testimony.
9:34:51 AM
AT EASE
9:38:27 AM
RECONVENED
Senator Dunleavy clarified that he had an interest in an
investment company that had an interest in a chiropractic
office.
SB 69 was HEARD and HELD in committee for further
consideration.