Legislature(1999 - 2000)
04/12/1999 01:32 PM Senate HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
SB 71-PHYSICIAN LICENSURE CHANGES
CHAIRMAN MILLER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:32 p.m. and brought up SB
71. After SB 71, the committee would hear a briefing by the Alaska
Food Coalition, followed by SB 21.
Number 010
DR. SARAH ISTO, Chairman of the Medical Board, spoke on behalf of
the board in support of SB 71, and expressed its appreciation of
Senator Miller and the committee for introducing this bill which is
important for the board's functioning and for Alaskans who are
patients. As background she noted there are about 2,000 licensed
physicians in the state, of whom about 400 are osteopaths and the
remainder, medical doctors. The board also licenses paramedics and
physician assistants, but this bill doesn't include those
practitioners who are in an up-to-date statute. SB 71 deals with
older provisions in the statute relating to medical doctors.
There is no reciprocity for medical licenses in the U.S. which
means each state sets its own standards, requiring people to apply
in each state they practice. DR. ISTO said Alaska statutes should
meet at least the same kind of standards that other states require
in order to get competent practitioners in our state.
DR. ISTO proceeded to explain the statute changes in SB 71
summarized in her letter to Senator Miller on April 7. She said
she grouped items together by subject matter in paragraphs rather
than by numerically following the statute. The italicized language
in her letter explains the board's reasoning and concerns that led
to these requested changes.
Paragraph (1) relates to the current situation in Alaska when
someone with a felony conviction applies for a medical license.
The board can consider the conviction only if it occurred in the
course of their practice of medicine or their duties as a
physician. The board received an application for a medical license
from penitentiary from someone who committed a brutal murder, and
the statute did not allow consideration of that part of the
applicant's history because it did not involve a patient and was it
not committed in the office or the hospital. DR. ISTO stated,
"Fortunately, there were other problems with that application and
we did not grant that person a license, because we would have been
very nervous, not being able to evaluate that part of the license."
This change adds language on a felony or misdemeanor substantially
related to the licensee's fitness to practice. A felony conviction
for tax evasion might not be considered by the board, but a brutal
murder should be.
Paragraph (2) adds "or its designee," and is a housekeeping measure
relating to licensed physicians who, when renewing their license,
are required to have 34 hours of continuing medical education. The
board sets up a plan, and physicians must wait until the board
meets again and even suspend their practice. This language change
would avoid having that delay built into a routine matter.
Paragraph (3) refers to Section 5 in the bill, another housekeeping
item relating to temporary or "locum physicians" replacing doctors
on vacation. The temporary physicians cannot renew that permit
without the board taking action at the moment the permit expires.
The board feels the renewals could be handled by the board's staff.
Paragraph (4) refers to Section 4 in the bill regarding physicians
in training. The only training program in Alaska is the three-year
Alaska Family Practice residency in Anchorage. Current statute
allows a permit to practice under the supervision of a training
program for only one year. By the time they complete their one
year, they must take an exam and get the results before they can
get an active license. If SB 71 passes, those who are foreign
medical graduates would be required to complete their entire
training before obtaining an independent license. This would
enable the board to renew those permits.
Paragraph (5) refers to Section 5. Currently the statute considers
only a suspension or revocation in another state in a new
applicant's file. But states also deny or have licenses
surrendered while an applicant is under investigation for
violations of law, or restrict or condition licenses, or place
people on probation. The board wants to be able to consider those
actions. This change would expand the language to include the
kinds of actions that other boards use.
Paragraph (6) refers to Section 1. Alaska is the only state that
requires citizenship of an applicant or permanent residence. There
are physicians legally here under visas allowing them to practice
temporarily, but they are not citizens or permanent residents. A
visiting specialist who is excellent couldn't be granted a license
by the board. Foreign trained physicians will have already had
three years of training according to this bill.
Paragraph (7) refers to Section 3. Forty-three states require
three years of post-graduate training for physicians who graduated
from foreign medical schools. Alaska does not have a way to
evaluate foreign education or, as in the case of Burma, even to get
the records. To confirm competency, most states require foreign
graduates to be trained in the U.S. in an accredited residency
program where they will be supervised for three years. The board
would like to do the same thing.
Paragraph (8) refers to Sections 2 and 6 and relates to applicants
who are U.S. and Canada trained and not considered to be from a
foreign medical school. Currently Alaska requires one year of
post-graduate training. There are few two-year programs, with most
programs lasting three to five years. The board wants to recognize
that situation and require those graduating after 1995 to have at
least 2 years, in order to evaluate competency. On the other hand,
if someone graduated in 1978, they have had a long work experience
and the board can evaluate that they are competent.
DR. ISTO concluded that in Alaska it's extremely important for
practitioners to have good skills and judgment, especially in rural
Alaska where there aren't a lot of specialists and equipment.
Thirty people were licensed at the last board meeting, and only
one would not have met these proposed criteria.
Number 205
SENATOR PEARCE asked if the Medical Board is notified when a
malpractice suit is filed or only if there's an actual judgment
against a doctor.
DR. ISTO replied a judgment or a settlement is required to be
reported to the board. The attorneys are aware of that requirement
and the board has sent out newsletters reminding the licensees of
it. The malpractice companies are careful to ensure that reporting
is done. She believed the board receives most of the reports.
SENATOR PEARCE asked if the board requires doctors to have
malpractice insurance. DR. ISTO answered "No, the board doesn't
get into the insurance business. Someone can be uninsured, but
they are still required to report."
SENATOR PEARCE asked if there could be a number of reports before
the board would evaluate a physician. DR. ISTO replied the board
looks at certain types of malpractice issues involving alcohol or
negligence. A pattern would concern the board, but there is no
computerized system and each report is scanned on arrival. A
patient can file a malpractice action and complain to the board.
All complaints to the board are evaluated, and the board knows if
there have been a number of complaints against a doctor.
Number 258
SENATOR ELTON said he appreciated Dr. Isto's concise sectional
analysis of the bill.
SENATOR PEARCE asked if there is a companion bill in the House.
DR. ISTO replied there is not, but the House expressed earlier
interest in the issue. SB 71 has a zero fiscal note.
SENATOR PEARCE asked if most hospitals require their doctors to
carry malpractice insurance. DR. ISTO responded she believed that
is true.
CHAIRMAN MILLER interjected he believed Ms. Isto is correct,
recalling that was an issue in tort reform a couple years ago. He
asked for a motion to adopt the Committee Substitute.
SENATOR WILKEN moved to adopt CSSB 71 (HES) Version D Lauterbach
4/7/99 in lieu of the original bill. Without objection, it was so
ordered.
Number 288
MS. CATHERINE REARDON, Director of the Division of Occupational
Licensing, Department of Commerce & Economic Development spoke in
support of the bill. She stated her division provides staff
support to the state Medical Board. The department appreciates the
time the committee has put into introducing and crafting the bill.
Following up on the previous discussion, MS. REARDON clarified the
board doesn't have statutory authority to require malpractice
insurance, and it would require legislative action if the committee
wanted to do that.
CHAIRMAN MILLER asked the wish of the committee.
SENATOR WILKEN moved to report CSSB 71 (HES) out with individual
recommendations and attached zero fiscal note. Without objection,
it was so ordered.
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