Legislature(2025 - 2026)BUTROVICH 205
02/27/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| SB88 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 9 | TELECONFERENCED | |
| += | SB 89 | TELECONFERENCED | |
| *+ | SB 88 | TELECONFERENCED | |
SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
3:32:05 PM
CHAIR DUNBAR announced the consideration of SENATE BILL NO. 89
"An Act relating to physician assistants; relating to
collaborative agreements between physicians and physician
assistants; relating to the practice of medicine; relating to
health care providers; and relating to provisions regarding
physician assistants in contracts between certain health care
providers and health care insurers."
3:33:40 PM
MARY SWAIN, Chief Executive Officer (CEO), Camai Community
Health Center, Naknek, Alaska, testified by invitation on SB 89.
She said Camai Community Health Center is a federally qualified
facility serving the Bristol Bay Borough. She stated the center
is critical for delivering primary, urgent, and emergency care,
including receiving all EMS and 911 cases in the region. In the
past year, the center handled over 2,000 patient visits,
including more than 150 emergency cases. She emphasized long-
standing recruitment challenges due to the remote location and
increasing dependence on physician assistants (PAs) and nurse
practitioners. She explained that the current state regulations
requiring physician collaborative practice agreements place
unsustainable financial and administrative burdens on facilities
like Camai. She noted the center pays over $55,000 annually for
physician collaboration, and delays in processing agreements
negatively affect patient care and safety.
MS. SWAIN expressed strong support for SB 89, stating it
modernizes the practice framework for PAs in Alaska by
authorizing a more autonomous model under State Medical Board
oversight. She supported the bill's provision that allows PAs to
practice independently after 4,000 hours of post-graduate
clinical experience, noting that formal training includes
approximately 2,000 hours. She called this a balanced approach
that ensures proper oversight while providing a path to autonomy
for experienced PAs. She cited examples from other states such
as Iowa, Montana, New Hampshire, North Dakota, Utah, and
Wyoming, which have eliminated statutory requirements for direct
physician supervision, creating optimal practice environments.
She added that Arizona also recently updated its laws to grant
greater independence to experienced PAs, improving team-based
healthcare delivery.
3:36:57 PM
MS. SWAIN concluded that SB 89 will reduce wait times and
improve healthcare accessibility without compromising quality.
She underscored that while the legislation supports providers,
it ultimately benefits patients.
3:37:32 PM
JENNIFER FAYETTE, PA, Co-Chair, Alaska Academy of Physician
Assistants, Anchorage, Alaska, testified by invitation on SB 89.
said SB 89 is a crucial measure to modernize Alaska's physician
assistant (PA) statutes and expand access to care. She noted
that PAs have been essential to Alaska's healthcare system since
the 1970s, serving both urban and underserved rural areas, yet
outdated legal requirements continue to create unnecessary
administrative hurdles for hiring and retaining PAs. She stated
that SB 89 directly addresses these issues by updating
collaborative practice language, allowing PAs to practice to the
full extent of their training without compromising patient
safety. She emphasized that the bill does not expand PA scope
into areas like independent surgery or attempt to equate PAs
with physicians but rather aligns regulations with current
clinical practices in Alaska. She described the bill as the
result of extensive discussions with physicians and a thoughtful
response to prior legislative recommendations.
MS. FAYETTE explained that removing outdated restrictions will
enhance flexibility in the healthcare system and improve patient
outcomes across the state. She stressed that modernization is
necessary not just to reduce administrative burden, but also to
sustain and grow Alaska's PA workforce, which faces significant
recruitment and retention challenges. She cited data from the
National Commission on Certification of Physician Assistants
(NCCPA), noting Alaska had the lowest PA workforce growth
nationally. She added that Alaska's healthcare licensing grew
only 14 percent over two years, compared to higher rates for
other provider types. Citing Department of Labor projections of
several thousand unfilled healthcare positions by 2030, she
concluded by urging support for SB 89 to ensure PAs can continue
contributing meaningfully to Alaska's healthcare system and to
meet the state's urgent care needs.
3:40:50 PM
SENATOR HUGHES expressed strong support for SB 89 and shared
that her husband, a retired PA, began his career in Bethel 40
years ago and was a member of the Alaska Academy of Physician
Assistants. She acknowledged the work of the association. She
sought clarification to address concerns and asked whether PAs
still need to complete 100 CME credits biennially to maintain
certification through the NCCPA, essentially doubling the
requirement for physicians.
MS. FAYETTE replied yes
3:42:03 PM
SENATOR CLAMAN referred to Ms. Fayette's statement about the
declining number of physician assistants (PAs) in Alaska and
requested additional context. He asked for a comparison with
trends in other states. He asked for national data to frame
Alaska's situation.
3:42:31 PM
MS. FAYETTE clarified that Alaska has seen a 14 percent increase
in PAs, but this growth is significantly lower than the 35
percent increase among advanced practice registered nurses
(APRNs). She added that nationally, PA numbers have increased by
approximately 11 percent, though many states are experiencing
much higher growth. She noted that the national median growth is
in the 20 percent range, with some states seeing up to a 50
percent increase in PA licenses. She stated she would submit the
relevant data from the NCCPA and emphasized that Alaska ranks at
the bottom in terms of PA workforce growth.
3:43:22 PM
CHAIR DUNBAR acknowledged that SB 89 does not aim to expand the
scope of surgery for PAs and explicitly stated that PAs cannot
perform surgery independently. He pointed out that certain
procedures, such as suturing, can be technically classified as
surgery. He noted that some in the medical community have raised
questions about how SB 89 addresses or defines surgical
activities. He asked for the sponsor or another testifier to
address this concern.
3:43:58 PM
MACKENZIE POPE, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, answered questions on SB 89. She
explained that the bill's language regarding surgery was
carefully placed under the authority of the State Medical Board,
which is tasked with developing regulations. She stated this
approach allows subject matter experts, such as physicians, PAs,
and other medical professionals, to define "surgery" in a way
that accurately reflects clinical practice. She emphasized that
the regulations and definition of surgery must not restrict
physician assistants from performing routine procedures already
within their established scope, such as suturing and stitching.
She clarified that the bill ensures the State Medical Board
cannot use its regulatory authority to impede PAs from
continuing to perform these common tasks.
SENATOR TOBIN stated the language if found in SB 89, page 2,
lines 6-7.
3:45:32 PM
MS. SWAIN provided a clinical perspective on the definition of
surgery within her facility, noting that in the absence of a
physician, surgical procedures are limited to those performed
with local anesthetic. She stated that procedures like suturing
using localized anesthetic are considered minor surgeries and
are allowed. However, any procedure requiring regional or
blocking anesthesia would fall outside the clinic's capabilities
and would require a physician.
3:46:22 PM
CHAIR DUNBAR opened public testimony on SB 89.
3:47:18 PM
BARTHOLOMEW GRABMAN, MD, representing self, Anchorage, Alaska,
testified in opposition to SB 89 stating that 4,000 hours of
clinical experience is insufficient for safe, independent
medical practice. He compared this to his own training as a
physician, which included roughly 18,000 clinical hours, and
emphasized that even with that background, he still consults a
supervising physician for every patient. He shared the
perspective of a colleague and former physician assistant (PA)
who stated her competence as a PA was significantly lower than
her current competence as a physician in training, highlighting
the difference in education and training. He argued that current
PA regulations under 12 AAC 40.410450 are not burdensome,
citing requirements such as monthly check-ins and quarterly
evaluations. He also stated that SB 89 does not improve rural
healthcare access, suggesting financial incentives would be a
more effective approach. He concluded by urging the committee to
reject SB 89 as written and recommended increasing the clinical
hour requirement to at least 6,000 or 8,000 hours, citing
Arizona as an example.
3:50:49 PM
DANIEL REYNOLDS, DO, representing self, Naknek, Alaska,
testified in support of SB 89 stating he has worked with PAs for
22 years across military, Indian Health Service, and private
practice settings, including in Naknek. He questioned a prior
speaker's claim of working in Naknek, noting he had not
encountered that individual during his eight years there. He
affirmed that PAs receive strong training, especially in family
medicine, and have also performed well in emergency department
settings. He described PA training as extensive and appropriate
for increased autonomy. He emphasized that PAs deliver high-
quality care and, like physicians, consult when needed. He
stated their training supports the level of independence
proposed in SB 89.
3:52:47 PM
SENATOR GIESSEL asked for confirmation that Dr. Reynolds was
amenable to entering into a collaborative agreement with a
physician assistant (PA) to support them during the transition
to independent practice.
DR. REYNOLDS responded, correct.
3:53:34 PM
KATHERINE VAN ATTA, PA, representing self, Naknek, Alaska,
testified in support of SB 89, stating she has been a PA for 20
years and a nurse midwife for seven, holding independent
licensure as an APRN and dependent licensure as a PA. She works
in both Wasilla and Naknek, where the nearest physician is
typically over 100 miles away. She also precepts medical
students in rural rotations. She argued that state-mandated
collaborative plans are unnecessary for experienced providers to
practice safely, citing her ability to consult and transfer care
as an independently licensed APRN. She emphasized that internal
facility-level oversight ensures competence and appropriate
scope of practice without requiring state-imposed collaboration.
She stated that SB 89 would help address healthcare shortages in
rural areas by reducing administrative burdens that limit the
ability of facilities to hire PAs. She concluded that the bill
would give rural clinics more flexibility to hire the most
qualified provider for their needs.
3:56:09 PM
MICHAEL MICHADU, PA, representing self, Mat-Su, Alaska,
testified in support of SB 89, sharing that he practiced as a PA
for three years in emergency departments across Virginia,
ranging from large teaching hospitals to small rural facilities.
He described receiving extensive hands-on training under
physician supervision, which prepared him well for independent
decision-making. He stated that after moving to Alaska to work
with Southcentral Foundation in both the Mat-Su Valley and rural
clinics like McGrath and Iliamna, he immediately experienced the
challenge of providing care without the team-based support he
was accustomed to. He expressed deep respect for the skill and
professionalism of the PAs he has worked with in Alaska. He
urged the legislature to align Alaska's PA practice laws with
the high standards already being demonstrated across the state.
3:58:48 PM
MOLLY SOUTHWORTH, MD, representing self, Anchorage, Alaska,
testified in opposition to SB 89, stating she has been a
physician in Alaska since 1985, with extensive experience in the
tribal system, private sector, and medical education through the
WWAMI program. She emphasized that while PAs strengthen the
healthcare system, SB 89 undermines physician-led teams, which
she believes would reduce care quality and hinder access to
specialists. She warned that passing SB 89 as written could
result in decreased access to quality care for patients. She
urged the legislature to instead focus on strengthening team-
based care and offered to share specific alternative
recommendations.
MS. SOUTHWORTH also shared a written message from Dr. Kamila
Sulak, president-elect of the Alaska College of Emergency
Physicians, who stated, "the physician voice is important, and
the physician groups we represent account for most of the
physicians in the state of Alaska, it is important that we stand
up strong for the highest quality care possible for our patients
and ourselves."
4:01:33 PM
MARGARET CARLSON CONSENTINO, MD, President, Alaska Academy of
Family Physicians, Anchorage, Alaska, testified in opposition to
SB 89. She said the Alaska Academy of Family Physicians,
representing 340 family doctors, and the organization opposes SB
89 in its current form. She noted that while they value their
work with PAs and have collaborated on alternative frameworks,
SB 89 does not reflect a mutually agreed-upon solution. She
acknowledged concerns with current collaborative plan
requirements and confirmed that the State Medical Board is
already working to revise them significantly. She emphasized the
importance of maintaining team-based care models, which she
believes have contributed to successful partnerships between
physicians and PAs. She recommended considering the North Dakota
model, which retains physician-led care teams without granting
full independence to PAs. She urged continued work on SB 89 to
ensure any changes preserve care quality and respect both
physician and PA roles.
4:04:07 PM
MEGHAN HALL, PA, President, Alaska Academy of Physician
Assistants, Anchorage, Alaska, testified in support of SB 89 as
the current president of the Alaska Academy of Physician
Assistants. She explained that the PA profession was originally
created to relieve overburdened physicians and improve access to
care, operating under collaborative agreements for supervision
and liability. She emphasized that the profession has evolved,
with PAs now holding master's degrees, national certifications,
individual licensure, and Drug Enforcement Administration
registration. She stated that while collaboration remains
essential in practice, formal collaborative agreements have
become outdated and now pose barriers to hiring. She noted
Alaska's critical healthcare shortage and warned that outdated
laws are pushing PAs to relocate to states with modernized
practice statutes. She urged support for SB 89 to help retain
the PA workforce and expand access to care across the state.
4:05:59 PM
CHAIR DUNBAR closed public testimony on SB 89.
4:06:38 PM
CHAIR DUNBAR held SB 89 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 88 Support Document The Effect of Placement Instability 2007.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB 88 Support Document Placement Narratives.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB 88 Support Document Months to Permanent Placement With Kinship.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB 88 Sponsor Statement Version A.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB 88 Sectional Analysis Version A.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB 88 Fiscal Note FCS FLSW 2.21.25.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB 88 Version A.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB 88 Fiscal Note JUD ACS 2.24.25.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |
| SB88 Support Letters as of 02262025.pdf |
SHSS 2/27/2025 3:30:00 PM |
SB 88 |