Legislature(2007 - 2008)BELTZ 211
04/19/2007 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB102 | |
| SB107 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 107 | TELECONFERENCED | |
| *+ | SB 140 | TELECONFERENCED | |
| += | SB 102 | TELECONFERENCED | |
| += | HB 118 | TELECONFERENCED | |
SB 107-NATUROPATHS
2:21:49 PM
CHAIR ELLIS announced SB 107 to be up for consideration.
TOM OBERMEYER, staff to Senator Davis, sponsor of SB 107,
explained the bill relates to establishing a Naturopathic
Advisory Committee and a Naturopathic Formulary Council. It
amends the duties of the State Medical Board and the Board of
Pharmacy relating to the naturopathic practice and provides an
effective date. He said the three-member advisory committee is
to be comprised of three licensed naturopaths appointed by the
commissioner of the Department of Commerce, Community & Economic
Development. It is responsible for selecting the Formulary
Council and reviewing allegations of member misconduct. The
Counsel will include three naturopaths, one medical doctor or
osteopath and one pharmacist appointed by the respective boards
to approve certain drugs to be prescribed by naturopaths and to
authorized prescription endorsements to qualified naturopaths.
While the State Medical Board licenses osteopaths, podiatrists,
physician assistants, intensive care and paramedics, and foreign
medical graduates, the Department of Commerce, Community &
Economic Development licenses naturopathic applicants who have
graduated from one of the four accredited schools of naturopathy
in the U.S. and one of the two schools in Canada. Applicants
must also have passed the Naturopathic Physician's Licensing
Examination.
New naturopathic procedures under SB 107 allow minor surgery,
including operative electrical and other methods of repair to
superficial lacerations and abrasion or lesions, and removal of
foreign bodies in superficial tissues. The bill also allows
naturopaths to use antiseptics and local anesthetics in
connection with allowed procedures. The law prohibits
naturopaths from performing major surgery and spinal and general
anesthetics.
Thirteen states license naturopaths and nine have instituted
formulary laws. The states are Alaska, Arizona, Connecticut,
Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon,
Utah, Vermont and Washington. Currently, Alaska has 40
practicing naturopaths, Washington has 802, Oregon has 715,
Arizona has 375, Connecticut has 210, Vermont has 117, Hawaii
has 85, Montana has 67, New Hampshire has 67, Maine has 27, Utah
has 18, and Kansas has 11. Nine states allow naturopaths to
prescribe without any M.D. supervision or protocol, but they
usually are allowed to prescribe only designated drugs.
Arizona has the broadest formulary in the nation allowing
naturopaths to prescribe all but I.V. medications, controlled
substances except morphine, cancer chemo-therapeutics, and anti
psychotic drugs. Kansas requires M.D. supervision and Maine
requires collaboration with a physician for one year prior to
independent prescribing.
MR. OBERMEYER said that naturopathic doctors focus on
preventative care and in keeping patients healthy and they
usually rely much less than M.D.s on the use of drugs. Patients
often turn to naturopathic doctors when traditional medicine has
failed. One of the reasons naturopaths require formulary or
prescribing law is to reduce the amount of combinations of drugs
patients are taking.
2:26:37 PM
He said SB 107 is designed to reasonably expand the services of
naturopathic doctors only to areas collateral to the needs of
their daily practice without infringing on the duties and
responsibilities of medical doctors licensed by the State
Medical Board. This type of bill has been before the Senate in
SB 306 in the last legislature; it went through several
revisions and the result was a task force that was to address
it. The Alaska State Medical Board indicated it didn't think the
process was complete.
2:27:08 PM
MARY MINER, N.D., said she is currently practicing in Anchorage,
and that she would address the educational requirements for
naturopaths and how they compare to other licensed health care
professionals in the State of Alaska.
She referenced Appendix E that compared the curricula of
National College, Bastyr University, Southwest (all naturopathic
colleges) and John Hopkins, Yale and Stanford. The basic
clinical education is similar across the board, she observed.
There are differences in the allopathic and the naturopathic
strength in the clinical applications. Naturopaths do a lot more
with botanical medicine, naturopathic philosophy, and oriental
medicine which are not included in the allopathic schools. The
total number of hours of education is similar.
2:29:36 PM
She also handed out a comparison of medical background education
of licensed professionals who are able to use prescription
medications at this time based on a UW study from two years ago
- including nurse practitioners, physician assistants, medical
doctors, and other states that license naturopaths. The
prerequisites to get in to college are fairly similar; the
education once they are in school is also quite similar.
Naturopaths have a different focus on being more wellness
oriented.
MS. MINER said it is within the scope of the practice of most
licensed M.D.s to use prescription medications, particularly
legend drugs, which are not controlled substances and
naturopaths just want to expand their licensing to fit their
training and have it available for their patients.
2:31:07 PM
GARY FERGUSON, N.D., said he practices in the Eastern Aleutians
and represents the Alaska Association of Naturopathic Physicians
as its Alaska Native liaison. His primary work is with the
Alaska Native population although he works for Eastern Aleutian
Tribes community health centers. He serves mainly the
underserved population that has huge health disparities. His
focus in the last five years has been in diabetes and diabetes
management.
One challenge to his practice in the Aleutians is that the nine
communities are remote and have a limited practitioner base. He
sometimes teams up with nurse practitioners and others, but it
still is often not enough. Medications often need to be changed
as health improves. Since he cannot prescribe changes, patients
needs separate appointments and sometimes they get the lost in
the shuffle. He has been trained in pharmacology and pharmaco-
kinetics of drugs and this bill would allow him to practice the
way he was trained. He supported the bill.
2:35:58 PM
EMILY KANE, N.D., said she graduated from an accredited
naturopathic school in 1992 and has been practicing in Juneau
for nearly 15 years. She has had hospital privileges with
Bartlett Regional Hospital for over a decade. So far the ideas
of comparable education have been presented along with expanding
of primary health care providers, which naturopaths are, in the
state of Alaska, which is underserved.
DR. KANE said she wanted to address consumer safety. Appendix K
covered states and disciplinary actions. In the years 2000 to
2003 in various states there were twice as many disciplinary
actions for medical doctors as for naturopaths. However, in
those years Arizona naturopaths had access to prescription drug
writing. However, she noted that it's feasible that Alaska's
zero disciplinary actions for the years surveyed relates to
naturopaths not having access to prescription medication. She
argued that prescription drugs have a much higher side effect
profile, which is why N.D.s get this training. She also noted
that one of the aspects of the bill insures continuing education
and staying abreast of pharmaceutical practices. Dr. Kane said
naturopaths want to provide the best care for their patients
within the scope of their practice.
SENATOR STEVENS asked if the disciplinary actions she mentioned
were for prescription misuse.
DR. KANE replied no; they covered any kind of disciplinary
action that would have been registered through the Division of
Occupational Licensing.
CHAIR ELLIS said the bill was referred to the Labor and Commerce
Committee because of scope of practice issues and workforce
development. He said the Alaska Medical Association opposed this
bill saying the legislature should spend its time expanding the
WWAMI slots and training programs because many M.D.s are
retiring. However, the legislature has doubled the WWAMI slots
this year and he supposed Dr. Kane would argue that N.D.s do
fill that need every day in our state and they are a class of
medical providers that could expand as well. He asked her if she
could comment on that point.
2:42:08 PM
DR. KANE responded that it's fantastic that the legislature has
expanded the WWAMI slots. She said she and Dr. Miner have been
practicing as family doctors for over 20 years. They are already
established in their communities and practicing as primary care
family doctors. She has 4,000 charts. She would be more useful
to her large patient base immediately. The new WWAMI doctors
will be needed, but it's not an either/or situation.
2:42:55 PM
SENATOR STEVENS said he understood Dr. Ferguson's remote
argument, but that's not the case here in Juneau where lots of
people can prescribe medications. He asked what is the rationale
is for providing her that opportunity in town.
DR. KANE replied that she makes referrals frequently saying she
is "well-embedded" in the medical community here. However,
sometimes it takes a long time to get in and the patient needs
the antibiotic immediately. Or they are just not going to go the
medical doctor. It's a freedom of choice in health care issue -
in part. There are plenty of medical doctors here, but on the
whole Alaskans are underserved and naturopaths are submitting
they are trained and available, established and providing
patient care already, and that they have more training than
nurse practitioners who already have prescriptive rights. This
would bring Alaska in line with all the other western states
that license naturopaths and provide prescriptive rights to
them.
2:44:45 PM
SCOTT LOOPER, N.D., Fairbanks, supported SB 107 and wanted to
add that the main reason naturopaths are doing this is to
provide the best quality care to their patients they can.
Sometimes it is in the patient's best interest to receive an
antibiotic, a diuretic or something like that. The fact is that
naturopathic physicians are trained to prescribe when needed
within the context of the practice of naturopathic medicine.
They want to provide quality care with the tools they are
trained to use.
2:46:40 PM
DR. LOOPER described how the right to prescribe is earned. You
attend classes where you learn how to use prescription
medications, then you move on to a clinic situation where under
the supervision of practicing licensed doctors, you practice
using them. After that, you take a national board exam; if you
pass that exam, you earn the right to get licensed.
In Alaska, they do every step of that process with the exception
of the licensing piece. It is often inconvenient for patients to
go to another doctor when their naturopathic doctor is trained
in the use of those medications. It's also more expensive, more
difficult and time consuming. He has a license in Oregon and
Arizona and is used to being able to use these tools on
occasion.
2:48:16 PM
CHAIR ELLIS asked if the lack of prescriptive powers keeps
naturopaths from locating to Alaska.
DR. LOOPER replied that he didn't know. He said the fact is that
naturopathic doctors don't prescribe much. When he had the right
to prescribe in Oregon and Arizona, he only wrote a script once
a week or two and most times he would be taking people off of
things. Not having prescriptive rights doesn't limit his ability
to help people, but it creates a certain frustration knowing
that you're going to be moving to a state that you can't do some
basic things, like writing for thyroid hormone replacement,
which is a normal thing to do in someone whose thyroid isn't
working right.
2:49:11 PM
PATRICIA ANDERSON, Anchorage resident, said she had been a
patient of an N.D. there and has been for over seven years. She
related how she is on her third bout of breast cancer and how
her naturopathic doctor worked with her oncologist to make her
chemotherapy less uncomfortable for her. Her naturopath has
extensive experience with cancer care. After she finished with
chemotherapy, she ended up on a bone loss type medicine and he
has helped her get the exact right kind of calcium to keep the
bone loss minimal. She also recognizes her naturopathic doctor
as her primary physician. She supported SB 107 even though she
has no need of regular prescriptions. She wanted to know that he
would be able to give them to her if she needed them.
2:51:26 PM
RICK URION, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community &
Economic Development (DCCED), disclosed that in a previous life
he lobbied for the State Medical Society and was instrumental in
writing the first law allowing for licensing of naturopaths in
the State of Alaska. Today he represents the administration on
this issue and has a neutral position on it, but he had an
opinion on the two committees the bill forms.
MR. URION said it appears that the advisory committee is really
a board, but it is being formed without being called a board. A
committee is appointed by the commissioner of DCCED and he
thought they might want to change that as well as add a member
of the public - as other boards have. The advisory committee
talks about disciplinary actions and that's what boards do.
Also, the Formulary Counsel consists of three members in the
bill, but it should consist of five members, three of which are
naturopaths and one physician. He also pointed out that existing
law makes it illegal for naturopaths to call themselves
physicians.
CHAIR ELLIS asked if he was suggesting that the committee
consider making the language more conventional to comport with
the way boards are set up for other professions.
MR. URION replied yes. It appears that they are forming a board
whether or not they are calling it that. All the other boards
consist of members of the profession and a member of the public.
The governor does the appointing, not the associations. They can
make recommendations.
2:54:50 PM
CHAIR ELLIS asked Mr. Obermeyer if there is a reason the bill
was drafted differently than all the other boards.
MR. OBERMEYER answered there was an initial question of whether
this type of practice would be regulated by the DCCED or the
State Medical Board. Basically, the naturopaths felt they were
criticized harshly in the last legislature and they wanted to
have some type of control. Documentation indicates that even in
California that the few physicians willing and trained for N.D.
supervision have difficulty getting malpractice coverage. There
are many issues and he didn't have the answers for everything.
He said the 40 naturopaths in Alaska are looking for a way to be
recognized in their profession and expand their practice to
minor procedures and to have an opportunity to be regulated
within their own group. Presumably they would want to keep
malpractice out of their profession.
CHAIR ELLIS requested the sponsor talk with Mr. Urion and draft
the bill with standard operating procedure and bring it back to
the committee next week.
2:57:53 PM
SENATOR DAVIS said she would do what is necessary to move the
bill along.
2:58:17 PM
CHAIR ELLIS asked if there was any work product from Senator
Seekins' Naturopathic Task Force.
MR. OBERMEYER replied there were no recommendations. He said the
State Medical Board said it was concerned that naturopaths are
not as well trained or educated. There is no residency program
for instance. He said this group is willing to address those
issues as necessary in order to have some type of regulation
that everyone agrees with.
CHAIR ELLIS said they would have another meeting as soon as
those things could get resolved in the committee substitute for
SB 107.
| Document Name | Date/Time | Subjects |
|---|