Legislature(2023 - 2024)DAVIS 106
05/02/2024 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s):|| Board of Marital and Family Therapy | |
| SB115 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | SB 115 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
4:15:28 PM
CHAIR PRAX announced that the final order of business would be
CS FOR SENATE BILL NO. 115(HSS) AM, "An Act relating to
physician assistants; relating to physicians; and relating to
health care insurance policies."
4:15:52 PM
SENATOR L?KI TOBIN, Alaska State Legislature, as prime sponsor,
introduced CSSB 115(HSS) AM to the committee. She explained
that the bill would allow physician assistants to operate within
their scope of practice but would not expand their scope of
practice in any way. She highlighted that the bill was amended
to include a 4,000-hour requirement for physician assistants to
operate as independent caregivers and to direct the State
Medical Board to establish a regulated physician assistant who
may move between different specialties of treatment. She shared
data that found that having a physician assistant at a general
practice increases the overall availability of care to all
patients and highlighted that the availability of a physician
assistant allows for more accessible rural health care.
4:23:44 PM
MICHAEL MASON, Staff, Senator L?ki Tobin, Alaska State
Legislature, on behalf of Senator Tobin, prime sponsor, read the
sectional analysis to CSSB 115(HSS) AM [included in the
committee packet, which read as follows]:
Senate Bill 115: Sectional Analysis
Section 1. Amends AS 08.64.107 by changing the term
"regulation" to "licensure
and scope of practice."
Section 2. Amends AS 08.64.107 by adding four new
subsections:
Subsection (b) describes the procedures and
evaluations physician assistants
can perform, including their ability to: perform
comprehensive health
histories and physical examinations of patients; treat
disease and injury; and
prescribe, dispense, order, and administer schedule
II, III, IV, or V
controlled substance under federal law if the
physician assistant has a valid
federal Drug Enforcement Administration registration
number.
Subsection (c) establishes that a physician assistant
with less than 4,000
hours of practice may practice only under
collaborative agreement with one
(or more) physician to provide care in a hospital,
clinic, or other clinical
setting. These collaborative agreements must be in
writing and describe how
the collaboration will be executed between the
physician and physician
assistant.
Subsection (d) requires that a physician assistant in
a collaborative
agreement or the collaborating physician shall provide
a copy of their
collaborative agreement and relevant documentation to
the State Medical
Board upon request.
Subsection (e) defines collaborative agreement.
Section 3. Amends 08.64.107 to authorize a physician
assistant to practice
medicine independently, with those practicing with
less than 4000 hours required
to operate under a collaborative agreement as
authorized in the previous section.
Section 4. Amends AS 11.71.900 to include physician
assistants under the definition of "practitioner."
Section 5. Amends AS 21.07.010 to disallow a contract
between a participating health care provider and
health care insurer from including a provision that
imposes a practice, education, or collaboration
requirement on physician assistants which is
inconsistent with or more restrictive than the
requirements stipulated under AS 08.64.107.
Section 6. Removes the direct supervision requirement
for physician assistants under the definition of
"attending physician" as stated in AS 23.30.395, which
allows employees to designate physician assistants as
responsible for their care under the Alaska Workers
Compensation Act.
Section 7. Removes the direct supervision requirement
for physician assistants under the definition of
"health care provider" as stated in AS 33.30.901,
which allows physician assistants to provide medical
services as a health care provider within the
Department of Corrections statute definition.
4:26:59 PM
HAROLD JOHNSTON, MD, Board Member, Alaska Primary Care
Association, gave invited testimony on SB 115. He explained
that the association is primarily comprised of physician
assistants and emphasized their support for SB 115. He said
that the current legacy system is no longer necessary and has
created a barrier for care in many rural communities. He
pointed out that there has been a shift in the way that care is
delivered and said that physician assistants are beginning to
play a larger role in health clinics.
4:32:18 PM
CHAIR PRAX asked whether physician assistants working in a rural
community would be working independently or with an
organization.
MR. JOHNSTON replied that the majority of physician assistants
he is aware of that are working in Alaska are working through an
organization.
CHAIR PRAX asked whether the organization Mr. Johnston was
referring to was part of a larger network of physician
assistants.
MR. JOHNSTON confirmed that it is part of a larger organization,
though the networking begins with each physician assistant
individually.
4:34:24 PM
JENNIFER FAYETTE, PA, President, Alaska Academy of Physician
Assistants, gave invited testimony on SB 115. She explained how
physician assistants serve their community and emphasized the
role that they play in delivering healthcare to rural
communities in Alaska. She highlighted that there is a shortage
of healthcare workers in Alaska and said that physician
assistants are the first ones to practice and collaborate with
doctors. She said that six other states have passed legislation
similar to SB 115 in the previous two years that she has been
working with the State Medical Board, and she explained that the
proposed legislation would ensure that physician assistants may
practice to their fullest potential as healthcare professionals.
4:40:03 PM
CHAIR PRAX asked how physician assistants are trained.
MS. FAYETTE answered that physician assistants apply to an
accredited body comprised of multiple representatives of varying
fields of healthcare professionals.
4:41:41 PM
SENATOR TOBIN added that physician assistants are required to go
through continuing education every two years.
4:42:13 PM
REPRESENTATIVE FIELDS asked how leaving the statute pertaining
to physician assistants broad could affect medical practice.
SENATOR TOBIN answered that SB 115 included specific sections
related to physician assistants to make sure that the physician
assistant's scope of practice was clear.
REPRESENTATIVE FIELDS asked whether physician assistants are
already allowed to practice with a degree of independence
similar to medical doctors.
SENATOR TOBIN directed her answer to public testimony.
4:44:15 PM
CHAIR PRAX opened public testimony on CSSB 115(HSS) AM.
4:44:372 PM
KATHERINE VAN ATTA, PA-C, CNM, representing self, testified in
support of SB 115. She explained her background in healthcare
and highlighted that SB 115 would support rural healthcare in a
regulatory environment that she opined was hostile toward rural
healthcare. She referenced a series of proposed regulations by
the State Medical Board and explained how they could have made
it "virtually impossible" to legally practice as a physician
assistant in rural Alaska. She opined that SB 115 would allow
physician assistants to legally practice in rural communities.
4:47:29 PM
REPRESENTATIVE RUFFRIDGE asked Ms. Van Atta what she meant when
she was referring to it being "virtually impossible" for a
physician assistant to legally practice under the State Medical
Board's previously proposed regulations.
MS. VAN ATTA replied that she was referring to the scope of
practice discussion that was occurring within the State Medical
Board and said that the proposed regulation would tie the scope
of practice of the physician assistant to the associated
physician.
4:50:03 PM
KARI BERNARD, PA-C, representing self, testified in support of
SB 115. She highlighted the scrutiny that Alaska physician
assistants are subject to upon their initial certification and
during their continued review. She said that SB 115 would
expand the already safe certification and review processes that
Alaska physician assistants are subject to and urged the
committee's support of the proposed legislation.
4:53:12 PM
MOLLY SOUTHWORTH, MD, representing self, testified in opposition
to SB 115. She highlighted the importance of physician
assistants and the role that they play in a clinic's ability to
provide quality healthcare to its patients. She explained that
the University of Washington has established a rural healthcare
program in Soldotna, Alaska, and emphasized that the University
of Washington's program is already working to train physician
assistants in providing rural healthcare.
4:58:10 PM
REPRESENTATIVE RUFFRIDGE asked Ms. Southworth for clarification
as to whether she was testifying in opposition to or support of
SB 115.
MS. SOUTHWORTH clarified that she was testifying in opposition
to SB 115.
REPRESENTATIVE RUFFRIDGE shared his uncertainty as to how any of
the subject matter Ms. Southworth testified on could be studied.
MS. SOUTHWORTH answered that physician assistants are not
currently allowed to collaborate with their patients' physician
collaborators and described a series of examples in which the
ability for a physician to collaborate with a physician
assistant would have alleviated the adverse outcomes of those
examples.
REPRESENTATIVE RUFFRIDGE told Ms. Southworth that he would
follow up with her later.
5:03:08 PM
KATHRYNE MITCHELL, representing self, testified in opposition to
SB 115. She said that she was specifically concerned with the
"insufficient minimum of 4,000 hours of supervised clinical
practice before independence." She highlighted that other
states have a figure closer to 8,000 hours and added that she,
as a physician, must work another 8,000-10,000 supervised hours
after she has already completed thousands of previous hours to
obtain her degree. She questioned the safety of a physician
assistant being able to work independently at 4,000 hours.
5:06:10 PM
MARGARET CARLSON, DO, Alaska Chapter of Family Physicians,
testified in opposition to SB 115. She said that the Alaska
Chapter of Family Physicians does not agree with the policies of
SB 115 as they are currently written, which would remove the
benefits of team-based, physician-led care and lead to a higher
cost to patients, a higher number of referrals to specialists,
and an overall degraded level of care for Alaskans.
5:10:10 PM
CHRISTI FROILAND, PA-C, Alaska Physician Assistant Academy,
testified in support of SB 115. She emphasized to the committee
that no physician assistant is ever going to practice alone,
regardless of whether they are approved to work independently.
She shared her experience in working as a physician assistant
and said that she has always extensively worked with her doctor
to ensure that the greatest level of care is given to a patient.
She said that SB 115 is "about much more than independence" and
urged the committee's support of the bill.
5:12:42 PM
The committee took an at-ease from 5:12 p.m. to 5:13 p.m.
5:13:25 PM
BETSY PACZAN-DOUDS, PA-C, President, Alaska Academy of Physician
Assistants, testified in support of SB 115. She said that the
bill would allow Alaska's healthcare system to meet its demands
by allowing physician assistants to practice to the fullest
extent of their abilities and training. She shared her
experience in working as a physician assistant being "regularly
confronted" with a shortage of resources to provide to patients
and said that SB 115 might be able to alleviate this shortage of
resources.
5:16:40 PM
MEGHAN HALL, PA-C, representing self, testified in support of SB
115. She explained that physician assistants are already
working with their physicians and said that the proposed
legislation would address an issue important to all Alaskans.
5:17:52 PM
MARY SWAIN, CEO, Cama'i Community Health Center, testified in
support of SB 115. She said that her health clinic has not been
able to employ a physician for over 15 years due to its remote
location. She explained that the cost of a physician's contract
is prohibitive to her clinic and highlighted that it would be
safe, effective, and less expensive to both the clinic and the
patient to allow for physician assistants to provide care to
patients.
5:20:35 PM
CAMILLA SULAK, MD, MEd, FACEP, representing self, testified in
opposition to SB 115. She shared her two concerns with SB 115,
one being the implications that the proposed legislation has for
general practice medicine in Alaska and the other with regard to
Alaska's emergency medicine. She opined that the current
collaborative model of the physician assistant and physician
relationship is working well and does not need to be changed.
5:24:50 PM
HELEN ADAMS, MD, Vice President, American College of Emergency
Physicians Alaska Chapter (AK-ACEP), testified in opposition to
SB 115. She said that it would be unsafe to allow physician
assistants to go "full sail" into independent practice. She
suggested the hourly requirement for a physician assistant to go
independent to be 10,000 hours and said that a physician
assistant that is operating on an independent basis must provide
specialized healthcare, not a general practice.
5:27:15 PM
CANDACE HICKEL, PA-C, testified in support of SB 115. She said
that regulations surrounding physician assistants are
"antiquated" and explained that healthcare education and
practice has advanced far since then. She highlighted the fact
that physician assistants often have twice the hours as that of
licensed practical nurses (LPNs), though an LPN is allowed to
practice independently with far fewer hours worked than a
physician assistant.
5:30:11 PM
REPRESENTATIVE RUFFRIDGE asked Ms. Hickel what her transition
from neurosurgery to cardiothoracic surgery was like and why she
chose to make that transition.
MS. HICKEL replied that she is a leader in the physician
assistant community in Anchorage and said that she was asked by
Providence [Alaska Medical Center] to make the transition
between the two types of care. She said that a physician
assistant's transition between two specialty types of care would
be best managed by their associated practice, organization, or
hospital, not the legislature.
5:32:04 PM
REPRESENTATIVE ANDREW GRAY, Alaska State Legislature, testified
in support of SB 115. He described his education and experience
in working as a physician assistant and emphasized the
importance of the collaborative model of care for physician
assistant that is new or younger in their career. He addressed
a few of the concerns raised by previous testifiers and
emphasized the ability of a physician assistant to provide
independently of their physician.
5:35:10 PM
REPRESENTATIVE MINA asked Representative Gray to speak to the
disparities that exist between the certification of physician
assistants in different states.
REPRESENTATIVE GRAY answered that the military will allow a
physician assistant to practice as long as they hold a state
license from any state in the U.S. He explained that the
process for renewing is different in Alaska because the renewal
application requires that a physician "sign off" on their
application for renewal.
5:37:49 PM
MACKENZIE POPE, Staff, Senator L?ki Tobin, Alaska State
Legislature, on behalf of Senator Tobin, prime sponsor,
commented that SB 115 is a straightforward bill that is meant to
improve healthcare in Alaska, not one to compete with doctors.
5:38:36 PM
REPRESENTATIVE RUFFRIDGE asked why there is no requirement that
a physician assistant's hours not be logged and further
questioned whether a physician assistant would have to complete
the 4,000-hour requirement of SB 115 after it is passed even if
they have already completed those requirements.
5:40:56 PM
MS. HICKEL answered that a physician assistant would no longer
have to file paperwork with the state if SB 115 were passed.
She emphasized that the practical endpoint of SB 115 is to allow
healthcare providers to do what they've been trained to do.
REPRESENTATIVE RUFFRIDGE commented that he wanted to make sure
that the hours worked by a physician assistant are somehow
logged.
MS. HICKEL explained that she was required to submit proof of
her qualifications and training hours to her employer when she
first applied to work as a physician assistant.
5:46:20 PM
CHAIR PRAX asked whether the system of logging hours would work
the same way if the physician assistant were to work on an
individual basis.
MR. HICKEL answered that physician assistants are required by
their associated national certifying organization to complete
their education and training and log the times associated with
both.
5:47:54 PM
REPRESENTATIVE MINA asked how the scope of practice of a
physician assistant is defined as it currently relates to
existing physician assistant regulations and asked what the
current scope of practice is for a physician assistant.
MS. POPE answered that the scope of practice of a physician
assistant is defined at the clinical site and the specific type
of training that the physician assistant has received.
5:52:32 PM
CHAIR PRAX asked whether there is concern of malpractice
occurring with a physician assistant that has been improperly
certified.
MS. HICKEL answered that the concern of malpractice is one
consistent with all medical providers.
5:53:38 PM
REPRESENTATIVE MINA asked how often a physician assistant is
actually engaged with their associated physician.
5:54:29 PM
MR. HICKEL explained the relationships between all members of a
patient's healthcare team and emphasized that a lot of medical
situations could be prevented by a physician assistant being
present at a local clinic.
5:56:51 PM
MS. POPE added that clinics are often employing out-of-state
providers for exorbitant amounts of money.
MS. HICKEL commented that the $59,000 figure cited by a previous
testifier was not an insignificant amount of money.
5:58:01 PM
CHAIR PRAX inquired about fiscal notes associated with SB 115.
SYLVAN ROBB, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development (DCCED), offered her understanding that the
cost of SB 115 would be absorbed by the state.
5:59:05 PM
REPRESENTATIVE RUFFRIDGE asked how hours would be logged if no
state agency is keeping record of a physician assistant's time
worked.
MS. HICKEL responded that the State Medical Board would adopt
regulations pertaining to a physician assistant's logging of
hours worked.
6:00:45 PM
CHAIR PRAX asked for the committee's will on CSSB 115(HSS) AM.
REPRESENTATIVE MINA commented that she would be okay to move the
bill to the House Labor and Commerce Standing Committee.
6:01:40 PM
REPRESENTATIVE SUMNER said that he could take up amendments in
the House Labor and Commerce Standing Committee.
REPRESENTATIVE MCCORMICK added that he was in support of moving
the bill out of the House Health and Social Services Standing
Committee.
6:02:20 PM
The committee took an at-ease from 6:02 p.m. to 6:05 p.m.
6:05:34 PM
CHAIR PRAX, after ascertaining that there was no one else who
wished to testify, closed public testimony on SB 115.
6:05:38 PM
REPRESENTATIVE RUFFRIDE moved to report CSSB 115(HSS) AM out of
committee with individual recommendations and the accompanying
fiscal notes.
REPRESENTATIVE SADDLER objected.
REPRESENTATIVE SUMNER told Representative Saddler that he was a
member of the House Labor and Commerce Standing Committee and
would be able to make changes to the bill in that committee.
6:07:08 PM
A roll call vote was taken. Representatives Sumner, Mina,
McCormick, Ruffridge, and Prax voted in favor of reporting CSSB
115(HSS) AM out of committee with individual recommendations and
the accompanying fiscal notes. Representative Saddler voted
against it. Therefore, CSSB 115(HSS) AM was reported out of the
House Health and Social Services Standing Committee by a vote of
5-1.