Legislature(2023 - 2024)BARNES 124
05/08/2024 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HJR27 | |
| SB182 | |
| SB239 | |
| SB182 | |
| SB234 | |
| SB115 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 336 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | SB 182 | TELECONFERENCED | |
| + | SB 234 | TELECONFERENCED | |
| + | HJR 27 | TELECONFERENCED | |
| += | SB 115 | TELECONFERENCED | |
| += | SB 239 | TELECONFERENCED | |
SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
4:26:05 PM
CHAIR SUMNER announced that the next 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."
4:26:33 PM
The committee took an at-ease from 4:26 p.m. to 4:28 p.m.
4:28:15 PM
REPRESENTATIVE RUFFRIDGE confirmed he would not offer Amendment
1. He moved to adopt Amendment 2 to CSSB 115(HSS) AM, labeled
33-LS0542\U.A.3, Gunther, 5/3/24, which read:
Page 3, line 7:
Delete "one or more collaborating physicians"
Insert "a collaborating physician"
Page 3, lines 7 - 8:
Delete "A collaborating physician or physicians"
Insert "The collaborating physician"
Page 3, lines 10 - 12:
Delete "one or more collaborating physicians who,
collectively, practice in each of the physician
assistant's practice areas"
Insert "the collaborating physician"
Page 3, following line 13:
Insert new paragraphs to read:
"(2) be between a physician assistant and a
collaborating physician who practices in each of the
practice areas of the physician assistant;
(3) describe the practice areas of the
physician assistant and the collaborating physician;"
Renumber the following paragraphs accordingly.
Page 3, line 22, following "assistant;":
Insert "and"
Page 3, line 24:
Delete "; and"
Insert "."
Page 3, lines 25 - 26:
Delete all material.
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE RUFFRIDGE said that Amendment 2 sought to clarify
that "collaborative physician" in the bill should be a singular
person, whereas in the underlying bill there is a desire to
clarify that there can be an alternate.
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
4:29:12 PM
SENATOR L?KI TOBIN, Alaska State Senator, as prime sponsor of SB
115, said she would defer to an expert to ensure there was
accurate information given.
4:29:27 PM
JENNIFER FAYETTE, PA, offered her belief that it went back to
statute versus regulation and opined that it was a confusing
conversation in the bill.
REPRESENTATIVE FIELDS asked whether limiting [the definition] to
one person produced a problem in, for example, a tribal health
system where two collaborating physicians could be beneficial.
MS. FAYETTE responded that collaboration and consultation are
always available to everyone. She opined that it is burdensome
to require more than one [collaborator].
4:31:03 PM
REPRESENTATIVE WRIGHT removed his objection.
REPRESENTATIVE CARRICK objected.
4:31:11 PM
A roll call vote was taken. Representatives Fields, Prax,
Ruffridge, Saddler, and Wright voted in favor of Amendment 2.
Representatives Carrick and Sumner voted against it. Therefore,
Amendment 2 was adopted by a vote of 5-2.
4:31:49 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 3 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.9, Gunther,
5/6/24, which read:
Page 3, line 4:
Delete "4,000"
Insert "10,000"
REPRESENTATIVE WRIGHT objected for purposes of discussion.
REPRESENTATIVE FIELDS explained that Amendment 3 would change
the hours prior to independent practice from 4,000 to 10,000.
He offered his belief that 4,000 hours is too low, and the
amendment is an attempt to strike a balance.
4:32:29 PM
CHAIR SUMNER sought clarity if it would be 5 years of full-time
work.
REPRESENTATIVE FIELDS replied yes, assuming one works 2,000
hours a year and he further noted that it would differ based on
practice.
4:33:05 PM
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
SENATOR TOBIN added that the amendment would require a physician
assistant (PA) to have additional hours, and if an assistant
were to switch specialties, there would be additional
requirements that would equal that of physicians. She gave an
example of Utah and its specific provisions. She noted that in
Alaska, there are not enough collaborating physicians and it
would make it more difficult on the PA to find collaborators for
those five years.
4:34:24 PM
REPRESENTATIVE CARRICK noted that Amendment 1, which was not
offered, would have moved from 4,000 to 8,000 hours.
REPRESENTATIVE CARRICK moved to adopt Conceptual Amendment 1 to
Amendment 3, to change the hours to 8,000.
REPRESENTATIVE RUFFRIDGE objected.
REPRESENTATIVE CARRICK said that the intent was to provide a
better balance between the scope of the bill and the underlying
amendment.
4:35:33 PM
REPRESENTATIVE FIELDS offered support for the conceptual
amendment.
4:35:38 PM
REPRESENTATIVE WRIGHT asked Senator Tobin whether 4,000 hours
was adequate and 8,000 was overkill.
SENATOR TOBIN deferred to Ms. Fayette for further clarity.
4:36:35 PM
MS. FAYETTE said that the ongoing misconception is how much
education one receives and noted that the PA program requires
2,000 hours to be accepted into medical school. She related
that the average person has 6,000 hours of patient care. She
advised that PAs are not trying to be doctors but are seeking a
pathway that gets people to provide better care and stay current
in what they do.
4:38:11 PM
REPRESENTATIVE FIELDS commented that 8,000 hours was the bare
minimum he could support.
4:38:44 PM
REPRESENTATIVE RUFFRIDGE stated that he had never heard of the
large number of hours being completed prior to going to school,
and asked, "The hours in what?"
MS. FAYETTE responded that it had to be repetitive patient care
and added that many students are emergency medical technicians
(EMTs), nursing students, and medical assistants. She shared
that her program had a minimum of 2,500 hours.
REPRESENTATIVE RUFFRIDGE shared an anecdote of his educational
background. He asked, in order to go to PA school, whether a
person that has completed high school or undergrad training
cannot apply.
MS. FAYETTE answered that they probably would not be accepted.
She clarified it must be paid hours and one must have 2,000 paid
patient care.
REPRESENTATIVE RUFFRIDGE asked whether there was a barrier put
in place by the schools and who established the hourly
requirement in order to attend school.
4:41:38 PM
SENATOR TOBIN explained that each program had different
prerequisite requirements. She listed the types of hourly
requirements and that programs require at least a bare minimum
to be accepted into these highly competitive programs. She
reiterated that it was not the intent to have PAs in line with
physicians.
4:43:12 PM
CHAIR SUMNER asked how the scope of practice would differ from
that of a physician under the proposed legislation.
SENATOR TOBIN pointed to the differences on page 2, line 5,
which showed a list of what PAs do, and for example, PAs do not
operate under regulation. She mentioned an inpatient procedure
such as stitches which may fall under an "operation."
4:44:34 PM
REPRESENTATIVE WRIGHT questioned whether 2,000 hours was
adequate for the scope of work but observed that 4,000 had been
compromised on.
4:44:46 PM
REPRESENTATIVE RUFFRIDGE provided his rationale and added that
he thought 10,000 hours made sense but not in the way that
Amendment 3 brought it forward. He affirmed he would not
support the conceptual amendment or the underlying amendment.
4:46:10 PM
A roll call vote was taken. Representatives Carrick, Fields,
and Sumner voted in favor of Conceptual Amendment 1 to Amendment
3. Representatives Wright, Ruffridge, Saddler, and Prax voted
against it. Therefore, the Conceptual Amendment 1 to Amendment
3 failed to be adopted by a vote of 3-4.
4:47:04 PM
REPRESENTATIVE CARRICK noted her appreciation for PA testimony
stating 4,000 hours as being adequate. She offered her support
for Amendment 3 being that she was not convinced that without
the amendment some of the parity would be received.
4:48:22 PM
SENATOR TOBIN gave a reminder that every PA program required
2,000 hours and these additional collaborative hours would be on
top of that.
4:48:57 PM
REPRESENTATIVE FIELDS questioned whether there were any doctors
online to give an overview of hours in school and clinical
rotation.
CHAIR SUMNER confirmed there was not anyone online or in the
room.
4:49:35 PM
A roll call vote was taken. Representatives Carrick and Fields
voted in favor of Amendment 3. Representatives Saddler, Wright,
Prax, Ruffridge, and Sumner voted against it. Therefore,
Amendment 3 failed to be adopted by a vote of 2-5.
4:50:10 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 4 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.10, Gunther,
5/6/24, which read:
Page 1, line 11:
Delete "[AND]"
Insert "and"
Page 1, line 12, through page 2, line 4:
Delete "; and
(5) hours of practice experience, if any,
that a physician assistant must complete under a
collaborative agreement to practice in a practice area
that is substantively different than the physician
assistant's previous practice areas; the board may not
require that a physician assistant complete more than
4,000 hours under this paragraph, in addition to the
hours required under (c) of this section, to practice
in a new practice area without a collaborative
agreement"
Page 3, lines 3 - 5:
Delete "Unless additional hours are required by
the board to practice in a new practice area under
(a)(5) of this section, a physician assistant with
less than 4,000 hours of practice experience"
Insert "Except as provided in (d) of this
section, a physician assistant"
Page 3, following line 26:
Insert a new subsection to read:
"(d) A physician assistant with 4,000 or more
hours of practice experience under a collaborative
agreement may provide primary care services permitted
under (b) of this section without having a
collaborative agreement in place."
Reletter the following subsections accordingly.
REPRESENTATIVE RUFFRIDGE objected.
REPRESENTATIVE FIELDS summarized that the amendment limits
independent practice of PAs to primary care.
4:51:07 PM
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
4:51:13 PM
SENATOR TOBIN offered her belief that "carve outs" are
problematic. She noted that a similar provision was proposed
out of state and the reality led to fewer PA practices. She
deferred to Ms. Fayette for further reasoning on the proposed
amendment.
MS. FAYETTE reiterated that the bill was put forward for access
to care. She noted that there are specialty doctors lacking in
parts of Alaska and gave personal examples of the scope of her
work in the clinic. She stressed the importance of recognizing
the shortages but still being able to "answer the call."
4:54:47 PM
REPRESENTATIVE RUFFRIDGE appreciated the testimony and asked Ms.
Fayette if the bill were to pass whether she would practice
independently or attempt to continue in a collaborative fashion.
MS. FAYETTE responded that the bill wouldn't change a lot for
her regarding a "surgical assist."
4:56:16 PM
ADJOURNMENT
CHAIR SUMNER recessed the House Labor and Commerce Standing
Committee meeting to 10 minutes following the adjournment of
House floor session. [The motion to adopt Amendment 4 was left
pending, with objection.]
7:13:15 PM
CHAIR SUMNER called the House Labor and Commerce Standing
Committee back to order. Present during the call back to order
were Representatives Prax, Carrick, Fields, Ruffridge, and
Sumner. Representatives Saddler and Wright arrived as the
meeting was in progress.
SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
7:13:19 PM
CHAIR SUMNER 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."
SENATOR TOBIN noted that Ms. Fayette wished to continue her
closing comments.
7:13:48 PM
MS. FAYETTE said that when a collaborator is lost, it causes
delayed care; therefore, access to care gets interrupted.
7:14:21 PM
A roll call vote was taken. Representative Fields voted in
favor of Amendment 4. Representatives Ruffridge, Wright,
Carrick, Prax, and Sumner voted against it. Therefore,
Amendment 4 failed to be adopted by a vote of 1-5.
7:15:05 PM
REPRESENTATIVE FIELDS stated that he will not move Amendment 5
and moved to adopt Amendment 6 to CSSB 115(HSS) AM, as amended,
labeled 33-LS0542\U.A.14, A. Radford/Gunther, 5/6/24, which
read:
Page 3, following line 29:
Insert a new subsection to read:
"(e) Before a physician assistant may provide
services under this section, the physician assistant
must inform the patient that the services will be
performed by a physician assistant and identify any
physician who is present for the services."
Reletter the following subsection accordingly.
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS explained that existing law does not
require PAs to identify themselves as such, and the amendment
would require the PA to relate that they are a PA.
7:16:03 PM
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
SENATOR TOBIN said that Ms. Fayette could speak to the
regulation.
7:16:24 PM
MS. FAYETTE said that current regulations require a sign that
shows a PA's credentials and that their education is on file.
In addition, they must wear a nametag or clothing that presents
them as a PA.
REPRESENTATIVE WRIGHT asked whether a PA greets and tells a
patient their name and title.
MS. FAYETTE confirmed that she does and added that she will
correct a patient if they think she is a physician.
7:17:08 PM
SENATOR TOBIN explained that it is in regulation that all who
are not MDs or physicians must identify themselves as not being
a doctor.
7:17:42 PM
REPRESENTATIVE CARRICK, referencing the second part of the
amendment, asked whether PAs currently need to identify a
physician who is present for the services.
MS. FAYETTE responded that in regulation, any provider should
present themselves.
7:18:25 PM
SENATOR TOBIN noted that 12 percent of collaborating physicians
have licenses outside the state.
REPRESENTATIVE CARRICK relayed her concern that the second part
of Amendment 6 would be challenging to put into place when there
is a lack of physicians.
7:19:40 PM
CHAIR SUMNER advised members of a new invited testifier.
7:20:04 PM
REPRESENTATIVE RUFFRIDGE asked the amendment sponsor if the
intent of the amendment is to allow a PA to perform services
only if a physician is present.
REPRESENTATIVE FIELDS responded that was not the intent because
remote collaborating physicians are necessary and helpful.
7:21:04 PM
SENATOR TOBIN noted that regulation provided penalties for
noncompliance of identification.
CHAIR SUMNER commented that if it was put in statute, penalties
would still exist in regulation.
SENATOR TOBIN said it was a concern in that the regulations
would need to be re-written and there may be confusion from the
medical board.
7:22:06 PM
REPRESENTATIVE FIELDS clarified it was not the intent to change
more details in regulations.
7:22:19 PM
REPRESENTATIVE CARRICK moved to adopt Conceptual Amendment 1 to
Amendment 6 to delete the following from line 5 [as numbered on
Amendment 6]: "and identify any physician who is present for
the services". There being no objection, it was so ordered.
CHAIR SUMNER advised that Amendment 6, as amended, with
objection, was before the committee.
7:23:11 PM
A roll call vote was taken. Representatives Fields, Ruffridge,
Saddler, Carrick, and Sumner voted in favor of Amendment 6, as
amended. Representatives Prax and Wright voted against it.
Therefore, Amendment 6, as amended, was adopted by a vote of 5-
2.
7:23:46 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 7 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.19, Gunther,
5/7/24, which read:
Page 2, line 3:
Delete "(c)"
Insert "(d)"
Page 2, line 31:
Delete "and"
Page 2, following line 31:
Insert a new paragraph to read:
"(13) assist in the performance of an
operation performed by a physician, osteopath, or
podiatrist licensed under this chapter; and"
Renumber the following paragraph accordingly.
Page 3, following line 2:
Insert a new subsection to read:
"(c) A physician assistant may not perform an
operation."
Reletter the following subsections accordingly.
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS summarized Amendment 7 and that the intent
was to offer better clarification for scopes of practice.
7:24:46 PM
REPRESENTATIVE SADDLER asked for definition regarding assisting
in the performance of an operation versus performing an
operation.
SENATOR TOBIN noted that the terms are not defined within the
amendment. She referred to the first part of the amendment as
being problematic, being it may create difficulties for
providers. She further noted other difficulties that may be
created.
7:26:52 PM
REPRESENTATIVE FIELDS requested a doctor online who could speak
to Amendment 7.
7:27:24 PM
KRISTIN MITCHELL, MD, President, Alaska State Medical
Association, after noting her credentials, said that the
definition of "operation" could be broadly determined and could
create complications. She briefly explained the definitions of
medical practitioners.
REPRESENTATIVE FIELDS asked whether the committee should
distinguish that PAs should not perform operations or withdraw
Amendment 7.
DR. MITCHELL replied that she was not an expert in legislative
language but suggested one possibility would be to specify that
a PA would assist with but not perform a surgery.
7:29:10 PM
CHAIR SUMNER asked about the difference between a surgery or an
operation and inquired what stitches would fall under.
DR. MITCHELL noted that there had been an open debate about what
was considered a procedure or minor surgery, and it was not
entirely clear. She gave an example that a minor surgery could
include removing skin lesions.
7:30:24 PM
REPRESENTATIVE FIELDS [moved to withdraw] Amendment 7. [There
being no objection, Amendment 7 was withdrawn.]
REPRESENTATIVE FIELDS moved to adopt Amendment 8 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.20, A.
Radford/Gunther, 5/7/24, which read:
Page 1, line 11:
Delete "[AND]"
Insert "and"
Page 1, line 12, through page 2, line 4:
Delete "; and
(5) hours of practice experience, if any,
that a physician assistant must complete under a
collaborative agreement to practice in a practice area
that is substantively different than the physician
assistant's previous practice areas; the board may not
require that a physician assistant complete more than
4,000 hours under this paragraph, in addition to the
hours required under (c) of this section, to practice
in a new practice area without a collaborative
agreement"
Page 3, lines 3 - 5:
Delete "Unless additional hours are required by
the board to practice in a new practice area under
(a)(5) of this section, a physician assistant with
less than 4,000 hours of practice experience"
Insert "Except as provided under (f) of this
section, a physician assistant"
Page 3, following line 29:
Insert new subsections to read:
"(e) A collaborative agreement may designate one
or more alternate collaborating physicians to whom the
responsibility to oversee and communicate with a
physician assistant under the collaborative agreement
may be assigned.
(f) Upon termination of a collaborative
agreement, a physician assistant with 4,000 or more
hours of practice experience may practice within the
scope of services authorized under the terminated
collaborative agreement without a collaborating
physician for up to one year."
Reletter the following subsection accordingly.
Page 3, line 31:
Delete "and a collaborating physician"
Insert ", one or more collaborating physicians, and,
if applicable, one or more alternate collaborating
physicians"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS summarized the amendment and highlighted
that it would allow PAs to designate an alternate collaborating
physician and, in the meantime, practice independently.
7:31:27 PM
REPRESENTATIVE SADDLER questioned termination and whether either
could terminate at will.
REPRESENTATIVE FIELDS clarified that it could be either, but was
not meant to imply a negative experience. He reiterated that
the intent is that the PA should be able to keep practicing.
REPRESENTATIVE SADDLER asked for clarity about termination.
7:32:49 PM
MS. FAYETTE said she had seen the language before in emergency
stipulations but in statute she opined it is unfair.
SENATOR TOBIN stated that she opposed the amendment because it
is hard to find collaborating physicians currently, and there
are now 313 PAs without collaborating physicians; therefore,
requiring them to identify an alternative is an overly
administrative burden and would not provide more access to care.
7:33:48 PM
REPRESENTATIVE SADDLER expressed confusion over the consistency.
[CHAIR SUMNER passed the gavel to Vice Chair Ruffridge.]
7:34:15 PM
The committee took an at-ease from 7:34 p.m. to 7:35 p.m.
7:35:17 PM
VICE CHAIR RUFFRIDGE asked for any further discussion on
Amendment 8.
7:35:31 PM
A roll call vote was taken. Representative Fields voted in
favor of Amendment 8. Representatives Prax, Saddler, Wright,
Carrick, and Ruffridge voted against it. Therefore, Amendment 8
failed to be adopted by a vote of 1-5.
7:36:23 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 9 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.21, A.
Radford/Gunther, 5/7/24, which read:
Page 1, line 12:
Delete "and"
Page 2, line 4, following "agreement":
Insert "; and
(6) range of different activities similar to clinical
rotations a physician assistant must perform when
obtaining hours of practice experience required under
(a)(5) or (c) of this section"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS synopsized that the amendment clarified
that in the hours performed under collaborating physicians,
there would be a range of experience similar to medical doctors.
He added it would make sense to have a breadth of tasks.
REPRESENTATIVE WRIGHT wished to hear from the bill sponsor on
how the proposed amendment would affect the spirit of the bill.
7:37:22 PM
SENATOR TOBIN referenced a document members received that
provided an overview of requirements for professions, but she
clarified it failed to note that PAs are required to complete 27
months of continuous education. She noted further requirements
regarding licensing in Alaska and that it is not an
apprenticeship program; PAs are not trying to be doctors.
REPRESENTATIVE WRIGHT added that he admired Representative
Fields' work toward apprenticeships but did not think this was
the piece of legislation for that.
7:39:04 PM
REPRESENTATIVE SADDLER asked about definitions regarding
clinical rotations and practice experience.
MS. FAYETTE said that clinical rotations are well established,
supervised, four-month rotations.
7:40:28 PM
VICE CHAIR RUFFRIDGE inquired whether the rotations are part of
the required 27 months.
MS. FAYETTE confirmed that was correct.
7:40:49 PM
REPRESENTATIVE SADDLER inquired further about the clinical
rotation.
MS. FAYETTE explained that you observe what is happening and
perform things, such as exams, under the supervision of your
supervising physician or PA.
REPRESENTATIVE SADDLER asked whether it was fair to say that a
clinical rotation is a supervised training or apprenticeship.
MS. FAYETTE answered that it is about gaining experience.
7:42:19 PM
VICE CHAIR RUFFRIDGE asked Ms. Fayette for accuracy that in 27
months, she performed 2,000 hours of clinical work, which is
approximately a year of training; therefore, that meant 15
months was course work, and 12 months was clinical work.
MS. FAYETTE responded yes.
7:42:51 PM
REPRESENTATIVE SADDLER asked about the definition of practice
experience.
SENATOR TOBIN opined that the amendment tried to mimic what
happens while a PA is in a training program. She restated the
percentage of collaborating physicians that do not live in
Alaska and that she was unsure how supervised clinical rotation
would happen in this context.
7:44:18 PM
[VICE CHAIR RUFFRIDGE passed the gavel back to Chair Sumner.]
7:44:40 PM
DR. MITCHELL offered her understanding that clinical rotations
would be for medical students and there are levels of training.
She shared her experience and expectations and expounded on the
levels of responsibilities one gains through the years. She
concluded that she could not draw a reasonable parallel between
time and practice experience without someone with whom a
learning individual could collaborate closely, among other
factors.
7:47:34 PM
REPRESENTATIVE PRAX asked Dr. Mitchell whether the requirement
was established in statute, regulation, or by the accreditor.
DR. MITCHELL deferred to Dr. Jones.
7:48:31 PM
ROXANNE JONES, MD, Secretary of the Board, Alaska Academy of
Family Physicians, explained that it was a combination and
briefly offered examples of residency timelines.
REPRESENTATIVE PRAX pointed to the specific requirements of the
residency program and whether it was established by the
accreditor as opposed to statue. .
DR. JONES confirmed that was correct.
7:50:18 PM
REPRESENTATIVE FIELDS noted that Dr. Mitchell captured the
intent for residency in reference to the different tasks
performed.
7:51:08 PM
REPRESENTATIVE PRAX expressed his uncertainty that establishing
this in statute would dictate the apprenticeship program for
industries, as that is established by unions, not state statute.
REPRESENTATIVE FIELDS clarified what he meant by
"apprenticeship," that there are standards and benefits from
learning on the job.
7:52:37 PM
REPRESENTATIVE RUFFRIDGE shared his concern that PAs might
tailor themselves to be in a particular practice areas based off
the collaboration agreement they have. According to the bill,
he opined that the PA should be in primary care.
7:54:39 PM
A roll call vote was taken. Representatives Carrick, Fields,
and Sumner voted in favor of Amendment 9. Representatives Prax,
Ruffridge, Saddler, and Wright voted against it. Therefore,
Amendment 9 failed to be adopted by a vote of 3-4.
7:55:17 PM
REPRESENTATIVE FIELDS stated he would not offer Amendments 10
and 11.
7:55:34 PM
CHAIR SUMNER moved to adopt Amendment 12 to CSSB 115(HSS) AM, as
amended, labeled 33-LS0542\U.A.17, Klein/Gunther, 5/7/24, which
read:
Page 1, line 1, following "physicians;":
Insert "relating to a physician assistant
licensure program for prison inmates; relating to
parole eligibility;"
Page 1, line 12:
Delete "and"
Page 2, line 4, following "agreement":
Insert "; and
(6) criteria for licensing prison inmates
under the program established by the Department of
Corrections under AS 33.30.192"
Page 5, following line 23:
Insert new bill sections to read:
"* Sec. 7. AS 33.16.090(a) is amended to read:
(a) A prisoner sentenced to an active term of
imprisonment of at least 181 days may, in the
discretion of the board, be released on discretionary
parole if the prisoner
(1) has served the amount of time specified
under (b) of this section or has completed the program
under AS 33.30.192 and is licensed as a physician
assistant under AS 08.64.107, except that
(A) a prisoner sentenced to one or more
mandatory 99-year terms under AS 12.55.125(a) or one
or more definite terms under AS 12.55.125(l) is not
eligible for consideration for discretionary parole;
(B) a prisoner is not eligible for
consideration of discretionary parole if made
ineligible by order of a court under AS 12.55.115;
(C) a prisoner imprisoned under
AS 12.55.086 is not eligible for discretionary parole
unless the actual term of imprisonment is more than
one year;
(D) a prisoner sentenced to a single
sentence within or below a presumptive range set out
in AS 12.55.125(c), (d)(2) - (4), (e)(3) and (4), or
(i) who has not been allowed by the three-judge panel
under AS 12.55.175 to be considered for discretionary
parole release is not eligible for consideration of
discretionary parole;
(E) a prisoner sentenced to a single
sentence, including a consecutive or partially
consecutive sentence, that is not eligible for a good
time deduction under AS 33.20.010(a)(3) and that has
not been allowed by the three-judge panel under
AS 12.55.175 to be considered for discretionary parole
release is not eligible for consideration of
discretionary parole; or
(2) is at least 60 years of age, has served
at least 10 years of a sentence for one or more crimes
in a single judgment, and has not been convicted of an
unclassified felony or a sexual felony as defined in
AS 12.55.185.
* Sec. 8. AS 33.30 is amended by adding a new
section to read:
Sec. 33.30.192. Physician assistant training
program. The department, in consultation with the
State Medical Board, shall establish a program that
allows prison inmates to pursue licensure as a
physician assistant under AS 08.64.107."
Renumber the following bill section accordingly.
REPRESENTATIVE WRIGHT objected.
CHAIR SUMNER explained that there was a provider shortage, and
the amendment is one way to address that.
7:56:29 PM
REPRESENTATIVE SADDLER commented that there was also a shortage
of peace and police officers and noted the possibility to
entertain a conceptual amendment.
7:56:41 PM
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
SENATOR TOBIN said that to be accredited, you must have an
established program in your facility, among other requirements.
7:58:19 PM
REPRESENTATIVE CARRICK noted a previous robust debate about
allowing prisoners tablets but that she appreciated the intent
of the amendment; however, she was not sure the body could make
a policy call of this magnitude.
7:59:15 PM
A roll call vote was taken. Representatives Fields, Carrick,
and Sumner voted in favor of Amendment 12. Representatives
Wright, Prax, Ruffridge, and Saddler voted against it.
Therefore, Amendment 12 failed to be adopted by a vote of 3-4.
7:59:54 PM
CHAIR SUMNER stated he would not offer Amendment 13.
8:00:02 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 14 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.24, Gunther,
5/8/24, which read:
Page 2, line 27, following "number;":
Insert "and"
Page 2, line 31:
Delete "; and"
Insert "."
Page 3, lines 1 - 2:
Delete all material.
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE RUFFRIDGE said the intent of the amendment was to
remove language that was "overly broad."
8:01:06 PM
The committee took an at-ease from 8:01 p.m. to 8:03 p.m.
8:03:02 PM
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
SENATOR TOBIN explained "scope of practice" and that there are
regulations and oversights of the PA profession. She understood
the section was broad, but it was a "catch all" section that
ensured that care could be provided.
8:06:03 PM
REPRESENTATIVE SADDLER observed that the language was quite
broad and questioned who defined what was competent.
SENATOR TOBIN replied that the scope of practice was determined
by factors including policies and laws.
8:08:47 PM
REPRESENTATIVE PRAX opined that there are two entities who will
make the determination: the judge or the lawyer. He added he
would be happy to let them make the decision as they are "more
competent than we are."
MS. FAYETTE noted the importance of the specific definitions of
regulations.
8:10:10 PM
A roll call vote was taken. Representatives Saddler, Ruffridge,
Fields, and Sumner voted in favor of Amendment 14.
Representatives Carrick, Prax, and Wright voted against it.
Therefore, Amendment 14 was adopted by a vote of 4-3.
8:10:57 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 15 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.25, Gunther,
5/8/24, which read:
Page 2, line 3, following "(c)":
Insert "and (f)"
Page 3, lines 3 - 4:
Delete "by the board to practice in a new
practice area under (a)(5)"
Insert "under (a)(5) or (f)"
Page 3, line 24:
Delete "and"
Page 3, line 26, following "areas":
Insert "; and
(8) designate a collaborating physician as
the primary collaborating physician"
Page 3, line 27, following "or":
Insert "primary"
Page 3, following line 29:
Insert new subsections to read:
"(e) A physician assistant and primary
collaborating physician shall maintain a record on a
form provided by the department of the number of hours
of practice experience obtained by the physician
assistant. The form must include the
(1) area of practice specialty of the
collaborating physician; and
(2) hours completed by practice type.
(f) Upon the physician assistant's completion of
4,000 hours of practice experience, additional hours
required under (a)(5) of this section, or additional
hours required under this subsection, the primary
collaborating physician shall attest on a form
provided by the department that the physician
assistant is competent to practice without
supervision. If the primary collaborating physician
determines that the physician assistant is not
competent to practice without supervision, the board
shall require that the physician assistant practice
under a collaborative agreement for additional hours,
as determined by the board.
(g) A physician assistant is entitled to a
hearing conducted by the board to appeal a
determination by a primary collaborating physician
that the physician assistant is not competent to
practice without supervision. The physician assistant
may appeal an adverse decision of the board to a court
of competent jurisdiction. The board or court may
reverse the primary collaborating physician's
determination that the physician assistant is not
competent to practice without supervision if the board
or court finds that the primary collaborating
physician's determination was arbitrary and capricious
or without just cause.
(h) The board shall randomly audit three percent
of the physician assistants licensed under this
section to assess each physician assistant's
compliance with the requirements of this chapter."
Reletter the following subsection accordingly.
Page 3, line 31:
Delete "a collaborating physician"
Insert "one or more collaborating physicians"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE RUFFRIDGE noted the amendment was lengthy and
summarized that the intent of the amendment was to establish how
and what the hours accomplish.
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
8:13:48 PM
SENATOR TOBIN confirmed that she worked with the amendment
sponsor and there would be no additional fiscal impact.
8:14:22 PM
REPRESENTATIVE SADDLER offered an assumption that the
collaborating physician was the employing physician. He noted
concern about the added responsibility on a physician who would
be made to determine who is competent, and that it was a
liability question.
DR. MITCHELL commented that the amendment provided sidebars,
extra supervision, and assurance that if there was independent
practice, the physician could evaluate the PA's abilities and
attest to them.
REPRESENTATIVE SADDLER asked whether physicians pass judgement
on their PAs currently.
DR. MITCHELL said she did not employ PAs, but she would presume
from her colleagues that if they did not feel the PA was
providing adequate care, they would request that person find
other employment.
8:18:11 PM
CHAIR SUMNER commented that if a PA was not working "shoulder to
shoulder" with a physician, that relationship would have less
value.
DR. MITCHELL opined that the amendment increases the value of
the agreement because it makes the PA supervisor be more
attentive to the skills and experience of the PA in that
environment.
8:19:46 PM
REPRESENTATIVE WRIGHT removed his objection.
REPRESENTATIVE PRAX objected.
8:19:55 PM
A roll call vote was taken. Representatives Ruffridge, Saddler,
Wright, Carrick, Fields, and Sumner voted in favor of Amendment
15. Representative Prax voted against it. Therefore, Amendment
15 failed to be adopted by a vote of 6-1.
8:20:38 PM
REPRESENTATIVE RUFFRIDGE stated he would not offer Amendment 16.
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 17 to CSSB
115(HSS) AM, as amended, labeled 33-LS0542\U.A.27, Gunther,
5/8/24, which read:
Page 2, line 2:
Delete "4,000"
Insert "6,000"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE RUFFRIDGE summarized the amendment how it related
to amounts of hours without a collaborative agreement.
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
8:23:06 PM
SENATOR TOBIN asked, "Do we have the right skills sets and
knowledge to determine what is the appropriate number of hours?"
She spoke to other states that are untethered, and she opined
that to remain competitive, 4,000 worked was a good pathway to
independence.
8:23:57 PM
REPRESENTATIVE SADDLER asked the amendment maker for
clarification that if a PA were to switch areas of practice,
they must have 6,000 additional hours.
REPRESENTATIVE RUFFRIDGE explained that 6,000 would be the
initial number of hours, and should the PA change practice
areas, they would need to go back into a collaborative agreement
for an additional 4,000 hours.
8:25:28 PM
REPRESENTATIVE RUFFRIDGE offered a conceptual amendment to
Amendment 17 that it would read: "page 3, line 4".
8:25:46 PM
The committee took an at-ease from 8:25 p.m. to 8:27 p.m.
8:27:04 PM
REPRESENTATIVE SUMNER announced there being no objection,
Conceptual Amendment 1 to Amendment 17 was adopted.`
8:28:23 PM
The committee took an at-ease from 8:28 p.m. to 8:29 p.m.
8:29:20 PM
A roll call vote was taken. Representatives Fields, Ruffridge,
Saddler, Wright, Carrick, and Sumner voted in favor of Amendment
17, as amended. Representative Prax voted against it.
Therefore, Amendment 17, as amended, was adopted by a vote of 6-
1.
8:29:48 PM
REPRESENTATIVE PRAX moved to adopt Amendment 18 to CSSB 115(HSS)
AM, as amended, labeled 33-LS0542\U.A.29, Gunther, 5/8/24, which
read:
Page 1, line 1:
Delete "and"
Page 1, line 2, following "policies":
Insert "; relating to internship and residency
requirements to practice medicine and osteopathy; and
relating to physician and osteopath specialty
designations"
Page 4, following line 13:
Insert a new bill section to read:
"* Sec. 4. AS 08.64.272 is amended by adding a new
subsection to read:
(d) The board shall adopt regulations allowing a
physician or osteopath licensed under this chapter who
has completed a residency or internship in a
particular practice area to receive a license
endorsement designating the physician or osteopath as
specializing in that practice area."
Renumber the following bill sections accordingly.
Page 5, following line 31:
Insert a new bill section to read:
"* Sec. 9. AS 08.64.200(a)(2), 08.64.205(2),
08.64.225(a)(2)(A), and 08.64.225(c) are repealed."
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE PRAX explained that the amendment would remove
the medical residency requirements for medical doctors and
doctors of [osteopathic medicine]. He further noted a
transitional component, which would allow physicians in the
middle of a residency program to complete it.
8:30:32 PM
CHAIR SUMNER asked Representative Prax whether he would be
incentivized to complete a residency program if the requirement
went away.
REPRESENTATIVE PRAX said, "It would be up to them."
8:30:47 PM
REPRESENTATIVE FIELDS said he opposed the amendment to maintain
public faith.
8:30:57 PM
REPRESENTATIVE CARRICK requested to hear from the bill sponsor.
8:31:03 PM
SENATOR TOBIN said she did not have a comment.
8:31:18 PM
A roll call vote was taken. Representatives Prax and Wright
voted in favor of Amendment 18. Representatives Fields,
Ruffridge, Saddler, Carrick, and Sumner voted against it.
Therefore, Amendment 18 failed to be adopted by a vote of 2-5.
8:31:50 PM
CHAIR SUMNER moved to adopt Amendment 16 to CSSB 115(HSS) AM, as
amended, labeled 33-LS0542\U.A.26, Gunther, 5/8/24, which read:
Page 5, lines 13 - 23:
Delete all material.
Renumber the following bill section accordingly.
REPRESENTATIVE WRIGHT objected.
CHAIR SUMNER explained that amendment untethers PAs that are
providing services in correctional facilities, and the intent
would be that they have a place to get their hours without a
collaborative agreement.
8:32:42 PM
The committee took an at-ease from 8:32 p.m. to 8:33 p.m.
8:33:24 PM
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
SENATOR TOBIN thanked the amendment maker for thinking about
prisoners, and offered her belief they should have access to
adequate care, but that the amendment created a two-tiered
system.
8:34:40 PM
REPRESENTATIVE SADDLER commented that he was not sure the bill
would prohibit a PA from working in a correctional facility, and
was not sure it was necessary unless there was an assumption the
PA would not have to go through the initial collaborative
agreement.
8:35:18 PM
CHAIR SUMNER said the intent of the amendment was to create a
"fast track" for work without a collaborative agreement.
REPRESENTATIVE SADDLER followed up about concerns with a two-
tiered system and that it could expose the state to litigation.
CHAIR SUMNER stated, "You need providers to provide care."
8:35:59 PM
REPRESENTATIVE PRAX opined that if prisoners were polled, they
would welcome this service.
8:36:13 PM
A roll call vote was taken. Representatives Fields, Prax, and
Ruffridge voted in favor of Amendment 16. Representatives
Carrick, Saddler, Wright, and Sumner voted against it.
Therefore, Amendment 16 failed to be adopted by a vote of 3-4.
8:37:06 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Conceptual Amendment
[19] to CSSB 115(HSS) AM, as amended, on page 2, line 10, to
delete "perform" and "interpret".
CHAIR SUMNER objected being it was past the amendment deadline
[and Conceptual Amendment 16 had not been previously submitted].
He then said it would "have to be the absolute last one."
REPRESENTATIVE RUFFRIDGE expressed concern about the language
offered previously about a broad interpretation on performing
diagnostics. He expounded on training and interpretation of
types of diagnostics.
8:39:19 PM
REPRESENTATIVE WRIGHT requested to hear from the bill sponsor.
MS. FAYETTE commented that the point of the bill is to increase
access to care and in rural areas, a PA may be the only person
who can provide it. She opined that it could put burdens on the
things PAs can do.
8:40:08 PM
REPRESENTATIVE CARRICK opposed the amendment. She said having
to see a physician to get a result read would be a hurdle to
many Alaskans. She reiterated that the intent of the
legislation is about untethering PAs, not about limiting their
scope of practice.
REPRESENTATIVE RUFFRIDGE responded that there is a process for a
Clinical Laboratory Improvement Amendment (CLIA) waiver, which
provides "up or down" diagnoses without the very specific
language.
8:42:09 PM
DR. MITCHELL shared her interpretations and said that she agreed
with Representative Ruffridge about the performance of
diagnostic procedures.
8:44:21 PM
REPRESENTATIVE SADDLER noted that part of the challenge is
requiring the legislature to make judgements about who is
qualified to perform what kind of medical services.
8:45:24 PM
REPRESENTATIVE CARRICK asked Dr. Mitchell whether removal of the
words "perform" and "interpret" in the section would limit a PA
to conduct certain tests.
DR. MITCHELL deferred to Dr. Jones.
8:46:14 PM
DR. JONES replied yes, the PA could still do tests such as a
urine analysis through a CLIA waived test that provides a yes,
no, or algorithmic answer. Striking the words would not prevent
this interpretation, she confirmed.
REPRESENTATIVE CARRICK asked whether a CLIA waiver was something
that a PA could get a blanket waiver for or whether it was
limited to specific situations.
DR. JONES responded that a CLIA waiver is based on a clinic
obtaining a specific test type for any patient and is assigned
to the clinic.
REPRESENTATIVE CARRICK sought clarity about a PA obtaining a
CLIA waiver.
DR. JONES said she did not know what the baseline requirements
would be for a CLIA waiver status for a lab, as it required a
medical doctor to sign off.
8:48:30 PM
CHAIR SUMNER asked Representative Ruffridge for more
clarification on the words that would be removed.
8:49:01 PM
The committee took an at-ease from 8:49 p.m. to 8:51 p.m.
8:51:04 PM
REPRESENTATIVE RUFFRIDGE [moved to withdraw] Conceptual
Amendment [19]. [There being no objection, Conceptual Amendment
19 was withdrawn.]
8:51:11 PM
CHAIR SUMNER moved to adopt Conceptual Amendment 4 to CSSB
115(HSS) AM, as amended, on page 2, line 11, following
"procedures", to insert "in compliance with regulation adopted
under AS08.64.106".
REPRESENTATIVE WRIGHT objected.
8:52:06 PM
The committee took an at-ease from 8:52 p.m. to 8:53 p.m.
8:53:19 PM
REPRESENTATIVE WRIGHT removed his objection.
8:53:25 PM
REPRESENTATIVE SADDLER objected and commented that something was
already in regulation.
SENATOR TOBIN said that the amendment would add new subsections
to Alaska Statute and added clarity to the phrase that would be
inserted.
REPRESENTATIVE SADDLER removed his objection. There being no
further objection, Conceptual Amendment [19] was adopted.
8:55:13 PM
The committee took an at-ease from 8:55 p.m. to 8:56 p.m.
8:56:17 PM
REPRESENTATIVE RUFFRIDGE moved to report CSSB 115(HSS) AM, as
amended, out of committee with individual recommendations and
the accompanying fiscal notes.
REPRESENTATIVE CARRICK objected for the purpose of discussion.
She thanked the PA and MDs that provided testimony as well as
the bill sponsor. She shared her thoughts that it was hard to
amend substantive bills this late in the session. She removed
her objection.
8:57:55 PM
REPRESENTATIVE SADDLER objected.
8:58:26 PM
A roll call vote was taken. Representatives Wright, Carrick,
Prax, Ruffridge, and Sumner voted in favor of the motion to
report CSSB 115(HSS) AM, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
Representative Saddler voted against it. Therefore, HCS CSSB
115(L&C) was reported out of the House Labor and Commerce
Standing Committee by a vote of 5-1.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 239 Amendment Packet.pdf |
HL&C 5/8/2024 3:15:00 PM |
SB 239 |
| S.pdf |
HL&C 5/8/2024 3:15:00 PM |
SB 239 |
| SB115 Amendment Packet 1.0.pdf |
HL&C 5/8/2024 3:15:00 PM |
SB 115 |
| SB115 Medical Profession Hours Comparison 5.8.2024.pdf |
HL&C 5/8/2024 3:15:00 PM |
SB 115 |