Legislature(2021 - 2022)DAVIS 106
05/03/2022 03:00 PM House HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB98 | |
| SB132 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 98 | TELECONFERENCED | |
| += | SB 132 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
3:58:45 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be SENATE BILL NO. 132, "An Act exempting veterinarians
from the requirements of the controlled substance prescription
database."
3:58:55 PM
The committee took a brief at-ease.
3:59:58 PM
CO-CHAIR ZULKOSKY announced the committee would hear invited
testimony.
4:00:33 PM
JIM DELKER, DVM, Legislative Liaison, Alaska Veterinary Medical
Association (AKVMA), shared a conversation he had had with an
Alaska State Trooper. He stated that the trooper, with over 20
years of experience working on a drug task force as an
undercover agent, had not witnessed any cases of drug abuse
involving humans with veterinary prescriptions. Also, he
referenced numerous physicians, including emergency care and
drug treatment specialists, who sent in letters to attest they
had never treated a person with a drug overdose, where the
person had obtained the drugs through a veterinarian.
DR. DELKER reported that at the request of the legislature,
AKVMA met with the Alaska College of Emergency Physicians (ACEP)
and the Board of Emergency Physicians to discuss some of the
concerns. He described the dialogue between the boards as
positive, and despite concerns from the physicians, there were
no concrete examples of drug abuse of this type brought forward.
He stated that the boards had also discussed the two studies the
physicians had referred to in their letters of concern. He
shared that one was an unrandomized survey conducted of a small
portion of veterinarians in Colorado; these veterinarians had
influenced Colorado to keep veterinarians out of the
Prescription Drug Monitoring Program (PDMP).
DR. DELKER noted the other study was a properly randomized study
from Pennsylvania; however, it only took data from a single
large referral hospital. He stated that only 6 percent of
veterinarians in the country work in a similarly specialized
setting and opined that it was unfair to say the study was
indicative of the prescribing habits of most veterinarians. He
shared that, in their discussion, members from the boards had
expressed disagreement with letters of support from former ACEP
members, while current members unanimously support the ACEP's
letter of concern; however, he stated that this is in direct
conflict with the conversations he had with current members, who
stated that they had never heard of SB 132, or the letter of
concern. He stated that some of these members had submitted
their own letters of support for SB 132.
DR. DELKER related that veterinarians are frustrated with the
task of repeatedly entering data, which "disappears" and cannot
be accessed by other physicians or veterinarians. He expressed
disagreement with the idea that veterinarians are "out of touch"
with the opioid epidemic. He shared a personal experience
concerning loss because of opioid addiction, and he suggested
that other veterinarians have similar stories. He acknowledged
that the opioid crisis is serious and opined that veterinarians
want to do their part to help. He asked that their efforts not
be wasted but instead result in measurable benefits.
4:06:15 PM
TRACY WARD, DVM, President, Alaska Veterinary Medical
Association, reviewed the current regulations on PDMP use in the
veterinarian field. She explained that all veterinarians who
prescribe, administer, or dispense Schedule II or III drugs must
query PDMP before doing so. She further explained the "zero
reporting" regulations, stating that veterinarians who dispense
any Schedule II, III, and IV substances must report to PDMP
daily, including on days they do not dispense. She listed the
dispense reporting exemptions, which included substances
dispensed in an emergency department for a supply lasting less
than 24 hours, controlled substances administered to an
inpatient of a hospital, controlled substances used at the scene
of an emergency, controlled substances used during or within 48
hours before or after a surgery, and writing a non-refillable
prescription which lasts no more than three days.
4:08:42 PM
The committee took a brief at-ease.
4:09:11 PM
CO-CHAIR ZULKOSKY asked Laura Carrillo or Sara Chambers from the
Department of Commerce, Community & Economic Development (DCCED)
what recommendations and accommodations have been made by DCCED
to make the utilization of PDMP more streamlined for
veterinarians.
4:11:16 PM
LAURA CARRILLO, MPH, Executive Administrator, Alaska Board of
Pharmacy, Prescription and Drug Monitoring Program, Division of
Corporations, Business and Professional Licensing, Department of
Commerce, Community and Economic Development, explained that
when the original bill passed in 2017, the Board of Veterinary
Examiners (BOVE) had several questions for DCCED, including who
to query when prescribing controlled substances for nonhuman
patients. She stated that the department advised the board to
query the human client and have this posted with the licensure.
She shared the board's other concern about animal and human data
comingling. She stated that DCCED worked with the Department of
Law and the database vendor on ways to clarify the data entry
process. In response to this, she stated, DCCED posted
guidelines on its website about how to properly input species
codes and prevent comingling of data, and the vendor added an
animal graphic to help practitioners visually differentiate
between human and animal prescriptions. She added that the
department continued talks with various boards to adjust issues
and instated a biweekly PDMP meeting of chairs to continue the
conversation.
4:15:22 PM
CO-CHAIR ZULKOSKY asked how DCCED's improvements made the
process more user friendly for veterinarians.
4:16:27 PM
MCKAYLA DICK, DVM, Past President, Alaska Veterinary Medical
Association, explained that as a small animal veterinarian she
had seen no changes in PDMP and very little guidance on how to
use it in a clinic setting. She stated that "the system just
doesn't work" for veterinarians because of the fundamental
differences in human and animal data. These differences have
led veterinarians to be investigated for clerical issues rather
than deliberate misuse of the system. She opined that the
changes put into place by DCCED have not been properly conveyed
to practitioners and often did not work to solve the issues.
4:17:46 PM
HAL GEIGER, PhD, Member, Board of Veterinary Examiners, shared
that the private conversations with veterinarians were
consistent with their public testimony, which expressed that
changes made by DCCED were not helpful, and training had been
insufficient. He reported that veterinarians are confused and
frustrated with a system which they find to be "completely
unworkable."
CO-CHAIR ZULKOSKY asked about other efforts the department had
made in response to the feedback that the changes were not
enough.
SARA CHAMBERS, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community and
Economic Development, expressed the belief that the department
had made all the changes brought to its attention and had
provided all information about the changes to the board. She
expressed the understanding that it was BOVE's responsibility to
disseminate that information. She opined that the board's
efforts to do so had "fallen by the wayside," and BOVE had not
posted the guidelines on its website or circulated them to
veterinarians. She posited that much of the frustration with
the system comes from the existential question of whether PDMP
is relevant to veterinarians and opined that, because
veterinarians believe their participation in PDMP to be
[useless], there is less motivation to implement the fixes
provided by the department. She expressed the belief that all
parties should buy in to PDMP and utilize the tools provided, or
statutory changes should be made.
4:22:39 PM
The committee took an at-ease from 4:22 p.m. to 4:26 p.m.
4:26:39 PM
REPRESENTATIVE SPOHNHOLZ referred to a report from DCCED on the
14 best practices for veterinary use of PDMP and asked Ms.
Carrillo to explain how the report was communicated to BOVE.
MS. CARRILLO explained that the Bureau of Justice Assistance
(BJA) compiled the report, and it was presented at the PDMP
training center in January 2022. She stated that the report
used studies conducted in other states to derive the best
practices. She shared that, to her knowledge, the report was
given to BOVE members during a board meeting, and it was
included in their meeting packet. In response to a follow-up
question, she said the report was presented to BOVE in February
of the same year.
REPRESENTATIVE SPOHNHOLZ opined that the best practices provided
by BJA were very detailed. She referenced a letter sent by Dr.
Papacostas to the Senate Finance Committee where he stated that
veterinarians now surpass dentists in the prescription of
morphine. She requested that Dr. Papacostas explain this
information and ACEP's stance on excluding veterinarians from
PDMP.
4:32:47 PM
NICHOLAS PAPACOSTAS, MD, FACEP, Alaska Chapter American College
of Emergency Physicians, confirmed that the statistic was
correct and clarified that both veterinarians and dentists
prescribe very low rates of opioids in comparison to medical
practitioners. He explained that the data was added in the
report for context because there was a discussion about
exempting veterinarians but not dentists from PDMP.
REPRESENTATIVE SPOHNHOLZ asked Dr. Papacostas to describe the
findings from the 2019 study published in the Journal of the
American Medical Association, which was cited in his letter.
DR. PAPACOSTAS explained that Dr. Delker was correct in his
testimony; the study had come from a single large veterinary
facility. He stated that the point of including this study is
because many veterinarians train at referral centers, so the
trend of increased opioid prescriptions at those facilities
could be indicative of the prescribing habits of veterinarians
in smaller, community-based practices as well.
REPRESENTATIVE SPOHNHOLZ requested that Dr. Geiger comment on
the information presented to BOVE during the February 2022 board
meeting concerning the best practices for veterinary
prescriptions. She questioned the material presented, the
discussions that occurred about implementing these practices,
and whether a more nuanced approach to veterinary participation
in PDMP is "out of the question."
4:35:50 PM
DR. GEIGER stated he was not prepared to speak about this
specific meeting, as there were many meetings where suggestions
were given by the department. He gave an example of a suggested
regulation which would not be possible to carry out. He
explained that the majority of testimony the board had heard
from veterinarians was that they try to use the PDMP but it
"just doesn't quite work" and has not worked since the
participation requirement was put into statute. He explained
that the requirement is to query the patient, but in the
veterinary world, the patient is the animal.
REPRESENTATIVE SPOHNHOLZ opined that, because of frustration
with the system, many veterinarians have chosen to see the
system as a failure rather than trying to find a solution. She
cited the earlier comparison to dentists and stated that
dentists prescribe fewer opioids a year than veterinarians, yet
there has been no push for an exemption from dentists. She
posited that this data is in direct opposition to the assertions
made during testimony. She requested Dr. Geiger's opinion.
DR. GEIGER replied that PDMP works for dentists and human
practitioners because PDMP was designed for human patients. He
shared that the board received a PDMP report which conveyed no
veterinarians had queried the system during a specific
timeframe, but during the discussion of the report, numerous
veterinarians and their staff reported they had queried the
system during the referenced timeframe. He expressed the
opinion that this exemplifies the system is not working for the
veterinary field.
4:39:58 PM
REPRESENTATIVE PRAX expressed the understanding that
veterinarians were required through regulation to query their
human clients' prescription drug use.
DR. GEIGER confirmed this understanding and spoke to
veterinarians' frustration around lack of clarity in who to
query.
4:41:01 PM
DR. WARD confirmed that the query is made to the person
physically in the room with the animal patient.
REPRESENTATIVE PRAX stated his opinion that this practice seemed
like a Health Insurance Portability and Accountability Act
(HIPAA) violation and asked whether the information about the
human client's prescription history was recorded. In response
to a request for clarification, he described a hypothetical
situation where someone goes to a veterinarian, discloses
his/her own medical history in order to receive medication for
the pet, and then later the person switches to a new
veterinarian. He asked whether the new veterinarian would be
able to see that the pet had previously been prescribed a
certain drug and whether this drug would now be a part of the
human client's history.
DR. WARD explained that before a veterinarian makes a
prescription, the human client's drug history would be
questioned. She posited that this would not affect the
veterinarian's decision on what to prescribe, because
veterinarians are not trained in human drug dosage. However,
she said, if the veterinarian decides to prescribe a scheduled
substance to an animal, this information would be entered under
the pet's name. She reported that a reoccurring issue is, when
a veterinarian tries to query PDMP for this pet later, the
information is often not visible. She added that the same issue
happens for medical doctors. She described the process as not
affecting public health, as veterinarians cannot interpret the
data from medical doctors and [doctors] cannot access the animal
data entered by the veterinarians. She confirmed that
veterinarians do prescribe more opioids than dentists; however,
this amount is less than one percent of all opioids prescribed
and does not include the types of opioids human addicts are
looking for. She stated that the focus has been on making PDMP
easier for veterinarians; however, she pointed out the lack of
productive data which results from this practice, which is the
main concern for veterinarians.
REPRESENTATIVE PRAX opined that veterinary participation in PDMP
"fundamentally" accomplishes nothing and potentially violates
the HIPAA rights of [the humans who bring in their pets].
DR. WARD expressed agreement with the statement. She stated
that "we are accomplishing nothing" in regard to drug prevention
and public health, while the process is done at a high cost [to
the state]. She reemphasized that the amount of opioids
prescribed by veterinarians is small in comparison to the amount
prescribed by physicians.
4:45:40 PM
REPRESENTATIVE MCCARTY referred to the statistic of opioid
prescriptions as being "data on morphine." He questioned
whether morphine is prescribed by vets more often.
DR. WARD explained that the data describes morphine milligram
equivalence (MME), which equates all the opioid class substances
to the relative equivalency with morphine; the statistic does
include all opioids prescribed.
REPRESENTATIVE MCCARTY questioned the data which suggests
veterinarians prescribe more opioids than dentists. He cited
his knowledge of dentist-related opioid addiction. He asked Dr.
Papacostas to provide the data behind the statement on
prescription amounts in his letter.
DR. PAPACOSTAS explained that the same data is in the white
paper in graph form, and it shows that from 2016 to 2018 the
amount of opioids prescribed by veterinarians had increased to
surpass the amount prescribed by dentists.
REPRESENTATIVE MCCARTY sought confirmation from Ms. Chambers
that the administration is taking a non-stance on the issue and
focusing on complying with the current statute.
MS. CHAMBERS responded in the affirmative.
REPRESENTATIVE MCCARTY recalled Ms. Chambers previous statement
which related that veterinary participation has been a challenge
for PDMP, and he remarked that there has been over a "hundred"
meetings a year between the different boards on this subject.
MS. CARRILLO explained that there have not been "hundreds" of
meetings on this specific issue, but it has been discussed, and
updates on PDMP have been a standing topic at all BOVE meetings.
REPRESENTATIVE MCCARTY shared his understanding that the
Division of Corporations, Business and Professional Licensing's
main objective with all state boards is to assist with their
professional duties to the state and ensure no harm is being
done.
MS. CHAMBERS confirmed his understanding.
REPRESENTATIVE MCCARTY acknowledged the division's effort to
follow statute and make the system workable for veterinarians;
however, he pointed out that BOVE has related the participation
in PDMP is "putting a square peg in a round hole." He shared
his belief that testimony points towards an unsolvable issue;
therefore, a change of statute is needed.
4:51:57 PM
MS. CHAMBERS voiced her belief that many tools are available to
the boards, and what boards do with the information directly
impacts veterinarians' ability to effectively use PDMP. She
expressed agreement that there is room for improvement; however,
there are options other than statute change still available.
She reiterated that many of the issues have been answered
through the resources created by the division. She argued that
many veterinarians feel frustrated by the system because they
were uninformed of the resources.
REPRESENTATIVE MCCARTY opined that the statute put into place in
2017 does not fit a certain group of professionals, and although
the division has done its part to make the system work according
to statute, PDMP does not work for veterinarians. He alluded
that the legislature should follow the suit of other states
which have exempted veterinarians.
4:54:09 PM
CO-CHAIR ZULKOSKY requested that Ms. Chambers confirm the
department had urged BOVE to adopt regulations which address the
challenges faced by PDMP.
MS. CHAMBERS responded in the affirmative.
CO-CHAIR ZULKOSKY questioned Dr. Geiger concerning the board's
response to the department, and its request to adopt regulation
regarding PDMP.
4:54:51 PM
DR. GEIGER explained that the board has received "high level
advice" which does not address the realities facing
veterinarians. He stated that there are "hundreds" of small,
day-to-day problems veterinarians must deal with, such as not
having internet access. He posited that getting all the
information to veterinarians for each of these issues is not an
easy task solved through regulation.
CO-CHAIR ZULKOSKY questioned whether the board has pursued
making any changes to regulations regarding PDMP, beyond the
more nuanced examples which have been given.
DR. GEIGER explained that the board did pass regulations trying
to make PDMP work. The board took the division's advice and put
the resources on the internet; however, the regulations have not
been able to get veterinarians the information they need.
CO-CHAIR ZULKOSKY asked Ms. Carrillo to supply the committee
with screenshots of PDMP for visual clarification, as well as a
list of the regulations put into place by BOVE. She questioned
the amount of nationwide PDMPs and whether there has been an
assessment completed on adapting PDMPs to meet the needs of
veterinarians.
MS. CARRILLO reported that the vendor used for PDMP has been
used by 43 other states. She offered to follow up to the
committee with additional information about adaptations for
veterinarians.
CO-CHAIR ZULKOSKY asked Dr. Papacostas about the tightening of
human medical documentation concerning controlled substances,
and how this could impact issues in the system. She also asked
for a layman's description of the difference between 5 million
and 2.9 million MME.
4:59:23 PM
DR. PAPACOSTAS explained that PDMP is a tool to identify
patients at risk of opioid addiction and get these patients into
treatment. He pointed out that it is "disturbing" if the data
veterinarians are entering is not visible to physicians. He
expressed the opinion that it is individual prescriptions which
expose people to opioids, and this is more of a concern than the
total amount of opioids being prescribed. He explained that
"catching" people misusing or diverting opioids is not the focus
of emergency physicians, but rather they want to determine how
patients are getting access to drugs, in hopes of intervening,
if needed. He restated that the total amount of opioids being
prescribed by veterinarians is not huge; however, he expressed
the belief that exposure to one prescription can make a
difference to a human patient. He voiced his support for
removing some of the restrictions on veterinary PDMP
participation and called for an investigation into why the
veterinary data is not visible. He iterated ACEP's support for
including veterinarians into the exemptions for very short-term
prescriptions, but it would still support veterinarians entering
long-term prescriptions into PDMP. He suggested that sending
prescriptions to pharmacists would help veterinarians who
struggle with entering prescriptions into PDMP.
[SB 132 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 98 Sectional Analysis Version GS 1708 W (4-19-22).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-4-2-041522-DHS-N.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-5-2-041522-DHS-Y.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-6-2-041522-DHS-Y.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98 - ver. B.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB98 Summary of Changes v.W (4-29-22).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB98 Summary (May 2, 2022).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |