Legislature(2021 - 2022)BELTZ 105 (TSBldg)
02/23/2022 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB179 | |
| SB132 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 179 | TELECONFERENCED | |
| + | SB 132 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
2:39:02 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SENATE BILL NO. 132 "An Act exempting
veterinarians from the requirements of the controlled substance
prescription database."
She stated her intention to move the bill if public testimony
didn't go beyond 3:00 p.m.
2:39:36 PM
NIKKI ROSE, Staff, Senator Roger Holland, Alaska State
Legislature, Juneau, Alaska, introduced SB 132 on behalf of the
sponsor. She paraphrased the following sponsor statement:
th
Alaska's 25 legislature created the Prescription Drug
Monitoring Program (PDMP) in 2008. The legislative
intent behind the PDMP was to create a database of
prescriptions for controlled substances in the state.
The PDMP may create obstacles for individuals seeking
opioids to obtain multiple prescriptions from
registered providers and may be a useful tool for
human doctors in combating the opioid crisis. Under
the current statutory framework, Alaska's
veterinarians are required to participate in the PDMP,
despite the irreconcilable differences between human
and veterinary medical practice. PDMPs have been
implemented in all 50 states, but 34 states have
recognized the unsuitability of veterinary
participation in the PDMP and exempted veterinarians.
SB 132 would add Alaska to that list.
The majority of states exempt veterinarians from PDMP
because they have recognized that PDMPs are designed
for use in human medicine; and veterinary exclusion
from PDMPs does not increase risk to the public.
Alaska's inclusion of veterinarians in the PDMP has
produced no identifiable benefit; yet the PDMP has
created a multitude of verifiable harms to the
veterinary profession and the Alaskans they serve. The
PDMP is inappropriate and not effective for use with
animal patients, as animals do not have identifiers
such as a social security number, and veterinarians
must view human owners' private health data before
treating an animal.
Alaska has the highest veterinary licensure cost in
the United States. Veterinary participation in the
PDMP contributes to this unnecessary financial burden
on a profession already experiencing extreme staffing
shortages, decreasing availability of veterinary
services to Alaskans. Moreso, a recent survey found
attempted veterinary doctor shopping across the entire
United States is essentially non-existent.
Veterinarians are tightly regulated by the Drug
Enforcement Agency, the Know Your Customer Act, and
the State licensing board. SB 132 seeks to correct an
expensive overreach so that Alaskans can have access
to treatment for their pets without compromising
public safety.
2:42:44 PM
MS. ROSE presented the sectional analysis for SB 132 that read
as follows:
[Original punctuation provided with minor formatting changes.]
Sec. 1
AS 17.30.200(o), relating to the controlled substance
prescription database, is amended by deleting the
Board of Veterinary Examiners from the list of
required notification by the Board of Pharmacy when a
practitioner registers with the database.
Sec. 2
Adds veterinarians to the list of practitioners not
required to comply with the controlled substance
prescription database under AS 17.30.200(t).
Sec. 3
Adds a definition of "practitioner" to AS 17.30.200(u)
Sec. 4
Repeals AS 08.98.050(a)(10), which obligates the board
of veterinary examiners to require licensees to
register with the controlled substance prescription
database.
2:43:53 PM
SENATOR STEVENS shared that he knew a veterinarian who
became addicted to the drugs he prescribed to animals. He
asked if the bill had sideboards to ensure that would not
happen in the future or if that situation was independent
of what the bill does.
MS. ROSE explained that this database would not capture
that kind of misuse because an individual would not put
information about their own drug use into the database.
CHAIR COSTELLO suggested that the invited testifiers could
talk about how veterinarians must look at pet owners'
personal prescription history even though veterinarians
have no training in human health matters.
2:45:29 PM
SENATOR REVAK mentioned the concern about doctor shopping
to feed an addiction and said he didn't want to exacerbate
that problem, but he did want to find a solution for
veterinarians.
CHAIR COSTELLO invited Dr. Tracy Ward and Dr. Rachel
Berngartt to give their presentation.
2:46:43 PM
DR. RACHEL BERNGARTT, Chair, Board of Veterinary Examiners,
Juneau, Alaska stated that she has been an Alaska licensed
veterinarian since 2002 working in a wide variety of
practice areas and she was speaking in support of SB 132.
2:47:24 PM
DR. TRACY WARD, President, Alaska Veterinary Medical
Association, Juneau, Alaska stated that she has been a
veterinarian for 32 years and has worked in several fields,
and she also spent considerable time in the pharmaceutical
industry. She is currently a small animal practitioner and
in several months will transition to be a shelter
veterinarian.
SENATOR STEVENS asked Dr. Ward and Dr. Berngartt to address
the concern about veterinarians who become addicted to the
drugs they prescribe for animals.
DR. BERNGARTT explained the process when a veterinarian
enters data in the Prescription Drug Monitoring Program
(PDMP) and said veterinary addiction is probably outside
the PDMP because professionals who are struggling with an
addiction are very unlikely to enter their own data into
the PDMP.
2:49:27 PM
DR. WARD said she believes some of the prepared testimony
addresses that concern a little more.
DR. WARD stated that both the Alaska State Veterinary
Medical Association, which is the professional body, and
the Alaska Board of Veterinary Examiners, which is the
regulatory body, strongly support SB 132. She and Dr.
Berngartt would discuss the reasons.
DR. WARD highlighted that just last Thursday the Alaska
Board of Pharmacy met and voted in support of this
exemption. They agree with the other 34 states that have
concluded that including veterinarians dilutes and confuses
the database. This vote was significant because this board
monitors, maintains, and interprets the data in the PDMP.
DR. WARD provided background on Alaska's PDMP, which was
established in 2008. In response to the growing opioid
epidemic, the PDMP was amended in 2017 to require
participation by all federal Drug Enforcement
Administration (DEA) permit holders, including
veterinarians. Neither the Alaska State Veterinary Medical
Association nor the Alaska Board of Veterinary Examiners
were consulted when the amendment was proposed.
2:51:26 PM
DR. WARD said there are a number of reasons that it makes
sense to exempt veterinarians. She would speak about the
practitioner concerns and Dr. Berngartt would talk about
the regulatory concerns.
She highlighted that the PDMP was not intended to be a
database for animals so it is not an effective tool for
tracking prescriptions for veterinarians or their patients.
The primary reason is the database was designed for human
medicine. Veterinary patients are animals and they do not
have unique identifiers such as a Social Security number
and the date of birth is often not known. When the law
passed initially, there was some confusion about who the
veterinarian would query because the Act talked about
querying the patient and the patients in a veterinary
practice are animals. It soon became clear that
veterinarians were supposed to query the animal owner's
prescription data when they prescribed a controlled
substance for the animal. This is despite the fact that the
information in the PDMP is not useful to veterinarians
because they are not trained in human medicine and dosages
do not translate from human to animal medicine. The data a
veterinarian enters into the PDMP for an animal patient is
similarly not useful for a medical doctor.
DR. WARD said Senator Revak brought up the next concern
which is privacy. Veterinarians are not trained in or bound
by the federal Health Insurance Portability and
Accountability Act (HIPPA) Privacy Rule. Furthermore,
veterinarians often work on shared computers in a large
treatment area so many people could see the information
that is entered. This is a concern for both veterinarians
and their clients. She asked the members if they would want
somebody who is not bound by HIPPA to see their private
prescription data. She pointed to the list of common
medications that veterinarians might see.
2:54:52 PM
SENATOR REVAK recalled that when they met he was comforted
that she mentioned that the dosages prescribed for animals
was comparatively small. This would make it much less
likely that an individual would "vet shop" to obtain drugs
for their personal use.
DR. WARD said that is relevant and she would respond to
that later in the presentation.
SENATOR STEVENS noted that dosages for large animals such
as horses could be quite large, then asked if anybody
tracked excessive use of drugs in a veterinary practice.
"How can you protect society from someone who may not have
scruples?"
2:56:27 PM
DR. WARD acknowledged he had valid concerns and noted that
the next slide discusses the fact that veterinarians are
monitored by the Drug Enforcement Agency and must adhere to
controlled substance regulations. She said she also wanted
to respond to his comment about large animals. She related
that she has experience with cattle, swine, and equine
practice and can say that controlled substances are almost
never used in food animals because the cost would be
prohibitive. Opioids are never used on horses because their
gastrointestinal tract would become impacted and the animal
would likely die.
SENATOR STEVENS thanked her for the response and shared
that his knowledge of veterinary science extended to All
Creatures Great and Small.
DR. WARD addressed the concern about abuse or diversion of
drugs by veterinarians. First, the PDMP was not intended to
track that information. It is about stopping shopping, not
diversion or self-use. If a veterinarian were to purchase a
drug for their own use or for diversion that would not be
entered into the database. There are, however, strict
regulations through the Drug Enforcement Agency (DEA). Any
veterinarian who prescribes or dispenses controlled
substances is licensed through the DEA and must adhere to
strict accountability, record keeping, and medication
storage requirements. Those records must be available to
the DEA on demand and local law enforcement agencies may
also request access.
DR. WARD continued to explain that manufacturers and
distributors of controlled substances are bound by Know
Your Customer type legislation that requires them to
maintain a Suspicious Order Monitoring System. These
companies must monitor, flag, and report a veterinarian's
unusual purchase patterns to the DEA. This is how the
majority of veterinary diversion is found. She drew a
parallel to a credit card company calling clients to ask
about unusual/potentially fraudulent charges on their card.
3:01:13 PM
DR. BERNGARTT delivered the second half of the
presentation. She reported that 34 other states have
exempted veterinarians from participating in the PDMP so
Alaska would not be a guinea pig. Increased veterinary
shopping or increased risk to the public would already be
evident, but that hasn't happened.
DR. BERNGARTT made the case that veterinarians are not a
source for the drugs that are of primary concern. She spoke
to the following from slide 9:
• The Board of Pharmacy reported that veterinarians
in Alaska from 20162018 prescribed .3% to 1% of
total Morphine Milligram Equivalents (MMEs).
• Opioid medications prescribed by veterinarians
(728,223) were only 0.34% of the total opioid
prescriptions (214 million) that were dispensed
by U.S. retail pharmacies in 2017.
• There is a natural barrier to vet shopping
since costs for veterinary care are paid up
front by the pet owner.
• There have been no identified cases of
veterinary shopping in Alaska.
3:04:38 PM
DR. BERNGARTT said another reason it makes sense to exempt
veterinarians from the PDMP is cost. Speaking as the chair
of the Board of Veterinary Examiners, she said the board
has seen an exponential increase in the cost of
investigations because the PDMP is unwieldy. She
highlighted that the state received a grant to cover some
of the cost of the PDMP. Costs are distributed between the
PDMP and the Board of Veterinary Examiners, but the grant
does not cover the board side of investigations.
3:06:23 PM
DR. BERNGARTT directed attention to slide 11 that
highlights that Alaska has the highest licensing fees for
veterinarians in the country. The state also has a critical
shortage of veterinarians and veterinary technicians.
Juneau, for example, used to have a nine doctor veterinary
hospital, and two hospitals that each had two doctors.
Currently, no overnight emergency animal services are
available in the community. Veterinary technicians are also
in very short supply. Further, Alaska has perhaps the
highest licensing fees for veterinarians in the country.
This makes it difficult to attract veterinarians to the
state. Alaska currently has 366 veterinarians who are
eligible to prescribe under the PDMP and just 266 licensed
technicians. That is less than one technician per doctor,
so it is not realistic to think that the technicians could
be charged with entering data into the PDMP to provide
relief for veterinarians.
3:08:16 PM
SENATOR STEVENS referred to the last line on slide 11 that
talks about charging veterinarians for the cost of
enforcement. He asked if she could place a dollar value on
this charge to veterinarians.
SR. BERNGARTT explained that the board is self-supporting
so the cost associated with the PDMP and investigations
comes from the fees charged to veterinarians and veterinary
technicians. Over the last several years the investigative
fees have become a concern and the only way to cover those
additional costs is to raise licensing fees.
SR. BERNGARTT concluded the presentation stating that a
"Yes" vote on SB 132 will allow veterinarians to:
• provide care for their patients;
• spend time with their patients instead of needless
querying and reporting unusable PDMP data
• increase the efficiency of the PDMP by eliminating
animal data that is not used
• allow more efficient tracking of human data in the
PDMP
• allow continued judicious use of controlled substances
that is already practiced by veterinarians, who are
regulated under the DEA
• allow veterinarians to continue to do their job
• eliminate unnecessary business burdens
3:11:34 PM
SENATOR GRAY-JACKSON said she appreciates the concerns of
her colleagues but since the bill was introduced last year
she has received many emails in support of the legislation.
She asked if there was any opposition to the bill because
she had heard none. She added that SB 132 makes sense and
she signed on as a co-sponsor.
DR. WARD replied that the Board of Pharmacy initially
expressed concerns similar to those articulated by
committee members, but the board recently voted to support
the bill.
3:12:31 PM
CHAIR COSTELLO opened public testimony for SB 132.
3:12:51 PM
DR. MCKAYLA DICK, Past President Alaska Veterinary
Association, North Pole, Alaska, stated that she is a
veterinarian who supports SB 132. It will allow the PDMP to
function as intended, which is to catch drug shoppers.
3:13:25 PM
TERRI LYONS, representing self, Wasilla, Alaska, stated
that she is a horse owner and there is a huge need for
large animal veterinarians in Alaska. She spoke to the
difficulties she has when her horse is in need of medical
attention in the middle of the night. SB 132 is one thing
that can be done to help this desperate situation.
3:14:45 PM
CHAIR COSTELLO closed public testimony on SB 132.
3:15:05 PM
At ease
3:18:05 PM
CHAIR COSTELLO reconvened the meeting and stated she would
hold SB 132 for future consideration.
3:18:30 PM
SENATOR MICCICHE said the discussion during the at-ease was
that he and other legislators amended the Alaska PDMP law
in 2017 in the belief that it would help to stem opioid
abuse. He said he has come to the conclusion that including
veterinarians in the PDMP is not the way to manage this
crisis.
SENATOR STEVENS said he was not trying to hold the bill up
because everything he heard makes sense. However, his
personal experience was causing him pause.
CHAIR COSTELLO said the veterinary community has worked
hard on this legislation and she appreciates that work. She
said her office would work to ensure that everyone is
comfortable with the bill.
CHAIR COSTELLO held SB 132 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 179 Transmittal Letter.pdf |
SL&C 2/23/2022 1:30:00 PM |
SB 179 |
| SB 179 Sectional Analysis version A.pdf |
SL&C 2/23/2022 1:30:00 PM |
SB 179 |
| SB 179 Fiscal Note 2417 - DCCED.pdf |
SL&C 2/23/2022 1:30:00 PM |
SB 179 |
| SB 179 AEA Presentation to SLAC - 2.22.22.pdf |
SL&C 2/23/2022 1:30:00 PM |
SB 179 |
| SB 179 Supporting Document - NREL Feasibility Study (2022).pdf |
SL&C 2/23/2022 1:30:00 PM |
SB 179 |
| SB 179 Written Testimony received as of 2.22.22.pdf |
SL&C 2/23/2022 1:30:00 PM |
SB 179 |
| SB 132 Presentation to SLAC 2.23.22.pdf |
SL&C 2/23/2022 1:30:00 PM |
SB 132 |