Legislature(2019 - 2020)ADAMS 519
03/22/2020 11:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB115 | |
| SB155 | |
| SB134 | |
| SB172 | |
| SB55 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 155 | TELECONFERENCED | |
| + | SB 55 | TELECONFERENCED | |
| + | SB 134 | TELECONFERENCED | |
| + | SB 172 | TELECONFERENCED | |
| += | SB 115 | TELECONFERENCED | |
| + | TELECONFERENCED |
CS FOR SENATE BILL NO. 172(L&C)
"An Act extending the termination date of the State
Medical Board; requiring a report on the State Medical
Board's audit compliance; and providing for an
effective date."
2:56:47 PM
ELIZABETH REXFORD, STAFF, SENATOR DONNY OLSON, introduced
herself and read the sponsor statement:
SB 172 will extend the termination date of the State
Medical Board (board).
The State Medical Board has served the public's
interest by effectively licensing physicians,
osteopaths, podiatrists, physician assistants, and
paramedics. The board monitored licensees and worked
to ensure that only qualified individuals practiced in
Alaska. Furthermore, the board has developed and
adopted certain regulatory changes to protect the
public, improve the licensing process, and improve the
delivery of services.
The most recent audit completed by the Division of
Legislative Audit has proposed a termination date that
is three years less than the eight-year maximum
allowed per statute. The Senate Labor and Commerce
committee recently amended the bill to reduce the
termination date by an additional two years for a
sunset date of June 30, 2023. Additionally, the
committee also required that the legislative audit
division submit a report concerning compliance of the
recommendations from the audit to the medical board
within one year after the effective date. The reduced
extensions and one-year report requirement are due to
the audit's finding that board had failed to follow
through on a few set priorities. First, the board
failed to consistently report license actions to the
Federation of State Medical Boards. Secondly, the
board has failed to adopt regulations governing
registration in the controlled substance prescription
database. These regulations require licensees to
register in a controlled substances prescription
database. Thirdly, the board did not monitor
compliance with the database registration requirement.
The board is tasked with adequately monitoring
licensees to ensure that those with a DEA number
register with the controlled substance prescription
database.
We respectfully request that the termination date of
the board be extended to align with the Senate Labor &
Commerce committee's recommendation of June 30, 2023,
as well as requiring the one-year report from
legislative audit. These changes are incorporated into
the current version.
Co-Chair Johnston thanked the sponsor and his staff for the
bill and invited Kris Curtis to the table.
2:59:52 PM
KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF
LEGISLATIVE AUDIT, conducted an audit of the State Medical
Board. She indicated a copy of the report was in members
packets. She reviewed the state audit:
The audit concluded the board served the public's
interest by effectively licensing physicians,
osteopaths, podiatrists, physician assistants, and
paramedics. The board monitored licensees and worked
to ensure only qualified individuals practiced in
Alaska. Furthermore, the board developed and adopted
certain regulatory changes to protect the public,
improve the licensing process, and improve the
delivery of services.
The audit also concluded the board did not serve the
public interest by inconsistently reporting board
license actions to the Federation of State Medical
Boards (FSMB). In addition, the board did not adopt
regulations to require licensees register in the
controlled substance prescription database and did not
adequately monitor licensees to ensure those with a
DEA number registered with the controlled substance
prescription database.
Ms. Curtis indicated the audit recommended the Legislature
extend the board for 5 years.
Ms. Curtis referred to the background section of the audit
on page 5. She read from the report:
Senate Bill 74, effective July 2017, required
occupational board licensees that prescribe controlled
substances to register with the controlled substance
prescription database maintained by the Board of
Pharmacy. The database is intended to reduce misuse,
abuse, and diversion of controlled substances.
Practitioners are required to check the database prior
to dispensing, prescribing, or administering
medications, with certain exclusions.
Ms. Curtis turned to page 11 which showed a schedule of
licensing activity. The board issued just over 1600 new
licenses from FY 16 through January 2019. As of the end of
January 2019 there were 5073 active licensees which
represented a 9 percent increase compared to the 2012
sunset audit.
Ms. Curtis pointed to page 14 which displayed a schedule of
revenues and expenditures. She indicated there was a
deficit in 2018 of over $800,000. In response to the
deficit they increased fees. The schedule of fees was shown
on page 15.
Ms. Curtis reported that the auditors made 3
recommendations for improvement beginning on page 18 of the
audit. She read from the report:
Recommendation No. 1: The board should adopt
regulations to guide the process for registering with
the controlled substance prescription database.
The board did not adopt regulations to require
licensees with a Drug Enforcement Administration (DEA)
number register with the controlled substance
prescription database. Senate Bill 74, Section 60
included uncodified law that directed all boards that
licensed occupations with prescription authority to
adopt regulations to implement the law.
Rather than adopt regulatory guidance for registering,
the board expanded the regulatory definition of
unprofessional conduct to include licensees that do
not register. The board also implemented regulations
that require review of the controlled substance
prescription database prior to prescribing or
dispensing and added an opioid maximum daily dosage.
Board members did not consider the importance of
establishing regulations to guide in the process and
believed the regulatory changes that were made were
sufficient to satisfy the requirements of Senate
Bill 74.
The database was intended to reduce misuse, abuse, and
diversion of controlled substances. The lack of
regulations regarding registration requirements
increases the risk that licensees will not register
which, in turn, limits the database's effectiveness.
As described in Recommendation No. 2, the audit found
a high degree of noncompliance with the registration
requirements.
We recommend the board adopt regulations to guide the
process for registering with the controlled substance
prescription database.
Recommendation 2: The board should develop procedures
to
ensure licensees with a DEA number register in the
controlled substance prescription database.
Per AS 08.64.101(a)(7), effective July 2017, the board
must
require a licensee who has a DEA registration number
to register with the controlled substance prescription
database. The audit reviewed 25 new licenses (of which
19 had a DEA number) and 15 renewal licenses (of which
13 had a DEA number).
Auditors noted that the application form for new
licenses did not require an applicant provide evidence
of registration with the controlled substance
prescription database. Division staff processed the
applications and the board approved the applications
without regard for whether or not the applicant
registered with the database. Auditors checked the
database and found that five of the 19 new license
applicants with a DEA number (26 percent) had not
registered four applicants were not listed in the
database and one was listed in the database with a
status of "pending." Auditors noted that the renewal
application was revised in November 2018 to request
applicants for renewal licenses list their controlled
substance prescription database registration number.
However, applicants were permitted to list a status of
"pending," and division staff did not verify that a
licensee obtained a registration number at a later
date. Four of the 13 renewal applicants with a DEA
number (31 percent) had a status of "pending."
The board and DCBPL failed to comply with
AS 08.64.101(a)(7) due to a lack of procedures and the
board's decision to allow licensees a grace period
before enforcing the new requirements. The law did not
provide for a grace period and had an effective date
of July 2017. The controlled substance prescription
database was intended to reduce misuse, abuse, and
diversion of controlled substances.
Incomplete information within the database limits its
effectiveness, which increases the risk that
controlled substances may be abused or diverted.
We recommend the board develop procedures to ensure
licensees with a DEA number register with the
controlled substance prescription database.
Recommendation 3: The board chair should work with
DCBPL's
director to establish and implement procedures to
ensure board disciplinary actions are reported in
accordance with state law.
Of the 140 board disciplinary actions issued by the
State Medical Board between FY 16 and January 2019, 44
(31 percent) were not reported to the FSMB as required
by AS 08.64.335.
Alaska Statute 08.64.335 states:
The board shall promptly report to the Federation
of State Medical Boards for inclusion in the
nationwide disciplinary data bank license and
permit refusals under AS 08.64.240, actions taken
by the board under AS 08.64.331, and license and
permit suspensions or surrenders under AS
08.64.332 or 08.64.334.
The 44 disciplinary actions not reported to FSMB were
actions taken by the board under AS 08.64.331.
According to DCBPL management, staff misunderstood the
types of actions to be reported.
Additionally, the board and DCBPL lacked written
procedures to ensure the actions were correctly
reported in a timely manner. The national data bank
maintained by FSMB is designed to restrict the ability
of incompetent physicians to move from state to state
without disclosure or discovery of a physician's
damaging or incompetent performance. DCBPL's failure
to report disciplinary actions increases the risk to
public safety.
We recommend the board chair work with DCBPL's
director to establish and implement procedures to
ensure board disciplinary actions are reported in
accordance with state law.
Ms. Curtis directed attention to the responses to the audit
beginning on page 31. The commissioner of DCCED stated that
corrective action had already been taken to make sure that
disciplinary actions were reported in compliance with state
law.
Ms. Curtis continued to page 33 of the audit containing the
response from the board chair. In response to
recommendation 1 to adopt regulations the board chair
reiterated her belief that the statutes clearly required
licensees to register with the controlled substance
prescription database. In her opinion, regulation did not
seem necessary. She also stated that the regulations that
were created were reviewed by the Department of Law and
were found to be sufficient. However, the chair stated that
the board would consult the Department of Law and take any
corrective actions that they deemed necessary.
Ms. Curtis continued that in response to recommendation 2
to develop procedures, the chair stated that a procedure
had been created to ensure that their licensees would be
registering with the database.
Ms. Curtis reported that in response to recommendation 3
the chair agreed to implement procedures to ensure
disciplinary actions were reported in accordance with state
law.
3:05:45 PM
Representative LeBon asked Ms. Curtis if she had a sense
that the State Medical Board was investigating as
appropriate. He queried about issues that might be falling
through the cracks and not actually reaching the decision
level. Ms. Curtis commented. "Theres always things that we
dont know." The audit always focused on efficiency to
which investigations were happening. The auditors did not
look at actual investigations and evaluate whether they
made a right decision. She could not properly address
Representative LeBons question.
Representative Knopp asked if the board was fully staffed.
Ms. Curtis relayed that the entire board had changed over
within the previous few months.
Representative Knopp asked Ms. Curtis to tell the committee
about the make-up of the board. He asked if the board
consisted of members of the public or whether they were
medical professionals. He asked the question because Ms.
Curtis had mentioned regulations. Ms. Curtis referenced
page 1 of the audit which went into detail about the
organization and function of the board. The board was
comprised of 8 members 5 physicians, 1 physicians
assistant, and 2 public members with no direct financial
interest. The Division of Corporations, Business, and
professional Licensing provided support for the board in
terms of drafting regulations. The Department of Law
reviewed the regulations.
Representative Knopp asked where the board fell short. He
wondered if it was turnover in membership. Ms. Curtis
thought they had a valid argument in that they felt like
the statutes were clear. The statute stated that licensees
had to register. In the boards opinion, additional
regulations were not needed. The auditors felt that the
non-compliance was so high, that it warranted putting
regulations into place.
3:08:39 PM
SENATOR DONNY OLSON, SPONSOR, wanted to respond to
Representative Knopps question. He indicated that the
board had changed out completely over the previous couple
of months. The issue he had with the new board members was
that they were either from Anchorage or Fairbanks with only
one person from Sitka. He thought there was a
maldistribution of board members. He agreed with the
auditors recommendation of having tighter constraints.
Co-Chair Johnston relayed that Dr. Richard Wein was online
and available for questions.
Senator Olson indicated he had been on the board
previously. He expressed concerns that a chairman had not
been named. He thought the circumstance was similar to a
ship without a captain at the helm.
Representative Knopp noted Senator Olsons comments about
proper geographic representation. He wondered if the board
would be better served with members that were more evenly
distributed throughout the state. He asked if there was
something the legislature could do to help. Senator Olson
responded that there was a statute which stated that
members should be from as many geographical areas of the
state as possible. However, the statute could be
interpreted loosely, giving the governor the ability to
choose whomever he wanted. He mentioned equipment and lab
tests. He deferred to Ms. Curtis to answer the remainder of
Representative Knopps question. Ms. Curtis asked
Representative Knopp to restate his question.
Representative Knopp thought an executive director was
needed for the board, as it did not appear that certain
things were being done. Ms. Curtis responded that the board
had an executive director. She reported that the position
had been occupied by someone for a long time but had left.
A new person had recently taken the position. She also
noted that the auditors were conducting an audit on the
Direct Entry Midwives whose board had turned over 100
percent. In the prior year, the Board of Nursing had turned
over 100 percent as well. She commented that there appeared
to be a pattern.
3:12:55 PM
Representative Josephson indicated his office had a bill to
improve the PDMP [Prescription Drug Monitoring Program]. He
thought Ms. Curtis had testified that the board did not
think regulations were needed, as the statutes were clear
enough in terms DEA prescribers having to register. He
asked if he had heard her correctly. Ms. Curtis responded
affirmatively.
Representative Josephson asked about the 26 percent that
did not register. He noted there were several providers
that did not prescribe opiates and would not need to
register. There were other providers that did prescribe
opiates but had not registered. He asked if he was correct.
Ms. Curtis responded that the percentage applied to the
number of providers that should have registered. He was
correct that not all providers had to register. However, 26
percent of providers who had a DEA number and were required
to register, did not do so.
Representative Josephson suggested it meant that providers
who had not registered could not get into the system to
look someone up, even if they wanted to. He asked if he was
correct. Ms. Curtis responded, "Yes."
3:14:27 PM
Representative Wool asked that if someone registered with
the PDMP, they would not necessarily check the database
before writing a prescription. Essentially, they could
write 10 prescriptions to 10 different people, never look
them up, and no one would know. Ms. Curtis was unsure
whether there was an audit trail function within the
database to monitor inquiries. There certainly could be.
There was no one responsible for monitoring the system.
Representative Wool thought there was a requirement that
physicians also enter prescription information that would
be accessible to pharmacies. However, it was not part of
the law. Only pharmacists had to check the database. Ms.
Curtis indicated it applied to all individuals who had
prescribing authority. They were supposed to check the
database before they administered or prescribed
medications. It was both.
Representative Wool explained that as he understood it,
providers only had to check the database to see the
patients history at the pharmacy. The provider did not
have to enter the prescription they were prescribing. Ms.
Curtis reported that there was a requirement that
prescriptions were uploaded into the database at some time
in the process. The audit took a deeper look at the issue
when it conducted a pharmacy audit. The Board of Pharmacy
extension date was limited to 3 years. In the next Board of
Pharmacy audit, the auditors would be looking at compliance
across all occupations.
Representative Josephson mentioned HB 242. He was
astonished that the board did not notify prescribers that
they were not in compliance with the law. It could put
pressure on the board to revoke a providers license.
Co-Chair Johnston noted Ms. Chambers was online and
available for questions.
Ms. Curtis mentioned that the auditors found it slightly
egregious that the board granted a grace period, as the law
did not provide for a grace period. The Board Chairs
response was that it was not the boards intention to grant
a grace period for complying with the law. The board only
intended to grant a grace period for enforcing the law.
From the auditors perspective there was not a difference.
Representative Carpenter wondered if the board members were
the same members through the previous 2 audits. Ms. Curtis
did not know what percentage of the board was in place
previously. The prior audit was in 2012. The auditors had
consistently found problems with reporting. In the chairs
response she did not think the auditors characterized the
finding correctly. She stated that the prior finding was
not exactly the same as the current funding. Ms. Curtis
agreed that the findings were slightly different, however,
the recommendation was the same. The auditors recommended
that they start reporting correctly in compliance with the
law which they had not been doing consistently. She
highlighted that they were not reporting the portion
related to civil fines.
3:19:18 PM
Co-Chair Johnston OPENED Public Testimony.
3:19:47 PM
CHARLES MCKEE, SELF, ANCHORAGE (via teleconference), was a
beneficiary of the McKee Trust and had had access to
medical facilities as recently as October. He spoke in
support of the extension of the medical board. He recalled
the governors veto of Medicaid funds. He referred to a
lawsuit in which a medical establishment of doctors and
nurses sued the current administration. The case was
settled out of court due to an artificial emergency that
was created by the current administration related to the
veto of Medicaid which he needed to access. He reminded
members the state was currently in emergency status but,
the artificial emergency was manifested by the current
administration which mandated that everyone sign a loyalty
pledge.
Co-Chair Johnston interjected that the testifier needed to
stay on the topic of the bill.
Mr. McKee indicated the State Medical Board should have
refused compliance like the staff at the Alaska Psychiatric
Institute (API) who resigned in protest. He reiterated his
approval of the extension.
3:21:46 PM
Co-Chair Johnston CLOSED public testimony.
CSSB 172(L&C) was HEARD and HELD in committee for further
consideration.
3:21:59 PM
AT EASE
3:22:53 PM
RECONVENED