Legislature(2021 - 2022)BUTROVICH 205
03/10/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HCR10 | |
| SB175 | |
| SB192 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HCR 10 | TELECONFERENCED | |
| += | SB 175 | TELECONFERENCED | |
| += | SB 192 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 192-BOARD OF LICENSED MIDWIVES
1:51:09 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 192
"An Act relating to midwives and the practice of midwifery;
relating to apprentice midwives; relating to the licensing of
midwives; relating to insurance requirements for the practice of
midwifery; and providing for an effective date."
1:51:28 PM
SENATOR SCOTT KAWASAKI, Alaska State Legislature, Juneau,
Alaska, sponsor of SB 192, stated that he introduced SB 192, on
behalf of midwives, to institute licensing requirements and
regulations for certified professional midwives, using a
nationally recognized midwife organization. He anticipated an
amendment. The bill aims to ensure safer at-home births and
improve prepartum and postpartum care for mothers and infants.
He indicated his willingness to consider suggestions to improve
the bill.
1:52:52 PM
SENATOR REINBOLD suggested he consider combining it with the
naturopath bill.
1:53:28 PM
SENATOR BEGICH related his understanding that part of the bill
was in response to a limited renewal of the Board of Certified
Direct-Entry Midwives. He asked Ms. Curtis how much of the bill
resulted from the scope of the legislative audit. He offered his
support for ensuring safe practices with births.
1:55:30 PM
At ease
1:56:33 PM
CHAIR WILSON reconvened the meeting.
1:56:55 PM
SENATOR BEGICH recalled that two years ago the legislative audit
led to a truncated renewal for the Board of Certified Direct-
Entry Midwives. He asked how much of this bill was related to
the audit findings and recommendations.
1:57:34 PM
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
Legislative Agencies and Offices, Juneau, Alaska, responded that
the report for the sunset audit of the Board of Certified
Direct-Entry Midwives [Audit Control Number 08-20123-20] dated
June 19, 2020, recommended a two-year extension. She said this
is six years less than the maximum eight years allowed in
statute. The division's recommendation for a reduced extension
was due to an issue related to an ongoing confidential
investigation that could potentially impact the board's ability
to protect the public. The audit made three recommendations that
did not affect the extension, but another issue did. The board
had identified a need to change certification statutes to align
Alaska's midwifery laws with national standards. Still, it had
not proceeded to do so due to a concern that it might impact
their fees. The auditors did not believe that was in the
public's best interest and made Recommendation [1]. She related
her understanding that this bill was attempting to remedy that,
which is how it links to the audit.
1:58:56 PM
SENATOR BEGICH related that based on conversations, there seemed
to be a difference of opinion as to the best approach. He
indicated that he would like to craft a simplified definition
related to the national organizations with different standards.
He noted that two or three national organizations have different
standards. He wondered if that would be consistent with the
audit recommendation.
MS. CURTIS answered that she had no comment because the auditors
did not look at the organizations nor identify if there was more
than one organization.
2:00:03 PM
SENATOR BEGICH recalled she had mentioned a confidential issue,
which cannot be discussed. He asked whether the matter had been
resolved or if a path to resolution existed.
2:00:25 PM
MS. CURTIS answered that auditors are about to start the next
sunset audit on the board since the audit recommended only a
two-year extension. This means the division will have
legislative oversight of that issue, and the audit report will
be completed this year.
2:00:44 PM
CHAIR WILSON related his understanding that midwives will still
be a licensed entity, at least until the completion of the next
audit.
2:01:03 PM
MS. CURTIS clarified that the Board of Certified Direct-Entry
Midwives was extended and will not sunset until June 2023. She
stated that the board would have a year to wind down its
affairs. She noted that if the board is not extended, the
Division of Corporations, Business, and Professional Licensing
would conduct the licensing process.
2:01:31 PM
SENATOR HUGHES asked whether the board would technically
continue until June 30, 2024.
2:01:49 PM
MS. CURTIS deferred to Ms. Chambers.
2:01:54 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development, Juneau, Alaska, responded that the board
would sunset on June 30, 2023, but the one year wind down would
allow it a grace period to wrap up its affairs until June 2024.
2:02:24 PM
SENATOR HUGHES noted Ms. Curtis mentioned a pending confidential
investigation and three audit recommendations. The board
identified a need to change certification statutes to align
Alaska's midwifery laws with national standards. She asked for
the other two audit recommendations.
2:02:39 PM
MS. CURTIS stated that Recommendation 1 was that the board
should recommend statutory changes that benefit the public. She
noted that the board identified a need to change certification
statutes to align Alaska's midwifery laws with national
standards. Recommendation 2 was that DCBPL's chief investigator
should ensure investigations are completed timely. She noted the
auditors found three investigations that had unjustified periods
of inactivity due to turnover and competing priorities.
Recommendation 3 was that the board should improve oversight of
the peer review process.
2:03:16 PM
SENATOR HUGHES acknowledged that she must remain neutral and
likely could not offer her opinion on the bill. She asked if the
three items were in the bill.
2:03:33 PM
MS. CURTIS stated that she had not reviewed SB 192.
2:02:35 PM
At ease
2:05:56 PM
CHAIR WILSON reconvened the meeting.
2:06:02 PM
SENATOR BEGICH said he has a copy of the legislative audit for
the board.
2:06:12 PM
SENATOR HUGHES asked for the third recommendation.
MS. CURTIS said Recommendation 3 was that the board should
improve oversight of the peer review process.
2:06:26 PM
SENATOR HUGHES noted that the bill changes the makeup of the
board. She asked whether that would benefit the public and the
peer review process.
2:06:41 PM
MS. CURTIS answered that she was unsure.
2:07:11 PM
CHAIR WILSON opened public testimony on SB 192.
2:07:30 PM
JOHANNA CROSSETT, representing self, Juneau, Alaska, stated that
she was a licensed midwife. She said she is curious about
changes that the committee may make. She related her
understanding that the intent of the bill was to address the
audit recommendations.
2:08:24 PM
RACHEL PUGH, Member, Board of Certified Direct-Entry Midwives,
Department of Commerce, Community and Economic Development
(DCCED), Eagle River, Alaska, stated that she is a certified
direct-entry midwife. She stated that Recommendations 2 and 3
have already been addressed by the board. She stated that SB 192
was designed to address Recommendation 3. She expressed her
interest in any proposed amendments. The board spoke in support
of SB 192, as written. She pointed out there is only one
certifying organization, the North American Registry of Midwives
(NARM). The other organizations are associations but do not
certify midwives. She related that she consulted with NARM when
working on the language in SB 192 to ensure that the statutes
fulfilled national standards.
2:10:50 PM
SENATOR HUGHES characterized the profession of midwifery as
important. She stated that she has a family member under the
care of a midwife. She asked Ms. Pugh to identify any provisions
in the bill that were not the result of audit recommendations.
MS. PUGH offered her view that the entire bill is designed to
meet national standards. She did not believe anything was
outside of that scope.
2:11:34 PM
SENATOR HUGHES related her understanding that the board would
remove seats on the board for the physician and advanced
practice nurse that works in a hospital setting. She asked
whether that was part of the sunset audit recommendation.
2:11:50 PM
MS. PUGH stated that it relates to the national standards. She
explained that the board went through the proposed statutes
line-by-line [during a board meeting]. She related that four [of
five] board members participated online. Those members
unanimously supported the proposed language, including the board
member serving in the Physician/OB practice position on the
board. The board supported changing the board composition to
consist of two members who are licensed midwives and two members
who are Advanced Practice Registered Nurses (APRN). Midwives
work closely with advanced practice registered nurses (APRNs)
because they understand the scope of practice. She said that
Certified Nurse Midwives/APRNs who work in hospitals and
Obstetricians (OB) physicians do not understand midwife
practices outside the hospital realm. She stated that it could
make the Board of Certified Direct-Entry Midwives' decisions
difficult because it requires the midwife board members to
explain how they conduct their jobs. She related that she had
worked with counterparts CNMs and APRNs working outside the
hospital and collaborating with the rest of the midwives in the
state. She noted that she is not the only midwife that works
closely with out-of-hospital CNMs and APRNs. She characterized
their working relationship as very good, so they would know more
about the scope of practice, which would be an asset to the
board.
2:13:47 PM
SENATOR HUGHES pointed out that changing the board composition
was not in the audit recommendation but it was something the
board decided would be beneficial.
2:14:06 PM
SENATOR BEGICH stated that the audit said the board identified a
need to change certification statutes to align Alaska's
midwifery laws with national standards. It says certified
direct-entry midwife (CDM) certification statutes are defined in
AS 08.65.060 through AS 08.65.080. It pointed out that the board
has the authority to establish regulations over the
certification process. He stated that the audit recommended that
the board pursue statutory changes that benefit the public,
which is somewhat vague.
SENATOR BEGICH stated that the bill is lengthy and makes
numerous suggestions. He wondered if it would be sufficient to
just focus on AS 08.65.050, which relates to the qualifications
for licensure. He read a portion of Sec. 08.65.050. The language
proposed [on page 5, lines 21-25 reads:
(1) holds a valid certified professional certificate,
if the certificate is issued by a nationally
recognized midwife organization recognized by the
board and the requirements for the certificate are
consistent with this chapter.
SENATOR BEGICH noted that the board could identify the
nationally recognized midwife organization. He asked whether
that was sufficient to meet the audit requirement.
2:15:45 PM
MS. PUGH said it was not because midwives currently practice
under a restriction of trade. She noted that CDMs are not
recognized by insurance companies, and Alaskan midwives do not
practice as Certified Professional Midwives (CPMs), which is the
national standard. She pointed out that it was challenging to
make proposed statutory changes because one change would have a
ripple effect. She noted that the enabling statute is 30 years
old and is not up to national standards.
2:16:47 PM
SENATOR BEGICH asked how many certified midwives in Alaska would
lose their certification if this bill were adopted.
2:17:20 PM
MS. PUGH offered her view that there would be less than five
midwives in Alaska without CPM certification.
2:17:32 PM
SENATOR REINBOLD thanked her for serving.
2:18:07 PM
IDA DARRAGH, CPM; Executive Director, North American Registry of
Midwives (NARM), Little Rock, Arkansas, stated that NARM is the
national organization that issues the credentials for Certified
Professional Midwives (CPM). She spoke in support of SB 192. She
said the CPM credential is nationally accredited by the National
Commission for Certifying Agencies (NCCA), providing the basis
for licensure in 37 states that license midwives to attend
births outside the hospital. She said it is the only national
credential that requires training and experience in out-of-
hospital births. Alaska has recognized Direct-Entry Midwives
since at least 1999. She indicated that SB 192 would bring
Alaska up to the national standard for the licensure of CPMs.
She related that passing the bill would change the title to a
licensed midwife. The term certified was based on meeting the
national certification standards of the national midwifery
credential, but each state does licensure. The current system in
Alaska already functions as a licensure program, so the title
should reflect that, even though it is not a change to the legal
path to practice in Alaska. She characterized it as a refinement
and improvement to the current system.
MS. DARRAGH stated that SB 192 would bring licensure up to the
national standard. All currently holding the title Certified
Direct Entry Midwife in Alaska have passed the national
certification exam, but some have not applied for the
credential. Those who are not CPMs but hold a state credential
can easily obtain the CPM credential with a simplified
application and a $50 fee. The credential would also verify that
they had met the continuing education, recertification, peer
review, and CPR training.
2:21:07 PM
KATHRYN AULT, Nurse Practitioner; President, American College of
Nurse-Midwives; Member APRN Alliance, Homer, Alaska, stated that
she also serves as the President of the American College of
Nurse-Midwives. She said that she was speaking on behalf of
herself and for the APRN Alliance. She offered that APRNs
support Direct-Entry Midwives and changed their licensure to
licensed midwives. However, APRN has issues and opposition with
some parts of the bill, so they do not support SB 192 as
currently written. She expressed concern about the changes to
the board composition and the difference for the nurse midwife
to be actively practicing out of the hospital. They think this
would erode some important relationships with in-hospital
providers because sometimes home births must transfer to the
hospital, and those relationships are meaningful when
transferring the patient.
2:22:20 PM
MS. AULT stated that the Division of Public Health has a quality
improvement measure that midwives and obstetricians are part of,
which strives to improve the transfer process from the community
to the hospital. She offered her view that this bill does the
opposite.
2:22:50 PM
MARY YANAGAWA, Certified Direct-Entry Midwife; President,
Midwives Association of Alaska (MAA), Wasilla, Alaska, provided
invited testimony for SB 192. She read prepared remarks,
beginning with the mission statement.
The Midwives Association of Alaska exists to promote
midwifery in Alaska through continuing education,
support, and structure for Direct Entry Midwives. We
are committed to the midwifery model of care,
providing choices in childbirth for women and babies.
The Midwifery Model of Care is based on the fact that
pregnancy and birth are normal life processes. The
Midwifery Model of Care includes monitoring the
physical, psychological, and social well-being of the
mother in a child-bearing cycle. We provide the mother
with individualized education, counseling, female
care, and continuous hands-on assistance during the
labor and delivery, and postpartum support. We
specialize in minimizing technological intervention,
identifying and referring women who require physical
attention, and we know the application of this woman-
centered model of care has been proven to reduce the
incidence of birth injury, trauma, and caesarean
section.
As an organization made up of fiercely independent and
strong women, it is understood that we will not all
agree on every detail of everything. We each come from
differing perspectives based on our individual lives,
practices, and callings. There is a midwife out there
for everyone, for every personality, and every
individual.
2:25:09 PM
We have heard from a small group of midwives within
our organization that the language of our statutes
today were not to their liking. We understand these
viewpoints that are shared with us and also recognize
that the majority of our midwives have expressed their
support with these statute updates.
MS. YANAGAWA added her personal comment. She said as a
woman who spent all of her child-bearing years in Alaska,
her voice matters. As a pregnant woman and new mother, she
felt mistreated by the mainstream medical hospital-based
system providers in Alaska.
MS. YANAGAWA stated that she had restricted options for
childbirth due to the practices and policies of hospital-
based providers in this state. Her treatment led her to
seek the midwifery profession, including the education,
advocacy, and Midwifery Model of Care that she currently
espouses. She stated that her search for a flexible and
compassionate provider within the hospital was fruitless.
MS. YANAGAWA stated that she drove the ALCAN when pregnant
with her sixth child to be under the care of out-of-
hospital community-based care in California. The midwives
were no different than the licensing and credentialing of
the CPMs in Alaska. She said she would have liked to have
used an Alaskan midwife if Alaska statutes and regulations
had not restricted their trade. She detailed some of her
trials and tribulations during her time in California.
2:27:30 PM
MS. YANAGAWA noted that the audit recommended that the
board pursue statutory changes that benefit the public. She
offered her view that numerous families support the
legislation.
MS. YANAGAWA stated that midwives do more than provide
care. They provide a safe space for women to feel
empowered. Midwives provide compassion, access to quality
care, and the ability to refer families when necessary. She
said midwives provide community-based care that is proven
to grow strong families with great outcomes.
2:28:55 PM
BETHANY KIRILLOV, representing self, Wasilla, Alaska, spoke in
support of SB 192. She stated that she is a licensed Direct-
Entry Apprentice Midwife. She said she has worked as an
apprentice and is also a mother of four children. She offered
her support for SB 192, as written, because it would benefit
mothers and midwives and fulfill the audit recommendations. She
expressed concern that some mothers have indicated they will
give birth without a caregiver present because of Alaska's
statutes that limit midwifery care.
MS. KIRILLOV stated that midwives exercising their training is
in the interest of Alaskans. She said women choose midwives to
have control over their care. She further stated that billing
private insurance will lessen the out-of-pocket expenses. She
stated that the current statutes are restrictive. She attended
the Via Vita School of Midwifery, which is acceptable for
licensure in Alaska. She said she supported NARM because they
issue the CPM credentials to midwives nationwide and administer
the national exam. NARM is an excellent choice to set standards
for Alaska's licensure. She expressed concern that the current
statutes limit midwifery education to a very narrow list of
schools.
2:33:03 PM
CHAIR WILSON closed public testimony on SB 192.
2:33:27 PM
SENATOR BEGICH stated his questions had been answered. He said
he would like to pare down the bill to focus on the audit
recommendations.
2:34:05 PM
SENATOR KAWASAKI thanked the committee for hearing the bill. He
expressed appreciation that Senator Begich offered to work
together on amendments.
2:34:26 PM
CHAIR WILSON held SB 192 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 192 APRN 3.3.22.pdf |
SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Midwives Assoc. of AK Letter.pdf |
SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Testimony 3.8.22.pdf |
SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 175 Letters 3.9.22.pdf |
SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| HCR 10 - CDC Heart Disease Facts.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HCR 10 |
| HCR 10 Sponsor Statement.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HCR 10 |
| HCR 10 2021 AMA 2021 Update.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HCR 10 |
| SB 175 Sectional Analysis v. I 3.1.2022.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 Sponsor Statement v. I 3.1.2022.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 v.I Work Draft 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 Explanation of Changes v. A-I 3.2.2022.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 (HB 265) Letters 03.02.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HB 265 SB 175 |
| SB 192 NARM letter of Support 3.23.21.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Sectional Analysis 3.2.22.pdf |
SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Sponsor Statement 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Supporting Doc Why We Need CPM 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Audit Recommendations DLA 6.19.2020.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 FN DCCED CBPL 2.25.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 FN DCCED IO 2.25.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Leg Legal Memo 1.18.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Leg Legal Memo 2.11.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Letters 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Sectional Analysis 3.3.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |