Legislature(2021 - 2022)BARNES 124
04/27/2022 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB186 | |
| SB190 | |
| SB193 | |
| HB405|| HB406 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 382 | TELECONFERENCED | |
| + | SB 45 | TELECONFERENCED | |
| += | HB 405 | TELECONFERENCED | |
| += | HB 406 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | SB 186 | TELECONFERENCED | |
| + | SB 190 | TELECONFERENCED | |
| + | SB 193 | TELECONFERENCED | |
SB 193-EXTEND BOARD OF CHIROPRACTIC EXAMINERS
3:57:42 PM
CO-CHAIR FIELDS announced that the next order of business would
be CS FOR SENATE BILL NO. 193(FIN), "An Act extending the
termination date of the Board of Chiropractic Examiners;
requiring a report on audit compliance by the Board of
Chiropractic Examiners; and providing for an effective date."
3:58:00 PM
MADISON GOVIN, Staff, Senator Peter Micciche, Alaska State
Legislature, presented CSSB 193(FIN) on behalf of Senator
Micciche, prime sponsor. She stated that the bill would extend
the sunset date for the Board of Chiropractic Examiners by five
years, making the new sunset 6/30/27. She said the bill would
also require that a report from the Division of Legislative
Audit be submitted to the Legislative Budget and Audit Committee
on the board's compliance with this year's audit.
MS. GOVIN explained the changes made in CSSB 193(FIN). She
spoke from the document in the committee packet titled "Senate
Bill 193 Extend Board of Chiropractic Examiners, Explanation
of Changes, Version I to Version G," which stated [original
punctuation provided]:
Page 1, Line 2
Inserts into the title "requiring a report on audit
compliance by the Board of Chiropractic Examiners."
Sec. 1 AS 08.03.010(c)(5) Page 1, Line 6
Extends the board extension from two years to five
years.
Sec. 2 Page 1, Lines 8-14
Adds a requirement for the legislative audit division
to prepare and submit to the Legislative Budget and
Audit Committee a report on the compliance of the
Board of Chiropractic Examiners with the
recommendations of the June 22, 2021 audit of the
board.
3:59:23 PM
CO-CHAIR FIELDS opened invited testimony.
3:59:52 PM
KRIS CURTIS, CPA, CISA, Legislative Auditor, Division of
Legislative Audit, provided invited testimony during the hearing
on CSSB 193(FIN). She spoke from the full audit report in the
committee packet titled "DEPARTMENT OF COMMERCE, COMMUNITY, AND
ECONOMIC DEVELOPMENT BOARD OF CHIROPRACTIC EXAMINERS SUNSET
REVIEW," dated 6/22/21. She said the audit found that the board
served the public's interest by conducting its meetings in
accordance with state laws, by amending certain regulations to
improve the chiropractic profession, and by effectively
regulating and licensing chiropractic physicians. The audit
also found, she continued, that one board member did not comply
with the statutory requirements for appointment and that
additional resources were needed to investigate cases in a
timely manner. She related that a five-year extension is
recommended rather than the eight-year maximum allowed for in
statute. This recommendation, she explained, is based on an
issue identified during the audit that may impact the board's
ability to protect the public, details of which are not included
in the public audit report to preserve the confidentiality of an
ongoing investigation.
4:00:42 PM
CO-CHAIR FIELDS asked what the legislature has done in the past
when it is found that a board member doesn't meet the statutory
requirements for appointment.
MS. CURTIS responded that the legislature doesn't act because
usually her recommendation is to the governor's office, which
typically removes the board member and appoints someone else,
and which was done in this case. In further response, she said
the governor's office has reported that this was done, but she
cannot verify it.
4:01:15 PM
REPRESENTATIVE MCCARTY asked whether this person was appointed
and confirmed or was in the appointment process.
MS. CURTIS replied that this person was appointed and confirmed.
In further response, she confirmed that after confirmation it
was found that the appointee didn't qualify. She stated that
this was an issue in the prior sunset audit as well. It is
usually not a risky area, she advised, so for all of Alaska's
boards [the Division of Legislative Audit] doesn't necessarily
send a notice to the public member to ensure that the member is
qualified. But, she continued, since there was a prior
recommendation related to this board, [the division] confirmed
the public member. It usually has to do with whether the member
has a direct financial interest in the health care industry, she
explained. In this case it was found that the board member was
a licensed emergency medical technician (EMT), so the member had
an interest in the health care industry and therefore didn't
comply with statutory requirements that prohibit this. The
public member must have that consumer perspective, she added,
and in this case the member didn't.
4:02:16 PM
CO-CHAIR FIELDS asked whether it is fair to characterize this as
an inadvertent violation.
MS. CURTIS replied yes.
4:02:24 PM
MS. CURTIS resumed her invited testimony. She drew attention to
page 5 [Exhibit 2] of the audit and reported that as of January
2021 there were 306 licensed chiropractors. She turned to the
board's schedule of revenues and expenditures on page 6 [Exhibit
3] and noted that [over the past four fiscal years] the board
alternated between a deficit and a surplus. She related that
according to management at the Division of Corporations,
Business and Professional Licensing (DCBPL), the deficit was
within a reasonable range and a fee increase was not
recommended. She pointed out the board's schedule of fees on
page 7 [Exhibit 4].
MS. CURTIS moved to pages 9-11 and outlined the two
recommendations made by the Division of Legislative Audit. She
said the first recommendation is that the governor should make
board appointments in compliance with statutory requirements.
The second recommendation, she related, is that the DCBPL
director should allocate sufficient resources to ensure cases
are investigated in a timely manner. The audit found that 11
cases had been open for over 180 days, she stated, and seven of
those cases were related to the same chiropractor and had been
combined into one case. For that one combined case the audit
found four periods of unjustified inactivity that ranged from
55-208 days, she continued, and according to DCBPL investigative
staff the inactivity was the result of competing priorities and
insufficient resources.
MS. CURTIS proceeded to pages 21-22 and discussed management's
response to the audit. She related that the commissioner of the
Department of Commerce, Community, and Economic Development
(DCCED) states that the department has hired two additional
investigative positions and the commissioner believes that will
increase the quality and timeliness of investigations. She
turned to the governor's response on page 23 and related that
the governor agrees with the recommendation and states that the
public member was removed. Ms. Curtis then reviewed the board
chair's response on pages 25-28. She reported that the chair
does not agree with the recommended extension of five years and
requests an eight-year extension because he believes the board
is being unfairly penalized by action of the division or the
governor's office.
4:04:20 PM
CO-CHAIR SPOHNHOLZ returned to the second recommendation on page
10 of the audit report. Regarding the 11 cases that were open
over 180 days between July 2017 and January 2021, she asked
whether each of the 11 cases was open 180 days or whether the
cases were cumulatively open 180 days.
MS. CURTIS responded that it was each of them. She noted that
180 days is an internal performance measure used by DCBPL. Lots
of reasons can cause a case to remain open, she noted, so the
Division of Legislative Audit looks at whether it is justified
and there are reasons a case is open. In these cases, she said,
the audit saw extended periods of inactivity, but with no
justification; it was found that it is an issue with resources
and competing priorities.
4:05:44 PM
REPRESENTATIVE MCCARTY asked whether this is a situation of the
division not being able to assist the board or the board not
taking responsibility to do such things as verifying a case.
MS. CURTIS answered that the board is kept outside the
investigative process so it can rule on the results of the
investigation in a quasi-judicial manner. Sometimes a board
member might be used for expertise, but then that board member
is not allowed to weigh in on the result, she noted. So, the
board typically monitors the cases on an upper level and doesn't
get into the details until the investigation is complete and
brought to the board.
REPRESENTATIVE MCCARTY inquired about whether the sunset should
be effective for the board when the division is supposed to be
assisting the board. He said it appears that the Board of
Chiropractic Examiners is doing fine as a board and that there
should be a sunset for the board and an annual sunset for the
division to ensure that the division is doing its job to help
the board.
MS. CURTIS replied that oftentimes board chairs do bring that up
and that some things are not within their control. It might be
considered a penalty or a discipline from the board chair's
perspective, she stated, but from her perspective and the law's
perspective, this is a legislative oversight process, this is
the legislature's ability to evaluate how this board is
operating and that includes the division's support to this
board. She explained that her recommendation for extension
reflects how timely she recommends the legislature come back to
review regulation of this specific occupation. She advised that
while the question is termed, "Should this board be extended or
not and for how long?" it could be phrased, "How much time
between now and when the legislature comes back in to review?"
4:08:47 PM
CO-CHAIR SPOHNHOLZ drew attention to the DCCED commissioner's
response to the audit on pages 21-22. She inquired about the
efforts taken by DCCED to ensure adequate staffing, whether the
specific 11 cases have been resolved, and what the current
timeframe is for processing complaints against a chiropractor.
4:09:29 PM
SARA CHAMBERS, Director, Division of Corporations, Business and
Professional Licensing (DCBPL), Department of Commerce,
Community, and Economic Development (DCCED), responded that page
22 outlines the steps that were taken. One step, she specified,
is that the division has added an additional senior investigator
position to provide more supervisory oversight and ensure that
investigators are following the division's procedures for
documentation. The concern is not so much whether there is or
isn't case activity, she explained, but that it hasn't been
documented and so there is no way for the auditor or anyone
looking at the case management systems to know whether activity
has taken place on those cases. She said DCBPL agrees that that
is not up to its stated standards, so adding another supervisor
position has been helpful. A zero-tolerance position on the
lack of documentation has been taken, she advised, and the
division is actively supervising and ensuring that DCBPL
investigators are acutely aware of the requirement to document
within every 30-45 days even if there is no case activity and to
describe what is being waited on and what is the process so that
anyone can evaluate whether a case is being properly managed.
Ms. Chambers stated that every case is different, so 180 days
could be appropriate management for some cases and for other
cases it could be more days or less days. Much of that is in
the hands of the respondent, she pointed out, and whether an
expert witness is needed. She related that the seven cases
rolled into one have made progress and are being actively
managed.
4:12:19 PM
CO-CHAIR SPOHNHOLZ observed on page 22 that an additional
Investigator III position has been added to the healthcare
licensing team. She inquired about the number of people on the
healthcare team and the number of healthcare licensing boards
for which the team is responsible for providing licensing
investigations and processing.
MS. CHAMBERS answered that she will get back to the committee
with those specific numbers, including the structure of today's
healthcare team as far as numbers of staff and the boards they
serve. She explained that those fluctuate with the demands of
the casework where there may be increases in complaints or an
increase in complexity requiring an investigator to manage a
lower caseload. She explained that DCBPL can have investigators
moving off and on that team; the division has partial
investigators assigned to certain boards and then some boards
like nursing and medical have multiple investigators due to the
high volume.
CO-CHAIR SPOHNHOLZ requested that the follow-up to the committee
be in writing so it can be distributed to members. She said she
wants to understand how the oversight is managed, particularly
for chiropractors. She stated that the one chiropractor with
seven complaints and the investigations not being followed up in
a timely manner could be impacting many Alaskans during this
amount of time.
MS. CHAMBERS offered her appreciation for Co-Chair Spohnholz'
comments. She stated that DCBPL is a public safety division and
part of what it does is protect the rights of the licensee. So,
she explained, the division has certain processes that it is
required to follow and sometimes cases are very unusual and may
be delayed when early action could jeopardize the case because
of those due process standards. She offered her reassurance to
the committee that these are of high importance to DCBPL.
4:16:04 PM
The committee took an at-ease from 4:16 p.m. to 4:20 p.m.
4:20:01 PM
CO-CHAIR FIELDS invited further questions from the committee on
CSSB 193(FIN).
4:20:24 PM
REPRESENTATIVE MCCARTY, regarding the prescription drug
monitoring program (PDMP), asked about the number of
investigations that occurred because of deficiencies in the
division's system versus a licensee wrong. He recalled that in
the past Ms. Chambers shared that licensees were investigated
but it was problems in the system that created an anomaly which
had to be investigated. Representative McCarty further inquired
about the sunset extension of two years versus five years.
MS. CHAMBERS responded that she doesn't understand the first
question because the division has not had system deficiencies
resulting in unwarranted investigation. She said the division
does have quite a few investigations that it must investigate
due to public complaints that don't result in discipline because
they are found to be not jurisdictional, unwarranted, or not
within the division's scope so it was more appropriate for
criminal law enforcement or the consumer protection unit under
the Department of Law. She offered to answer the question
further if the representative wished to rephrase it.
REPRESENTATIVE MCCARTY restated his question about a sunset
extension of two years versus five years.
MS. CHAMBERS replied that the auditor's recommendation was for a
five-year extension, the Senate Labor and Commerce Standing
Committee reduced the extension to two years, and then the
Senate Finance Committee reversed it back to the auditor's
recommendation.
[CSSB 193(FIN) was held over.]