Legislature(2001 - 2002)
02/28/2002 01:37 PM Senate L&C
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
SB 274-PHYSICIANS' LOCUM TENENS PERMITS
CHAIRMAN BEN STEVENS called the Senate Labor & Commerce Committee
meeting to order at 1:37 p.m. and announced SB 274 to be up for
consideration.
SENATOR OLSON, sponsor of SB 274, said he would address version
F. Section 1 that says a Member of the State Medical Board or
its designee may grant a temporary permit to practice medicine to
a visiting physician or osteopath for two new situations.
Subsection (a)(2) allows for the temporary hire of a physician or
osteopath by a licensed doctor for the purpose of valuation for
permanent employment. Subsection (a)(3) allows a hospital or
mental health facility to temporarily fill a staff vacancy
through a locum tenens permit while seeking permanent employment
of a licensed physician or osteopath.
Section 2 changes the initial duration of a permit from 60 days
to 90 consecutive days. It can be extended for an additional 60
days if the permittee completes an application for licensure and
pays the associated fee. An individual's exercise of a locum
tenens permit is limited in the aggregate to 240 days in any 24
consecutive months.
Section 3 allows the board to further extend a permit if there is
a medical necessity to protect public health and safety.
SENATOR TORGERSON asked if the Medical Board supported this.
SENATOR OLSON said talks with Jim Jordan, Executive Director,
Alaska State Medical Association, HESS, API, and the State
Medical Board have resulted in a consensus on section 2.
SENATOR TORGERSON moved to adopt the CS to SB 274, Lauterbach.
There were no objections and it was so ordered.
MS. ANNE HENRY, Division of Mental Health, supported SB 274 and
said she would answer questions.
MS. CATHERINE REARDON, Director, Division of Occupational
Licensing, said her division staffs the Medical Board. She said
the different parties were able to get together and almost reach
consensus on this issue. The only item in dispute at this point
is section 3. The Medical Board does not want section 3 in the
law, but the other parties do want it. It gives the Medical Board
the ability to extend locum tenens licenses beyond the 90 days
(plus 60 more days, if you apply for a permit), if the Board or
its designee determines that the extension is necessary in order
to provide essential medical services for the protection of
public health and safety. The Board maintained their objection to
section 3 because they are uncomfortable with open-ended amounts
of time in which people can continue working under a locums and
section 3 leaves it up to the Board's discretion, but they don't
want it. This is simply a difference in philosophy between the
different parties.
DR. ROBERT SCHULTZ said he has been a psychiatrist practicing in
Alaska for 16 years and has had plenty of opportunity to come up
against the circumstances of unstaffed mental health centers and
understaffing at API. He felt very strongly that improving their
staffing would greatly help the state.
He has often seen people who couldn't get into the understaffed
hospitals end up getting hospitalized and getting an outpatient
visit as an inpatient, which costs the state a great deal of
money. Also, people having access to staff in a timely fashion
means their medications get adjusted and rearranged so that they
don't need hospitalization. He supported SB 274.
MR. NICK KLETTI, Medical Director, API, supported SB 274,
including section 3. He said:
We are in the fortunate position currently of having a
full-time medical staff - all of our doctors here being
full-time employees, but API traditionally has gone
through some periods where it's been difficult to
recruit doctors who come up to Alaska first of all and,
secondly, to work with a population that is
hospitalized here…It is greatly to the hospital's
advantage to have full-time psychiatrists or a
physician and not to have locum tenens. In fact, it's
looked at by regulatory agencies as also greatly
desirable to have full-time physicians. Unfortunately,
we're put in the position where often when there are
vacancies, which many rural states have, because it's
difficult to attract physicians to rural states. Of
either providing less than optimal care using temporary
physicians or having no care at all for those patients
and given that choice, I would rather go with a locum
tenens physician - even in an on-going fashion - even
if the license has to be renewed because of patient
care concerns in an on-going way without limitation.
With Occupational Licensing overseeing that and of
course all the credentialing matters a hospital would
have to go through to make sure a physician is doing
her job properly and safely. But I am in very strong
support of this bill. I think this will greatly help
Alaskans and the health care here.
MS. SUSAN HUMPHRY BARNETT, Assistant Administrator, Providence
Health System, supported CSSB 274. She said Providence Health
System runs a community mental health center on Kodiak Island.
They have had fairly continuous coverage, but it is very
difficult to recruit psychiatrists in rural Alaska and there are
times when there is no recourse, but to use locum tenens. She
understands that the Medical Board opposes section 3, but it
really needs to be there, because if you can't recruit a
permanent person, you at least have coverage for people who
really need this type of care. Other specialties have recruiting
difficulties - for instance the Anchorage area has a shortage of
internal medicine physicians and pediatric surgeons and
neurologists. She concluded saying they very strongly support the
committee substitute.
MR. KARL SANDFORD, Assistant Administrator, Fairbanks Memorial
Hospital, supported the CSSB 274, particularly section 3. He said
it costs a lot of money to bring a locum tenens physician to
Alaska and it is not in our best interest overall to have that
turn over every one or two months. "Therefore, I would like to
have the opportunity, if need be, to extend a locum tenens
position if possible."
MR. SANFORD said there is a national shortage in many areas of
physicians and expecting it to be resolved in a two to three
month period is unreasonable.
CHAIRMAN STEVENS asked Ms. Reardon to explain what was meant by
the Board's designee in section 3.
MS. REARDON explained that the Board they could designate someone
to serve this function. Generally, the physician they designate
is the executive administrator of the Medical Board, but they
might decide to designate a single board member.
CHAIRMAN STEVENS asked if the board wanted to testify or was she
delivering their position.
MS. REARDON said she was delivering their position.
SENATOR LEMAN moved to pass CSSB 274(L&C) from committee with
individual recommendations. There were no objections and it was
so ordered.
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