Legislature(1993 - 1994)
03/01/1994 03:00 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 507 - LICENSING OF OPTOMETRISTS & PHYSICIANS Number 340 REP. TOOHEY stated that Section 1 of the bill addresses the concerns of the State Medical Board to interview an applicant for licensure in person. She indicated that the board would like the section to be expanded to include a designated representative. She said because of the large geographical area of the state and the expense involved in traveling, the change would be prudent. She said the provision would allow actively licensed physicians who have been previously approved by the board to interview applicants. She further stated that Section 2 deals with granting temporary permits for locum tenens for the purpose of providing temporary medical coverage for an unserved area as approved by the board. She said the board wishes to amend that section of statute to allow locum tenens physicians to practice for limited periods of time. Locum tenens licenses would serve as 60 day permits in remote areas with the knowledge and scrutiny of the board. She said under current status locum tenens permits may only be issued to physicians who are substituting for an absent physician. She said the legislation would allow for a temporary permit to be issued to a physician who would be practicing in an area that does not have a residing physician. She said the same requirements for a full license are expected for temporary licensure. REP. TOOHEY indicated those requirements as being: proof of education, residency or internship, Federation of State Medical Board approval, and at least one verification from another state where the physician is licensed. She further stated that in Section 3 of the bill, the locum tenens permit may be issued to a nonresident optometrist for the purpose of assisting or substituting for an optometrist licensed under AS 08.72.172. She said if a practitioner in a remote area of Alaska becomes seriously ill or injured and must leave temporarily, presently the physician must close down the clinic. She said the proposal would allow a specialist, perhaps in the area of subnormal vision and visual therapy, to be scheduled to assist local doctors where specialist care does not exist now. REP. TOOHEY said Dr. David McGuire, Chairman of the Alaska State Medical Board, was on line to answer any questions pertaining to Sections 1 and 2 of the bill. She also said that Dr. Roy Box was available via teleconference from Wrangell to discuss Section 3. She said there were others in the audience from the Alaska Medical Association who could assist with questions. CHAIR BUNDE explained that Dr. McGuire was in the process of connecting with offnet. He asked Rep. Toohey if she had further testimony. CHAIR TOOHEY said she was finished. CHAIR BUNDE asked for Dr. Roy Box to testify. Number 468 DR. ROY BOX, Optometrist, stated that the problem is that there is a limited number of doctors and all have established offices, so if an optometrist needs to leave his office, it's almost impossible to get someone to fill in. He said if there was a broader selection of licensed doctors from other parts of the country, it would be easier to maintain uniform care for patients. He further stated that his profession is emerging into specialty areas; i.e., subnormal vision; and those practitioners are often located in the larger metropolitan areas in other states. CHAIR BUNDE asked for questions. There were none. He then went to Dr. McGuire in Anchorage. Number 523 DR. DAVID MCGUIRE, Chairman, Alaska State Medical Board, testified via offnet on HB 507. He stated that existing statute requires the board to interview all applicants for permanent and temporary licenses. He said the board suggested having designated reviewers. He felt that having designated examiners would ease the burden of travel for physicians coming to Alaska to be licensed. He urged the passage of HB 507 to allow for designated reviewers. Number 603 CHAIR BUNDE encouraged Dr. McGuire in his endeavors. REP. OLBERG read the definition of locum tenens from the dictionary. Locum tenens: a person, especially a physician or member of the clergy, who substitutes for another. Number 630 CHAIR BUNDE asked if there were any further questions or comments. Number 633 DR. LEHMANN, President, Alaska State Medical Association, testified in Juneau in support of HB 507. He stated that the proposal was a good start and could be made even better. He said the current system of licensure was unnecessarily cumbersome because of the interview. He asserted that the problem, especially in rural areas, of obtaining licensure is that it is unduly expensive, cumbersome, and sometimes precludes having adequate physician coverage in various parts of the state. He offered that his interview for licensure took no longer than two minutes and he felt that the interview itself does not accomplish much. He explained that he informally interviewed 30 physicians and only one said that he had a meaningful interview. DR. LEHMANN related an incidence where a doctor from the Virginia Mason Clinic in Washington came to conduct a specialty clinic in Sitka. The doctor had to fly from Sitka to Anchorage, drive a rental car to Wasilla, and interview with a layperson of the board, who did not have his interview material with him. Dr. Lehmann lamented that the interview consisted of, "Hi. How are you?" He said the process seems ineffective. DR. LEHMANN indicated that on line 5, under Section 1, if the word "shall" could be changed to "may" it would allow the board to interview everybody at their discretion, including the option of eliminating the interview process completely. The proposed amendment would allow the board to interview anyone they so choose, and consequently the board would be able to spend more time hunting down "nefarious characters." Number 734 REP. VEZEY suggested that the words "in person" be deleted from Section 1, instead of adding the word "may," indicating that in this age of technology, telecommunications and audiovisual communication is becoming more acceptable. DR. LEHMANN said he was unsure what a telephonic interview would accomplish. REP. VEZEY asked what an in person interview would accomplish. DR. LEHMANN maintained that if the interviewer has serious concerns regarding the applicant, it is important to conduct the interview in person. REP. VEZEY disagreed due to the factors of the time, money, and travel that are involved. He said because of the geographical expanse of Alaska, the state is forced to look to other means of communication. He reiterated that he had no problem changing the word "may" to "shall," but he felt that the words "in person" were too restrictive for the board. DR. LEHMANN said that he would have no problems adding the words or telephonically to interview the person. REP. VEZEY stated that it would be redundant. He also said that interactive video is an option. Number 791 DR. LEHMANN said, "I did not want to step on any toes from the state medical board. And this way, they would still have their option to interview anybody they chose." CHAIR BUNDE asked Dr. McGuire's reaction to the issue being addressed. DR. MCGUIRE asserted that the medical board is held to a high standard. He related a story of an interviewee who appeared for his licensure review and was noticeably psychotic. He said that another interviewee was granted licensure and sometime later the interviewee showed obvious signs of psychosis. He indicated that in those instances a telephonic interview would not have sufficed. He felt that there were legal implications as to the interviewees that are asked to interview in person and those who are not. He said the board's approach is to have everybody interviewed so as to avoid legal problems. Number 856 CHAIR BUNDE stated for the record that Reps. Brice, Nicholia, Olberg, Kott, Vezey, Toohey and Bunde were present. He then said that he values the interpersonal, in person, visual, and nonverbal aspects of an interview. He felt that substituting the word "may" with "shall" would only invite litigation. REP. VEZEY said there is no substitute for a credentials and reference check. He said he found the interview process the least useful tool in selecting qualified personnel. He reiterated that in person interviews are very archaic. Number 900 CHAIR TOOHEY maintained that the issue should be decided by the medical community. Number 905 CHAIR BUNDE took an informal poll as to those in favor of the word remaining "shall" and those who would prefer the word to be "may." The poll unanimously favored using the word "may." He polled again, asking if the words "in person" should be deleted or if the word "telephonically" should be added. CHAIR TOOHEY interjected and said she would accept a friendly amendment that indicates in person or by telephone. CHAIR BUNDE asked if Rep. Toohey was proposing an amendment. CHAIR TOOHEY said she would make the proposal at the pleasure of the committee. CHAIR BUNDE told Rep. Toohey to address the proposal and the committee would vote. Number 942 REP. BRICE said it was his understanding that there was still concerns regarding the word telephonically. CHAIR BUNDE asked for the amendment so the committee could further discuss the issue. REP. OLBERG asked if it was Rep. Vezey who suggested deleting the words "in person." CHAIR BUNDE said yes. Number 954 REP. VEZEY made a motion to amend HB 507, Section 1, line 5, to change the word "shall" to "may." CHAIR BUNDE asked for discussion. He then expressed his opposition to the amendment. He reiterated his concerns pertaining to legal problems that could be inherent by changing the word to "may." He called for a vote. Reps. Toohey, Vezey, Olberg, Nicholia, and Brice voted "yea" and Reps. Kott and Bunde voted "nay." CHAIR BUNDE stated that HB 507 as amended was before the committee. He then asked for further discussion. Number 012 REP. VEZEY made a motion to amend HB 507, Section 1, line 6, by deleting the words "in person." CHAIR BUNDE stated that the committee had heard the amendment and asked for further discussion. There was none. REP. OLBERG asked, "does the use of the word `may' mean allow for `may not'?" REP. BRICE said yes. CHAIR BUNDE said that word "may" would allow for an interviewee to be interviewed in person, not in person, or not at all. He asked Rep. Vezey if that was his interpretation. REP. VEZEY said yes. He felt that in person is unduly restrictive and felt that its deletion would not invite litigation. CHAIR BUNDE asked if Rep. Vezey still preferred to delete the words "in person" as opposed to having the line read "may be interviewed in person." REP. VEZEY said once the words have been changed from "shall" to "may," the sentence becomes permissive, and leaving the words "in person" becomes redundant. REP. OLBERG suggested going back to the use of the word "shall" and then deleting the words "in person." He then read the sentence, "All applicants for licensure shall be interviewed by at least one member of the board or the board's designated representative." Number 069 CHAIR BUNDE declared that there was an amendment before the committee. He asked for further discussion. DR. MCGUIRE said that his prior comments were still germane and indicated that it was up to the legislature to decide what the rules were going to be. CHAIR BUNDE reiterated the intent of the amendment. He asked Dr. McGuire if under those guidelines would he continue to interview applicants. Number 100 DR. MCGUIRE said a common ground must be found and the decision should be that of the legislature. He said the board would comply. CHAIR BUNDE said there was no intention within the bill as amended to require an interview to be conducted telephonically. He then asked for further discussions or any objections. Chair Bunde stated his objection for the record. He then called for a vote. Number 126 CHAIR TOOHEY clarified by saying that the intent of the amendment was to remove the words "in person." Reps. Vezey, Olberg, and Toohey voted "yea" and Reps. Bunde, Kott, Nicholia, and Brice voted "nay." Number 135 CHAIR BUNDE stated that the amendment failed. He asked for further discussion. DR. MCGUIRE asked if the provision for the designated representative had survived the process. CHAIR BUNDE said yes, the issue was not discussed at all. Number 152 CHAIR BUNDE closed public testimony and asked the pleasure of the committee for HB 507 as amended. REP. KOTT made a motion to pass HB 507 as amended out of committee with individual recommendations. CHAIR BUNDE, hearing no objections, declared HB 507 was so moved. He then brought HB 324 to the table.
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