Legislature(2003 - 2004)
04/27/2004 03:11 PM House HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
HB 434-NATUROPATHIC MEDICINE Number 1283 CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 434, "An Act relating to the practice of naturopathic medicine; and providing for an effective date." ALEX MALTER, M.D., President, Alaska State Medical Association, testified on HB 434, and answered questions from the members. He urged the members not to support this bill. Dr. Malter provided the following statement: The expansion of naturopaths' scope of practice would not enhance patient care, nor would it improve access to care. Training for naturopaths is less rigorous for that of medical doctors in both length and depth of study. The emphasis on natural healing does not allow sufficient time for its students to fully learn the accepted pathology, physiology, and pharmacology necessary to treat most medical conditions. DR. MALTER pointed to Attachment 1 [The Professional Scope of Practice for Naturopaths] in the packet provided to the committee which was compiled by the [Alaska Association of Naturopathic Physicians, Inc.] and which shows different treatment techniques studied by naturopaths. He said this is a broad list and it is important to note that pharmaceutical treatment is at the bottom of the list. He said it is the Alaska State Medical Association's position that four years of training and two years of clinical training is not enough time to master that entire list and still become proficient at using prescription drugs. He said that he is not convinced that the first two years of naturopath school and medical school are the same. DR. MALTER said he believes that for any courses that cover the material in similar depth medical students are better prepared to learn that material because admission to medical school requires extensive undergraduate science background and then passing rigorous competitive exams. He referred to Attachment 2 [Table 17. Nonexclusive list of schools providing education and training for naturopaths, 2000.] and explained that by comparison there are no similar admission tests for naturopath schools and some do not even require a college degree to get in, he said. More importantly, medical students spend at least an additional four years in school and residency before licensure. These clinical years emphasize the appropriate safe use of medicines and are the backbone of physician training, he added. Naturopath programs do not require such residencies and the last two years of their schools focus on alternative treatments, he said. Physicians can't be licensed after medical school; they are licensed two years later. The bill before the committee would allow naturopaths to be licensed after completing naturopath school and not doing any clinical focus on pharmacological agents. This could be unsafe for Alaskans, he emphasized. DR. MALTER told the members that some individuals would say that naturopaths are better educated than PAs. He said he believes that it is not the amount of schooling that qualifies an individual, it is the focus of that training. Physician's assistants are immersed in the safe use of medicines and are therefore more qualified even though their training may be slightly less than a naturopath. Number 1398 DR. MALTER told the members that a comprehensive analysis for Massachusetts Special Commission on Complimentary Medicine concluded that naturopathic medicine is a dangerous activity and no amount of regulation is likely to mitigate this fact. He said that Medicare has also expressed similar reservations and asked the members to look at Attachment 3 [Conclusion of Medicare's Report on Naturopaths, U.S. Department of Health, Education, and Welfare, Independent Practitioners under Medicare, December, 1968] which reads as follows: Conclusions: Naturopathic theory and practice are not based on the body of basic knowledge related to health, disease, and health care which has been widely accepted by the scientific community. Moreover, irrespective of its theory, the scope and quality of naturopathic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment. DR. MALTER told the members that he personally has cared for a patient who died prematurely because she had been under a naturopath's care for six months for chronic fatigue syndrome. He explained that when she came to him she had very advanced lymphoma and died quite quickly of a disease that would have been either curable or certainly easily treatable to prolong her life. DR. MALTER emphasized that he believes expanding the scope of the 30 naturopaths in Alaska is really unlikely to improve access to care. He said he is not aware of any naturopaths practicing in parts of the state where access is most critical. The association believes it would be unwise and unsafe for the state to endorse the practice of naturopathy by granting these folks prescriptive authority and urged the members not to support the bill, Dr. Malter concluded. Number 1539 REPRESENTATIVE SEATON commented that naturopath is a nonregulated term and he noted that Dr. Malter used the term frequently in his testimony. This bill deals exclusively with naturopathic physicians. He pointed out that this bill would restrict the use of the term naturopath to only naturopathic physicians in the future. Right now anyone can hang out a shingle that says naturopath, so the requirement that only naturopathic physicians can use the term will guarantee some medical expertise to that term, he said. Representative Seaton asked if Dr. Malter has distinguished between the two terms. Number 1585 DR. MALTER responded that the only requirement to be considered a naturopathic physician is that an individual would have to go through a naturopathic school or program. He said his concern is that in some cases a person does not even have to go through high school to get into the program. In many cases these programs do not even require much of a science background; however, he acknowledged that these individuals must pass an exam. Dr. Malter posed the question of whether the committee want to endorse someone as a physician who had four years of a graduate program, but who has had minimal training in the safe and appropriate clinical use of pharmaceuticals. REPRESENTATIVE SEATON emphasized that naturopathic physicians have been licensed in Alaska for 17 years, not naturopaths. Many of the people that are being mentioned are not actually naturopathic physicians, he clarified. It is important to keep the terms straight, Representative Seaton emphasized. DR. MALTER said he appreciates what Representative Seaton is saying, but pointed out that if the committee were to look at the requirements to attend these schools it would be found that there are no required undergraduate science classes. He said it is the Alaska State Medical Association's feeling that the legislature should be cautious about endorsing the practice in any way that might suggest to residents of Alaska that the state is really endorsing the practice. [HB 434 was taken up again later in this hearing.] The committee took an at-ease from 5:20 p.m. to 5:29 p.m. HB 434-NATUROPATHIC MEDICINE Number 0611 CHAIR WILSON returned attention to HOUSE BILL NO. 434, "An Act relating to the practice of naturopathic medicine; and providing for an effective date." CHAIR WILSON told the members that the working document before the committee is CSHB 434, Version Q, Mischel, 4/24/04. Number 0581 BARBARA COTTING, Staff to Representative Jim Holm, Alaska State Legislature, testified on behalf of Representative Holm, sponsor of HB 434. She said that much of what is in this version of the bill was a result of collaboration between Chair Wilson and Linda Anderson. Number 0520 LINDA ANDERSON, Lobbyist, Naturopaths Association of Alaska, testified on HB 434. For the record she corrected an earlier statement by Ms. Cotting that she and Chair Wilson worked collaboratively on the bill; they did not, but she did bring the bill to the Chair earlier today, she said. There are compromises included in the bill and on-going discussions with individual medical doctors are continuing. This same version is currently in the other body of the legislature as well, she added. MS. ANDERSON told the members that the key changes in the bill is that the legislation will remove all schedule 2 drugs from the naturopathic physicians' ability to prescribe. The thrust of the compromise of this legislation is that this bill will allow naturopaths to prescribe, but in doing so they would be required to enter into a collaborative agreement with a medical doctor and that medical doctor will agree to a formulary of prescriptions. So in this bill naturopaths could prescribe legendary drugs and schedules 3, 4, and 5 drugs. That agreement will be on a case-by-case basis depending on those naturopaths and their specialties. Number 0377 MS. ANDERSON summarized that if a naturopath can find a physician to enter into a collaborative agreement then the naturopath will have a tailored prescriptive ability. The bill also includes peer review. It simply says since there is no board, the Division of Occupational Licensing will oversee the regulations and the complaints will be filed, the division will pick up the file and call a group of identified naturopathic physicians who would review the complaints. Ms. Anderson said the bill suggests that the group meet quarterly; however, the division has said that quarterly meetings are not necessary. She added that there has been fewer that one complaint a year. MS. ANDERSON pointed out that another key part of the bill is that collaborative agreements are repealed after four years. The idea is that after the medical communities have worked with naturopathic physicians and medical physicians the track record will speak for itself. She said she believes there will not be any further need for collaboration. MS. ANDERSON pointed out that in 14 other states naturopathic physicians are given prescriptive authority. Naturopaths are willing to meet that test of collaborative work to assure the public safety for Alaskans. Number 0179 MS. ANDERSON commented that many of the members heard Dr. Malter's testimony and were provided with information on naturopath programs. She told the members that not one of the programs that he listed are from federally approved medical schools for naturopaths. Ms. Anderson stated that this bill is only addressing those individuals who have attended one of the five federally recognized medical schools for naturopaths in the nation. It is a very different list, she emphasized. Dr. Malter provided the committee with a list of schools that are not currently regulated at all, she stated. [HB 434 was held in committee.]
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