Legislature(2009 - 2010)CAPITOL 106
04/01/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SCR13 | |
| SB238 | |
| HB282 | |
| HB126 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SCR 13 | TELECONFERENCED | |
| + | SB 238 | TELECONFERENCED | |
| + | HB 282 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 126 | TELECONFERENCED | |
HB 282-NATUROPATHS
4:12:35 PM
CO-CHAIR HERRON announced that the next order of business would
be HOUSE BILL NO. 282, "An Act relating to naturopaths and to
the practice of naturopathy; establishing an Alaska Naturopathic
Medical Board; authorizing medical assistance program coverage
of naturopathic services; amending the definition of 'practice
of medicine'; and providing for an effective date." [In front
of the committee was CSHB 282 (L&C), 26-LS1208\T.]
REPRESENTATIVE CATHY MUNOZ, Alaska State Legislature, said that
HB 282 would establish a naturopathic board, and she paraphrased
the sponsor statement [original punctuation provided] [Included
in the committee packets.] which read:
House Bill 282 creates a Naturopathic Medical Board
for the purpose of expanding allowed practices and
procedures of Naturopathic Doctors (NDs) and regulates
the practice of naturopathic medicine. The board will
consist of three naturopaths, one licensed pharmacist,
and one public member. The board will work with the
Division of Occupational Licensing to issue licenses,
and will have authority to investigate and discipline
as required. In addition, the state will authorize
prescription endorsement which will be offered for the
first time for NDs who have practiced for five years;
participated in 60 hours of pharmacology education
from an approved program; and met all the requirements
relating to administration and prescription of drugs,
vaccinations, hormones, and medical devices. The
prescription endorsement must be renewed every two
years. The bill mandates continuing medical education
of 35 hours bi-annually, 15 of which must be in
pharmacy education. Prescribing authority will give
flexibility to NDs to provide necessary medical
treatment to patients. Prescription rights, which are
already permitted for advanced nurse practitioners,
will allow access to a range of commonly prescribed
medicines that can be used in correlation with
naturopathic treatment to improve patient care.
HB 282 will align the definition of a naturopathic
physician with the U.S. Department of Labor which
released a new definition of naturopathic physician to
include job titles of "Naturopathic Doctor, Physician,
and Doctor of Naturopathic Medicine." This is an
important step in recognizing NDs as qualified doctors
and primary care physicians.
Naturopathic doctors are highly trained medical
professionals. NDs attend a four-year post-graduate
professional naturopathic medical program and are
educated in the same basic sciences as conventional
medical students. Studies concentrate on holistic and
traditional approaches to therapy with a strong
emphasis on disease prevention and optimization of
wellness. Naturopathic doctors take similar rigorous
professional board exams for licensure and continue
educational training each year.
As Alaska continues to face shortages in the
healthcare professions, HB 282 provides an avenue to
help fill the gap of primary care physicians. This
bill will reasonably expand the services of
naturopaths and follow the responsibilities set forth
by the board while providing the important services
for keeping Alaskans healthy.
4:16:32 PM
CO-CHAIR HERRON asked to clarify that Representative Munoz had
requested to adopt a proposed Committee Substitute (CS) for HB
282.
4:17:23 PM
CO-CHAIR KELLER moved to adopt proposed Committee Substitute
(CS) for HB 282, 26-LS1208\W, Bullard, 3/30/10, as the working
draft.
REPRESENTATIVE SEATON objected for discussion.
4:17:55 PM
KENDRA KLOSTER, Staff to Representative Cathy Munoz, Alaska
State Legislature, explained the differences between CSHB 282
(L&C), Version T, and the proposed Committee Substitute (CS) for
HB 282, Version W. She referred to Version T, and directed
attention to page 3, line 13, which she pointed out had been
moved to page 5, line 14 in Version W. She stated that the
language, "establish a list of prescription drugs", was removed.
She explained that it would have been problematic for a
pharmacist to refer to a list of medications, but that it still
included the prescription rights for non-controlled legend
drugs.
4:19:41 PM
MS. KLOSTER, in response to Representative Seaton, said that the
proposed prescription rights were not more expansive, but the
wording and the placement in the bill had required editing. She
explained that the original intent had included the non-
controlled legend drugs.
4:20:52 PM
REPRESENTATIVE MUNOZ added that the intent was to allow
naturopaths to prescribe common, non-addictive pharmaceuticals,
including antibiotics, immunizations, and hormones.
4:21:57 PM
REPRESENTATIVE T. WILSON relayed that she had received a lot of
letters from doctors who were upset about the bill, and she
inquired if there would be the opportunity to work with the
sponsor to resolve these issues.
4:22:37 PM
CO-CHAIR HERRON asked Representative Munoz about the physician
concerns.
4:23:07 PM
REPRESENTATIVE MUNOZ, in response, said that they were referred
to as naturopathic physicians under federal law. She opined
that there was some misinformation and some fear of the
expansion of prescriptive rights. She directed attention to
advanced nurse practitioners, who were now also allowed "to
prescribe commonly prescribed drugs that has resulted in better
opportunities, easier working relationship with their patients,
broader access to care for Alaskans." She pointed out that
naturopathic physicians had considerably more training, so that
it was appropriate to offer limited prescriptions of
pharmaceuticals. She opined that Alaskans would benefit.
4:24:44 PM
REPRESENTATIVE MUNOZ asked Representative T. Wilson if the
concern was for the term "physician" or about the prescriptive
rights.
REPRESENTATIVE T. WILSON replied that it was both.
REPRESENTATIVE MUNOZ explained that the original bill had been
more expansive for the ability to prescribe, but that this was
refined to commonly used prescriptions, and that the proposed CS
was much more restrictive.
REPRESENTATIVE T. WILSON, in response, said that the comments
had been about the proposed CS as well.
REPRESENTATIVE MUNOZ recalled that they were probably opposed to
the advanced nurse practitioners prescriptive rights, as well.
4:26:29 PM
REPRESENTATIVE SEATON removed his objection. There being no
further objection, Version W was adopted as the working draft.
REPRESENTATIVE CISSNA pointed to the shortage of caregivers in
Alaska and opined that this was another solution for care.
4:27:59 PM
REPRESENTATIVE MUNOZ related a personal story about her son and
a naturopathic physician.
4:30:09 PM
WAYNE ADERHOLD, read from his submitted written testimony
[Included in the committee packets.]:
Most people can agree that our medical system is
broken and in need of an overhaul, but getting
agreement on the solution is another story. HB 282 is
one step in the right direction and should be pushed
through into law now. According to the March 8th
issue of Newsweek in a piece titled, "We the Problem,"
"our leaders are paralyzed by the very thought of
asking their constituents to make short term
sacrifices for long term benefits. They cannot bring
themselves to raise taxes on the middle class or cut
social security and medical benefits to the elderly.
They'd get clobbered at the polls. So, any day of
reckoning gets put off and put off again, and debts
pile up." I agree with this assessment that a
majority of the populace seems locked into an
entitlement and instant gratification mentality and
believe that it applies equally to our medical and
financial woes. I don't envy your job when most of
the right decisions nowadays involve sacrifice, but I
have some good news for you. There is a significant
and growing segment of your constituents who are
willing to take responsibility for their own medical
issues and deal with the root causes of their
problems. They neither respect nor trust a quick fix.
This same attitude carries over into finances, so
please know that some of us understand your need to
make unpopular decisions just as we may take the
harder road toward better overall health. We are the
patients who choose our primary care doctor based on
their ability to teach us how to take better care of
ourselves, not simply dole out the latest sample of
something that a magazine ad says we should ask about,
and will only bury our symptoms. We work with
naturopathic physicians in a collaborative way, and to
go in knowing that we will be given homework and the
medicines prescribed will be paid for out of own
pockets. So we pay attention and use them
judiciously, because we truly believe we are doing
ourselves some good. When I checked recently with the
office of the two ND's who serve us here on the Kenai
Peninsula there were approximately 1200 active
patients at the Homer practice and 1800 in the Kenai-
Soldotna office. These are very significant numbers
and they are growing steadily. These are everyday
working people who are only different because they
make a conscious decision to take personal
responsibility for their health and commit to delayed
gratification, if necessary. My own personal journey
that has taken me from the allopathic to the
naturopathic model of treatment began in 1993 with the
slow but very successful treatment of the herniated
lumbar disc which avoided surgery. Seventeen years
later, and sixty years old, I will add, I'm mobile and
active in all sports I care to participate in, which
is basically bicycling and cross country skiing. In
the meantime, I have dealt with an array of the
mundane, like flu, to the more complicated, anxiety
and adrenal fatigue, to the downright scary, malignant
melanoma, ie. cancer. All with a near total and ever
increasing reliance on ND's and naturopathic medicine.
And when I say ND, by the way, I'm thinking physician
for that previous discussion. I'd be happy to share
specific details with anyone who wants to know more
about my experiences and how it consciously committed
to naturopathic treatment, particularly if you are at
all skeptical of the need to pass HB 282. The last
thing I want to speak to the safety and the "first do
no harm" aspect, for this is the strongest argument
for allowing ND's to deal with minor surgery and
prescription drugs, if anyone is going to use them. I
would much rather trust these tools to someone who
would use them as a last resort than have had
firsthand experience with both MDs and NDs. Please do
not be swayed by last minute scare tactics from the
ASMA that usually come under the guise of "patient
safety." ASMA is mainly concerned with the safety of
the members' financial status, not my health. When I
sat on the board of my local hospital a few years ago,
and we were in the process of instituting a
requirement for malpractice insurance for the medical
staff, I learned that the insurers were charging about
ten times more for MDs versus NDs. Our local hospital
doesn't credential NDs so it was a moot point, and
that's another story. It certainly spoke to how
insurers viewed risk and practitioners likelihood for
doing harm. The recent $1.8 million jury verdict in a
trial here in Homer which found malpractice against
both the MD and the hospital tells me that the Alaska
State Medical Board and ASMA could devote more time to
governing their own membership. The naturopaths
deserve their own board and governance. Please move
HB 282 out of committee and pass it into law this
session. Thank you.
4:35:52 PM
ASHLEY MAY, Naturopathic Doctor, said that he supported HB 282
as it would better provide naturopathic doctors (ND) in Alaska
the access to the tools necessary to be efficient, primary care
doctors. He opined that more primary care NDs would now
practice in Alaska, which will be vital to Alaskan health care.
He pointed out that currently only about 30 percent of medical
doctors entered primary care. He noted the significance for
Alaska, as 15 percent of Alaskans had difficulty finding primary
care doctors, which was twice the national average. He said
that this was where NDs would fill that gap. He declared
support for a naturopathic board, in order to implement
continuing education requirements and adopt regulations
necessary to provide a high level of medical care to Alaskans.
He opined that the current bill was an "extraordinary compromise
on the part of naturopathic doctors." He compared the proposed
naturopathic board membership to that of the Alaska State
Medical Board and the Alaska Board of Pharmacy, both of which
had a higher medical membership on its boards. He stated his
support for HB 282.
4:38:27 PM
PATRICK NEARY, ND, read from his prepared testimony. [Included
in the committee packets.] He stated that HB 282 clarified the
Naturopathic licensing statutes, and would bring Alaska up to
the current standard of Naturopathic medical care offered in the
other licensed states. He pointed out that HB 282 would provide
Alaskan families with increased access to care and increased
freedom of choice to health treatment while also increasing
safety and oversight of the profession. He clarified that the
bill included Naturopathic Medical services within Medicaid and
Denali KidCare, would align the prescriptive authority of
Naturopaths in Alaska with the national norms, and would create
a Naturopathic Medical board to protect public safety. He spoke
about the shortage of primary healthcare providers both
nationally and in Alaska, and that Naturopaths would help assist
those unmet needs. He spoke about the opposition to licensure
for 15 classes of midlevel providers, which included
naturopaths, by the American Medical Association (AMA). He
explained the current educational standard for an ND, which
included a 4-5 year doctoral program of basic and clinical
medical sciences from nationally accredited Naturopathic medical
colleges, in addition to a Bachelors degree. He spoke about the
limits to Naturopathic training and knowledge, and agreed that
the prescription abilities were not meant to be on a par with
MDs. He spoke about the excellent safety record of NDs and that
searches of the legal databases for both Oregon and Washington
revealed no legal cases against Naturopaths. He stated the
benefits to Alaskans, especially low income Alaskans, for more
freedom of medical choice and access to care. He stated his
support for HB 282.
4:47:22 PM
CO-CHAIR HERRON asked that the committee hold its questions
until the next meeting.
4:48:00 PM
DAVID OTTOSON, paraphrased from his submitted written testimony
[original punctuation provided]: [Included in the committee
packet.]
I am testifying as a consumer of health care. For the
last 25 years, the primary health care providers for
my family have been naturopathic doctors. We have
been successfully treated for numerous ailments,
including sinus infections, earaches, urinary tract
infections, and insomnia. I have worked with a number
of naturopaths and have found them all to be extremely
competent and highly professional.
As far as I am concerned, this legislation should be
completely non-controversial. Every other state on
the West Coast has a Naturopathic Board. Naturopaths
are highly trained health care providers whose focus
is on wellness, education and prevention. It seems to
me that this is exactly the kind of health care that
we need more of.
I have heard that some members of the medical
community are concerned that ND's might practice
outside of their area of competence. I think this is
a red herring. There is no evidence this has been a
problem in other states. And I am not aware that it
has been a problem in Alaska either.
I can tell you from my own experience that the NDs I
have worked with are well aware of their limitations,
and have referred me to other providers when that was
appropriate.
In fact, a few years ago, I came back from a trip to
Africa with a bad case of what I thought was
traveler's diarrhea. I had been staying in a place
with notoriously bad water and had gotten the runs
from drinking the water earlier in my trip.
After several days, I wasn't getting any better and
was experiencing alternating fever and chills. It was
a naturopathic doctor, Emily Kane, who recognized that
I might have something more serious. So she came over
to my house during her lunch hour and drew my blood
and sent it away to be tested for malaria. It came
back positive the next day.
I went to Bartlett hospital and ultimately ended up at
the University of Washington Hospital in Seattle to be
treated for a nasty case of cerebral malaria. It was
because of Dr. Kane's alert intervention that I was
diagnosed with a life threatening condition in time to
be successfully treated.
Two things about this. Number one, it illustrates the
highly personalize form of medical care that is
typical of the naturopathic profession. How many
doctors do you know who make house calls? Yet Dr.
Kane is not the first naturopath to make a house call
at my house.
Number two, it is an example of a naturopath making a
correct diagnosis and referring a patient to
appropriate care. Dr. Kane did not suggest that I
treat my cerebral malaria with colloidal silver or
wormwood. She urged me to go to the hospital and get
treated. and when it turned out that Bartlett
Hospital did not have the appropriate drugs or
expertise to treat my condition, I was transferred to
the University of Washington, where I had the good
fortune to be treated by one of the leading malaria
experts in North America.
ND's clearly have a role to play in our health care
system. They are primary care providers who can treat
many if not most of the common conditions that people
go to a doctor for. The care they provide is
personalized, cost effective, and prevention oriented.
Perhaps most important, it is focused on individuals
taking responsibility for their own wellness. I
firmly believe that we will never get medical costs
under control until we acknowledge that all of us need
to start taking better care of ourselves. Helping
people do this is one thing NDs do best.
I urge you to support this legislation.
4:51:56 PM
[HB 282 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| CS HB 282 support letter - Tom Laing 03.30.2010.doc |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| CS HB 282 support letter - Center for Natural Medicine 03.23.2010.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| CS HB 282 - 26-LS1208.W - for intro into (H) HSS.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| SCR 13 support letter - K. Turkington 03.15.2010.pdf |
HHSS 4/1/2010 3:00:00 PM |
|
| DCCED fiscal note for CS HB 282 - 26-LS1208.W.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |