Legislature(2009 - 2010)CAPITOL 106

04/01/2010 03:00 PM HEALTH & SOCIAL SERVICES

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= bill was previously heard/scheduled
Moved Out of Committee
Moved Out of Committee
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Heard & Held
                       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
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
     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                                                                    
     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