Legislature(2001 - 2002)
02/12/2001 03:20 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
HB 91-ADD PHYSICIAN ASST TO STATE MEDICAL BOARD Number 0043 CHAIR LISA MURKOWSKI announced that the first order of business was HOUSE BILL NO. 91, "An Act relating to the membership and quorum requirements of the State Medical Board." REPRESENTATIVE HUGH FATE, Alaska State Legislature, sponsor of HB 91, said the bill is based on a request from the Alaska Academy of Physician Assistants and noted that the Alaska State Medical Board (ASMB) supports the bill. The bill adds one licensed physician assistant ("PA") to the ASMB and changes the quorum for meetings from four to five [people]. REPRESENTATIVE FATE explained that there is currently no PA license representative on the board, even though consideration of PA licensure, regulation, and discipline are frequent topics [at ASMB meetings]. PAs are also an increasingly significant factor in providing medical care. REPRESENTATIVE FATE stated that participation of a PA would strengthen and support the ASMB and contribute to its decision- making process by providing valuable opinions representing a wider spectrum of medical practitioners in Alaska. Number 0199 TOM WILSON, Alaska Academy of Physician Assistants, via teleconference, said there are approximately 250 licensed PAs in Alaska, licensees of the ASMB for 20 years. He echoed Representative Fate's explanation of the need for a PA on the board. MR. WILSON said PAs care for over 50,000 Alaskan each month in a wide number of institutions and locations, and, therefore, would provide a good representation of their patient population in matters before the ASMB. The PAs have proven an interest in and a willingness to accept the great responsibility and commitment required to be a member of the ASMB by attending all meetings over the past four years. MR. WILSON said "we" feel that we would offer to the state, "our patients, our profession, and the ASMB a valuable opinion that will represent a wider spectrum of medical practitioners in Alaska." He said this was presented to the ASMB in Juneau on January 19 [2001], and they voted to accept a PA on the ASMB. Number 0404 REPRESENTATIVE KOTT asked Mr. Wilson when PAs began to be recognized in Alaska, and what level of participation there has been in the past with PAs and the ASMB. Number 0430 MR. WILSON replied that prior to 1980 there was not a statute or regulation for PAs. The original regulation for guiding the practice and licensing of PAs in Alaska happened in 1980. Physician assistants have been avidly attending ASMB meetings for the past four years. Number 0516 ED HALL, Physician Assistant, Alaska Academy of Physician Assistants, via teleconference, said he supports the decision the ASMB made. He emphasized that it was a unanimous decision that PAs be granted a seat on the ASMB. He said it is very important that "we" have a representative. He thanked Representative Fate for sponsoring the bill, and mentioned that he has experience with people who are not medical doctors (MDs) participating on the board. MR. HALL said when he and Mr. Wilson were in Juneau three weeks ago, a question was raised about what sort of opposition would there be to this bill. He said there has not been any opposition to the bill because PAs and the MDs that work with them think it is a good thing. MR. HALL commented that he had sent a letter to the Alaska State Medical Association (ASMA) and has not heard from them. He said he presented the whole resolution to them in order to see that the bill passed through. He suggested that John Hall speak to that, since he has been active with ASMA. Number 0661 CHAIR MURKOWSKI verified that Mr. Hall had not received a response from ASMA. MR. HALL said he had not, but John Hall may be able to speak to that since he has been active with ASMA. Number 0691 REPRESENTATIVE KOTT asked Mr. Hall to enlighten the committee as to whether there has been significant growth in the number of PAs since 1980, and what the net effect has been of an increased number providing medical service in rural Alaska. Number 0726 MR. HALL said there has been growth in PAs, with the concept being about 30 years old. Since the inception in Alaska, there has been increasing growth; there are now about 250 providers, with the predominance in the rural areas. He said rural Alaska has been better served because of the PAs. Number 0756 REPRESENTATIVE KOTT asked if the 250 currently practicing PAs that Mr. Hall referred to include those in the military. MR. HALL said he didn't think that it included military PAs. REPRESENTATIVE KOTT said, then, he would think that the number of PAs would be larger, and he also suspects that as the military PAs move into the private sector, it is probably a plus for "you guys." Number 0803 JOHN HALL, Emergency Physician, Providence Hospital, member of the Alaska Emergency Medicine Associates, via teleconference, stated [that he is part of] a group of 13 [physicians], who are board-certified in emergency medicine and provide emergency care at Providence Hospital in Alaska. He said in addition to covering the emergency department at Providence, "we" also serve as sponsors for multiple PAs around the state. He said he serves as primary collaborator for 12 PAs for British Petroleum ("BP"), and his partner serves as the alternate collaborator. MR. HALL said "we" also serve as collaborators for Fairweather, and for a company called Remote Medical, who provide PAs for BP whenever their PAs are on vacation or continuing medical education. He said "they" also serve several other clinics that are just starting to open around the state. One is down in Port Anchorage (ph) for Veco and another one in Deadhorse. He understands that they want to open one in Nikiski and there are several other projects around the state. This demonstrates that PAs are rapidly growing throughout the state. MR. HALL noted that both private hospitals in Anchorage, Providence and Regional, have granted privileges to PAs and nurse practitioners within the last six months for them to work in the hospitals. He said "they" will be working under the supervision of a physician but will have responsibilities such as taking care of patients on their own under supervision, writing histories and conducting physicals, and doing transfer dictations as well as discharge summaries. Number 0922 MR. HALL said the bottom line is that PAs are becoming more and more prevalent in the state. When he began doing this 13 to 15 years ago, there were not very many PAs working in Anchorage, and now it's difficult to find a large office that doesn't have at least one. Many physicians in private practice are employing PAs to help them with their workload. He said as a physician who has served as a collaborator for a long time, he thinks it is time to have a PA on the ASMB, and he speaks in support of that. MR. HALL mentioned that he has worked on the grievance committee for the ASMA, and he figures that the reason a letter hasn't been received is because sometimes "the State Medical Association just works rather slowly, they don't have ... (indisc.) meetings." He said from his association with members on the ASMA, [he doesn't believe] there wouldn't been any opposition to having a PA on the ASMB. Number 0987 REPRESENTATIVE MEYER asked whether the difference between a PA and an Emergency Medical Technician (EMT) is just a difference in education. Number 1006 MR. HALL replied that [the difference] is in the amount of schooling and training. He said an EMT comes at different levels; an EMT 1, 2, 3, and EMT paramedic each has a certain amount of education. He said an EMT 1 has about 140 hours of training, and a paramedic would have anywhere from a year to two years of training. A PA usually has to have a college degree, and some medical, health, or health science background, and go on to at least two years that includes training in hospital (indisc.). For example, Mr. Ed Hall had gone to Emory University and received a master's degree as a PA. Number 1056 REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, commented that she lived in Tok for four years, and during that time "we" weren't able to get an MD to come and practice. There were advanced nurse practitioners or PAs under the purview of a doctor out of Delta Junction. She said PAs were an absolute necessity and she doesn't know what would have been done without them. She said the PAs had to make the decisions that a doctor would make. She spoke in support of the bill. Number 1107 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Community and Economic Development (DCED), said her division staffs the ASMB. She reiterated that the ASMB does support adding a PA to the board. Number 1131 REPRESENTATIVE HALCRO said it looked like the vote was unanimously in support of adding a PA to the board. He asked if there is any reason that it has taken this long to get one on the board. Number 1155 MS. REARDON replied that she believes this is the first time that bill has been introduced to do it, "a matter of waiting for the time to be ripe," in the opinion of the PAs and MDs. REPRESENTATIVE KOTT said he was hoping that one of the PA members could validate what Ms. Reardon had said. He said the issue of putting a PA on the board has been around for a couple of years. Number 1188 MR. ED HALL said it has just been in the past four years that PAs have dedicated time and funds to send representatives to the medical board meetings, although the interest hasn't just been inspired in the last four years. He explained that in the years of attending meetings, "we" have realized that PAs carry a lot of business with the ASMB. As [PA] numbers grew, "we" felt it was important to be a part of the board. Long ago there was some bad history, some attitudes were not really appreciated and tolerated by other members, which gave them a rocky footing with the board. He said in the past four to five years the relationship has improved considerably. Number 1260 MR. WILSON reiterated Mr. Ed Hall's comment that four years ago PAs decided not to make a commitment to be a member of the ASMB. He said serving an apprenticeship over four years, they would be able to prove to themselves and to the medical board that they were very ready for the commitment and responsibility. He said he thinks they have done that. He said to his knowledge, he doesn't believe there have been prior efforts to have a PA on the ASMB. Number 1319 REPRESENTATIVE KOTT said adding a PA to the board brings the membership up to eight, an even number, which could be problematic unless the board tends to agree on things. He asked Ms. Reardon if there are other boards with an even-numbered membership. Number 1346 MS. REARDON responded that the only other division board with an even number of voting members is the Board of Architects, Engineers, and Land Surveyors, with ten members. She said it doesn't present a problem because a tie loses under the division's system, so the outcome of any vote would be certain. And it is not unusual to have an even number of members because vacancies and seats can take several months to fill; at any time during the year, there may be several boards with an even number of people. Number 1404 MS. REARDON mentioned that boards tend to operate in a fairly collaborative manner, not usually with a one-vote difference. There has to be a quorum, and the majority of the votes wins. Number 1454 REPRESENTATIVE FATE mentioned that he spent five years on the Board of Dental Examiners, and was a presiding officer for two years. He was there when the dental hygienists applied and finally a bill "was put in for the hygienists." He said at first there might have been some resistance by the Board of Dental Examiners, and perhaps, the dental society. "We" were pleased when the hygienists got on the board; the contribution they made was truly significant because they were part of the healing team. He said this was what made him want to help out. He had been through this "maneuver" before. Number 1492 CHAIR MURKOWSKI stated that it is particularly telling when the ASMB unanimously endorses the addition to its board. Number 1505 REPRESENTATIVE HAYES asked what the fund source "RSS" meant. Number 1515 MS. REARDON replied that it means "receipt-supported services," a type of program receipts that mean license fees. The receipt- supported services aspect of that means that this is a program where fees cover the operation cost; there is a list of those programs in statute now. She explained that they are accounted for a bit separately [when compared to] other aspects of the general fund. The addition to the ASMB will be funded through license fees. Number 1567 MS. REARDON said there are 2,200 licensees under the ASMB, so it should not be a huge thing. Number 1570 REPRESENTATIVE KOTT revisited the issue of PAs in the military. He said he thinks the origin of PAs started with the military because he remembered getting service about 30 years ago. He said he appreciates all of the work that PAs have done over the years and knows that it did alleviate a lot of the physicians' workload. Number 1597 REPRESENTATIVE KOTT made a motion to move HB 91 out of committee with individual recommendations and attached fiscal note. There being no objection, HB 91 was moved out of the House Labor and Commerce Standing Committee.
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