Legislature(2003 - 2004)
03/24/2004 03:28 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 434-NATUROPATHIC MEDICINE CHAIR ANDERSON announced that the first order of business would be HOUSE BILL NO. 434, "An Act relating to the practice of naturopathic medicine; and providing for an effective date." Number 0136 CLYDE B. JENSEN, Ph.D., Oregon Health and Science University, noted that he'd traveled to Juneau at his own expense from his home in Portland. He testified: I'm particularly interested in rural care and the impact that naturopathic medicine can have upon rural health care. I've been introduced earlier as a Ph.D. in pharmacology and a medical educator. I'm best known, though, as an administrator of medical colleges. I've been responsible for the executive administration of colleges of allopathic or M.D. [medical doctor] medicine, osteopathic or D.O. [doctor of osteopathy] medicine, naturopathic or N.D. [naturopathic doctor] medicine, and oriental medicine, so I'm frequently called upon to speak before policymaking groups on issues pertaining to the "curative" educational programs of those several different professions. ... Number 0212 DR. JENSEN continued: The three bullet points that I will share with you are naturopaths versus naturopathic physicians; a second will be comparative medical education; a third will be continuing medical education and prescription authority. ... One of the things that I have learned as I have met with some members of the legislature today is that there is not an awareness of the fact that the term "naturopath" is an unregulated term. It can be owned by anyone who chooses to use it. A naturopath - or a person can call himself a naturopath - in those states in which naturopathic physicians are not licensed - and there are no regulations in those states that would prevent that person from referring to himself and holding himself out as a naturopath. I've seen correspondence from the Alaska State Medical Association that suggests that there may not be an awareness among members of the M.D. profession in the state that not all people who call themselves naturopaths are trained in the way that naturopathic physicians, of the type who are seated behind me, are trained. That, then, takes me to my next bullet, which is comparative education. Naturopathic physicians are trained in four colleges in the United States. Two additional colleges either exist or are developing in Canada, and in each case it is necessary for them to receive a bachelor's degree before being admitted into those colleges. In each case the course of study in those colleges is four years in duration. The content of those four years of study would be very similar, and in many cases identical, to the training that is received in M.D. and D.O. colleges; particularly, the first two years of that training is identical to that which is received in M.D. and D.O. colleges. The second two years, as many of you know, is spent training in clinics and in hospitals and, because the nature of naturopathic medicine and the practice of it is different from that of M.D. and D.O. medicine, naturopathic physicians receive clinical training in outpatient clinics and largely under the supervision of naturopathic physicians. Number 0433 DR. JENSEN continued: That, then, brings me to the third and final bullet that I will share with you, that is, continuing medical education and prescription authority. What I've learned as I have visited with a few members of the legislature today is that there are those who are concerned about expanding the scope of practice of naturopaths in Alaska to include the authority to write prescriptions for drugs. And the question is asked, "What kind of training do they have in the use of pharmaceutical products in their practices?" It's an excellent question. In the two years of training at the beginning of the four-year naturopathic medical education program, naturopathic medical students are taught pharmacology; that is the classroom basic training in the use of drugs. We teach them in that coursework how drugs act upon the body, how the body acts upon the drugs. I can tell you, as both a pharmacologist and as a former leader of those colleges, that that classroom training is the same whether you are studying to be an M.D., a D.O., or an N.D. In the latter two years of training, M.D.s will go to hospitals and multi-specialty group practices, where they will see a lot of drugs prescribed. Naturopathic medical students will go to outpatient clinics, where they will see fewer drugs prescribed because, once again, they are studying under the supervision of naturopathic physicians who typically use few drugs. Number 0544 DR. JENSEN continued: Continuing medical education is the process that other states that have allowed prescription-writing authority to naturopathic physicians to use, in order to ramp up their ability to utilize pharmaceutical products that they may have had somewhat limited experience in using while they were going to medical school. In my judgment, those states in which naturopathic physicians are permitted to prescribe drugs are sufficiently well trained to utilize the drugs that they prescribe. I will also tell you that, in my experience, naturopathic physicians are very reticent to prescribe drugs, because they became naturopathic physicians for the purpose of being able to use other types of therapies - and they simply do that very, very well. My promise was that I would be brief. I've touched upon three bullets, and there are a number of other topics that might be of interest to you. I'll read a menu of things that I can discuss if you're interested. Naturopathic medicine is an emerging profession; I can speak with you about what that means. I'm presently writing a book on medical (indisc.) versus the medical continuum. ... Naturopathic medicine and rural health, I think, may have some particular importance to this state because of the primary-care shortage in areas. Primary care and naturopathic medicine is a topic that I'm quite interested in; those are subjects that I'd be happy to address as well. Number 0659 REPRESENTATIVE GUTTENBERG said it is interesting to note the reference to the fact that if "we don't do anything" and there's no licensing requirements and no statutes relating to naturopathic medicine, that anybody can call himself or herself a naturopath. DR. JENSEN replied that in Alaska a license is required. He said that in other states healthcare consumers may go to a person whose business card says naturopath, but they will not know the nature of their training. Some people in the state medical association are not aware of this, he noted. Number 0720 REPRESENTATIVE GATTO said you used the term "naturopathic physician" several times. DR. JENSEN agreed. REPRESENTATIVE GATTO said that in statute it says, "A person who practices naturopathy shall clearly disclose that the person's training and practices in naturopathy. ... A person who practices naturopathy may not use the word physician in the person's title." Alaska excludes that possibility, he added. DR. JENSEN said that varies from jurisdiction to jurisdiction. REPRESENTATIVE GATTO asked Dr. Jensen how he feels about that. DR. JENSEN replied, "Those who are trained in four-year colleges of medicine, should be, deserve to be, recognized as physicians and their patients are already referring to them as such." REPRESENTATIVE GATTO said he believes that the people who are using the word "physicians" would object to that. DR. JENSEN said you could expect that those from the conventional health care professions whose responsibilities includes protecting the public, would want to be certain that those who call themselves physicians have been appropriately trained. Dr. Jensen opined that they have been trained appropriately. REPRESENTATIVE GATTO asked about the four colleges and whether Dr. Jensen has an association with any of them. DR. JENSEN replied that he was at one time the president of the oldest of the four colleges in Portland, Oregon. He said he served in that capacity for five years and completed that service about two years ago. REPRESENTATIVE GATTO asked if naturopaths frequently sell products within their own offices and if they had prescription drug rights, if they would be a dispensing pharmacy. Number 0829 DR. JENSEN replied that in many cases it is necessary for naturopaths to both compound and dispense products from their own offices because [the products] are not available from other retail sources. Naturopathic physicians have been taught to blend mixtures of herbs and nutrients in ways that are not commercially available, he noted. REPRESENTATIVE GATTO asked if they do that now. DR. JENSEN said yes. REPRESENTATIVE GATTO pointed out that the prescription drug rights [in the bill] go beyond that and extend their ability to compound prescription drugs in addition to the existing stock that they have. He asked Dr. Jensen for his opinion on that. DR. JENSEN said that, personally, he feels that would be inappropriate. He said he does not believe that that is the intent of this legislation. REPRESENTATIVE GATTO said, "But it would allow it." DR. JENSEN said he has not read the legislation so he cannot respond to that. REPRESENTATIVE GATTO said that the legislation does call for prescription drug rights to be given to individuals who now only compound natural ingredients for dispensing or selling from their own offices. Number 0946 DR. JENSEN replied that Representative Gatto has asked a very incisive question, one that Dr. Jensen has not thought of. He said there are two reasons why M.D.s and D.O.s do not sell products from their offices. One is that both of those professions have codes of ethics that for purposes of conflict of interest preclude physicians from selling products that they prescribe. The second reason is that most of those physicians also receive Medicare and Medicaid reimbursements and cannot sell products for private gain. Naturopathic physicians are not compelled by either of those two reasons, he pointed out. He said that his personal opinion is that dispensing for private gain from any practice is a dubious activity. He noted that the exception to that is when a naturopathic physician must compound products that are not available from other retail sources, they may have no choice but to dispense. He restated that he does not believe it is the intent of this legislation to permit the dispensing and sale of pharmaceutical products. Number 1038 REPRESENTATIVE CRAWFORD said that the way that the bill is written now, it would give unlimited ability to prescribe drugs. He asked if Dr. Jensen recommends that [naturopathic physicians] be able to prescribe addictive and psychotropic drugs. DR. JENSEN said that he has some apprehensions about that. The scope of practice that is needed by most primary care physicians is the scope of practice that can probably function quite well without scheduled substances or at least [Schedule II] substances where there is a high abuse potential, he opined. He related that he thinks it is a valid concern. REPRESENTATIVE GATTO stated that it does not matter which doctor he speaks with, they all have the same opinion, that naturopaths should not be allowed to dispense prescription medication. He said that he has heard the naturopaths say that they have all the business they can handle, and they are not going to make any additional income from dispensing drugs. He asked what argument could be made in favor of allowing naturopaths to prescribe prescription drugs. Number 1138 DR. JENSEN said he may not be the best person to answer the question because he is not a naturopath. He pointed out that a naturopath is a very comprehensively trained physician and Alaska is one of the most ubiquitous, health personnel shortaged states in the country because of the large land mass and the sparse population. Naturopathic physicians can play a very positive and powerful role in meeting the needs, particularly of rural Alaskans, who may not have access to healthcare otherwise, he opined. DR. JENSEN continued: If they are restricted in their scope of practice, so that naturopathic physicians are unable to do the things that they are really capable of doing, the people who [will] suffer are not the physicians. They'll continue to make a decent living. The people who will suffer are the patients that would like to have access to adequate and appropriate health care and whose physicians are limited in performing the services that they should perform. Now, if I were a naturopathic physician and I had devoted four or more years of my life being trained, and I practiced in a jurisdiction that didn't value my training, I'd probably would be disappointed with the jurisdiction and I may not practice there long. I suspect that part of the rationale behind this legislation has to do with appropriate recognition for some very high quality training. REPRESENTATIVE GATTO gave an example of earaches and antibiotics, which are not given any more. He asked if naturopaths would keep up on that information as well as any physician. DR. JENSEN replied that continuing education is the way that any physician is supposed to keep up. "Speaking to that specific example that you have given, off all of the health care professionals with which I have worked, the naturopath would be the least likely to venture into the prescription of drugs for purposes that they may not be warranted," he pointed out. REPRESENTATIVE GATTO asked if it is Dr. Jensen's opinion that the regular physicians are simply in a "turf protection". DR. JENSEN said he is very reluctant to say that a state medical association or an individual would oppose legislation for purposes of economics, but agreed that there is an economic impact that can be expected by M.D.s, D.O.s, and mid-level providers in the state, should the scope of naturopathic physicians be expanded. He pointed out that naturopaths are taught to do something that a lot of conventional providers don't have a lot of time to do, and that's to touch, talk, and work with their patients and get to know them. There will be health care consumers who will choose to receive more of their care from naturopathic physicians as the scope of practice enables them to provide the care that they desire, he added. "These are physicians who can compete, and the time will come when they will," he concluded. CHAIR ANDERSON pointed out that there is a fear of devaluation of the medical license of a medical doctor, scientific uncertainty in physicians' minds of the verifiability of some of the practices, the fear of misdiagnosis, and the question of the quality of the education. He asked Dr. Jensen if those are the arguments he has heard in other states. Number 1483 DR. JENSEN said they are. He related that he left the University of Oklahoma in 1996 to meet his first naturopathic physician in Oregon, and until that time, that was also his opinion. He related that during the five years he became somewhat of an expert on the subject, he found that his concerns were unwarranted. CHAIR ANDERSON, reporting on refutes to the three aforementioned concerns, said that the education [of naturopaths] surpasses that of nurse practitioners, midwives and physician assistants. In terms of the Western/Eastern medicine debate, Chair Anderson said that issue is not so easily decided. In terms of the devaluation of the medical license, it has been stated that the naturopath's patients aren't being taken from traditional practices, and both have more than enough patients. He asked if Dr. Jensen agrees. DR. JENSEN agreed. He added that as for the economic issue, naturopathic physicians are not receiving entitlement reimbursement, so there is no competition for that dollar. In most cases, naturopathic physicians are also not receiving third party reimbursement. Most people are willing to pay out of pocket for those services. Number 1603 REPRESENTATIVE LYNN pointed out that there is probably not scientific certainty for anything. He asked how the typical person chooses from the variety of medical treatments available. He wondered how a person knows where to go for their medical problem. He said he will probably vote no recommendation on this bill. DR. JENSEN replied that the average person probably does not have enough information to know where to go today. The average person is probably going to gather information from other health care professionals, and as the professionals become more and more knowledgeable, they will be able to make referrals to one another more frequently and more confidently, he related. DR. JENSEN explained: In the world of health care, we used to refer to conventional and alternative medicine and then we discovered that there were things about alternative medicine that were more compatible with conventional medicine than we thought, and so we started referring to conventional medicine and alternative medicine as complimentary medicine because they could work together. Today, there's a new buzzword within the field and it's called integrative medicine. That's where M.D.s and D.O.s and N.D.s and D.C.s and other types of health care professionals can actually work as a team. I predict that the day will come, and it will come only as a consequence of legislation that permits each of the groups to practice the things that they have been taught to practice, but I predict that the day will come when there will be health care managers in individual offices or in groups of offices that will help patients navigate through this very complex assortment of health care options. And, the day will come when M.D.s will be referring to N.D.s and N.D.s to D.C.s - we're simply not there yet. But, you've raised a very difficult question for health care consumers in the year 2004. How are they going to know? They never will know, though, if we don't allow health care professionals to practice that scope of practice that they've been trained to deliver. REPRESENTATIVE LYNN opined that it is a very dangerous thing for the consumer because he or she is at the mercy of health care providers. DR. JENSEN related that there is a protective mechanism in all jurisdictions for the consumer. Among those protective mechanisms are the board of examiners or the licensing board. Whenever a consumer is confronted by a situation that he or she thinks may be dubious, he or she can report that to the board, which is required by law to review it. Number 1801 REPRESENTATIVE GUTTENBERG asked, "Are we licensing here above the education level, or does this match the authority that we're giving naturopaths?" DR. JENSEN replied that the current license in Alaska is below the level of education of a naturopath. The proposed legislation would come closer to, but not exceed the level to which they are trained, he opined. He noted that the mention of controlled substances earlier is one example of what he considers the high end of a primary care practice. That is where there is some risk to which patients would be exposed, he said. CHAIR ANDERSON wondered if this legislation is setting a precedent and is beyond the scope of what naturopaths are allowed to do in other states. DR. JENSEN said, "No, there are other states in which the scope and practice already exceeds that which is recommended by this legislature." Number 1888 REPRESENTATIVE DAHLSTROM asked if his appropriate title is doctor. CHAIR ANDERSON said, "Ph.D." DR. JENSEN replied that his daughter says he is the kind of doctor who never helps anyone. REPRESENTATIVE DAHLSTROM thanked Dr. Jensen for coming and testifying at his own expense. She asked for clarification about the four-year degree and wondered if English and math are part of the course requirements. DR. JENSEN replied that the English and math classes are taken before a person enters the four-year naturopathic program. REPRESENTATIVE DAHLSTROM said, "So, I have a four-year degree already, and this is a second four-year degree on top of it." DR. JENSEN said yes, and thanks for asking that question. REPRESENTATIVE DAHLSTROM asked for Dr. Jensen's opinion about a naturopathic physician having to team up with a traditional physician in the same office in order to practice. DR. JENSEN said the teaming up part is happening more and more often for the convenience of the patient, but for supervision purposes there may be a precedent set in California where their statute does call for some association between naturopathic physicians and conventional physicians. CHAIR ANDERSON asked if that devaluates the naturopathic license and is very expensive because of the need to relocate to a doctor's office. DR. JENSEN said if he were a naturopathic physician he would avoid that type of relationship for the reasons Chair Anderson described. Number 2037 REPRESENTATIVE DAHLSTROM asked if the state of California offers full prescription rights to their naturopathic physicians. DR. JENSEN said he does not believe so. He noted that it was a bill recently passed in the last legislative session and has not yet been implemented. REPRESENTATIVE DAHLSTROM wondered if Dr. Jensen would consider it to be a friendly amendment to the bill to change it to allow just Schedule I drugs, a section that deals with the compounding of drugs, and whether they could or could not be sold out of the office. DR. JENSEN replied that he understands the intent of the question but that he has to change the terminology because a Schedule I substance is the most dangerous of all the drugs. The friendly amendment would allow prescription authority up to a certain level of scheduled substances such as Schedule II, he suggested. He said he would encourage the discussion of that. CHAIR ANDERSON noted the arrival of Representative Holm and brought him up to date, explaining that Representative Dahlstrom is looking into limitation on prescriptions and on dispensing from a [naturopath's] office of things like antibiotics. REPRESENTATIVE DAHLSTROM clarified that she is not thinking of antibiotics, but of compounds such as acne medicine. Number 2147 CHAIR ANDERSON closed public testimony. He asked Representative Gatto to report on the subcommittee's findings. REPRESENTATIVE GATTO said he did not submit a letter signed by all three members of the subcommittee, partly because he could not decide on the issue. With regard to question number one, which asked for a compromise with the Alaska Medical Association, there was none to be had, he reported. With regard to question two, discussion of Section 6, regarding minor surgery, most of the [subcommittee] agreed that they did not know what minor surgery is. In California minor surgery is to repair a laceration without sutures, he reported. Representative Dahlstrom brought up the fact that laser surgery does not use sutures, he said. There was discussion of whether floating a catheter through a tiny opening is surgery or a procedure, and so the group decided they were not clear on the definition of minor surgery. With regard to question three, the discussion of Section 15, the repeal of AS 08.45.040, which refers to the disclosure that naturopaths are required to disclose to each patient that their training is in naturopathy, and whether or not they have malpractice insurance, he said he is not sure that Section 15 is even in the bill. Number 2251 CHAIR ANDERSON reported that Section 15, page 7, line 19, repeals AS 08.45.040, which Representative Gatto as chair of the subcommittee referred to, states: Disclosures required by person who practices naturopathy. Subsection (a) ... shall clearly disclose that the person's training and practices in naturopathy (1) to each patient and (2) on all material used in the practice of naturopathy and made available to patients or to the public. (b) A person who practices naturopathy without being covered by malpractice insurance shall disclose to each patient that the person does not have the insurance. CHAIR ANDERSON said he is unclear why that should be repealed. He asked Representative Holm why that is. REPRESENTATIVE HOLM said he is unsure why that section is repealed. CHAIR ANDERSON restated the unresolved questions that are still before the committee. One is the reconciliation with the Alaska Medical Association, which does not support the bill. The parameters dealing with prescriptions still need to be resolved, the definition of minor surgery still needs to be defined, and there is a repeal of a disclosure section to figure out, he related. The issue about prescribing of drugs would also need to be resolved, he added. Number 2354 REPRESENTATIVE DAHLSTROM requested that Representative Gatto, as chair of the subcommittee, discuss those issues with the maker of the bill before the committee votes on the bill. TAPE 04-32, SIDE B Number 2365 CHAIR ANDERSON replied that he is committed to moving the bill out without objection from the committee. He said he agrees with the general intent of the bill. REPRESENTATIVE ROKEBERG suggested that the members of the committee offer amendments if they wish to. Number 2345 DANIEL JAMES YOUNG, N.D., a naturopathic physician and a licensed acupuncturist, addressing the repealing of [Section 15], reported that 17 years ago there was not a license for naturopathic physicians in Alaska. He said this section is antiquated and refers to the practice of naturopathy, which Dr. Jensen explained is different from the practice of a naturopathic physician. He said that patients know clearly that they are dealing with a naturopathic physician. It is now common practice for naturopathic physicians to carry malpractice insurance, and it didn't used to be available, he added. REPRESENTATIVE GATTO asked if malpractice is required. DR. YOUNG replied that he is not sure if it is required, but everyone has it. REPRESENTATIVE GATTO said, "The ones you know of." He suggested keeping the disclosure in the bill. DR. YOUNG said it is his understanding that naturopathic physicians have malpractice insurance and the patients know it. Number 2236 CHAIR ANDERSON suggested that if a naturopathic physician is going to perform minor surgery and prescribe medication, the bill should mandate malpractice insurance. REPRESENTATIVE ROKEBERG said there is no mandated insurance requirement in any of the licensing procedures in the state. He asked if [Section 15] is not repealed would there be parity or would M.D.s then have to make the same disclosure. Number 2184 REPRESENTATIVE DAHLSTROM offered Conceptual Amendment 1, on page 2, line 27, with the intent of adding the definition of minor surgery. CHAIR ANDERSON objected. He stated that the amendment is too broad. REPRESENTATIVE ROKEBERG pointed out that there already is a definition of minor surgery in the bill on page 6, line 19. He said he thinks it adequately describes the issue. CHAIR ANDERSON clarified that page 6, lines 20-30, describe minor surgery. REPRESENTATIVE DAHLSTROM said to disregard that, and then she prepared to offer Conceptual Amendment 1 dealing with the prescriptive rights, but said she did not know which section to add it to. Number 2116 REPRESENTATIVE ROKEBERG suggested page 5, line 16. He asked if Representative Dahlstrom is thinking about adding a level [of drug]. REPRESENTATIVE DAHLSTROM said correct. REPRESENTATIVE ROKEBERG asked the witness for his opinion on what levels would be appropriate. Number 2094 DR. YOUNG replied that his understanding is that the intent in this area was to allow naturopathic physicians to be able to access the prescription-type medications that they need to practice naturopathic medicine safely. [This section] was based on state laws from other states that license naturopathic physicians. Schedule II drugs allow for use of narcotic substances for the relief of pain, he explained. Schedules III and IV [drugs] lessen the extent of potential for psychological or physiologic dependence, he said. "We haven't outlined it here because we thought that that would be in the regulations and that it also implies that not all naturopathic physicians were going to apply for a DEA [Drug Enforcement Administration] license, it was only those that had specific training and a specialization, as such, and would cover additional pharmacal therapeutics ...." Number 2017 CHAIR ANDERSON asked Representative Dahlstrom to consider withholding Conceptual Amendment 1 because of the fact that there are two more committees of referral and [the amendment] could not be finished today. He suggested passing the bill on to House Health, Education, and Social Services Standing Committee to address all of this issues. He also opined that scheduling HB 434 with House Judiciary Standing Committee is unnecessary and could be waived. REPRESENTATIVE CRAWFORD said he does not feel comfortable letting the bill move on without addressing the concerns. He suggesting limiting the amount of the ability to prescribe drugs to level III and IV. He said he does not want psychotropic and anti-psychotic drugs to be included. CHAIR ANDERSON asked how long the bill has been held for the subcommittee. It has been thirty days and the subcommittee came back with nothing, he opined. He said now he is being told by the whole subcommittee that there is no agreement on any of these concerns and he is being asked to hold the bill. REPRESENTATIVE ROKEBERG said he would like to move an amendment. REPRESENTATIVE DAHLSTROM noted that she would be more comfortable with the amendment about the prescriptive level being handled in this committee. Number 1865 REPRESENTATIVE ROKEBERG moved to adopt Amendment 1, to delete [paragraph 4] on page 5, lines 16 and 17. REPRESENTATIVE ROKEBERG explained that this is a point of contention and the bill has two more committees to go to. REPRESENTATIVE CRAWFORD objected. He said that deleting [paragraph 4] is the correct thing to do but it does not go far enough. REPRESENTATIVE ROKEBERG asked if Schedule III and IV drugs are controlled substances. Number 1733 DR. YOUNG suggested dropping it down to Schedule II drugs. The dangerous psychotropic drugs are in Schedule I, he said. REPRESENTATIVE ROKEBERG asked if Schedule I - IV drugs are DEA controlled substances. DR. YOUNG replied yes. The schedules are set up by the Drug Enforcement Agency. Schedule I are drugs that are usually research only and very dangerous, he explained. REPRESENTATIVE ROKEBERG repeated his question. DR. YOUNG said yes. REPRESENTATIVE ROKEBERG pointed out that Amendment 1 deletes all controlled substances. CHAIR ANDERSON asked if abortion is minor surgery. DR. YOUNG said no. Number 1621 REPRESENTATIVE CRAWFORD asked if Prozac and Zoloft are controlled substances. JASON HARMON, N.D., explained that Schedule II drugs are medicines that have a high potential for abuse. An example of a Schedule III drug is cough syrup and other codeine-based medicines. Valium is an example of a Schedule IV drug, he added. REPRESENTATIVE ROKEBERG said he would include psychotropic and psychotherapeutic drugs as a friendly amendment to Conceptual Amendment 1. Number 1491 REPRESENTATIVE LYNN asked what schedule RU486 would be under. DR. HARMON said he does not know. He asked for clarification of the amendment, and whether the DEA license for naturopathic physicians would be deleted. REPRESENTATIVE ROKEBERG said that is correct and there would be two other committees to put it back in. CHAIR ANDERSON asked if there were any further objections to Conceptual Amendment 1. REPRESENTATIVE GUTTENBERG objected. A roll call vote was taken. Representatives Gatto, Dahlstrom, Lynn, Rokeberg, Crawford, and Anderson voted in favor of Conceptual Amendment 1. Representative Guttenberg voted against it. Therefore, Conceptual Amendment 1 was adopted by a vote of 6-1. Number 1396 REPRESENTATIVE DAHLSTROM said that everyone in the room could see what just happened in the last ten minutes. She related: The subcommittee met and discussed this and had meeting after meeting after meeting, talked with professionals from every aspect. You can see what happened here in the last ten minutes. We had paperwork that was ready to be presented; we got information to change those facts. I personally have been working on this since June, and so I don't take real kindly to someone telling me that they're embarrassed by what my actions were in the subcommittee and I state that for you to consider. I mean I think that there certainly have been things that have happened in this legislature that maybe people could and should be embarrassed about. I am not embarrassed by what our subcommittee did and the intent that we had from the very first time we met until talking just right before we got here have been the concerns that are still on all of our minds. And, I feel it necessary to put that on the record. CHAIR ANDERSON replied that his statement about embarrassment was simply that "a lot of folks came in and I feel that we didn't conclude or even come to any consensus." He noted that his comments were not directed at Representative Dahlstrom or toward any individual person. REPRESENTATIVE LYNN said that debate and voting is necessary based on the perceived merits and demerits of the bill, whether anyone flew in to testify or not. Number 1279 REPRESENTATIVE GATTO said a person does not have to be present to make sure that the bill passes out. He noted that the subcommittee did have agreements and the agreements were that prescription drug privileges were not in the best interest. He said Representative Dahlstrom is correct in that the committee did spent a lot of time on this bill. He said that there was concern because it appears that the naturopathic physicians already seem to be taking privileges that are addressed in this bill. DR. HARMON said he does not represent himself as a doctor of naturopathic medicine even though it states that on his card. CHAIR ANDERSON said that the next subcommittee should come up with some level of recommendation in order to be more concise. He said he does appreciate the subcommittee's work. REPRESENTATIVE GATTO said that he did not have a chance to address question number four, but the committee eventually got to it. Number 1183 REPRESENTATIVE ROKEBERG moved to report HB 434 out of committee, as amended, with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 434(L&C) was reported from the House Labor and Commerce Standing Committee.
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