Legislature(2009 - 2010)BARNES 124

03/10/2010 03:15 PM LABOR & COMMERCE


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03:37:41 PM Start
03:38:08 PM HB282
04:49:06 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 282 NATUROPATHS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                       HB 282-NATUROPATHS                                                                                   
                                                                                                                                
3:38:08 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON announced that the only 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."                                                                             
                                                                                                                                
3:38:22 PM                                                                                                                    
                                                                                                                                
KENDRA KLOSTER, Staff, Representative Cathy Munoz, Alaska State                                                                 
Legislature, paraphrased the sponsor statement, which read                                                                      
[original punctuation provided]:                                                                                                
                                                                                                                                
     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.                                                                                              
                                                                                                                                
3:39:46 PM                                                                                                                    
                                                                                                                                
MS. KLOSTER  referred to the  section-by-section analysis  of the                                                               
bill.  She explained that  Sections 1-3 would establish an Alaska                                                               
Naturopathic Medical Board  under AS 08, and adds to  the list of                                                               
boards  under   the  purview  of  the   Department  of  Commerce,                                                               
Community, &  Economic Development  (DCCED).  Sections  4-5 would                                                               
amend   Alaska  statutes   to  require   the   board  to   review                                                               
qualifications for licensure.  Section  6 would add a new section                                                               
to AS  08, which defines  the scope and practice  of Naturopathy.                                                               
Section  7  would  amend  the restrictions  on  the  practice  of                                                               
Naturopathy  and  allows  a  licensed  ND  to  prescribe  certain                                                               
medications  and engage  in  minor surgery.    This section  also                                                               
would  remove  the restriction  of  a  ND  to  use the  title  of                                                               
physician,  which is  tied  to the  federal  definition, such  as                                                               
Naturopathic physician.                                                                                                         
                                                                                                                                
MS.  KLOSTER  related that  Section  8,  which  would add  a  new                                                               
section  under  AS  08  to   establish  a  two-tier  prescription                                                               
endorsement.    A  Type  1  endorsement  would  allow  an  ND  to                                                               
prescribe   non-controlled   substances  such   as   antibiotics.                                                               
Naturopaths would  be required to  practice for five  years prior                                                               
to   receiving  a   prescription  endorsement   and  meet   other                                                               
requirements  before receiving  this endorsement.   To  receive a                                                               
Type 2 endorsement, a ND must  meet the requirements for a Type 1                                                               
endorsement and  must also  be registered  with the  Federal Drug                                                               
Enforcement  Administration  (DEA).   The  DEA  monitors  medical                                                               
practitioners who  prescribe controlled prescription drugs.   She                                                               
related  that most  NDs do  not  prescribe controlled  substances                                                               
such as  narcotics.  She  explained that Section 8  also includes                                                               
continuing Education requirements for Naturopaths.                                                                              
                                                                                                                                
3:42:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH referred to Section  8 and asked whether this                                                               
bill would  enhance the ability  for NDs to practice  beyond what                                                               
is currently allowed.                                                                                                           
                                                                                                                                
MS.  KLOSTER   answered  yes.    Currently,   Naturopaths  cannot                                                               
prescribe medications, she said.                                                                                                
                                                                                                                                
REPRESENTATIVE BUCH referred  to page 6, lines 9,  and asked what                                                               
is included in Type I endorsement.                                                                                              
                                                                                                                                
MS.  KLOSTER  explained that  this  provision  would set  up  the                                                               
prescription  endorsements.   The  proposed Naturopathic  Medical                                                               
Board  would regulate  the prescriptions  allowable.   Thus, this                                                               
subsection would establish the first-tier  designation for NDs to                                                               
prescribe non-controlled  substances, which are  non-addictive in                                                               
nature.  She  referred to lines 13-16, which would  set up a Type                                                               
II  endorsement.     The  proposed  board   would  establish  the                                                               
prescriptions Naturopaths could prescribe.                                                                                      
                                                                                                                                
3:44:48 PM                                                                                                                    
                                                                                                                                
MS. KLOSTER  continued.   Section 9  would instruct  the proposed                                                               
board  and DCCED  to  adopt regulations  to  implement AS  08.45.                                                               
Section 10 would  add a new section to provide  authority for the                                                               
DCCED to  charge fees,  such as  for licensure,  license renewal,                                                               
and prescription endorsement.  Section  11 would add a definition                                                               
for  board, which  means the  Alaska Naturopathic  Medical Board.                                                               
Section 12, would amend the  statutory definition of "practice of                                                               
medicine"  to permit  a practitioner  of Naturopathy  to use  the                                                               
words "doctor  of medicine" or  "physician" if, and only  if, the                                                               
designation contains the word "Naturopathy  or Naturopathic".  As                                                               
previously  stated,  this  is  to   align  the  definition  of  a                                                               
Naturopathic  doctor with  the federal  definition.   Section  13                                                               
would add Naturopaths to the  list of licensees.  Sections 14-15,                                                               
would  add   Naturopathic  services  to  reference   the  federal                                                               
Medicaid program.  The fiscal  note from the Department of Health                                                               
and Social Services reflects a  one-time cost for upgrades to the                                                               
computer system to allow for federal reimbursement.                                                                             
                                                                                                                                
3:46:21 PM                                                                                                                    
                                                                                                                                
MS. KLOSTER  explained that Sections  16-20 would  add provisions                                                               
for the DCCED  and Alaska Naturopathic Board to  proceed to adopt                                                               
regulations  necessary  to implement  the  changes  made by  this                                                               
bill.                                                                                                                           
                                                                                                                                
3:47:20 PM                                                                                                                    
                                                                                                                                
ASHLEY MAY,  Doctor of  Naturopathy, (ND),  explained that  he is                                                               
supportive of  this bill.   He  said he  has reviewed  the letter                                                               
sent by  the Alaska  State Medical  Association [March  1, 2010].                                                               
He did  not agree with  the allegation that Naturopaths  (NDs) do                                                               
not  have sufficient  education and  training.   He related  that                                                               
most  Naturopathic  students  earn  from 55  to  110  credits  in                                                               
pharmacology  classes, which  does not  include their  additional                                                               
education and  training in order  to prescribe for  pediatric and                                                               
geriatric patients.   Additionally, Naturopathic  students obtain                                                               
244 hours of botanical medicine  and herb drug interaction course                                                               
work.     With  respect   to  minor   surgery,  he   stated  that                                                               
Naturopathic  students  receive from  50  to  66 hours  of  minor                                                               
surgery.   Further, Naturopathic  students have  clinical shifts.                                                               
He related  that his school  had clinical shifts supervised  by a                                                               
medical   doctor.       Naturopathic   students   must   complete                                                               
competencies  for minor  surgery and  must pass  a minor  surgery                                                               
test,  which  is included  in  national  board examination.    He                                                               
recalled   most   NDs   scored  exceptionally   well   on   these                                                               
examinations.  Most of the  pharmacological classes are taught by                                                               
pharmacists  or doctorate  level teachers.   Some  are taught  by                                                               
medical doctors.  Naturopathic  students graduate from federally-                                                               
funded and  accredited Naturopathic Medical Schools.   He offered                                                               
that he faces restrictions on his  practice on a daily basis.  He                                                               
explained  that  it  is  often necessary  to  refer  patients  to                                                               
medical  doctors to  prescribe antibiotics  for strep  throat, or                                                               
the removal of  a cyst.  This takes money  from the patient since                                                               
they  select  a  naturopathic  doctor but  must  subsequently  be                                                               
treated by a medical doctor.                                                                                                    
                                                                                                                                
3:50:14 PM                                                                                                                    
                                                                                                                                
DR.  MAY  described an  example  of  a  patient he  treated  this                                                               
morning who had high blood  pressure which indicated the need for                                                               
pharmaceutical treatment.  He had  to refer his patient to Urgent                                                               
Care  to see  a  doctor  or other  medical  person authorized  to                                                               
prescribe,  which   points  out  how  this   limitation  provides                                                               
disjointed care to ND patients.   He would also like to volunteer                                                               
to  go to  villages to  provide  care and  dispense vaccines,  or                                                               
perform  minor surgeries,  in addition  to providing  botanicals,                                                               
herbs,  and other  supplements, but  cannot do  so.   He restated                                                               
that NDs have limitations in scope  of practice.  He related that                                                               
most  Naturopathic  schools are  similar  in  the education  they                                                               
provide.                                                                                                                        
                                                                                                                                
3:51:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH  asked whether  Dr. May had  reviewed letters                                                               
from the  Alaska State  Medical Association.   He referred  to an                                                               
ASMA letter of March 1, 2010 in opposition to the bill.                                                                         
                                                                                                                                
DR.  MAY  summarized  his  view  that  ASMA's  concern  was  that                                                               
patients  with serious  disease would  rely solely  on treatments                                                               
provided by practitioners by  Naturopathy ignoring the treatments                                                               
proven  to  be  safe  and   effective  by  science-based  medical                                                               
physician.    He  responded  that NDs  work  closely  with  other                                                               
practitioners and  refer out to  physicians.  He stated  that NDs                                                               
do  not solely  rely on  botanical or  herbs and  can distinguish                                                               
when the need for pharmaceuticals or minor surgery is indicated.                                                                
                                                                                                                                
3:53:13 PM                                                                                                                    
                                                                                                                                
DR.  MAY related  that the  ASMA references  a 1968  report which                                                               
indicated Naturopathic theory  and practice was not  based on the                                                               
body of basic knowledge related  to health and disease.  However,                                                               
this  research  was  prior  to   the  founding  of  most  of  the                                                               
Naturopathic schools.   Thus, the  information is outdated.   The                                                               
ASMA  asserts  that  naturopathic   doctors  have  little  or  no                                                               
training to  perform surgical procedures,  which is not  true, he                                                               
said.    He  restated  the substantial  hours  of  education  and                                                               
training that  most NDs complete.   The  same claim is  made with                                                               
respect to  pharmaceuticals.  Prescribing drugs  is not something                                                               
that NDs  normally perform, but  as primary care  physicians, NDs                                                               
should have the ability to  prescribe and are handicapped without                                                               
it.                                                                                                                             
                                                                                                                                
3:54:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  BUCH  asked  for comparison  of  credentials  for                                                               
naturopathic doctors compared  to medical doctors.   He asked for                                                               
similarities and differences in education and training.                                                                         
                                                                                                                                
DR.  MAY again  referred to  the ASMA  letter, which  states that                                                               
Naturopaths do not  have a Bachelor's degree.  This  is not true.                                                               
He related that during the first  two years of medical school the                                                               
course work  for NDs  and medical  students is  nearly identical.                                                               
The Naturopathic  student's course work includes  classes such as                                                               
anatomy, physiology,  and pathology.   However,  in the  last two                                                               
years  Naturopathic students  learn botanical,  nutrient therapy,                                                               
and homeopathy.  Naturopaths have  approximately 1,000 more hours                                                               
of  classroom  time than  a  conventional  medical school.    The                                                               
difference  in  training begins  during  the  last two  years  of                                                               
medical school since medical  students primarily perform clinical                                                               
work,  including clinical  rotations and  specialties.   However,                                                               
naturopathic  students are  not generally  required to  perform a                                                               
residency although some states require  residencies.  He surmised                                                               
that the lack of residencies  and limited opportunities available                                                               
for them is due to the growing number of naturopathic graduates.                                                                
                                                                                                                                
3:57:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH asked about  improving the scope to prescribe                                                               
contained  in  HB  282.    He  asked  Dr.  May  to  identify  the                                                               
differences.                                                                                                                    
                                                                                                                                
DR.  MAY  explained  that currently,  NDs  cannot  prescribe  any                                                               
pharmaceutical drugs.   This  bill would  allow NDs  to prescribe                                                               
certain controlled  substances based  on the proposed  ND board's                                                               
recommendations.  He  offered his belief that NDs do  not want to                                                               
prescribe cancer drugs  and many other drugs, but  NDs would like                                                               
the  ability  to prescribe  medications  such  as antibiotics  or                                                               
thyroid medications, which would  be especially helpful for those                                                               
engaged in primary care practices.   He pointed out that he faces                                                               
this  limitation  on   a  daily  basis  and   his  patients  must                                                               
subsequently see a medical doctor  to seek routine prescriptions.                                                               
The effect  is that the  patients are  charged fees twice:   once                                                               
for  the naturopathic  doctor's visit  and once  for the  medical                                                               
doctor's visit.                                                                                                                 
                                                                                                                                
3:59:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH related  that the proposed ND  board would be                                                               
comprised of  Naturopaths to oversee  Naturopaths.  He  asked for                                                               
comments on the composition of the proposed board.                                                                              
                                                                                                                                
DR. MAY thought  a broad composition would be best.   He recalled                                                               
that HB 282 outlines the  board composition to include three NDs,                                                               
one licensed pharmacist, and one  public member.  He also thought                                                               
having a  medical doctor on  the board  would be beneficial.   He                                                               
offered that  NDs need some prescribing  authority, and achieving                                                               
a  broad perspective  and balance  on  the proposed  Naturopathic                                                               
Medical  Board  would be  helpful  to  determine the  appropriate                                                               
prescribing allowable.                                                                                                          
                                                                                                                                
4:00:30 PM                                                                                                                    
                                                                                                                                
DR.  MAY,   in  response  to   Chair  Olson,   related  currently                                                               
approximately 20-25 Naturopaths practice  in Alaska.  He recalled                                                               
conversations with colleagues  in other states who  would move to                                                               
Alaska  as primary  care naturopathic  doctors, but  the lack  of                                                               
prescription  and minor  surgery  keeps the  numbers  lower.   He                                                               
predicted  that   passage  of   HB  282  would   encourage  other                                                               
naturopathic doctors to practice in Alaska.                                                                                     
                                                                                                                                
CHAIR OLSON referred to page two  of a letter in members' packets                                                               
from the medical  community.  He said, "Only  20 states currently                                                               
license  Naturopaths.    Many  of  these  states  do  not  permit                                                               
Naturopaths  to   prescribe  controlled  substances   or  perform                                                               
surgeries."   He  asked  how many  states  currently allow  those                                                               
activities.                                                                                                                     
                                                                                                                                
DR.  MAY  answered  that  he  did not  know.    He  offered  that                                                               
Washington State, where he attended  school, and Arizona do allow                                                               
for an  expanded scope of practice.   The problem is  the lack of                                                               
communication on the  education level of Naturopaths.   He stated                                                               
that  some NDs  do  not prescribe  pharmaceuticals  and have  not                                                               
"pushed for this."  He  characterized the process as molding this                                                               
traditional medicine into conventional  medicine and the need for                                                               
convergence  of  the  two  types of  medicine  is  becoming  more                                                               
evident.                                                                                                                        
                                                                                                                                
4:02:46 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON remarked that other  medical professions have weighed                                                               
in heavily  with opposition,  including the  American Osteopathic                                                               
Association and  several physicians' associations.   He expressed                                                               
surprise  at   so  much  opposition   with  so   few  Naturopaths                                                               
practicing in the state.                                                                                                        
                                                                                                                                
DR.  MAY   suggested  that  many   other  practitioners   do  not                                                               
understand the practice  of Naturopathy or do  not have knowledge                                                               
of the  level of education  of Naturopaths.   Thus, professionals                                                               
may fear  what the  NDs can or  cannot do.   He surmised  that 30                                                               
years ago the same arguments applied to Osteopathic physicians.                                                                 
                                                                                                                                
4:03:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN asked  whether Dr. May is  comfortable with a                                                               
medical doctor or osteopath serving  on the proposed Naturopathic                                                               
Medical Board.                                                                                                                  
                                                                                                                                
DR. MAY  answered yes.   He  related that he  does not  want this                                                               
debate to be an "us" against  "them" situation.  He said he works                                                               
with MDs and Osteopathic doctors  in Fairbanks.  He characterized                                                               
his   working   relationship  with   MDs   as   a  good   working                                                               
relationship, offering  that they  refer clients to  one another.                                                               
He expressed  an interest  in working together  on this  issue to                                                               
benefit Alaskans.                                                                                                               
                                                                                                                                
4:04:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN  asked whether  he would  like to  become a                                                               
primary care physician or if he currently considers himself one.                                                                
                                                                                                                                
DR.  MAY  responded that  he  considers  himself a  primary  care                                                               
physician.                                                                                                                      
                                                                                                                                
4:05:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN  asked Dr. May  to evaluate whether  he has                                                               
enough   education  and   experience  to   evaluate  all   health                                                               
experiences.                                                                                                                    
                                                                                                                                
DR. MAY answered that he is  confident and competent as a primary                                                               
care physician.                                                                                                                 
                                                                                                                                
REPRESENTATIVE NEUMAN asked if Dr.  May thought he should be able                                                               
to prescribe class  I and class II prescription  medications.  He                                                               
disclosed  that his  wife  is  a pharmacist.    He then  recalled                                                               
several discussions he held with  physicians and pharmacists, who                                                               
expressed concerns that NDs do  not have the practical and hands-                                                               
on  experience of  mixing drugs  and solutions  and how  the body                                                               
reacts  to   different  chemicals.     He  remarked   that  nurse                                                               
practitioners can do so because  they spend a considerable amount                                                               
of time  alongside doctors.   However, under this bill  NDs would                                                               
take on the responsibilities as  a primary role, which is similar                                                               
to the MD's current practice.   He asked whether Dr. May feels he                                                               
has the ability to make the calls.                                                                                              
                                                                                                                                
4:07:04 PM                                                                                                                    
                                                                                                                                
DR. MAY answered  that he does.  He stated  NDs need the expanded                                                               
role.   He related that  he works  with a nurse  practitioner and                                                               
they have held many discussions  on prescribing.  He believes the                                                               
process  is quite  similar.   Additionally,  NDs  are trained  in                                                               
drug, herb,  and supplement interactions.   He suggested  that 66                                                               
percent of the  general population takes some  type of supplement                                                               
or herb,  but often do  not mention  it to their  medical doctor.                                                               
However, the  supplements, herbs,  drugs, and nutrients  can have                                                               
significant interactions.  He pointed  out that he would heed the                                                               
advice  of pharmacists.    He noted  that in  2003,  a study  was                                                               
released by  the Nutrition Institute  of America that  showed the                                                               
total  deaths from  properly  prescribed pharmaceuticals  totaled                                                               
783,000, which is the  number one cause of death in  the U.S.  He                                                               
noted that  figure is higher than  the number of people  who died                                                               
from heart disease  or cancer.  He remarked that  NDs hold a one-                                                               
hour long  initial consultation with  patients, which  allows him                                                               
to get to  know his patients.  He can  consider interactions with                                                               
herbs, supplements, and  drugs.  He compared that  to the average                                                               
seven-minute  visit with  medical doctors.   He  did not  wish to                                                               
criticize medical doctors, but would  like to illustrate that NDs                                                               
spend  considerable time  with their  patients.   The reason  for                                                               
this is that  NDs believe it is a better  way to provide adequate                                                               
care to their patients.                                                                                                         
                                                                                                                                
4:10:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN affirmed that  he consulted three different                                                               
pharmacists who expressed concerns  about allowing Naturopaths to                                                               
prescribe due to the reactions to solutions and drugs.                                                                          
                                                                                                                                
4:10:32 PM                                                                                                                    
                                                                                                                                
CHAIR  OLSON  asked about  the  limited  liability insurance  for                                                               
malpractice that NDs carry.                                                                                                     
                                                                                                                                
DR.  MAY   offered  his  belief   that  the  minimum   amount  of                                                               
malpractice  insurance that  NDs carry  is $1  - 3  million.   He                                                               
remarked that  NDs are required  to carry  malpractice insurance.                                                               
In  further response  to  Chair  Olson, he  did  not believe  any                                                               
problem would  exist with  adding the drug  endorsement.   He did                                                               
think it  would impact  the cost of  medical malpractice,  but he                                                               
thinks the cost would be warranted.                                                                                             
                                                                                                                                
4:11:25 PM                                                                                                                    
                                                                                                                                
EMILY  KANE,  Naturopathic  Doctor  (ND),  stated  that  she  has                                                               
practiced for 16  years as a naturopathic doctor in  Juneau.  She                                                               
stated  she graduated  from an  Ivy League  college in  1978, and                                                               
decided to  attend medical school  at age  30.  She  related that                                                               
she stretched  out a  four-year program to  six years  to include                                                               
specialty training.   She attended Bastyr  University in Seattle,                                                               
graduating  in 1992,  the  Naturopathic and  Acupuncture/Oriental                                                               
Medicine  program.   She describe  Bastyr University  as probably                                                               
the  preeminent   university  in  North  America,   although  she                                                               
mentioned that all six North  American schools' were cited in the                                                               
Princeton  review of  medical schools  as being  some of  the top                                                               
medical schools in the country.   Thus, all six schools doctorate                                                               
programs were  cited for excellence.   The Naturopaths  undergo a                                                               
preceptorship, which is similar to  a residency.  She divided her                                                               
time between Arizona, West Virginia,  and China.  She related she                                                               
selected  China for  her residency  since not  many opportunities                                                               
existed for  hospital residencies.  She  explained that currently                                                               
all  the  Naturopathic  training  schools are  located  in  major                                                               
cities and are  connected to hospitals.  She  offered that Bastyr                                                               
University  participates  in  a  program  at  the  University  of                                                               
Washington  which  allows medical  students  to  learn at  Bastyr                                                               
University  about Naturopathy,  and naturopathic  students attend                                                               
UW for residency work.                                                                                                          
                                                                                                                                
4:13:52 PM                                                                                                                    
                                                                                                                                
DR. KANE  explained her experience  in China exposed her  to many                                                               
diseases, including pulmonary and  obstructive diseases.  Now all                                                               
new graduates, such  as Dr. May, as a recent  graduate must weigh                                                               
whether  to continue  to practice  in Alaska  due to  the limited                                                               
scope of  practice.  She pointed  out several errors in  the ASMA                                                               
letter addressed  to Governor  Parnell.   Only 15  states license                                                               
naturopathic doctors,  of which 9 allow  prescription endorsement                                                               
and minor surgery.   Alaska is the only state  which licenses NDs                                                               
that do not allow them to  have a self-governing board.  She said                                                               
that  this bill  specifically identifies  the composition  of the                                                               
board consisting  of three naturopathic doctors,  one pharmacist,                                                               
and one  public member  who may  be a medical  doctor (MD).   She                                                               
stated that  the NDS did  not want to  force doctors to  serve on                                                               
their proposed  board.  She  commented that she has  had hospital                                                               
privileges for  many years.   Some medical  doctors are  vocal in                                                               
their  opposition.    However, a  well-oiled  scope  of  practice                                                               
partnership (SOPP)  effort was  begun by  the AMA  in 2006.   She                                                               
explained that NDs  are one of the 10  targeted mid-level medical                                                               
professionals.   She  characterized this  as an  unfortunate turf                                                               
war.   She opined that a  small number of medical  colleagues are                                                               
"waging this  turf war."  She  offered her belief that  she works                                                               
well with  the medical community.   She said, "We  refer patients                                                               
to  each  other.     They  completely  understand   my  level  of                                                               
intelligence  around human  physiology,  anatomy, and  diagnostic                                                               
skills.  And  that I refer when appropriate.   They appreciate my                                                               
referrals and we work very well together."                                                                                      
                                                                                                                                
4:16:54 PM                                                                                                                    
                                                                                                                                
DR. KANE  pointed out that  what interferes with her  practice is                                                               
that she  cannot treat patients the  way she is trained  to treat                                                               
them.    She  described  several  issues  which  arose  with  her                                                               
patients,  including   one  in  which   a  woman  who   had  lost                                                               
significant weight,  and during  a routine visit,  she determined                                                               
her patient's blood pressure was  very high.  She recommended her                                                               
patient see the  nurse practitioner, but she would  have liked to                                                               
have  prescribed  drugs  at  the  time.   She  related  that  her                                                               
patients have  chosen her as  their primary health  care provider                                                               
and she  would like to  be able to treat  them since she  has the                                                               
education, training, and experience to do so.                                                                                   
                                                                                                                                
4:21:32 PM                                                                                                                    
                                                                                                                                
DR.  KANE stated  that she  helps her  patients understand  their                                                               
health  and  encourages working  as  a  team.   She  referred  to                                                               
several letters from  pharmacists and the Board  of Pharmacy, who                                                               
have written  in support of the  bill.  Some pharmacists  may not                                                               
be accustomed  to working with NDs.   Until a few  years ago, NDs                                                               
had   access  by   regulation   to   some  prescription   natural                                                               
substances.     Some   natural   substances   are  presented   in                                                               
pharmaceutical  dosage  and  since  the  statute  superseded  the                                                               
regulations,   the   NDs   could   no   longer   prescribe   some                                                               
pharmaceuticals.    She  related a  number  of  pharmacists  have                                                               
worked with NDs, while others do not have the familiarity.                                                                      
                                                                                                                                
4:23:47 PM                                                                                                                    
                                                                                                                                
DR.  KANE said  she  often received  referrals for  bio-identical                                                               
hormone  prescription, which  she  can no  longer prescribe,  but                                                               
works with  precursors to the  hormone.   She would like  to have                                                               
the ability to  prescribe when patients need  stronger support of                                                               
the bio-identical hormone.   She said, "I'm never  going to reach                                                               
for the  prescription pad  first unless  that's clearly  the most                                                               
indicated.    So my  therapeutics  will  remain less  potentially                                                               
dangerous."    She  related  that  she pays  $800  per  year  for                                                               
malpractice insurance.   The rates  are low because  few problems                                                               
happen  with  naturopathic physicians.    She  explained that  in                                                               
Oregon,  Naturopaths have  had  prescription  endorsement for  50                                                               
years, 20  years in  Arizona, and 30  years in  Washington State,                                                               
which is a long track record.                                                                                                   
                                                                                                                                
4:25:30 PM                                                                                                                    
                                                                                                                                
DR.  KANE explained  that most  NDs do  not use  pharmaceuticals.                                                               
She remarked  some patients often  see multiple doctors,  who are                                                               
not  always aware  of the  prescriptions other  medical providers                                                               
have  prescribed.     Thus,  case  management   is  an  important                                                               
component of her  job.  She referred to a  recent letter from the                                                               
pharmacists'   association   that   relates  they   support   the                                                               
establishment of  the Alaska Naturopathic Medical  Board with the                                                               
purpose of regulation of the  practice of naturopathic doctors in                                                               
Alaska.   She  related  the concept  of  a two-tier  prescription                                                               
provision came  from a bill  introduced in the Senate  about four                                                               
years  ago.    The  idea was  to  have  prescription  endorsement                                                               
including a  federal Drug Enforcement  Agency (DEA) number.   She                                                               
commented that  NDs are  already set up  to participate  with the                                                               
DEA,  but  she  does  not  request a  number  since  it  is  only                                                               
necessary  when  prescribing schedule  I-V  drugs.   Schedule  VI                                                               
drugs are for antibiotics  and anti-hypertensive diuretics, while                                                               
Schedule  VII drugs  are over  the counter  drugs.   The way  the                                                               
schedule was developed the smaller  the number the more dangerous                                                               
the drugs, in  terms of addiction and abuse.   She suggested that                                                               
NDs only  need Schedule  VI drugs.   However, if  the legislature                                                               
would feel  more comfortable with  federal oversight by  the DEA,                                                               
she believed that would be acceptable,  as well.  She offered her                                                               
belief that  her colleagues, the medical  doctors, and physicians                                                               
would likely  be opposed  to prohibit NDs  from having  access to                                                               
all the  drugs.  She  pointed out that some  NDs    specialize in                                                               
oncology and one practices in  Anchorage.  She explained that his                                                               
practice also includes a nurse  practitioner, who has the ability                                                               
to prescribe.   However, while she has some  cancer patients, she                                                               
co-manages   and  helps   them   offset  the   side  effects   of                                                               
chemotherapy.  She  said she wants to present a  picture that the                                                               
NDs are  not trying  to use  substances they do  not know  how to                                                               
use.   NDs have  deep and thorough  training in  pharmacology and                                                               
pharmacology   interaction,  the   interaction  with   nutrients,                                                               
supplements, and over  the counter herbs.  She  remarked that NDs                                                               
are the only level of  medical practitioners specifically trained                                                               
in    supplement,   nutrient,    and   herb    interaction   with                                                               
pharmaceuticals.                                                                                                                
                                                                                                                                
4:29:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH asked for her title.                                                                                        
                                                                                                                                
DR. KANE  answered that she is  a Naturopathic Doctor (ND)  and a                                                               
licensed   acupuncturist  (LAC).      In   further  response   to                                                               
Representative  Buch, she  related  that she  is  referred to  as                                                               
"Doctor."                                                                                                                       
                                                                                                                                
4:30:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH  referred to page  6 and to  the prescription                                                               
drug  types, type  I and  type II  schedules, referenced  in that                                                               
provision of the bill.                                                                                                          
                                                                                                                                
DR. KANE explained the two-tier  designation for NDs in the bill.                                                               
She explained  this is a tier  developed in this bill  as a point                                                               
of negotiation.   Thus, Tier I  would not require a  federal DEA,                                                               
or federal oversight so Naturopaths  could not prescribe Schedule                                                               
I -  V drugs.   Some nurse  practitioners have a  federal number,                                                               
while  others do  not want  "drug hounds"  calling them  at home.                                                               
The second type, Tier II,  would refer to Naturopaths that choose                                                               
not to  have a  DEA number,  and only have  access to  Schedule 6                                                               
drugs, or Schedule VII drugs, which are over the counter drugs.                                                                 
                                                                                                                                
4:33:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH asked  about the effective date  of the bill,                                                               
which  is two  parts, with  most  sections effective  on July  1,                                                               
2010.  According to this bill,  the state would improve the scope                                                               
of medications, but  will authorize more types  of surgeries, and                                                               
another  section creates  a proposed  Naturopathic Medical  Board                                                               
(NMB).   He related  that the enhancements  would go  into effect                                                               
prior to the NMB being established.                                                                                             
                                                                                                                                
DR. KANE thinks  the language should be clarified,  that it would                                                               
not be  appropriate for NDs to  have an expanded scope  without a                                                               
NMB board.   She offered her  belief that the purpose  of the NMB                                                               
is  to   provide  ongoing   appropriate  opportunities   for  the                                                               
professionals who  would fall under  the purview of  the proposed                                                               
NM board.  Currently NDs  have a national organization that gives                                                               
them continuing  education opportunities.   The  DCCED's Division                                                               
of  Corporations, Business,  and  Professional  Licensing, as  an                                                               
agency,  currently   does  not   have  the  ability   to  provide                                                               
continuing educational opportunities.  The  other reason is to be                                                               
certain  professionals  are  not  going  beyond  their  scope  of                                                               
practice.    She  suggested  that   the  NMB  would  oversee  the                                                               
professionals.                                                                                                                  
                                                                                                                                
4:35:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN stated that he  is fortunate to be covered by                                                               
three types  of insurance:   state, Medicare,  and military.   He                                                               
asked if his health insurance would cover her services.                                                                         
                                                                                                                                
DR. KANE  related that he could  only use his Alaska  Care, which                                                               
has recognized  Naturopathy since  1986.   Medicare is  a federal                                                               
decision  and NDs  are  working  to have  this  addressed at  the                                                               
federal level.   TRICARE is a component of the  government and is                                                               
linked to federal funding for military health care.                                                                             
                                                                                                                                
4:37:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN asked for the typical annual income.                                                                        
                                                                                                                                
DR. KANE  was unsure.   She speculated that the  specialty doctor                                                               
would likely  earn a  lot more than  a general  practitioner, who                                                               
probably earns on average about  $250,000 per year and an average                                                               
ND would earn from $50,000 - $60,000 per year.                                                                                  
                                                                                                                                
4:38:12 PM                                                                                                                    
                                                                                                                                
DR. KANE,  in response  to Representative  Lynn, stated  she sees                                                               
about eight patients on a busy  day, but more typically would see                                                               
five to six patients per day.                                                                                                   
                                                                                                                                
4:38:43 PM                                                                                                                    
                                                                                                                                
CHAIR  OLSON  asked   what  types  of  minor   surgery  would  be                                                               
contemplated.                                                                                                                   
                                                                                                                                
DR. KANE related that the  minor surgeries would cover items such                                                               
as wart  removal for pathology  reports, skin tags,  and sutures.                                                               
She  related that  she  specializes in  women's  health care  and                                                               
sometimes  an endometrial  biopsy  is necessary.    The types  of                                                               
surgeries contemplated would not be  anything in a body cavity or                                                               
the eyes, and is typically limited to growths.                                                                                  
                                                                                                                                
4:40:14 PM                                                                                                                    
                                                                                                                                
DAVID OTTOSON, Juneau,  Alaska, explained that he  and his family                                                               
uses  Naturopaths.   He  has  seen a  number  of Naturopaths  for                                                               
numerous ailments, including  sinus infections, earaches, urinary                                                               
tract  infections,   and  insomnia.     He  has  found   all  the                                                               
Naturopaths he has seen to  be highly professional and competent.                                                               
He  has been  very  satisfied with  the quality  of  care he  has                                                               
received.    He  said,  "To  me,  it  is  amazing  that  this  is                                                               
controversial,  this   legislation  at  all,  because   what  the                                                               
Naturopathic community is looking at  is just an expansion of the                                                               
scope of  practice, in accordance  with what they are  trained to                                                               
do."   They may wish to  prescribe an antibiotic for  an earache,                                                               
which made  sense to him.   He asked the  reason he should  go to                                                               
another  doctor or  nurse practitioner  if  my child  has an  ear                                                               
infection.  It  is not cost effective to see  a second physician.                                                               
This idea that  somehow Naturopaths will work  outside their area                                                               
of  competence  is totally  at  odds  with  his experience.    He                                                               
related his  own experience  of five years  ago when  he returned                                                               
from Africa  and was  sick.   He initially did  not think  it was                                                               
serious, but he contracted chills and a fever.                                                                                  
                                                                                                                                
4:43:38 PM                                                                                                                    
                                                                                                                                
MR. OTTOSON continued to relate  his personal experience with Dr.                                                               
Kane.   He said  that she  stopped by  his house,  remarking that                                                               
house calls  are something NDs  will perform.   She drew  a blood                                                               
sample and  had it  tested.   She discovered  he had  malaria and                                                               
sent him  to the hospital for  treatment since it was  beyond her                                                               
experience.  The  Bartlett Regional Hospital in  Juneau could not                                                               
treat him  as the  drugs were  not available in  Juneau.   He was                                                               
Medivaced to Seattle.   The type of malaria he  had contracted is                                                               
often fatal, so he was very  fortunate to be treated by expert on                                                               
malaria at the University of  Washington facility.  He emphasized                                                               
from  his experiences  that he  has found  that Naturopaths  will                                                               
refer something they are not  qualified to treat; they know their                                                               
limitations.  He has found NDs  work with people to improve their                                                               
own health.  He suggested that  society needs to move to a system                                                               
in  which people  take  responsibility for  their  own health  to                                                               
control health  care costs.   Some people  need to  be encouraged                                                               
and helping  people is  one thing  NDs do best.   He  offered his                                                               
belief  that Naturopaths  represent the  medicine of  the future.                                                               
He urged members to support HB 282.                                                                                             
                                                                                                                                
4:46:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH stated he  appreciated Mr. Ottoson's personal                                                               
testimony.   He  explained that  legislators need  to be  assured                                                               
that there are  not unintended consequences, but  he supports the                                                               
concept.                                                                                                                        
                                                                                                                                
4:47:51 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON related that the  ramifications are more serious with                                                               
medical issues.                                                                                                                 
                                                                                                                                
[HB 282 was held over.]                                                                                                         

Document Name Date/Time Subjects
HB282 Letter Dr Emily Kane 3-3-10.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 USDOL Definition of Naturopathic Physician.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 Comparison of Naturopathic and Major Medical Schools.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 ND Curriculum Book List.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 Letter DCCED 3-1-10.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 AANP AMA summary Statement.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 Letter AOA 3-8-10.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 AANP AMA Summary Statement (2).pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 Email from Suzette Mailloux 2-12-10.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 Email Jessica McCord 3-9-10.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 Letter AANP Karen Howard 3-9-10.pdf HL&C 3/10/2010 3:15:00 PM
HB 282
HB282 Letter Wayne Aderhold 3-10-10.pdf HL&C 3/10/2010 3:15:00 PM
HB 282