Legislature(2017 - 2018)BARNES 124

03/09/2018 03:15 PM House LABOR & COMMERCE

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Audio Topic
03:26:57 PM Start
03:28:25 PM Confirmation Hearing(s)
03:31:27 PM HB147
03:38:10 PM HB326
04:55:57 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SSHB 147 Out of Committee
-- Public Testimony --
Scheduled but Not Heard
-- Public Testimony --
<Bill Hearing Canceled>
-- Public Testimony --
Scheduled but Not Heard
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+ Confirmation Hearing - Board of Professional TELECONFERENCED
Heard & Held
-- Public Testimony --
Scheduled but Not Heard
-- Public Testimony --
            HB 326-NATUROPATHS: LICENSING; PRACTICE                                                                         
CHAIR KITO  announced that  the next order  of business  would be                                                               
HOUSE  BILL  NO.  326,  "An  Act  relating  to  the  practice  of                                                               
naturopathy; relating  to the licensure of  naturopaths; relating                                                               
to   the  Department   of  Commerce,   Community,  and   Economic                                                               
Development; and providing for an effective date."                                                                              
3:38:10 PM                                                                                                                    
The committee took a brief at ease from 3:38 p.m. to 3:38 p.m.                                                                  
3:38:56 PM                                                                                                                    
REPRESENTATIVE  GERAN TARR,  Alaska State  Legislature, presented                                                               
HB 326 as  prime sponsor.  She explained the  proposed bill would                                                               
outline a clear scope of practice for naturopaths across Alaska.                                                                
3:39:43 PM                                                                                                                    
The committee took an at-ease from 3:39 p.m. to 3:40 p.m.                                                                       
3:40:55 PM                                                                                                                    
REPRESENTATIVE  TARR  said  the  proposed  bill  addresses  three                                                               
issues: access,  cost, and allowing professionals  to practice at                                                               
the  whole scoped  of  their  training.   She  indicated slide  1                                                               
showed a map of healthcare costs around America.                                                                                
3:41:55 PM                                                                                                                    
REPRESENTATIVE TARR  moved to  slide 2,  "Restrictive Regulations                                                               
Create  a  Significant  Gap  Between  Naturopathic  Training  and                                                               
Allowed Scope":                                                                                                                 
        • Shortage of primary care remains in Alaska                                                                            
          despite the presence of NDs trained to provide it                                                                     
        • NDs qualify for Indian Health Service's national                                                                      
          loan   repayment  program   aimed  at   increasing                                                                    
          healthcare  access  in   remote  Alaska,  but  are                                                                    
          unable  to make  use of  this program  due to  the                                                                    
          limited scope of practice.                                                                                            
        • This decreases competition, drives up costs and                                                                       
          limits access for healthcare consumers                                                                                
3:43:29 PM                                                                                                                    
REPRESENTATIVE TARR moved to slide 3, "Solution: Allow                                                                          
Naturopaths to Practice What They are Educated to Do":                                                                          
        • Immediately enables dozens of  new primary  care                                                                      
          providers (~57)                                                                                                       
        • This scope is  being practiced  safely  in  many                                                                      
          other states                                                                                                          
3:44:01 PM                                                                                                                    
REPRESENTATIVE TARR spoke to slide 4, "What Are Naturopathic                                                                    
Doctors (NDs)?"                                                                                                                 
        • Training to provide evidence-based primary care,                                                                      
          with a patient-centered focus that prioritizes                                                                        
          disease prevention over symptom management and                                                                        
          drug therapies                                                                                                        
        • Emphasis on longer office visits (~60-90 min.)                                                                        
        • This approach tends to reduce need for healthcare                                                                     
          utilization, as well as long-term costs                                                                               
3:45:16 PM                                                                                                                    
REPRESENTATIVE TARR spoke to slide 5, "Education":                                                                              
     4-Year Accredited Medical School Program                                                                                   
        • 2 Years of  basic  sciences;  2  years  clinical                                                                      
          sciences and treatment methods                                                                                        
        • Regulated by the Council of Naturopathic Medical                                                                      
          Education, which is overseen by the US Department                                                                     
          of Education - same as other medical schools                                                                          
        • NDs must   pass    the   two-part   Naturopathic                                                                      
          Physicians Licensing Examinations (NPLEX), before                                                                     
          being licensed to practice                                                                                            
3:46:57 PM                                                                                                                    
REPRESENTATIVE TARR addressed slide 6, "ND Therapeutic Order                                                                    
Progresses From Minimal to Higher Levels of Intervention as                                                                     
        • Clinical Nutrition / Diet                                                                                             
        • Counseling / Behavior Change                                                                                          
        • Hydrotherapy & Others                                                                                                 
        • Herbal Medicine                                                                                                       
        • Physical Manipulation                                                                                                 
        • Pharmaceuticals (Not allowed in AK)                                                                                   
        • Minor Surgery (Not allowed in AK)                                                                                     
3:47:28 PM                                                                                                                    
REPRESENTATIVE TARR moved to slide 7, "HB 326: Key Provisions":                                                                 
          HB 326 defines a clear scope of practice for                                                                          
     naturopathic doctors which                                                                                                 
     reflects their education and training                                                                                      
        • Cleans up outdated language                                                                                           
        • Allows NDs to  perform minor  office  procedures                                                                      
          (minor surgeries)                                                                                                     
        • Allows issuance of vitamins, minerals  and other                                                                      
          non-controlled substance prescription medications                                                                     
        • Requires 24 hours of continuing education every 2                                                                     
3:48:55 PM                                                                                                                    
REPRESENTATIVE TARR spoke to slide 8, "Key Provision: "Minor                                                                    
Office Procedures":                                                                                                             
        • Allows repair of superficial lacerations  & skin                                                                      
          biopsies (e.g. stitches, wart removal, punch                                                                          
        • Does NOT include any sort of major,  internal or                                                                      
          plastic surgery, or those involving the eyes,                                                                         
          tendons, ligaments, nerves, or blood vessels                                                                          
        • NDs complete an avg. of 100 hour of  training in                                                                      
          this area                                                                                                             
        • Being practiced safely in many other states                                                                           
3:49:41 PM                                                                                                                    
REPRESENTATIVE TARR addressed slide 9, "Key Provision:                                                                          
Prescriptive Authority":                                                                                                        
        • Applies  only   to    Non-Controlled   Substance                                                                      
         medications (excluding Testosterone & Ambien)                                                                          
        • Alaska already allows prescriptive authority for                                                                      
          other healthcare providers with equal or lesser                                                                       
          pharmacological training                                                                                              
        • This is being practiced safely in in many other                                                                       
3:51:10 PM                                                                                                                    
REPRESENTATIVE WOOL  asked for clarification regarding  the color                                                               
code on slide 9.  He asked what the grey represents.                                                                            
REPRESENTATIVE TARR answered that she  did not have an answer and                                                               
would have to get back to him.                                                                                                  
3:51:46 PM                                                                                                                    
REPRESENTATIVE  TARR moved  on to  slide 10,  "HB 326  offers one                                                               
clear,  safe  and  tangible step  towards  better  healthcare  in                                                               
        • Increases competition and drives down healthcare                                                                      
        • Improves healthcare access                                                                                            
        • Provides clear guidance to state regulators                                                                           
        • Allows healthcare professionals to do what they                                                                       
          are educated to do                                                                                                    
3:53:05 PM                                                                                                                    
REPRESENTATIVE  TARR  pointed  out  the  relative  comparison  to                                                               
letters of support  and one letter of opposition.   She added the                                                               
answer   to   the  map   question   was   that  grey   represents                                                               
3:54:09 PM                                                                                                                    
ABBY  LAING,   President,  Alaska  Association   of  Naturopathic                                                               
Physicians,  testified  in the  hearing  on  HB  326.   She  said                                                               
naturopathic doctors  (NDs) want  to provide the  best healthcare                                                               
possible.   She said Alaska  has highly  restrictive regulations.                                                               
She said the proposed bill  would drive down healthcare costs and                                                               
would allow greater freedom to  better access to healthcare.  She                                                               
added  the  proposed bill  is  straightforward  and would  remove                                                               
outdated language.                                                                                                              
3:57:43 PM                                                                                                                    
REPRESENTATIVE  JOSEPHSON asked  whether the  grey states  on the                                                               
map are unregulated.                                                                                                            
MS. LAING answered in the affirmative.                                                                                          
CHAIR  KITO mentioned  one  of the  provisions  was proposing  to                                                               
change the prescription authority of NDs.   He pointed out one of                                                               
the items being  removed from prohibition is a poison.   He asked                                                               
whether the request was for the ability to prescribe poisons.                                                                   
MS. LAING  answered the  aim is  to clear  up some  language. She                                                               
emphasized there is no intention or desire to prescribe poison.                                                                 
3:59:20 PM                                                                                                                    
REPRESENTATIVE WOOL asked  whether the grey states on  the map do                                                               
not have naturopaths.                                                                                                           
MS. LAING  deferred to Dr.  David Schleich.   She said  that some                                                               
states do not  have naturopaths, and in some states  NDs are just                                                               
not regulated.                                                                                                                  
4:01:05 PM                                                                                                                    
MELINDA  RATHKOPF,  Medical  Doctor,   Board  of  Alaska  Medical                                                               
Association,  testified in  opposition  to HB  326.   She  talked                                                               
about  her experience  in medical  school.   She stated  it's not                                                               
uncommon  to do  additional  testing on  patients  who come  from                                                               
naturopathic  care  providers.    She addressed  the  claim  that                                                               
naturopaths  can   help  bring   down  healthcare  costs.     She                                                               
underlined that for some patients  it drives up healthcare costs.                                                               
She further  addressed the question  of access to  the controlled                                                               
substances  database should  prescription privileges  be granted.                                                               
She  shared her  concerns about  preventative health.   She  said                                                               
that traditionally, NDs haven't  embraced vaccination.  She spoke                                                               
to a  2009 study stating  children are significantly  less likely                                                               
to be vaccinated against preventable  diseases if they are in the                                                               
care  of  a naturopath.    Alaska  is  still below  the  national                                                               
average in  childhood immunization,  and she  said she  is afraid                                                               
that  with  more  naturopaths practicing,  there  will  be  fewer                                                               
children  with  vaccinations. She  relayed  her  experience as  a                                                               
general  pediatrician  and  stated  it  would  be  impossible  to                                                               
maintain 90-minute  appointment times.   She shared  her concerns                                                               
about  training.    She  said   family  practice  physicians  get                                                               
anywhere from 9,000 to 10,000  hours of residency training, where                                                               
naturopaths  generally get  under 1,00  hours of  training, which                                                               
she said  is often optional.   She  added she has  concerns about                                                               
oversight.  She queried who  would monitor patient care issues to                                                               
ensure patient safety.                                                                                                          
4:05:46 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON stated HB  426 says that the naturopaths                                                               
are not  seeking to  prescribe controlled  substances.   He asked                                                               
whether she  was suggesting there  was a  way around that  in the                                                               
proposed bill.                                                                                                                  
DR.  RATHKOPF  stated  naturopaths  were asking  to  be  able  to                                                               
prescribe  testosterone  and zolpidem.    She  underlined if  she                                                               
wanted  to  prescribe  similar  substances,  she  would  have  to                                                               
consult the controlled substances database before prescribing.                                                                  
4:06:46 PM                                                                                                                    
REPRESENTATIVE  JOSEPHSON  asked  whether  zolpidem  is  a  sleep                                                               
DR. RATHKOPF answered in the affirmative.   She said Ambien was a                                                               
common name for it.                                                                                                             
4:07:00 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON  declared he believes that  young people                                                               
need  vaccinations.   He asked  Dr.  Rathkopf whether  it is  the                                                               
culture of naturopathy to "frown on" immunization.                                                                              
DR. RATHKOPF  said she is not  the best person to  answer what is                                                               
taught in  a naturopathic school.   She  said she does  find that                                                               
the patient population that goes  to naturopaths seems to be less                                                               
likely to be immunized.                                                                                                         
4:08:16 PM                                                                                                                    
MS. LAING said it is a  paradox because naturopaths are unable to                                                               
provide vaccines.   She added it  is standard of care  to provide                                                               
US Centers  for Disease Control  and Prevention  (CDC) guidelines                                                               
for vaccines to patients.                                                                                                       
4:09:23 PM                                                                                                                    
REPRESENTATIVE  WOOL  asked  Dr. Rathkopf  whether  she  supports                                                               
nurse practitioners having prescriptive powers.                                                                                 
DR. RATHKOPF answered  she has been in Alaska for  12 years.  She                                                               
said she  was trained  in states  where nurse  practitioners were                                                               
not  allowed prescriptive  powers.   She added  a rebuttal  to an                                                               
early  statement.   She  spoke  to a  study  in Washington  state                                                               
regarding child immunization by  naturopaths.  She specified that                                                               
in   that  state,   naturopaths   were   allowed  to   administer                                                               
vaccinations  and the  statistics still  showed low  immunization                                                               
4:11:00 PM                                                                                                                    
REPRESENTATIVE  WOOL asked  whether Dr.  Rathkopf supports  nurse                                                               
practitioners  having prescriptive  powers now  that they  are in                                                               
DR.   RATHKOPF  answered   she  works   with  a   lot  of   nurse                                                               
practitioners   and   she  has   not   had   issues  with   nurse                                                               
practitioners.   She added  most are  trained in  similar medical                                                               
backgrounds and philosophies as allopathic doctors.                                                                             
4:12:37 PM                                                                                                                    
REPRESENTATIVE  JOSEPHSON  mentioned  his father  represents  the                                                               
naturopaths  on the  issue of  the scope  of their  license.   He                                                               
asked Ms.  Chambers whether there  is anything in the  request in                                                               
the  legislation that  seems outside  the scope  of practice  for                                                               
states that allow more robust forms of naturopathy.                                                                             
4:12:50 PM                                                                                                                    
SARA   CHAMBERS,  Division   Operations   Manager,  Division   of                                                               
Corporations,  Business, and  Professional Licensing,  Department                                                               
of Commerce, Community, &  Economic Development (DCCED), answered                                                               
questions  in the  hearing  on HB  326.   She  answered the  only                                                               
primary   area  the   department   is  concerned   with  is   the                                                               
administration   of  testosterone,   a   schedule  3,   federally                                                               
scheduled  drug  product.    She  indicated  the  department  has                                                               
requested some changes to the proposed bill.                                                                                    
REPRESENTATIVE WOOL asked how long  Alaska has been a state which                                                               
licenses NDs.                                                                                                                   
MS. CHAMBERS said she would confirm that the answer is 1986.                                                                    
4:15:23 PM                                                                                                                    
CHAIR KITO opened public testimony on HB 326.                                                                                   
4:15:45 PM                                                                                                                    
KAILA BUERGER testified  in support of HB 326.   She said that HB
326  would allow  NDs to  practice their  extensive knowledge  by                                                               
issuing   vitamins,   minerals,  and   non-controlled   substance                                                               
prescription  medication,  as  well as  performing  minor  office                                                               
procedures.  She  spoke to treating the root of  the issue versus                                                               
the symptoms.   She said it was time all  doctors took a holistic                                                               
approach,  rather   than  handing  out  prescription   drugs  and                                                               
antibiotics.  She shared some  personal experience with NDs.  She                                                               
gave some statistics regarding diabetes.                                                                                        
4:25:29 PM                                                                                                                    
CLYDE  JENSEN,  PhD,  National University  of  Natural  Medicine,                                                               
testified in the  hearing on HB 326.  He  gave his qualifications                                                               
and  background  in  teaching   pharmacology.    He  opined  that                                                               
naturopaths  are well  trained at  professional degree  level and                                                               
said he sees no reason they  should be as restricted as they have                                                               
been in Alaska.                                                                                                                 
4:27:07 PM                                                                                                                    
SCOTT  LUPER,   Medical  Director,  Alaska  Center   for  Natural                                                               
Medicine, testified in  the hearing on HB 326.   He described his                                                               
practice and  underlined that he  is the father of  five children                                                               
who are all vaccinated.                                                                                                         
4:28:33 PM                                                                                                                    
JODY  OAKES  testified in  support  of  HB  326.   She  shared  a                                                               
personal story of  migraines and how an ND helped  her manage her                                                               
pain.  She said she feels safe in the care of her ND.                                                                           
4:30:21 PM                                                                                                                    
BARON GLASSGOW, Executive  Director, Arizona Naturopathic Medical                                                               
Association, testified  in the hearing  on HB  326.  He  gave the                                                               
history  of the  Arizona  Naturopathic Medical  Association.   He                                                               
said naturopathic doctors in Arizona  are considered primary care                                                               
providers.  He  added they complete pediatric course  work on how                                                               
and when to  administer vaccinations.  He stated  NDs can perform                                                               
vaccinations in the state of Arizona.                                                                                           
4:32:03 PM                                                                                                                    
ANNETTE O'CONNELL  testified in  support of HB  326.   She shared                                                               
she  was diagnosed  with  celiac  disease as  a  young woman  and                                                               
compared  the  treatment  she  received  from  a  medical  and  a                                                               
naturopathic doctor.   She said she  is forced to go out of state                                                               
to get her care.                                                                                                                
4:34:08 PM                                                                                                                    
ROB DOWNEY,  MD, testified in the  hearing on HB 326.   He shared                                                               
his  qualifications  and  background.   He  said  he  has  shared                                                               
patients with NDs in trauma and  mental health. He said he thinks                                                               
the minor  surgical procedures requested  in the  legislation are                                                               
extremely safe and limited and will help Alaskans.                                                                              
4:36:41 PM                                                                                                                    
ALAN  GROSS, MD,  testified in  support of  HB 326.   He  said he                                                               
believes the  regulatory interpretations  on naturopaths  are too                                                               
restrictive.    He  opined  naturopaths  coming  from  accredited                                                               
facilities  should be  allowed to  perform  minor procedures  and                                                               
prescribed   non-controlled  substances.     He   spoke  to   his                                                               
experience working with  naturopaths.  He said  the proposed bill                                                               
would lower the cost of healthcare in the state.                                                                                
4:38:26 PM                                                                                                                    
GARY FERGUSON testified in support of  HB 326. He shared he works                                                               
primarily in  public health with  Alaska Native communities.   He                                                               
said naturopaths help reduce the medicines that elders are on.                                                                  
4:40:54 PM                                                                                                                    
STEVE GEDDES testified  in the hearing on HB 326.   He shared his                                                               
personal experience  with naturopathic care.   He said  he thinks                                                               
it is reasonable for naturopaths to treat health conditions.                                                                    
4:43:26 PM                                                                                                                    
DAVID  SCHLEICH, PhD,  President, National  University, testified                                                               
in  support of  HB  326.   He  said  National  University is  the                                                               
longest-standing accredited  university of  naturopathic medicine                                                               
in  the   United  States.     He  gave  his   qualifications  and                                                               
background.   He   highlighted    that   the   accreditation   of                                                               
naturopathic  programs is  "exactly  consistent with"  allopathic                                                               
programs and the  accrediting bodies come from  the Department of                                                               
Education. He  spoke to  the concern  about residencies.  He said                                                               
naturopathy  students  are  prevented from  access  to  residency                                                               
match by  federal practice.    He commented on immunization.   He                                                               
said the  program at his organization  has extensive immunization                                                               
training,  meeting  all requirements  in  those  states in  which                                                               
vaccination  is  approved.   He  stated  in  Oregon  naturopathic                                                               
doctors are  considered primary care  providers.  He  stated that                                                               
the comment  regarding 1,000 hours  of naturopathic  residency is                                                               
not accurate.                                                                                                                   
4:48:59 PM                                                                                                                    
REPRESENTATIVE   JOSEPHSON    referred   to   a    comment   that                                                               
"there is  lots of teaching  about immunology," that did  not say                                                               
what is taught.                                                                                                                 
DR. SCHLEICH  answered what is taught  is the same thing  that is                                                               
taught in  standard allopathic  medical schools.   He  added that                                                               
the  prerequisites   for  entering  his  program   are  virtually                                                               
identical to those for medical schools.                                                                                         
4:50:20 PM                                                                                                                    
JENNIFER YOUNG shared  that she is a cardiac nurse,  married to a                                                               
naturopathic doctor. She said she  comes across many patients who                                                               
want to be  treated naturally.  She referred to  a comment by Dr.                                                               
Rathkopf  regarding  immunization.    She  opined  it  is  not  a                                                               
reflection of  the naturopathic doctors,  but that  people choose                                                               
for themselves not to be immunized.                                                                                             
4:52:37 PM                                                                                                                    
DANIEL  YOUNG, Naturopathic  Doctor, testified  in support  of HB
326.   He stated  he has practiced  naturopathic medicine  for 26                                                               
years. He  said naturopathic providers are  trained in ambulatory                                                               
care.  He stated  he had  been in  practice with  another medical                                                               
doctor.    He said he  thinks naturopathic doctors should  all be                                                               
able to practice  how they are trained and  communicate with each                                                               
other.  He underlined the patient is the primary importance.                                                                    
4:55:09 PM                                                                                                                    
MICHAEL DANZ testified  in support of HB 326.   He said he thinks                                                               
NDs should  be allowed to  give the type  of care they  have been                                                               
restricted from [administering].                                                                                                
[CHAIR KITO held over HB 326.]                                                                                                  

Document Name Date/Time Subjects
HB147 Summary of Changes ver A to ver J 2.13.18.pdf HL&C 3/9/2018 3:15:00 PM
HB 147
HB147 Sponsor Statement ver J 2.5.18.pdf HL&C 3/9/2018 3:15:00 PM
HB 147
HB147 Sectional Analysis ver J 2.13.18.pdf HL&C 3/9/2018 3:15:00 PM
HB 147
HB147 version A.pdf HL&C 3/9/2018 3:15:00 PM
HB 147
HB147 version J.pdf HL&C 3/9/2018 3:15:00 PM
HB 147
HB147 Fiscal Note DCCED-CBPL 2.22.18.pdf HL&C 3/9/2018 3:15:00 PM
HB 147
HB147 Letters of Support 2.13.18.pdf HL&C 3/9/2018 3:15:00 PM
HB 147
HB326 Letters of Support 3.10.18.pdf HL&C 3/9/2018 3:15:00 PM
HB 326
HB326 Letters of Opposition 3.10.18.pdf HL&C 3/9/2018 3:15:00 PM
HB 326