Legislature(2009 - 2010)BUTROVICH 205
03/13/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
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| Start | |
| SB61 | |
| SB70 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 70 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 61 | TELECONFERENCED | |
SB 70-NATUROPATHS
CHAIR DAVIS announced the consideration of SB 70.
2:00:38 PM
TOM OBERMEYER, Staff to Senator Davis, said SB 70 expands the
practice of naturopathy in Alaska. It establishes a naturopathic
medical board and authorizes coverage of naturopathic services
by the medical assistance program. The 40 practicing naturopaths
in Alaska claim their training qualifies them to help bridge the
shortage of primary care physicians in the state. They point out
that they must refer patients to M.D.s for prescriptions while
nurse practitioners and physician assistants already can obtain
prescription endorsements. Importantly, SB 70 adds "naturopathic
services" to the list of services under AS 47.07.030(b) to allow
Medicare reimbursement for patient services.
Allopathic and osteopathic physicians have for years opposed the
expansion of naturopathic practice claiming that it's a matter
of public safety and that naturopaths are not sufficiently
trained to provide expanded medical care. SB 70 attempts to
address some of those concerns. He brought attention to a recent
letter from the Alaska State Medical Association stating their
continued opposition to the bill.
MR. OBERMEYER said the new naturopathic board will consist of
three naturopaths, one licensed pharmacists and one public
member who may be a licensed physician. The Alaska Department of
Commerce, Community & Economic Development (DCCED) will, at the
board's request, issue licenses and prescription endorsements to
licensed naturopaths who have practiced for five years and have
submitted proof of 60 hours of pharmacology education from an
approved program. The endorsement must be renewed every two
years with proof of 35 hours of continuing education. He noted
that 15 states already license naturopaths for expanded practice
so this isn't new.
2:05:25 PM
MR. OBERMEYER said Alaska is experiencing a growing shortage of
primary care physicians and it makes sense to expand the scope
of field for naturopaths who already act as primary care
providers for many. "SB 70 is designed to reasonably expand the
services of naturopaths without infringing on the duties and
responsibilities of medical doctors and osteopaths licensed by
the State Medical Board." He added that this addresses only the
naturopaths that have graduated from a four-year naturopathic
residency school and have passed a naturopathic physician
examination.
He noted the changed effective dates and provisions that have
added to ensure that naturopaths that are currently licensed in
the state would maintain their license. Applications for new
licenses and renewals will continue to be processed by DCCED
until the board establishes application review procedures in
regulation.
CHAIR DAVIS directed committee to sectional analysis. She stated
that it is not her intention to move the bill today.
2:12:08 PM
THOMAS P. VASILEFF, M.D., President, Alaska State Medical
Association (ASMA), stated that ASMA opposes SB 70 because of
quality of care and patient safety issues. He submitted written
testimony as well as a copy of the American Medical Association
(AMA) scope of practice study that represents data about
naturopaths. He relayed that the state medical society has been
advised not to seek agreement on the content of SB 70 outside
the legislative process. A task force should instead be convened
to address this issue.
DR. VASILEFF said ASMA questions that naturopaths' education has
the comparable depth and breadth of medical doctors and believes
that prescribing drugs and performing minor surgery should be
left to M.D.s and D.O.s. He urged the committee to oppose SB 70.
2:15:02 PM
SENATOR THOMAS said he'd like to see a more substantive
comparison of the similarities and differences between the
training of the two types of doctors.
DR. VASILEFF responded the ASMA scope of practice data series
details that.
SENATOR THOMAS said he's looking at the document and he doesn't
see the great differences that have been portrayed.
2:17:15 PM
SENATOR PASKVAN said he's trying to understand the difference
between the standard of care provided by an M.D. and the
standard of care provided by a naturopath with respect to a
differential diagnosis process upon initial presentation.
DR. VASILEFF maintained that there is a significant difference
between the education and skills and differential diagnosis of a
naturopath versus an M.D. or D.O. and it's well delineated in
the scope of practice.
SENATOR PASKVAN asked his perspective of the standard of care
differential in an initial patient presentation.
DR. VASILEFF reiterated that the general approach and education
of a D.O. and an M.D. is significantly different than for a
naturopath and is outlined in the practice data series that he
submitted.
2:19:27 PM
SCOTT LUPER, N.D., Fairbanks, said he has been a practicing
naturopath for eight or nine years and it's his contention that
public safety is best served by passing SB 70. In Alaska
naturopaths are well trained and tested healthcare providers
that want to practice as they were trained. They have graduated
from accredited schools, have passed national board exams, and
are qualified to practice as SB 70 allows. This is nothing new
and simply updates the law. He noted that the track record for
safety is better for the naturopathic profession than for other
healthcare professions with the complaint rate for naturopathic
physicians being half what it is for medical doctors. It is a
chronic frustration for N.D.s that they cannot provide the
treatment they have been trained to provide.
He clarified that continuing education is not the norm for the
naturopathic profession. To his knowledge, Alaska is the only
state that licenses naturopathic physicians and doesn't require
continuing education. That law should be brought up to date to
match the type and quality of education that is manifest in the
N.D. profession.
2:23:43 PM
SENATOR PASKVAN said he's trying to figure out what in the
differential diagnosis process is the standard of care for
passing a patient on to an M.D. or D.O.
DR. LUPER explained that the standard of care is to make a
referral when another physician is able to provide better care
or has specialized training to provide a specific service that
is better than what an N.D. can provide.
2:25:33 PM
SENATOR DYSON asked if N.D.s should have the same reporting
requirements as M.D.s and D.O.s who are required by law to
report to public safety certain types of injury like knife and
gunshot wounds and sexual abuse.
DR. LUPER said yes. He reports them now because that's what a
good doctor does regardless of the requirements.
2:26:47 PM
GARY FERGUSEN, N.D., President, Alaska Association of
Naturopathic Physicians, Anchorage, said he has practiced in
Alaska as a licensed naturopath since 2002. He highlighted that
a key point in patient safety is to serve the patient to the
best of their needs. Often in his practice a patient requires
something that he cannot prescribe which is inconvenient for the
patient, more expensive, and doesn't allow him to meet the goal
of providing good care. He refers appropriately to either a
nurse practitioner colleague or, if he's in the Pribilof Island
region, to a provider who may have a lengthy wait list.
DR. FERGUSEN said a challenge he sees in the Alaska Native
healthcare system is the critical shortage of qualified
providers. When he's providing care in remote villages, to have
to wait for the next nurse practitioner, physician's assistant,
M.D. or D.O. to come through to write a prescription is a
convenience and safety issue for the patient. SB 70 would
improve the quality of care, patient safety, and would allow
N.D.s to provide care as they are trained and nationally tested
to be able to do.
2:30:30 PM
PEGGY SWANSTROM, representing herself, Anchorage, said she
supports SB 70. She told the committee that her high cholesterol
was reduced 24 points under the treatment of her naturopath and
she is grateful that her insurance covers this service. She
maintained that naturopathic medicine is a compliment to medical
science and it's in the patient's best interest that they work
together. She noted that she works in an assisted living
facility and knows that many seniors have trouble finding a
physician who will take on Medicare patients. If N.D.s were an
option it would be very helpful to seniors. Finally, she relayed
that in her final will, she made it clear that she wants her
family to consult with her naturopath before they agree to any
tests or procedures.
2:34:13 PM
SERENA GREEN, representing herself, said she is under
naturopathic care and she supports SB 70. She suffered migraines
for more than a decade as different M.D.s treated her symptoms
with pharmaceuticals. They didn't try to find out the cause or
how they could stop them from happening. When she visited a
naturopath, their approach was to find the cause. Within a month
her naturopath was able to treat her migraines and lower her
blood pressure without using pharmaceuticals. Referencing the
prescription provision, she expressed frustration at having to
go to an M.D. to get the steroid spray she needs for her sinus
problem. She would prefer to go to just one doctor who knows her
entire medical history. It doesn't make sense that her
naturopath has to refer her to an M.D. whenever she needs a nose
spray. She agrees with the previous testimony that naturopathy
is a complement to the medical field.
2:37:12 PM
LORRAINE ECKSTEIN, representing herself, stated support for SB
70. For eight years a naturopath successfully treated her for
fibromyalgia, pre-diabetes, and blood pressure problems. But
when she needed stitches in her hand or antibiotics for strep
throat she had to go to a walk-in clinic. She appreciates that
those are available, but they don't know her and she is as
likely to be seen by a physician's assistant as an M.D. She
understands that they have less training than her naturopath.
It's a terrible waste of resources that my naturopath can't
treat me for these conditions, she said. She urged the committee
to pass SB 70.
2:39:33 PM
KARYN GROVE, representing herself, stated support for SB 70. She
is a naturopathic patient and her husband recently became a
licensed naturopath in Alaska. The standard of care she receives
is excellent; her N.D. spends more time with her and provides
solid advice. When she's gone to an M.D. they're often rushed.
She believes that continuing education for naturopaths is very
important and should be a part of the standard for licensing.
She is less concerned about prescriptive rights than the fact
that her child's school doesn't recognize physicals that are
done by a naturopath.
2:42:08 PM
EMILY KANE, N.D., Vice-President, Alaska Association of
Naturopathic Physicians (AKANP), said she has practiced in
Juneau for 15 years. She observed that most of the members heard
the bill last year and that the difference in SB 70 is that it
establishes the Alaska Naturopathic Medical Board. This is
supported by AKANP, the division of corporations, business, and
professional licensing within DCCED, and the pharmacy board as
the most effective way to regulate the profession, she said. An
M.D. is certainly invited to be on the board; this isn't a turf
war, but will provide better quality of care to the patient.
DR. KANE said her level of education is fairly typical of
naturopaths who are licensed to practice in Alaska. She
graduated from a four-year college followed by eight years of
medical training. She spent six years at Bastyr University
receiving nearly 2,500 hours of supervised clinical training.
That is one of the six accredited schools for naturopathic
medicine in North America. The national licensing exams she
passed include five basic science topics and 14 clinical science
topics. Subsequent to graduation she spent four months in
intensive hospital rotations and another year in a clinical
residency with a senior naturopath. She then opened a private
practice.
DR. KANE said she hopes that outlining her training and
education helps to offset the notion that naturopaths lack depth
and breadth in their training. She has significantly more
training than the average nurse practitioner who has a greater
scope of practice than she does as a naturopathic physician in
Alaska. She works closely and cooperatively with M.D.s in town,
"but in this political arena they won't stick their neck out for
me."
She has been affiliated with Bartlett Regional Hospital for over
ten years and routinely uses the radiology and pathology
services. Never has there been a hint of a problem. She noted
that she is required to carry malpractice insurance and it's
much less expensive than for M.D.s. Insurance companies are
experts at determining risk and N.D.s have been evaluated as a
very low risk profession. Every year she gets continuing medical
education as part of the biannual recertification for her Alaska
license. She strongly favors the aspect of SB 70 requiring
continuing medical education.
2:52:06 PM
DR. KANE said the main issue with regulation is patient safety
and allowing patients access to the proven, low tech, effective,
safe, and inexpensive services is part of that. N.D.s are expert
at solving chronic healthcare problems with safe medication, but
sometimes pharmacological intervention is needed. No one
disputes that health care is in crisis in this country and
licensing to full capacity a group of well-trained professionals
whose model is wellness and prevention is one aspect that can
work to turn this crisis around.
In closing she relayed that she is a nationally recognized
expert in bio-identical hormone replacement therapy and in this
state she is hamstrung because she isn't allowed to prescribe
that. She maintained that if Alaska doesn't update its
regulations, it won't attract new naturopaths.
2:55:30 PM
JENNIFER STRICKLER, Licensing Chief, Division of Corporations,
Business, and Professional Licensing, Department of Commerce,
Community & Economic Development, said the department's position
on the bill is neutral, believing that it is up to the industry
to convince the Legislature whether or not to expand the scope
of practice of naturopaths. However, if the Legislature elects
to expand the scope of naturopaths it is preferable that a board
is established. If the bill passes she suggested it include a
section amending AS 08.03.010, which is the termination date of
regulatory boards. This would make the new Alaska Naturopathic
Medical Board subject to legislative oversight.
SENATOR DYSON asked if naturopaths should be subject to
investigation for malfeasance like M.D.s.
MS. STRICKLER replied this bill subjects the proposed board to
the Centralized Licensing Act. Under that DCCED has the
responsibility to investigate, but it also has a section of
powers and duties of the board under which it takes action
against its licensees.
SENATOR DYSON asked if the fees for licensing cover the cost of
investigations.
MS. STRICKLER said that's correct; all licensing programs under
centralized licensing are subject to the self sufficiency clause
in AS 08.01.065.
2:58:00 PM
ARTHUR ARNOLD, representing himself, said Alaska should join the
15 states that [have instituted formulary laws] for licensed
naturopaths. He has heart disease in his family and had a heart
attack at age 38. He relies on two naturopaths, a cardiologist,
and an endocrinologist. His naturopath diagnosed his diabetes,
but can't prescribe his insulin care so he has to travel to
Anchorage every six months to fill his prescription. He sees his
naturopath as his primary care physician and strongly supports
SB 70.
CHAIR DAVIS asked those who are unable to testify today to
submit their testimony to her office.
3:02:23 PM
TIM KELLY, Lobbyist, Alaska State Medical Association, clarified
that N.D.s are not recognized by the federal government for
reimbursement under Medicare and Medicaid is reimbursed on a
state-by-state basis. He said there are significant missing
items in SB 70 that are contained under Section 8.64.010 on the
state medical board. Because of the significant differences in
the enabling legislation, it would behoove the sponsor's staff
to look at the provisions on patient safety, sanctions and
revoking of licenses, and reporting of certain injuries.
Although Dr. Luper testified that certain types of injuries
should be reported, there is no requirement to do so under the
naturopath enabling legislation. At a minimum the committee
should incorporate the reporting requirements of the state
medical board. This isn't a question of whether or not there
should be a board of naturopathy; this is a question of the
extension of scope of practice, he said. He noted that he
submitted an AMA report on the scope of practice data series for
naturopaths, which should be considered before the bill is
passed.
CHAIR DAVIS announced she would hold SB 70 for further
consideration.
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