Legislature(2009 - 2010)BUTROVICH 205
03/13/2009 01:30 PM HEALTH & SOCIAL SERVICES
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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.