Legislature(2009 - 2010)BUTROVICH 205

03/13/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSSB 61(HSS) Out of Committee
                       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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
CHAIR DAVIS announced she would hold SB 70 for further                                                                          

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