02/24/1994 02:20 PM Senate L&C

 SENATOR KELLY introduced SB 266 (DIRECT-ENTRY MIDWIVES/BOARD &                
 PRACTICES) sponsored by SENATOR LOREN LEMAN, and invited ANNETTE              
 KRIETZER, Aide to SENATOR LEMAN. to testify.                                  
                                                                               
 MS. KRIETZER gave a brief review of the six sections in a Sectional           
 Analysis, and she began by explaining SB 266 would extend the                 
 termination date of the Board of Certified Direct-Entry Midwives,             
 define the scope of practice of certified direct-entry midwives,              
 and provide for an effective date.                                            
                                                                               
 MS. KRIETZER directed the attention of the committee to a report              
 prepared by RANDY WELKER, CPA, for the Legislative Budget and Audit           
 Committee.  She quoted SENATOR LEMAN as being encouraged by the               
 professionalism of the allied health professionals such as physical           
 therapists, nurse practioners, physician Assistants, and others who           
 have called SENATOR LEMAN'S office, fearful they were being kept              
 out of the health care reform debate by physicians.                           
                                                                               
 MS. KRIETZER reviewed the letters in the bill packet, some in                 
 opposition and others in support of the bill, including a letter              
 from GOVERNOR WALTER HICKEL.                                                  
                                                                               
 MS. KRIETZER explained she has drawn on her experience as a health            
 policy maker in the Aleutians East Borough, and as the health                 
 director from her former community in the Aleutians, which involved           
 hiring mid-level practioners for their clinic and emergency medical           
 services, for her experise.  She described how overlapping client             
 populations can produce friction among health providers.                      
                                                                               
 Number 060                                                                    
                                                                               
 MS. KRIETZER focused on possible reservations about SB 266, which             
 she determined had to do with putting into regulation the list of             
 women, for whom a midwife may not knowingly assist in delivery.               
 She directed attention to the statutes and reviewed the list in the           
 bill packet dealing with the serious conditions that would preclude           
 the assistance of a midwife.                                                  
                                                                               
 MS. KRIETZER defined the difference in practice by physicians                 
 assistants, EMTs, and nurses, all who practice under the liability            
 protection of a physician, but she said advanced nurse practioners            
 and midwives do not.  She discussed the problems for the midwives             
 in being solely liable for their work.                                        
                                                                               
 SENATOR KELLY thanked MS. KRIETZER, and called on WENDY THON, on              
 teleconference from Anchorage.                                                
                                                                               
 Number 103                                                                    
                                                                               
 MS. THON identified herself as being on the Legislative Committee             
 for the Alaska Nurses Association, and testified to some opposition           
 to SB 266.  She explained the nurses association does support the             
 extension of the Direct-Entry Midwife Board until 1998.  However,             
 they had reservations concerning the scope of practice issues in              
 Section 2, paragraph (6).                                                     
                                                                               
 MS. THON explained all professional groups are defined in statute,            
 but the definition of direct-entry midwives does not indicate they            
 see a certain subset or narrow group of population such as low risk           
 pregnant women.  She further explained the definition was lacking             
 in statute without the specific language in AS 08.65.140 (a-f) as             
 repealed in Section 4 of the bill.                                            
                                                                               
 SENATOR KELLY turned the teleconference network to Wasilla to hear            
 from PAM WEAVER, a member of the Board of Certified Direct-Entry              
 Midwife.                                                                      
                                                                               
 MS. WEAVER spoke to the comments from MS. THON and thought there              
 could be an agreeable solution.  She wanted the legislation to move           
 forward.                                                                      
                                                                               
 In Juneau, SENATOR KELLY invited KAYE KANNE, Chair of the Board of            
 Certified Direct-Entry Midwife from Talkeetna, to testify.                    
                                                                               
 MS. KANNE testified in support of SB 266, the extension of the                
 board, and moving the laundry list from the statute to regulation,            
 where she thought it belongs - technically.                                   
                                                                               
 Number 151                                                                    
                                                                               
 MS. KANNE explained the board has written thirty seven pages of               
 regulations and licensed 20 midwives.  She referred to the high               
 risk list conditions in statute, which she said needs to be in                
 regulation where the board can update it from year to year.  She              
 explained the list, which changes, was put in statute in 1985 when            
 there was no board established.  She further explained, although it           
 was updated in 1992, the board was not yet in place and regulations           
 hadn't been written yet.  She thought updating was an important               
 reason to put the list in regulation.                                         
                                                                               
 MS. KANNE said the Legislature approved the creation of the Board             
 of Certified Direct-Entry Midwife to regulate the practice of                 
 midwifery in Alaska, but midwives do not want to take on the                  
 liability of delivering high risk babies and have no intention of             
 changing the list or deleting anything from it.  She thought there            
 might be additions in the future.                                             
                                                                               
 SENATOR KELLY asked if that's the case, why does the board want to            
 take it out of statute, and MS. KANNE answered that they might want           
 to add to the list.  She used an entry dealing with 42 weeks post             
 dates, to explain the changes that have made in the medical                   
 guidelines.                                                                   
                                                                               
 SENATOR KELLY suggested she was giving conflicting testimony on               
 changing the list.  MS. KANNE clarified they had no intention of              
 making the list more lenient, and high risk deliveries would not be           
 allowed.                                                                      
                                                                               
 SENATOR KELLY asked for clarification on what was requested in                
 Section 4, and MS. KANNE explained it was the statute on page 6 (d)           
 of the booklet.                                                               
                                                                               
 Number 200                                                                    
                                                                               
 MS. KANNE explained, in researching other professional definitions,           
 no other professional group had a laundry list of things they                 
 cannot do.  SENATOR KELLY countered by saying there was a list for            
 optometrists as opposed to ophthalmologists which don't.                      
                                                                               
 SENATOR RIEGER thought there was good policy in pushing as much               
 practice as possible to primary care providers, but was concerned             
 about the implications of the legislation in relation to proposed             
 statutes.  He wanted to see a list of what was being proposed                 
 before repealing current law.                                                 
                                                                               
 MS. KANNE explained why the list needed to be placed in regulation,           
 but thought the regulations would be returned to the legislature              
 for confirmation.                                                             
                                                                               
 MS. KRIETZER clarified the regulation process was a public process            
 and allows for public comment, where concerns are raised.                     
                                                                               
 Number 245                                                                    
                                                                               
 SENATOR KELLY reminded MS. KRIETZER the bureaucracy enacts                    
 regulations all the time that people don't want, and he explained             
 how the board could change the regulations.                                   
                                                                               
 MS. KANNE said they have a certified nurse-midwife and an OB-GYN on           
 the Board of Certified Direct-Entry Midwives as well as two direct-           
 entry midwives and a public member.  She explained it has been an             
 agreeable membership, and everyone wanted to see the safe practice            
 of midwives.  She referred to the regulations the board has written           
 and said they were strict.  SENATOR KELLY said he didn't see the              
 necessity for change and asked MS. KRIETZER for her answer.                   
                                                                               
 MS. KRIETZER explained the changes would make it more accessible              
 for a board through the public process to keep up with changes in             
 medical standards, and she explained possible changes in standard             
 of care.                                                                      
                                                                               
 SENATOR LINCOLN admitted to being confused on the changes, and she            
 quizzed MS. KANNE on the reasons for the changes.  She asked if               
 there was anything on the list that should not be in statute, and             
 MS. KANNE repeated her contention about updating the list.  She               
 referred to the 1992 changes, when the board met with the nurses              
 association, and she reviewed the additions to the list at that               
 time.                                                                         
                                                                               
 Number 297                                                                    
                                                                               
 SENATOR LINCOLN asked if it was difficult to get the changes, and             
 MS. KANNE reviewed the 1992 changes that set up the board.  SENATOR           
 LINCOLN asked if there was anything on the list now that needed to            
 be changed, and MS. KANNE said there wasn't, but she knew the                 
 guidelines change each year.                                                  
                                                                               
 SENATOR LINCOLN assured MS. KANNE the legislature has always                  
 complied to the wishes of the midwives, and she didn't think it was           
 difficult to get a statute changed.                                           
                                                                               
 MS. KANNE said the midwife association cannot afford a lobbyist,              
 and since she lives in Talkeetna, it is difficult and expensive to            
 come to Juneau.  SENATOR LINCOLN said she has 93 communities who              
 are in her same shoes, but she thought the prevailing mechanism was           
 the one for the legislature to use.  She didn't think there should            
 be a need to hire a lobbyist each time a change in statute is                 
 required, and she suggested the committee hold the bill.                      
                                                                               
 SENATOR KELLY admitted to the same reservations, but had no                   
 opposition to extending the board, and there was agreement among              
 the members of the committee.                                                 
                                                                               
 SENATOR KELLY said he would hold the bill and work with SENATOR               
 LEMAN'S staff for a future meeting for some other arrangement.                
 SENATOR SHARP said he would want some idea as to what is proposed.