Legislature(2007 - 2008)BELTZ 211
04/19/2007 01:30 PM Senate LABOR & COMMERCE
Audio | Topic |
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Start | |
SB102 | |
SB107 | |
Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
*+ | SB 107 | TELECONFERENCED | |
*+ | SB 140 | TELECONFERENCED | |
+= | SB 102 | TELECONFERENCED | |
+= | HB 118 | TELECONFERENCED | |
SB 107-NATUROPATHS 2:21:49 PM CHAIR ELLIS announced SB 107 to be up for consideration. TOM OBERMEYER, staff to Senator Davis, sponsor of SB 107, explained the bill relates to establishing a Naturopathic Advisory Committee and a Naturopathic Formulary Council. It amends the duties of the State Medical Board and the Board of Pharmacy relating to the naturopathic practice and provides an effective date. He said the three-member advisory committee is to be comprised of three licensed naturopaths appointed by the commissioner of the Department of Commerce, Community & Economic Development. It is responsible for selecting the Formulary Council and reviewing allegations of member misconduct. The Counsel will include three naturopaths, one medical doctor or osteopath and one pharmacist appointed by the respective boards to approve certain drugs to be prescribed by naturopaths and to authorized prescription endorsements to qualified naturopaths. While the State Medical Board licenses osteopaths, podiatrists, physician assistants, intensive care and paramedics, and foreign medical graduates, the Department of Commerce, Community & Economic Development licenses naturopathic applicants who have graduated from one of the four accredited schools of naturopathy in the U.S. and one of the two schools in Canada. Applicants must also have passed the Naturopathic Physician's Licensing Examination. New naturopathic procedures under SB 107 allow minor surgery, including operative electrical and other methods of repair to superficial lacerations and abrasion or lesions, and removal of foreign bodies in superficial tissues. The bill also allows naturopaths to use antiseptics and local anesthetics in connection with allowed procedures. The law prohibits naturopaths from performing major surgery and spinal and general anesthetics. Thirteen states license naturopaths and nine have instituted formulary laws. The states are Alaska, Arizona, Connecticut, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont and Washington. Currently, Alaska has 40 practicing naturopaths, Washington has 802, Oregon has 715, Arizona has 375, Connecticut has 210, Vermont has 117, Hawaii has 85, Montana has 67, New Hampshire has 67, Maine has 27, Utah has 18, and Kansas has 11. Nine states allow naturopaths to prescribe without any M.D. supervision or protocol, but they usually are allowed to prescribe only designated drugs. Arizona has the broadest formulary in the nation allowing naturopaths to prescribe all but I.V. medications, controlled substances except morphine, cancer chemo-therapeutics, and anti psychotic drugs. Kansas requires M.D. supervision and Maine requires collaboration with a physician for one year prior to independent prescribing. MR. OBERMEYER said that naturopathic doctors focus on preventative care and in keeping patients healthy and they usually rely much less than M.D.s on the use of drugs. Patients often turn to naturopathic doctors when traditional medicine has failed. One of the reasons naturopaths require formulary or prescribing law is to reduce the amount of combinations of drugs patients are taking. 2:26:37 PM He said SB 107 is designed to reasonably expand the services of naturopathic doctors only to areas collateral to the needs of their daily practice without infringing on the duties and responsibilities of medical doctors licensed by the State Medical Board. This type of bill has been before the Senate in SB 306 in the last legislature; it went through several revisions and the result was a task force that was to address it. The Alaska State Medical Board indicated it didn't think the process was complete. 2:27:08 PM MARY MINER, N.D., said she is currently practicing in Anchorage, and that she would address the educational requirements for naturopaths and how they compare to other licensed health care professionals in the State of Alaska. She referenced Appendix E that compared the curricula of National College, Bastyr University, Southwest (all naturopathic colleges) and John Hopkins, Yale and Stanford. The basic clinical education is similar across the board, she observed. There are differences in the allopathic and the naturopathic strength in the clinical applications. Naturopaths do a lot more with botanical medicine, naturopathic philosophy, and oriental medicine which are not included in the allopathic schools. The total number of hours of education is similar. 2:29:36 PM She also handed out a comparison of medical background education of licensed professionals who are able to use prescription medications at this time based on a UW study from two years ago - including nurse practitioners, physician assistants, medical doctors, and other states that license naturopaths. The prerequisites to get in to college are fairly similar; the education once they are in school is also quite similar. Naturopaths have a different focus on being more wellness oriented. MS. MINER said it is within the scope of the practice of most licensed M.D.s to use prescription medications, particularly legend drugs, which are not controlled substances and naturopaths just want to expand their licensing to fit their training and have it available for their patients. 2:31:07 PM GARY FERGUSON, N.D., said he practices in the Eastern Aleutians and represents the Alaska Association of Naturopathic Physicians as its Alaska Native liaison. His primary work is with the Alaska Native population although he works for Eastern Aleutian Tribes community health centers. He serves mainly the underserved population that has huge health disparities. His focus in the last five years has been in diabetes and diabetes management. One challenge to his practice in the Aleutians is that the nine communities are remote and have a limited practitioner base. He sometimes teams up with nurse practitioners and others, but it still is often not enough. Medications often need to be changed as health improves. Since he cannot prescribe changes, patients needs separate appointments and sometimes they get the lost in the shuffle. He has been trained in pharmacology and pharmaco- kinetics of drugs and this bill would allow him to practice the way he was trained. He supported the bill. 2:35:58 PM EMILY KANE, N.D., said she graduated from an accredited naturopathic school in 1992 and has been practicing in Juneau for nearly 15 years. She has had hospital privileges with Bartlett Regional Hospital for over a decade. So far the ideas of comparable education have been presented along with expanding of primary health care providers, which naturopaths are, in the state of Alaska, which is underserved. DR. KANE said she wanted to address consumer safety. Appendix K covered states and disciplinary actions. In the years 2000 to 2003 in various states there were twice as many disciplinary actions for medical doctors as for naturopaths. However, in those years Arizona naturopaths had access to prescription drug writing. However, she noted that it's feasible that Alaska's zero disciplinary actions for the years surveyed relates to naturopaths not having access to prescription medication. She argued that prescription drugs have a much higher side effect profile, which is why N.D.s get this training. She also noted that one of the aspects of the bill insures continuing education and staying abreast of pharmaceutical practices. Dr. Kane said naturopaths want to provide the best care for their patients within the scope of their practice. SENATOR STEVENS asked if the disciplinary actions she mentioned were for prescription misuse. DR. KANE replied no; they covered any kind of disciplinary action that would have been registered through the Division of Occupational Licensing. CHAIR ELLIS said the bill was referred to the Labor and Commerce Committee because of scope of practice issues and workforce development. He said the Alaska Medical Association opposed this bill saying the legislature should spend its time expanding the WWAMI slots and training programs because many M.D.s are retiring. However, the legislature has doubled the WWAMI slots this year and he supposed Dr. Kane would argue that N.D.s do fill that need every day in our state and they are a class of medical providers that could expand as well. He asked her if she could comment on that point. 2:42:08 PM DR. KANE responded that it's fantastic that the legislature has expanded the WWAMI slots. She said she and Dr. Miner have been practicing as family doctors for over 20 years. They are already established in their communities and practicing as primary care family doctors. She has 4,000 charts. She would be more useful to her large patient base immediately. The new WWAMI doctors will be needed, but it's not an either/or situation. 2:42:55 PM SENATOR STEVENS said he understood Dr. Ferguson's remote argument, but that's not the case here in Juneau where lots of people can prescribe medications. He asked what is the rationale is for providing her that opportunity in town. DR. KANE replied that she makes referrals frequently saying she is "well-embedded" in the medical community here. However, sometimes it takes a long time to get in and the patient needs the antibiotic immediately. Or they are just not going to go the medical doctor. It's a freedom of choice in health care issue - in part. There are plenty of medical doctors here, but on the whole Alaskans are underserved and naturopaths are submitting they are trained and available, established and providing patient care already, and that they have more training than nurse practitioners who already have prescriptive rights. This would bring Alaska in line with all the other western states that license naturopaths and provide prescriptive rights to them. 2:44:45 PM SCOTT LOOPER, N.D., Fairbanks, supported SB 107 and wanted to add that the main reason naturopaths are doing this is to provide the best quality care to their patients they can. Sometimes it is in the patient's best interest to receive an antibiotic, a diuretic or something like that. The fact is that naturopathic physicians are trained to prescribe when needed within the context of the practice of naturopathic medicine. They want to provide quality care with the tools they are trained to use. 2:46:40 PM DR. LOOPER described how the right to prescribe is earned. You attend classes where you learn how to use prescription medications, then you move on to a clinic situation where under the supervision of practicing licensed doctors, you practice using them. After that, you take a national board exam; if you pass that exam, you earn the right to get licensed. In Alaska, they do every step of that process with the exception of the licensing piece. It is often inconvenient for patients to go to another doctor when their naturopathic doctor is trained in the use of those medications. It's also more expensive, more difficult and time consuming. He has a license in Oregon and Arizona and is used to being able to use these tools on occasion. 2:48:16 PM CHAIR ELLIS asked if the lack of prescriptive powers keeps naturopaths from locating to Alaska. DR. LOOPER replied that he didn't know. He said the fact is that naturopathic doctors don't prescribe much. When he had the right to prescribe in Oregon and Arizona, he only wrote a script once a week or two and most times he would be taking people off of things. Not having prescriptive rights doesn't limit his ability to help people, but it creates a certain frustration knowing that you're going to be moving to a state that you can't do some basic things, like writing for thyroid hormone replacement, which is a normal thing to do in someone whose thyroid isn't working right. 2:49:11 PM PATRICIA ANDERSON, Anchorage resident, said she had been a patient of an N.D. there and has been for over seven years. She related how she is on her third bout of breast cancer and how her naturopathic doctor worked with her oncologist to make her chemotherapy less uncomfortable for her. Her naturopath has extensive experience with cancer care. After she finished with chemotherapy, she ended up on a bone loss type medicine and he has helped her get the exact right kind of calcium to keep the bone loss minimal. She also recognizes her naturopathic doctor as her primary physician. She supported SB 107 even though she has no need of regular prescriptions. She wanted to know that he would be able to give them to her if she needed them. 2:51:26 PM RICK URION, Director, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community & Economic Development (DCCED), disclosed that in a previous life he lobbied for the State Medical Society and was instrumental in writing the first law allowing for licensing of naturopaths in the State of Alaska. Today he represents the administration on this issue and has a neutral position on it, but he had an opinion on the two committees the bill forms. MR. URION said it appears that the advisory committee is really a board, but it is being formed without being called a board. A committee is appointed by the commissioner of DCCED and he thought they might want to change that as well as add a member of the public - as other boards have. The advisory committee talks about disciplinary actions and that's what boards do. Also, the Formulary Counsel consists of three members in the bill, but it should consist of five members, three of which are naturopaths and one physician. He also pointed out that existing law makes it illegal for naturopaths to call themselves physicians. CHAIR ELLIS asked if he was suggesting that the committee consider making the language more conventional to comport with the way boards are set up for other professions. MR. URION replied yes. It appears that they are forming a board whether or not they are calling it that. All the other boards consist of members of the profession and a member of the public. The governor does the appointing, not the associations. They can make recommendations. 2:54:50 PM CHAIR ELLIS asked Mr. Obermeyer if there is a reason the bill was drafted differently than all the other boards. MR. OBERMEYER answered there was an initial question of whether this type of practice would be regulated by the DCCED or the State Medical Board. Basically, the naturopaths felt they were criticized harshly in the last legislature and they wanted to have some type of control. Documentation indicates that even in California that the few physicians willing and trained for N.D. supervision have difficulty getting malpractice coverage. There are many issues and he didn't have the answers for everything. He said the 40 naturopaths in Alaska are looking for a way to be recognized in their profession and expand their practice to minor procedures and to have an opportunity to be regulated within their own group. Presumably they would want to keep malpractice out of their profession. CHAIR ELLIS requested the sponsor talk with Mr. Urion and draft the bill with standard operating procedure and bring it back to the committee next week. 2:57:53 PM SENATOR DAVIS said she would do what is necessary to move the bill along. 2:58:17 PM CHAIR ELLIS asked if there was any work product from Senator Seekins' Naturopathic Task Force. MR. OBERMEYER replied there were no recommendations. He said the State Medical Board said it was concerned that naturopaths are not as well trained or educated. There is no residency program for instance. He said this group is willing to address those issues as necessary in order to have some type of regulation that everyone agrees with. CHAIR ELLIS said they would have another meeting as soon as those things could get resolved in the committee substitute for SB 107.
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