Legislature(2009 - 2010)BELTZ 105 (TSBldg)
02/09/2010 02:00 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB247 | |
| SB248 | |
| SB117 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 247 | TELECONFERENCED | |
| *+ | SB 248 | TELECONFERENCED | |
| *+ | SB 117 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 247-EXTENDING BOARD OF PHARMACY
2:05:54 PM
CHAIR PASKVAN announced SB 247 to be up for consideration.
JIM COLVER, staff to Senator Olson, sponsor of SB 247, said this
bill extends the Board of Pharmacy that will sunset on June 30,
2010. The fiscal note of $130,300 is to pay staff, board per
diem and transportation for three board meetings a year. The
Legislative Budget and Audit Division recently completed an
audit of the board and concluded that the termination date for
the Board of Pharmacy should be extended until June 30, 2018. He
noted that the termination date in SB 247 says June 30, 2015,
and he said the sponsor wanted the committee to amend that date
to align it with the audit recommendation of June 30, 2018.
2:08:17 PM
MR. COLVER said the audit also recommended that the department
should improve administrative support (for various small
accounting and staffing issues) and the department has responded
that it is dealing with those issues. Additionally, it
recommended that the board and staff need to work with the
Office of the Governor to improve recruitment of qualified board
applicants to ensure a full board.
He said SB 247 is supported by the Alaska Pharmacists
Association.
2:08:49 PM
SENATOR THOMAS joined the committee.
2:09:37 PM
PAT DAVIDSON, Division of Legislative Audit, Legislative Affairs
Agency, Alaska State Legislature, said she conducted an audit of
the Board of Pharmacy and recommended extending it to June 30,
2018, an eight-year extension as provided by law. The audit also
found that administrative support by the department was
insufficient for the board to get its work done; so this needs
some correction. She remarked that her audits have found this
issue as well as others exist with most of the other boards.
Another issue, Ms. Davidson said, is that the Office of the
Governor did not make timely appointments to the boards. These
boards are voluntary and take peoples' time, and if a board
doesn't have a full slate of members, that makes the other
members work harder, which, in turn, decreases their willingness
to be reappointed and makes it harder to get new members.
2:11:17 PM
The last was a technical issue, she said, that had to do with
collaborative protocols. She explained that typically one
doesn't go to a pharmacist to get an injection, but in certain
circumstances a pharmacist in association with a physician will
go through a collaborative protocol that allows the pharmacist
to dispense a flu shot, for instance. She explained that
regulations require that an written agreement between the
physician and the pharmacist and it has to be submitted to the
board. She found that those protocols were for one length of
time - one year, but the board allowed that protocol to exist
for two years. She recommended that the board limit itself to
approving those protocols for a time limited to what is reached
between the pharmacist and the physician.
CHAIR PASKVAN said he understands that the two requirements are
that the doctors review the decisions made by the pharmacists at
least once every three months and that the doctors would get the
patient records. He asked if those protocols were the ones
addressed in the audit.
MS. DAVIDSON answered yes. Regulations identify those things,
but the board wasn't necessarily following all those regulations
in approving the protocols.
CHAIR PASKVAN asked if some of the agreements were written for
periods of time longer than the doctor had committed to and if
that would result in the pharmacist dispensing flu shots beyond
the period of time the doctor had agreed to.
MS. DAVIDSON replied that she didn't see any evidence of the
protocols actually being enforced beyond the written agreement
between the pharmacist and the physician. However, in reviewing
those protocols the board should make sure that everything that
is required by regulation be written into the protocols and that
the board limits itself to adopting it for the timeframe that is
in the written agreement.
CHAIR PASKVAN asked her to more fully explain the cooperative
practice agreements.
MS. DAVIDSON responded that those agreements were required so
that the physician could review the decisions made by the
pharmacist at least once every three months and so patient
records could be provided to the physician. She found those were
not always specifically spelled out in the written agreement. In
regard to the timeframe, either the practitioner or the
pharmacist could be confused as to how long they would be
allowed; so to avoid those sorts of confusion, it is important
that the board go through the written cooperative agreement
process. And then limit their approval of that for the time
frame indicated in the written agreement.
2:15:58 PM
CHAIR PASKVAN asked if a template is followed for the protocols,
whether it's for flu shots or something else, that is board
approved and that regulations could be compared to.
MS. DAVIDSON replied there is no template established for those.
CHAIR PASKVAN asked if there is any reason they couldn't have a
template to make it easier to compare protocols with the
regulations.
MS. DAVIDSON said because the written agreements could cover a
wide range of what the practitioners and pharmacists are
comfortable in delegating, she didn't know if creating a
template would necessarily be beneficial. Practitioners would
probably change things to fit their individual circumstances.
2:18:13 PM
CHAIR PASKVAN found no questions on recommendation 1.
SENATOR MEYER commented that he had already heard SB 247 in the
Legislative Budget and Audit Committee and he was very familiar
with it.
CHAIR PASKVAN said recommendation 2 identified deficiencies and
the first one was errors in license statistics; he asked her to
more fully explain that.
MS. DAVIDSON responded that an annual report is prepared for
each of the boards to give an idea of its activities. It
identifies how many new licenses were issued, how many renewals
there were; some boards that have license by credentials versus
examination will break those out. They will also talk about non
licensing statistics like investigations and actions taken as a
result of investigations, for instance. She said that she would
talk about this recommendation a lot because she has found
different types of licensing statistics errors in different
boards. This is one of the things she saw when verifying
statistics that were included in annual reports.
CHAIR PASKVAN said a paragraph on page 8 addressed a key
administrative staff member that was both unqualified and
untrained. He asked how a key person could get that position.
MS. DAVIDSON deferred that answer to the department.
CHAIR PASKVAN asked if this board had more turnover than others.
MS. DAVIDSON replied that her experience with boards in general
is that they have a higher turnover rate because they are
relatively entry level positions and better opportunities are
available elsewhere.
CHAIR PASKVAN said language on page 8 says "may provide policy
makers with misleading information" and he wanted to know what
types of information that would be.
MS. DAVIDSON explained that goes back to the annual reports;
various boards have issues come up that may rise to a very high
level or may be dealt with at a board level. As an example, if
insufficient pharmacists were a concern, and if their statistics
were understated by 100 or 200 percent, a situation would be
created where someone who is relying on that information would
come to a bad conclusion. Or if someone was using the annual
reports to monitor numbers of physician assistants or EMTs for
the Medical Board, for instance, or to correlate the
relationship between the number of licensees and what the
university is doing, when you have bad statistics, you will get
bad policy information. What she was trying to express is that
these data get published and people will use it. She asserted
also, "It comes from a state agency; it should be good data."
CHAIR PASKVAN asked if misleading information extends to
budgeting issues and if turnover of key administrative staff
members was one of her concerns.
2:24:23 PM
MS. DAVIDSON replied that she didn't look at staffing in
particular; boards and commissions are financially self
supporting. Their conclusion with regards to the Board of
Pharmacy is that it has no financial deficits, because the
licensees themselves pay for those things.
2:25:18 PM
CHAIR PASKVAN asked if the fee that is being assessed isn't high
enough, would that indirectly affect being able to hire enough
people to do the work.
MS. DAVIDSON replied that she hadn't looked at staffing enough
to make any recommendations about it and maybe the department
would want to address it.
2:25:48 PM
CHAIR PASKVAN found no questions on recommendation 2 on page 8
and went to the last recommendation on page 9 and said the
number of vacancies that are identified goes to the core issue
of consumer protection and asked if she could add anything.
MS. DAVIDSON replied that it goes back to maintaining good
membership on the boards so that work can get done. You don't
want the occupational boards to be so focused on what is good
for the occupation. If the state is going to be involved in
regulating an occupation, there has to be a good public need for
it and that is where the public members, particularly, bring a
valuable perspective. So when it's a public member vacancy, not
only does everybody else have a bigger work load, but a
different point of view is missing from deliberations.
CHAIR PASKVAN asked if she has come across an "unwillingness or
uneasiness" with either the public or professional members of a
board about sitting on it because of APOC reporting
requirements.
MS. DAVIDSON answered that the members of the board that she
talks to are already appointed and they would already be over
that hurdle. But that might come up from people who decided not
to apply to serve on a board. That might be a good question for
the Governor's Office in terms of what sort of barriers they are
having in getting board members.
CHAIR PASKVAN asked if she has come across instances where there
just wasn't an applicant for a board position or where a
qualified applicant was just not being appointed.
MS. DAVIDSON replied that the audit just looked at how many
vacancies there were.
2:29:27 PM
SENATOR MEYER remarked that one member resigned because of a
direct financial interest in the health care industry. How big
of an issue is that? He said you would want people who have
knowledge of the pharmaceutical industry on the board. He then
asked how they determine whether or not a conflict of interest
is too great; is it a subjective call?
MS. DAVIDSON answered that the generic law for public members is
that they can't have a financial interest in that occupation.
However, this board in particular has a requirement in statute
that the public member cannot have direct financial interest in
the health care industry.
SENATOR MEYER asked how direct financial interest is defined. Is
owning stock in a hospital a health care interest?
MS. DAVIDSON answered that she didn't know the specific details
on this one. However, what happened to this public member is he
passed through when he was appointed, but then he changed jobs
once he was a board member and that created a conflict with the
statute. She explained that during the audit they ask public
members to certify that they meet the requirements and this
member was unwilling to do that.
2:31:45 PM
JENNIFER STRICKLER, Operations Manager, Division of
Corporations, Business and Professional Licensing, Department of
Commerce, Community and Economic Development (DCCED), said they
would probably hear recommendation 2 repeated for every sunset
audit report. She said unfortunately the division went through a
couple of "rough years" with an administrative officer who was
not "very accounting savvy" and he didn't educate himself. Since
he moved on, someone with an accounting background was hired.
Mistakes were corrected to such a degree that some of the boards
are now pleased with the budget reports they are getting.
MS. STRICKLER explained that the Board of Pharmacy, for example,
gets direct support from the licensing unit, but an
administrative unit handles all of the budgetary and accounting
information. The enforcement unit does enforcement. The problems
they ran into were in the administrative unit in the
Professional Licensing area. She recalled that Ms. Davidson
mentioned the entry level licensing examiners are range 13 and
while they had tried to get them reclassed higher, they hadn't
been successful. That is not where the issues lie, however; she
said it was with the group that provides the licensing
statistics to the administrative group. The problem came with
the former administrative officer she had just mentioned who
didn't educate himself about their accounting system. For
several years, although the writing on the wall, this person was
her peer and he was allowed to stay. She said it is a shame that
this problem had to get such a level before he moved on. The
report said that "known procedures were in place" and they were,
but they had been "thrown out" by this individual, which made
the problem worse. She has taken great strides to recreate the
procedures and to correct a lot of the mistakes.
CHAIR PASKVAN asked if some of the high turnover was a product
of the unqualified and untrained person.
MS. STRICKLER answered yes; she said there was great turnover in
the administrative and licensing staff; but turnover in the
licensing areas of all of the programs is because of the pay
level of that job class.
CHAIR PASKVAN asked if the fees being charged the professionals
are sufficient for members of the board to operate in a
responsible manner.
MS. STRICKLER answered yes; in fact, the fees will be lowered by
$100 across all categories that pay more than $200.
2:36:45 PM
CHAIR PASKVAN asked how the fee can be lowered and services can
still be adequately provided - focusing on the consumer
protection aspect.
MS. STRICKLER replied that because of posting errors in the cost
accounting system (direct and indirect costs of expenditures)
caused by the former employee she went back and compared that to
what is in the state's accounting system. She found a big
disparity; so everything was corrected and now matches the state
accounting system to date. Fortunately, this board had
accumulated a surplus which allows the fee to be lowered now.
CHAIR PASKVAN found no questions regarding recommendation 2.
2:37:54 PM
SENATOR THOMAS asked if this area is in good shape now.
MS. STRICKLER replied "yes."
2:38:21 PM
CHAIR PASKVAN went to the issue of policy makers receiving
misleading information and he wanted to know if he was asking
the right question.
MS. STRICKLER responded that any information he sees from the
boards to date will be accurate. The possible misleading
information would be incorrect licensing statistics - not from
the licensing staff that had accurate information - but from the
financial person it was submitted to in the division that
prepares the annual reports.
2:39:48 PM
CHAIR PASKVAN found no further questions on SB 247 and concluded
public testimony for the day. So SB 247 was held for further
work.
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