Legislature(2011 - 2012)BELTZ 105 (TSBldg)
02/16/2012 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB125 | |
| SB149 | |
| SB175 | |
| SB25 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 125 | TELECONFERENCED | |
| += | SB 149 | TELECONFERENCED | |
| *+ | SB 175 | TELECONFERENCED | |
| *+ | SB 25 | TELECONFERENCED | |
| *+ | SB 174 | TELECONFERENCED | |
SB 175-PRACTICE OF NATUROPATHY
1:40:47 PM
CHAIR EGAN announced SB 175 to be up for consideration.
SENATOR PASKVAN moved to bring CSSB 175(L&C), version \B, before
the committee [labeled 27-LS1230\B].
CHAIR EGAN objected for purposes of public testimony.
DANA OWEN, staff to the Senate Labor and Commerce Committee,
explained that the committee substitute (CS) inserts Senator
Giessel's amendment from the last hearing. The intent is to
bring statute in line with its original intent.
CHAIR EGAN asked where the amendment was located.
MR. OWEN replied in the second section of the bill.
SENATOR PASKVAN said his understanding is that section 2 returns
the practice to what has historically been done for the last 18
years.
MR. OWEN replied the intent of the amendment was to bring into
statutes the language that was originally covered in regulation.
However, Senator Giessel asked to have several words struck from
her original amendment and the final version of the amendment
that includes those changes.
SENATOR GIESSEL explained that the amendment, on page 2, line 1,
says, a "dietetic remedy" but in regulation it says "dietetic
substance". She changed "substance" to "remedy", but then all of
section (c), lines 3-13, were the amendment. She removed "or
other natural substance" that was in regulation because it
seemed to be a source of confusion.
SENATOR PASKVAN said removing that phrase doesn't change the
practice over the last 18 years.
SENATOR GIESSEL replied that was her discussion with Dr. Jasper
who felt it did not change the practice.
1:45:20 PM
At ease from 1:45:20 to 1:46:11 p.m.
1:46:11 PM
DR. CAROLYN BROWN, M.D., Douglas, said she practices clinical
obstetrics and gynecology, public health and preventive
medicine. Naturopaths have indicated that this measure is needed
because some pharmacies have recently refused to supply them
with natural or herbal medicines and that they are doing so
because of instructions from the Alaska Division of
Corporations, Business and Professional Licensing. That struck
her as a bit unusual and in the spirit of transparency and lack
of any stated documentation of facts or other data that she
could find, she thought it would be good to find just what the
nature of the problem is.
She said Senator McGuire indicated that SB 175, would not expand
the scope of practice, but rather protect the practice. She
asked what needs protection in statute that is not provided in
regulatory language that has an 18-year history.
DR. BROWN said of the thousands of biopharmaceuticals, many are
from concentrates and extracts for which the Food and Drug
Administration has authority and it would be very helpful to
know which specific drugs, medicines and pharmaceuticals the
naturopaths wish to have prescriptive authority for. Do they
want prescriptive authority for everything in the Physician Desk
Reference (PDR)? Almost everything in the PDR has at one time
been a natural drug. She said there is a lack of documentation
about why a change in statute or regulation is really needed.
1:53:23 PM
DR. BOB URATA, M.D., Juneau, testified against SB 175, because
it would expand the scope of practice of naturopathy by giving
them prescriptive authority for prescription drugs. Because it
isn't specific and could be interpreted broadly, they will be
able to prescribe penicillin and cephalosporin antibiotics which
are derived from fungus, streptomycin and genomycin,
tetracycline antibiotics and the macrolide antibiotic which come
from the actinomycetes fungus. He mentioned other FDA-controlled
medicines that could be prescribed by naturopathic doctors if
this passes, which is not the intent of this bill.
DR. URATA said some of his patients go to naturopaths and that
is fine with him, but he did have patient once on a strong
chemotherapy drug for cancer. During the time when his white
blood cell count was at its lowest he was getting colonics from
naturopathic doctor to reduce its side effects. This is a
dangerous procedure and unfortunately it caused a serious blood
infection called Sepsis, requiring the patient to get
hospitalized. He has done well, but ever since he asked patients
not to get colonics while they are on chemotherapy. Patient
safety must be the utmost concern in this bill. This means
doctors of any kind must practice within the scope of their
education, training and experience, and allowing naturopathic
doctors to prescribe prescription drugs controlled by the FDA is
a dangerous expansion of their scope of practice.
SENATOR PASKVAN said he understands that pharmacies have stopped
distributing products to naturopaths in a manner they had done
for the prior 18 years and asked if that was his understanding
as well.
DR. URATA replied that he wasn't familiar with that.
SENATOR GIESSEL asked if he was the person prescribing the
oncologic drug.
DR. URATA replied yes along with the oncologist; family practice
doctors work with closely with the specialist in order to
provide the care patients need rather than having to move out of
town away from their homes, friends and support.
SENATOR GIESSEL said access to care is the key.
DR. URATA agreed.
1:58:19 PM
DR. ELIZABETH ROLL, Bethel, said she is a family practice
physician and opposed SB 175. She said naturopathic doctors
should not be able to prescribe drugs that are regulated by the
FDA, because they have not had the training in them. She said
the intent of the bill is not to expand their scope of practice,
but that is exactly what it does. It doesn't clarify what drugs
they could and couldn't prescribe. She had seen several
instances where bad things had occurred.
SENATOR PASKVAN asked if she was aware that pharmacies stopped
distributing products they were distributing for the last 18
years.
DR. ROLL replied that she hadn't heard that.
2:01:01 PM
JENNIFER YOUNG, representing herself, Chugiak, said she is a
cardiac nurse and a patient of Dr. Daniel Young; she said she
sees the benefits of both allopathic and naturopathic medicine.
Often she thinks having both would make a patient's outcome
better than using just one of them. Naturopathic doctors in this
state have had rigorous training in order to serve their
patients, and she asked that they be allowed to use the tools of
their trade to give Alaskans health care choices. Without
putting this regulation into law their choices will become
severely limited.
She said she is married to Dr. Young who is a naturopath and had
been helped by naturopathic medicine. What bothers her is that
medical doctors don't have the training in natural substances
that naturopathic physicians do and that these are very helpful
and the choice of many people who need care. That choice should
not be taken away because of fear and bias.
2:03:24 PM
DANIEL YOUNG, N.D., said he had practiced in Eagle River for 17
years and supported SB 175. He said it is disturbing that
another profession can "just dictate" what another profession
does. He has 26 years of education and attended a naturopathic
medical school that is accredited by the Council of Naturopathic
Medical Education that is overseen by the U.S. Department of
Education. This is the same body that accredits allopathic and
osteopathic medical educations. There is no doubt that
naturopathic doctors are the experts in the practice of their
naturopathic medicine.
MR. YOUNG said naturopaths have practiced in Alaska for 26 years
and have an excellent safety record. The current statute is not
a good one, but they have made due. On several occasions over
the past few years they have tried to make it commensurate with
their education only to be stonewalled by the opposition that
disseminates misinformation based on opinion, bias, ignorance
and fear. This bill does nothing more than preserve the current
practice of naturopathic medicine in Alaska and allows the
thousands of patients they serve to continue their right to
choose their form of medicine.
Naturopaths practice from their heart a medicine that they
believe in and know will work and improve the lives of their
patients. Naturopathic medicine is safe and effective and
affordable. They do not wish to write for antiquated natural
substances such as penicillin or digitalis, quinine or some
anticancer medications because quite frankly they have better
things to offer.
2:06:11 PM
DR. JOSEPH ROTH, Valley Medical Center, said he is a family
doctor in Juneau. He said he was against SB 175 mainly because
the prescriptive substance wording is very ambiguous.
SENATOR PASKVAN asked if he was aware that pharmacies are not
distributing the products they had been distributing for the
last 18 years.
DR. ROTH replied that he was not aware of that, but wasn't
surprised. He knows from some of the committees he sits on at
the hospital that there are concerns about "creep" of what
naturopaths are starting to prescribe and that their level of
education isn't appropriate for, like digitalis and synthroid, a
thyroid medication.
SENATOR PASKVAN asked if he knew the source of the pushback.
DR. ROTH replied that he didn't, but one of his committees had
to review a complaint about a naturopath for using a substance;
he didn't know if it was from a group or an individual.
DR. LAWRENCE SMITH, M.D., Eagle River, said he had served as a
physician in the Army and for Alaska Native Health Care and
continues to serve in private practice in his community now. He
said he didn't hold any animosity toward those practicing
naturopathy, but he wanted to urge them to carefully consider
the wording of SB 175. The word "prescription" can mean many
things. It's generally considered an order or a request to
another party to respond by fulfilling that request. It can
range from a prescription for eye glasses to recommendations for
an exercise or wellness program.
DR. SMITH said he believed that the prescribing of drugs and
pharmaceutical preparations that require a prescription should
be limited to those whose training is designed for such a
practice and that allopathic training provides for the
prescribing of such medications. He didn't presume to have the
knowledge of naturopathic preparations to the same degree as
those trained in naturopathic medicine and makes no such claims
to his patients. Likewise, if individuals want to prescribe or
dispense prescription medications, they should attend medical
schools that confirm an M.D. or a D.O. degree.
He didn't think that "naturally derived substances" was
adequately defined as many drugs that require prescriptive
authority have their basis in naturally occurring substances. If
the FDA or the DEA requires a prescription to be written in
order for a substance to be dispensed, then this should be left
in the hands of those trained in allopathic medicine. Ultimately
their main concern should be for patient care. Patients make
many choices about where to receive care and limitations need to
exist on scope of practice and delivery of care for all levels
of health care providers.
He urged them to not blur the lines of distinction past the
point of safety for patients and said that limiting naturopaths
to natural substances is a step in the right direction.
2:12:15 PM
DR. MARY FOLAND, President, Alaska State Medical Association,
said she is a family practitioner and works at Primary Care
Associates in Anchorage. She said she is a past president of the
Alaska Academy of Family Physicians; both of those have the
health of Alaskans as their primary concern. She said not to
interpret the lack of calls and letters from physicians and
patients as disinterest in this bill that has the potential to
have tremendous and irreversible impact on patient safety. It is
not an issue of turf protection or competition.
DR. FOLAND said the stated goal of this bill to preserve the
status quo is not as straight forward as it seems, but its
language would actually expand the prescriptive privileges
beyond what is currently legal and to a nebulous limit. The
phrase "any natural substance" is vague and includes things that
were mentioned already. It would be helpful to have a "wish
list" of what naturopaths want to prescribe and then doctors
could evaluate and research each thing on that list
scientifically.
She has heard of vitamin B12, Vitamin C, saline and capsaicin in
certain percentages, and the general opinion of the doctors she
has talked to is that those would be fine. Medications listed by
the FDA as prescription drugs, which by definition require a
prescription by a licensed physician, would not be okay. It has
never been the intent of the State Medical Association or the
Academy of Family Physicians to restrict or shut down the
practices of naturopaths. They really want to clarify what
substances specifically can be used within an appropriate scope
of practice for future reference.
2:17:11 PM
SENATOR PASKVAN asked if she was aware that other natural
substances language had been removed.
DR. FOLAND replied yes; but there is still room for
clarification.
SENATOR PASKVAN asked if she was aware that pharmacists are not
distributing products as they have done over the last 18 years
with respect to naturopaths.
DR. FOLAND replied yes.
SENATOR PASKVAN asked what the reason is for pharmacies to stop
doing that.
DR. FOLAND replied when the Division of Corporations, Business
and Professional Licensing was looking into the issue, they
found prescriptive practices that made them uncomfortable.
SENATOR PASKVAN asked if she was saying the source of the
pharmacies ceasing to distribute products is the division.
DR. FOLAND replied that was her understanding.
SENATOR DAVIS asked her to expand on what the division did. They
had the information, and what did they do when they found out?
Did they tell her, or did they send letters out to stop the
practice?
DR. FOLAND replied that she just heard that in the last week's
testimony.
SENATOR DAVIS said they had asked the division and they denied
it and asked Dr. Foland if she had inside information.
DR. FOLAND replied that she didn't have inside information. She
just listened to the previous hearings on the bill.
SENATOR DAVIS said she understood that Dr. Foland was told there
was reason why the division had a concern and that something was
sent out. Therefore the prescriptions were not filled for
naturopaths.
DR. FOLAND said the only information she has is from listening
to testimony at the previous hearings.
2:20:20 PM
JIM JORDAN, Executive Director, Alaska State Medical
Association, said he hadn't seen the CS to SB 175, so he didn't
want to offer an opinion on it. But he did suggest defining
"prescription drug" using the definition found in FDA statutes
and regulations, because it would make their application more
consistent between the medical community and the pharmacies.
2:22:07 PM
SENATOR GIESSEL said the reference to prescription drug occurs
in things that a naturopath cannot do and the CS might assuage
some of his concerns.
MR. JORDAN responded that he also believed that the FDA
definitions would apply to other areas of drugs that do not need
prescriptive authority.
2:23:21 PM
AMY CHADWICK, N.D., Palmer, said a naturopath's
education is extensive in human anatomy, physiology, disease and
the use of natural medicine and all they are asking for is to
maintain the current standard of practice they have had for the
last 18 years, not expand their scope of practice. She remarked
that many of the examples of medications used here were
antiquated and wouldn't be used anyway by a responsible
physician.
2:24:28 PM
CHRISTIN COX, N.D., Juneau, said she has practiced safely in
Juneau for the last 10 years under the current statute and
regulations and they are just trying to move current regulations
into statute. None of the horror stories have come to pass for
the last 18 years, and she did not see why anything would change
from moving regulation language into statute.
MS. COX said she has served 564 patients in the City of Juneau
safely without any problems. It's frustrating that in a day when
people need access to safe, affordable, health care that they
are fighting to preserve their already limited scope of
practice. A Wall Street Journal article said that there will be
a shortage of 30,000 general practitioners in the U.S. in the
next couple of years. The reason there is a shortage is because
general medicine doesn't pay like specialties do. Naturopathic
doctors choose to be general practitioners, and they go into
this field knowing they will never make the kind of money that
medical doctors do, and they provide access to care that
patients don't otherwise have and oftentimes can't afford.
CHAIR EGAN closed public testimony saying he would hold this
bill until Tuesday.
SENATOR PASKVAN said he was willing to pass it today, but if
they wait until Tuesday, his focus would be on getting some
answers from the Division of Corporations. He said:
I'll make it even a little more focused. In other
words, my perception is that the pharmacies have
ceased distributing products to naturopaths as they
have done for the last 18 years. If the division
hasn't done anything to correct what appears to be a
wrong, then the question is how long do they do
nothing before they become an active participant in
that wrong. That's the first question, and then the
second question is how long can the division do
nothing before their plausible deniability erodes to
nothing. I want to have answers to those questions.
CHAIR EGAN said he wanted Mr. Habegar and Ms. Chambers back on
Tuesday to answer questions that have been brought up twice.
[SB 175 was held in committee.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| Sponsor Statement Senate Bill 25 Feb 2012.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| Sectional Analysis SB 25 version D.PDF |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| 101909_Draft_E_policies.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| 2010EnergyPathway8-12Press.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| 12-23-2011_Vol1_SoutheastAlaskaIRP.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| 2011AIDEAAnnualReport.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| RIRP Executive Summary.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| SB 25 Power Point Presentation S L&C.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 25 |
| SB 174 Sponsor Statement.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 174 |
| SB174 Sectional Analysis.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 174 |
| SB 174 Excerpt Report McDowell.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 174 |
| SB 174 Excerpt DOL Report.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 174 |
| SB174-DOLWD-CO-2-13-12.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 174 |
| SB 174 Legal Opinion 090211.pdf |
SL&C 2/16/2012 1:30:00 PM |
SB 174 |
| SB 175 list of medications, CW Jasper 021612.PDF |
SL&C 2/16/2012 1:30:00 PM |
SB 175 |