Legislature(2019 - 2020)BELTZ 105 (TSBldg)
02/18/2020 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 172 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 172-EXTENDING THE STATE MEDICAL BOARD
1:55:25 PM
CHAIR BISHOP reconvened the meeting and announced the
consideration of SENATE BILL NO. 172, "An Act extending the
termination date of the State Medical Board; and providing for
an effective date."
He noted that this was the first hearing and public testimony
would be heard.
1:55:54 PM
SENATOR DONNY OLSON, Alaska State Legislature, Juneau, Alaska,
sponsor of SB 172, stated that this bill extends the life of the
State Medical Board for five years. He explained that the board
is composed of physicians and lay people who review medical
license applications. This board safeguards the people of Alaska
by ensuring that these licensees are operating in a legal and
professional manner.
CHAIR BISHOP asked Ms. Curtis
1:57:47 PM
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
Alaska State Legislature, Juneau, Alaska, reviewed the sunset
audit for the State Medical Board. She directed attention to the
April 26, 2019 sunset audit of the Department of Commerce,
Community and Economic Development (DCCED), State Medical Board
that was in members' packets. She explained that the purpose of
a sunset audit is to determine whether a board or commission is
serving the public's interest and should be extended. She
paraphrased the following REPORT CONCLUSIONS:
The audit concluded the board served the public's
interest by effectively licensing physicians,
osteopaths, podiatrists, physician assistants, and
paramedics. The board monitored licensees and worked
to ensure only qualified individuals practiced in
Alaska. Furthermore, the board developed and adopted
certain regulatory changes to protect the public,
improve the licensing process, and improve the
delivery of services.
The audit also concluded the board did not serve the
public interest by inconsistently reporting board
license actions to the Federation of State Medical
Boards (FSMB). In addition, the board did not adopt
regulations to require licensees register in the
controlled substance prescription database and did not
adequately monitor licensees to ensure those with a
DEA number registered with the controlled substance
prescription database.
In accordance with AS 08.03.010(c)(13), the board is
scheduled to terminate on June 30, 2020. We recommend
the legislature extend the board's termination date to
June 30, 2025, which is three years less than the
eight year maximum allowed per statute. The reduced
extension is mainly due to the failure of the board to
consistently report license actions to the FSMB, adopt
regulations governing registration in the controlled
substance prescription database, and monitor
compliance with the registration requirement.
1:59:14 PM
MS. CURTIS directed attention to the Background Information
section of the audit that begins on page 5. She related that the
section explains the following:
Senate Bill 74, effective July 2017, required
occupational board licensees that prescribe controlled
substances to register with the controlled substance
prescription database maintained by the Board of
Pharmacy. The database is intended to reduce misuse,
abuse, and diversion of controlled substances.
Practitioners are required to check the database prior
to dispensing, prescribing, or administering
medications, with certain exclusions.
MS. CURTIS turned to Exhibit 2 on page 11 that shows that the
board issued about 1,600 new licenses from July 1, 2015 through
January 31, 2019. At the end of January 2019 there were 5,073
active licensees, which represents a nine percent increase
compared to the previous sunset audit in 2012.
She turned to Exhibit 3, Schedules of Revenues and Expenditures,
on page 14. It shows that at the end of FY18, the board had a
deficit of just over $800,000. The board responded to the
deficit by raising fees, which are listed in Exhibit 4 on page
15.
MS. CURTIS directed attention to the three recommendations for
improvements that begin on page 18.
Recommendation No. 1: The board should adopt
regulations to guide the process for registering with
the controlled substance prescription database.
The board did not adopt regulations to require
licensees with a Drug Enforcement Administration (DEA)
number register with the controlled substance
prescription database. Senate Bill 74, Section 60
included uncodified law that directed all boards that
licensed occupations with prescription authority to
adopt regulations to implement the law.
Rather than adopt regulatory guidance for registering,
the board expanded the regulatory definition of
unprofessional conduct to include licensees that do
not register. The board also implemented regulations
that require review of the controlled substance
prescription database prior to prescribing or
dispensing and added an opioid maximum daily dosage.
Board members did not consider the importance of
establishing regulations to guide in the process and
believed the regulatory changes that were made were
sufficient to satisfy the requirements of Senate Bill
74.
The database was intended to reduce misuse, abuse, and
diversion of controlled substances. The lack of
regulations regarding registration requirements
increases the risk that licensees will not register
which, in turn, limits the database's effectiveness.
As described in Recommendation No. 2, the audit found
a high degree of noncompliance with the registration
requirements.
We recommend the board adopt regulations to guide the
process for registering with the controlled substance
prescription database.
2:01:43 PM
Recommendation No. 2: The board should develop
procedures to ensure licensees with a DEA number
register in the controlled substance prescription
database.
Per AS 08.64.101(a)(7), effective July 2017, the board
must require a licensee who has a DEA registration
number to register with the controlled substance
prescription database. The audit reviewed 25 new
licenses (of which 19 had a DEA number) and 15 renewal
licenses (of which 13 had a DEA number). Auditors
noted that the application form for new licenses did
not require an applicant provide evidence of
registration with the controlled substance
prescription database.3 Division staff processed the
applications and the board approved the applications
without regard for whether or not the applicant
registered with the database. Auditors checked the
database and found that five of the 19 new license
applicants with a DEA number (26 percent) had not
registered four applicants were not listed in the
database and one was listed in the database with a
status of "pending."
Auditors noted that the renewal application was
revised in November 2018 to request applicants for
renewal licenses list their controlled substance
prescription database registration number. However,
applicants were permitted to list a status of
"pending," and division staff did not verify that a
licensee obtained a registration number at a later
date. Four of the 13 renewal applicants with a DEA
number (31 percent) had a status of "pending."
The board and DCBPL failed to comply with AS
08.64.101(a)(7) due to a lack of procedures and the
board's decision to allow licensees a grace period
before enforcing the new requirements. The law did not
provide for a grace period and had an effective date
of July 2017.
The controlled substance prescription database was
intended to reduce misuse, abuse, and diversion of
controlled substances. Incomplete information within
the database limits its effectiveness, which increases
the risk that controlled substances may be abused or
diverted.
We recommend the board develop procedures to ensure
licensees with a DEA number register with the
controlled substance prescription database.
2:02:15 PM
Recommendation No. 3: The board chair should work with
DCBPL's director to establish and implement procedures
to ensure board disciplinary actions are reported in
accordance with state law.
Of the 140 board disciplinary actions issued by the
State Medical Board between FY 16 and January 2019, 44
(31 percent) were not reported to the FSMB as required
by AS 08.64.335.
Alaska Statute 08.64.335 states:
The board shall promptly report to the Federation of
State Medical Boards for inclusion in the nationwide
disciplinary data bank license and permit refusals
under AS 08.64.240, actions taken by the board under
AS 08.64.331, and license and permit suspensions or
surrenders under AS 08.64.332 or 08.64.334.
The 44 disciplinary actions not reported to FSMB were
actions taken by the board under AS 08.64.331.
According to DCBPL management, staff misunderstood the
types of actions to be reported. Additionally, the
board and DCBPL lacked written procedures to ensure
the actions were correctly reported in a timely
manner.
The national data bank maintained by FSMB is designed
to restrict the ability of incompetent physicians to
move from state to state without disclosure or
discovery of a physician's damaging or incompetent
performance. DCBPL's failure to report disciplinary
actions increases the risk to public safety.
We recommend the board chair work with DCBPL's
director to establish and implement procedures to
ensure board disciplinary actions are reported in
accordance with state law.
2:03:11 PM
MS. CURTIS directed attention to the responses to the audit. On
page 31, the commissioner of the Department of Commerce,
Community and Economic Development (DCCED) stated that
corrective action had been taken in accordance with state law.
On page 33 the board chair, in response to Recommendation No. 1,
reiterated her belief that the statutes clearly require
licensees to register so regulations appear to be unnecessary.
She also stated that the Department of Law reviewed the
regulations the board created and found them to be sufficient.
The chair did say the board would consult the Department of Law
and take action that was deemed necessary.
In response to Recommendation No. 2 to develop procedures to
ensure that licensees register, the chair stated a procedure had
been created to ensure compliance. The chair further stated that
it was not the board's intention to grant a grace period to
comply with the law, only for enforcing the law.
The chair agreed with Recommendation No. 3 to implement
procedures that disciplinary actions are reported to the
national databases.
2:04:27 PM
CHAIR BISHOP asked if there were questions.
2:04:36 PM
SENATOR STEVENS asked if the normal extension was 8 years and
the audit recommendation was a 5-year extension.
MS. CURTIS answered yes.
SENATOR STEVENS asked if she believes these deficiencies will be
corrected in 5 years.
MS. CURTIS replied she hoped so but Legislative Audit did not
have a mechanism to check until the next sunset in 5 years.
SENATOR STEVENS asked if she thought a 3-year extension might be
better.
MS. CURTIS replied Legislative Audit will take a hard look at
the controlled substance database across all professions and the
degree of compliance when it conducts a sunset audit on the
Board of Pharmacy. She noted that pharmaceuticals was the reason
that the board received a 4-year extension on the last audit.
2:05:53 PM
SENATOR COSTELLO called the audit surprising. She asked if the
board or the physician would be liable if there was a death or
egregious outcome as a result of prescription drug abuse and it
turns out that the board wasn't doing due diligence in asking
people to report and hasn't written regulations.
CHAIR BISHOP said the Department of Law could answer that at the
next hearing. He expressed concern that there was a prescription
drug abuse epidemic and the board still was not in compliance
three years after Senate Bill 74 passed.
He asked Ms. Chambers to discuss the fiscal note.
2:08:25 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, explained that SB
172 was a sunset audit so there was no appropriation request for
FY21 because the board would go away if the board sunsets. The
costs in subsequent years reflect the cost of the medical board
itself. There was $30 thousand in travel for eight board members
and one staff to attend four board meetings per year. Services
fees for public noticing of board meetings, training and
conference fees, and per diem stipends for board members amounts
to $1,500 per year.
2:10:40 PM
CHAIR BISHOP thanked Ms. Chambers and opened public testimony.
2:11:05 PM
TIM OLSEN, Physician Assistant and Chair, State Medical Board,
Anchorage, Alaska, assured the committee that the findings and
recommendations in the audit would be addressed in a short
period of time.
2:12:15 PM
SENATOR STEVENS asked what he meant by a "short period of time."
MR. OLSEN answered that the inconsistency resulted from the lack
of clarity on the guidelines set forth for the board, but now
all the required regulations will be passed.
SENATOR STEVENS asked for a time certain.
MR. OLSEN replied there was a large turnover in state medical
board members which made it difficult to give a more specific
answer, but it would require just one telephonic meeting that
could take place in the next month.
CHAIR BISHOP listed the individuals available to answer
questions.
2:14:23 PM
CHAIR BISHOP said his office would work with members to find a
path forward and public testimony would remain open.
SENATOR OLSON said in closing that he anticipated that the board
would come together to address the problems the audit
highlighted.
CHAIR BISHOP held SB 172 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 172 Sponsor Statement.pdf |
SL&C 2/18/2020 1:30:00 PM SL&C 3/3/2020 1:30:00 PM |
SB 172 |
| SB172 DRAFT Fiscal Note DCCED CBPL 02-14-20.pdf |
SL&C 2/18/2020 1:30:00 PM SL&C 3/3/2020 1:30:00 PM |
SB 172 |
| Audit of DCCED State Medical Board w responses.pdf |
SL&C 2/18/2020 1:30:00 PM SL&C 3/3/2020 1:30:00 PM |
SB 172 |
| L&C Optometry Examiners Steffes #1.pdf |
SL&C 2/18/2020 1:30:00 PM |
Confirmations |
| L&C Professional Counselors Vinson #1.pdf |
SL&C 2/18/2020 1:30:00 PM |
Confirmations |
| L&C Workers Compensation Board Williams #1.pdf |
SL&C 2/18/2020 1:30:00 PM |
Confirmations |
| L&C Workers Compensation Appeal Ford #1.pdf |
SL&C 2/18/2020 1:30:00 PM |
Confirmations |
| L&C Workers Compensation Appeal Steele #1.pdf |
SL&C 2/18/2020 1:30:00 PM |
Confirmations |