Legislature(2001 - 2002)

02/28/2002 01:37 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
             SB 274-PHYSICIANS' LOCUM TENENS PERMITS                                                                        
CHAIRMAN BEN STEVENS called the Senate  Labor & Commerce Committee                                                            
meeting to  order at 1:37 p.m. and  announced SB 274 to  be up for                                                              
SENATOR OLSON,  sponsor of SB 274,  said he would  address version                                                              
F. Section  1 that  says a Member  of the  State Medical  Board or                                                              
its designee may grant a temporary  permit to practice medicine to                                                              
a  visiting  physician  or  osteopath   for  two  new  situations.                                                              
Subsection (a)(2) allows for the  temporary hire of a physician or                                                              
osteopath by  a licensed doctor for  the purpose of  valuation for                                                              
permanent  employment.  Subsection  (a)(3)  allows a  hospital  or                                                              
mental  health  facility  to  temporarily  fill  a  staff  vacancy                                                              
through a locum  tenens permit while seeking  permanent employment                                                              
of a licensed physician or osteopath.                                                                                           
Section 2  changes the initial duration  of a permit from  60 days                                                              
to 90 consecutive  days. It can  be extended for an  additional 60                                                              
days if the  permittee completes an application  for licensure and                                                              
pays  the associated  fee.  An individual's  exercise  of a  locum                                                              
tenens permit  is limited in the  aggregate to 240 days  in any 24                                                              
consecutive months.                                                                                                             
Section 3 allows the board to further  extend a permit if there is                                                              
a medical necessity to protect public health and safety.                                                                        
SENATOR TORGERSON asked if the Medical Board supported this.                                                                    
SENATOR  OLSON said  talks with  Jim  Jordan, Executive  Director,                                                              
Alaska  State  Medical  Association,  HESS,  API,  and  the  State                                                              
Medical Board have resulted in a consensus on section 2.                                                                        
SENATOR TORGERSON  moved to  adopt the CS  to SB 274,  Lauterbach.                                                              
There were no objections and it was so ordered.                                                                                 
MS. ANNE  HENRY, Division of Mental  Health, supported SB  274 and                                                              
said she would answer questions.                                                                                                
MS.  CATHERINE   REARDON,  Director,   Division  of   Occupational                                                              
Licensing, said  her division staffs  the Medical Board.  She said                                                              
the different parties  were able to get together  and almost reach                                                              
consensus on  this issue. The only  item in dispute at  this point                                                              
is section  3. The Medical  Board does not  want section 3  in the                                                              
law, but the other parties do want  it. It gives the Medical Board                                                              
the ability  to extend  locum tenens licenses  beyond the  90 days                                                              
(plus 60 more  days, if you apply  for a permit), if  the Board or                                                              
its designee determines  that the extension is  necessary in order                                                              
to  provide  essential  medical services  for  the  protection  of                                                              
public health and safety. The Board  maintained their objection to                                                              
section 3 because  they are uncomfortable with  open-ended amounts                                                              
of time in  which people can  continue working under a  locums and                                                              
section 3 leaves  it up to the Board's discretion,  but they don't                                                              
want it.  This is simply  a difference  in philosophy  between the                                                              
different parties.                                                                                                              
DR. ROBERT SCHULTZ  said he has been a psychiatrist  practicing in                                                              
Alaska for 16 years  and has had plenty of opportunity  to come up                                                              
against the circumstances  of unstaffed mental health  centers and                                                              
understaffing at API.  He felt very strongly that  improving their                                                              
staffing would greatly help the state.                                                                                          
He has  often seen people who  couldn't get into  the understaffed                                                              
hospitals end  up getting hospitalized  and getting  an outpatient                                                              
visit  as an  inpatient, which  costs the  state a  great deal  of                                                              
money. Also,  people having  access to staff  in a timely  fashion                                                              
means their medications  get adjusted and rearranged  so that they                                                              
don't need hospitalization. He supported SB 274.                                                                                
MR.  NICK  KLETTI,  Medical  Director,   API,  supported  SB  274,                                                              
including section 3. He said:                                                                                                   
     We are in  the fortunate position currently  of having a                                                                   
     full-time medical staff - all  of our doctors here being                                                                   
     full-time  employees,  but API  traditionally  has  gone                                                                   
     through  some  periods  where  it's  been  difficult  to                                                                   
     recruit doctors who come up  to Alaska first of all and,                                                                   
     secondly,   to   work   with  a   population   that   is                                                                   
     hospitalized  hereā€¦It  is  greatly   to  the  hospital's                                                                   
     advantage   to  have   full-time   psychiatrists  or   a                                                                   
     physician and  not to have  locum tenens. In  fact, it's                                                                   
     looked  at  by  regulatory   agencies  as  also  greatly                                                                   
     desirable to  have full-time physicians.  Unfortunately,                                                                   
     we're  put in the  position where  often when there  are                                                                   
     vacancies,  which many rural  states have, because  it's                                                                   
     difficult  to attract  physicians  to  rural states.  Of                                                                   
     either providing less than optimal  care using temporary                                                                   
     physicians or  having no care at all for  those patients                                                                   
     and given  that choice, I would  rather go with  a locum                                                                   
     tenens physician  - even in  an on-going fashion  - even                                                                   
     if  the license  has to  be renewed  because of  patient                                                                   
     care  concerns in  an on-going  way without  limitation.                                                                   
     With  Occupational  Licensing  overseeing  that  and  of                                                                   
     course all  the credentialing  matters a hospital  would                                                                   
     have to  go through  to make sure  a physician is  doing                                                                   
     her job  properly and  safely. But I  am in very  strong                                                                   
     support  of this bill.  I think  this will greatly  help                                                                   
     Alaskans and the health care here.                                                                                         
MS.  SUSAN HUMPHRY  BARNETT, Assistant  Administrator,  Providence                                                              
Health  System, supported  CSSB 274.  She  said Providence  Health                                                              
System runs  a community  mental health  center on Kodiak  Island.                                                              
They  have  had  fairly  continuous   coverage,  but  it  is  very                                                              
difficult to recruit  psychiatrists in rural Alaska  and there are                                                              
times when  there is  no recourse,  but to  use locum tenens.  She                                                              
understands  that the  Medical  Board opposes  section  3, but  it                                                              
really  needs  to  be  there,  because  if  you  can't  recruit  a                                                              
permanent  person,  you at  least  have  coverage for  people  who                                                              
really need this  type of care. Other specialties  have recruiting                                                              
difficulties - for  instance the Anchorage area has  a shortage of                                                              
internal   medicine   physicians   and  pediatric   surgeons   and                                                              
neurologists. She concluded saying  they very strongly support the                                                              
committee substitute.                                                                                                           
MR.  KARL SANDFORD,  Assistant Administrator,  Fairbanks  Memorial                                                              
Hospital, supported the CSSB 274,  particularly section 3. He said                                                              
it costs  a lot  of money  to bring  a locum  tenens physician  to                                                              
Alaska and  it is not  in our best  interest overall to  have that                                                              
turn over  every one or  two months.  "Therefore, I would  like to                                                              
have  the  opportunity, if  need  be,  to  extend a  locum  tenens                                                              
position if possible."                                                                                                          
MR. SANFORD  said there  is a national  shortage in many  areas of                                                              
physicians  and expecting  it to  be resolved  in a  two to  three                                                              
month period is unreasonable.                                                                                                   
CHAIRMAN STEVENS  asked Ms. Reardon  to explain what was  meant by                                                              
the Board's designee in section 3.                                                                                              
MS. REARDON explained that the Board  they could designate someone                                                              
to serve  this function. Generally,  the physician  they designate                                                              
is  the executive  administrator of  the Medical  Board, but  they                                                              
might decide to designate a single board member.                                                                                
CHAIRMAN STEVENS asked  if the board wanted to testify  or was she                                                              
delivering their position.                                                                                                      
MS. REARDON said she was delivering their position.                                                                             
SENATOR  LEMAN moved  to pass  CSSB 274(L&C)  from committee  with                                                              
individual recommendations.  There were  no objections and  it was                                                              
so ordered.                                                                                                                     

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