Legislature(2003 - 2004)

05/06/2004 03:12 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                                                                         
                       STANDING COMMITTEE                                                                                     
                          May 6, 2004                                                                                           
                           3:12 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Peggy Wilson, Chair                                                                                              
Representative Carl Gatto, Vice Chair                                                                                           
Representative John Coghill                                                                                                     
Representative Paul Seaton                                                                                                      
Representative Kelly Wolf                                                                                                       
Representative Sharon Cissna                                                                                                    
Representative Mary Kapsner                                                                                                     
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
HOUSE BILL NO. 434                                                                                                              
"An Act relating to the practice of naturopathic medicine; and                                                                  
providing for an effective date."                                                                                               
     FAILED TO MOVE OUT OF COMMITTEE                                                                                            
SENATE BILL NO. 306                                                                                                             
"An Act relating to the practice of naturopathic medicine; and                                                                  
providing for an effective date."                                                                                               
     SCHEDULED BUT NOT REFERRED                                                                                                 
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: HB 434                                                                                                                  
SHORT TITLE: NATUROPATHIC MEDICINE                                                                                              
SPONSOR(S): REPRESENTATIVE(S) HOLM                                                                                              
02/04/04       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/04/04       (H)       L&C, JUD                                                                                               
02/04/04       (H)       HES REFERRAL ADDED AFTER L&C                                                                           
02/18/04       (H)       L&C AT 3:15 PM CAPITOL 17                                                                              
02/18/04       (H)       Heard & Held <Assigned to Subcmte>                                                                     
02/18/04       (H)       MINUTE(L&C)                                                                                            
03/03/04       (H)       L&C AT 3:15 PM CAPITOL 17                                                                              
03/03/04       (H)       <Bill Hearing Postponed>                                                                               
03/24/04       (H)       L&C AT 3:15 PM CAPITOL 17                                                                              
03/24/04       (H)       Moved CSHB 434(L&C) Out of Committee                                                                   
03/24/04       (H)       MINUTE(L&C)                                                                                            
03/29/04       (H)       L&C RPT CS(L&C) 2DP 2NR 3AM                                                                            
03/29/04       (H)       DP: CRAWFORD, GUTTENBERG; NR: LYNN,                                                                    
03/29/04       (H)       DAHLSTROM; AM: GATTO, ROKEBERG,                                                                        
03/29/04       (H)       ANDERSON                                                                                               
04/13/04       (H)       HES AT 2:00 PM CAPITOL 106                                                                             
04/13/04       (H)       Heard & Held                                                                                           
04/13/04       (H)       MINUTE(HES)                                                                                            
04/27/04       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
04/27/04       (H)       Heard & Held                                                                                           
04/27/04       (H)       MINUTE(HES)                                                                                            
05/04/04       (H)       HES AT 2:30 PM CAPITOL 106                                                                             
05/04/04       (H)       Scheduled But Not Heard                                                                                
05/06/04       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
WITNESS REGISTER                                                                                                              
JASON HARMON, N.D.                                                                                                              
Alaska Association of Naturopaths                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified on HB 434 and answered questions                                                                 
from the members.                                                                                                               
Robert Urata, M.D.                                                                                                              
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 434 and                                                                      
answered question from the committee.                                                                                           
SHARON FISCHER, M.D.,                                                                                                           
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 434 and                                                                      
answered questions from the members.                                                                                            
JOY DO NEYHART, M.D.                                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 434 and                                                                      
answered questions from the committee.                                                                                          
KIM POOLE, Registered Pharmacist                                                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on HB 434, and answered questions                                                                
from the members.                                                                                                               
KATHERINE GRIESEL, Advanced Nurse Practitioner                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
DONALD LEHMANN, M.D.                                                                                                            
Sitka, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
JOHN TROXEL, M.D., Plastic Surgeon;                                                                                             
Member, Alaska State Medical Board                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 434 and                                                                      
answered questions from the members.                                                                                            
DOUGLAS EBY, M.D., Physician Executive                                                                                          
South Central Foundation                                                                                                        
Alaska Native Medical Center                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified on HB 434, and answered questions                                                                
from the committee.                                                                                                             
JOSEPH KLEJKA, M.D., Medical Director                                                                                           
Yukon-Kuskokwim Medical Center                                                                                                  
Bethel, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on HB 434.                                                                                       
ELIZABETH ROLL, M.D., Medical Staff President                                                                                   
Yukon-Kuskokwim Health Corporation                                                                                              
Bethel, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
CHARLES STEINER, M.D.                                                                                                           
Tanana Valley Clinic                                                                                                            
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified on HB 434.                                                                                       
DONALD IVES, M.D.                                                                                                               
Tanana Valley Clinic                                                                                                            
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
CLAY TRIPLEHORN, M.D.                                                                                                           
Tanana Valley Clinic                                                                                                            
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
ROSEMARY HEWITT                                                                                                                 
Cordova, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of HB 434.                                                                            
PATRICIA SENNER, Past President                                                                                                 
Alaska Nurses Association                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified on HB 434.                                                                                       
MEGAN LeMASTERS, M.D.                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
LYNN HORNBEIN, M.D.                                                                                                             
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 434.                                                                            
JANICE SHEUFELT, M.D., Medical Director                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on HB 434.                                                                                       
JAMES THOMPSON, M.D., Emergency Room Physician                                                                                  
Bartlett Regional Hospital                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
CAROLYN BROWN, M.D.                                                                                                             
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 434.                                                                         
TIMOTHY PETERSON, M.D., Emergency Room Physician                                                                                
Bartlett Regional Hospital                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 434, and                                                                     
answered questions from the members.                                                                                            
SCOTT LUPER, N.D.                                                                                                               
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified on HB 434 and answered questions                                                                 
from the committee.                                                                                                             
JASON HARMON, N.D.                                                                                                              
Alaska Association of Naturopaths                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 434 and answered                                                                
questions from the members.                                                                                                     
ALEX MALTER, M.D., President                                                                                                    
Alaska State Medical Association                                                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on  HB 434, and answered questions                                                               
from the members.                                                                                                               
ACTION NARRATIVE                                                                                                              
TAPE 04-41, SIDE A                                                                                                            
Number 0001                                                                                                                     
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:12  p.m.                                                               
Representatives Wilson, Wolf, Seaton,  and Cissna were present at                                                               
the call to  order.  Representatives Gatto,  Coghill, and Kapsner                                                               
arrived as the meeting was in progress.                                                                                         
CHAIR WILSON  announced for the record  that Representative Gatto                                                               
has joined the meeting.                                                                                                         
HB 434-NATUROPATHIC MEDICINE                                                                                                  
Number 0067                                                                                                                     
CHAIR WILSON announced  that the only order of  business would be                                                               
HOUSE  BILL  NO.  434,  "An  Act  relating  to  the  practice  of                                                               
naturopathic  medicine; and  providing  for  an effective  date."                                                               
She reminded the members that  the committee has previously heard                                                               
this bill, but a new version will be heard today.                                                                               
Number 0115                                                                                                                     
REPRESENTATIVE SEATON moved to  adopt CSHB 434(HES), 23-LS1574\W,                                                               
as  the  working  document.    There  being  no  objection,  CSHB
434(HES), version W, was before the committee.                                                                                  
CHAIR  WILSON explained  that the  differences between  this bill                                                               
and [SB 306] are that two  provisions were removed from the bill.                                                               
The provision which  said that medical doctors would  not be held                                                               
responsible was removed; and also,  the sunset provision has been                                                               
removed from the bill.  In  response to an unidentified person in                                                               
the audience's  question if minor  surgery is still in  the bill,                                                               
Chair Wilson responded that the  minor surgery provision has also                                                               
been removed.                                                                                                                   
CHAIR  WILSON  commented  that  there  has  been  some  confusion                                                               
related  to   definitions  of  naturopaths   versus  naturopathic                                                               
Number 0301                                                                                                                     
JASON HARMON, N.D., Alaska  Association of Naturopaths, testified                                                               
on  HB  434,  and  answered  questions  from  the  members.    He                                                               
explained  that currently  it  is unlawful  to  utilize the  term                                                               
"physician" in a  naturopath's title, so the  terms naturopath or                                                               
doctor of naturopathic medicine are  used.  In other states where                                                               
naturopaths  are  licensed  the term  naturopathic  physician  is                                                               
utilized in most of those states,  he said.  Dr. Harmon explained                                                               
that  in  Seattle,  Washington,  where  he  attended  school,  he                                                               
graduated as  a naturopathic physician.   The current  bill would                                                               
reflect the standards  as are addressed in other  states so those                                                               
who graduate with doctorate degrees  would be called naturopathic                                                               
physicians, he added.                                                                                                           
CHAIR WILSON  pointed out that  there are individuals who  take a                                                               
course  in naturopathy  and  hang  up a  shingle.    What is  the                                                               
difference between those folks and  those who are being addressed                                                               
in this bill, she asked.                                                                                                        
Number 0369                                                                                                                     
DR. HARMON  said that  he understands that  there is  concern for                                                               
those  who do  not have  an  undergraduate degree;  who have  not                                                               
attended  a  five-year  medical   school;  and  have  not  passed                                                               
Naturopathic  Physicians  Licensing  Examination  (NPLEX).    The                                                               
State  of Alaska  requires that  these exams  be passed  before a                                                               
doctor of  naturopathy can practice.   He emphasized that  it has                                                               
been that way since  the law was first passed 17  years ago.  Dr.                                                               
Harmon commented that the Division  of Occupational Licensing can                                                               
confirm what  he is  telling the committee.   Copies  of statutes                                                               
related  to  licensing of  naturopathic  doctors  have also  been                                                               
provided to the committee, he added.                                                                                            
Number 0455                                                                                                                     
CHAIR WILSON asked if HB 434 changes those statutes.                                                                            
DR. HARMON replied  that this bill does not  change the statutes.                                                               
It  clearly  states  that  an   individual  would  have  to  have                                                               
completed an undergraduate degree, graduated  from a four to five                                                               
year  medical university  for a  post-graduate  degree, and  then                                                               
pass the  NPLEX board exams in  order to apply for  a [license to                                                               
practice] naturopathy in the state of Alaska.                                                                                   
CHAIR  WILSON  announced  for   the  record  that  Representative                                                               
Kapsner has joined the meeting.                                                                                                 
Number 0504                                                                                                                     
REPRESENTATIVE SEATON  clarified that  this bill does  change the                                                               
current situation  in Alaska where  anyone can hang up  a shingle                                                               
as a  naturopath.  He pointed  out that if HB  434 passes doctors                                                               
of  naturopathy, naturopaths,  and naturopathic  physicians would                                                               
be reserved  terms and  could only  been used  by those  who have                                                               
gone through the Division of Occupational Licensing process.                                                                    
DR.  HARMON said  that  the current  bill  maintains the  current                                                               
standards  in  statute.   Since  1985  it  has been  unlawful  to                                                               
practice  naturopathy in  Alaska unless  the individual  has gone                                                               
through  an undergraduate  degree, four  to five  year accredited                                                               
naturopathic medical  school, and  passed the NPLEX  board exams.                                                               
He commented that he can see  how the committee could be confused                                                               
because  some  physicians  who   have  testified  have  told  the                                                               
committee  something  different.    Dr. Harmon  added  that  that                                                               
misunderstanding could have  been one of the  reasons for concern                                                               
among physicians also.   He acknowledged that  if individuals who                                                               
where not  educated at  the level  naturopathic doctors  are, and                                                               
were asking  for the ability to  practice as this bill  sets out,                                                               
there  would be  danger to  the public.   He  said he  hopes that                                                               
process clarifies that point.                                                                                                   
Number 0649                                                                                                                     
Robert  Urata,  M.D., testified  in  opposition  to HB  434,  and                                                               
answered  question from  the committee.   He  told the  committee                                                               
that he is a family physician  and has lived and worked in Juneau                                                               
since 1984.   Dr.  Urata shared  that he was  born and  raised in                                                               
Wrangell  and  graduated from  the  high  school in  Wrangell,  a                                                               
picture of which is on the  wall behind the members.  A beautiful                                                               
school, he commented.                                                                                                           
DR. URATA said he is here to  testify in opposition to HB 434 and                                                               
the [SB  306] which gives  naturopaths the authority to  do minor                                                               
surgery   and  prescribe   medicine.     He  commented   that  he                                                               
understands  that minor  surgery  is no  longer  included in  the                                                               
current  version of  the  bill.   Dr.  Urata  stated  that he  is                                                               
testifying in  opposition to  the bill  because he  believes this                                                               
will affect the safety of his fellow Alaskans.                                                                                  
DR. URATA shared  some experiences he has had  with patients here                                                               
in  Juneau.   One patient  who had  breast cancer  was undergoing                                                               
chemotherapy which caused a low white  blood cell count.  She was                                                               
also seeing  a naturopath  who was  not aware  of that,  he said.                                                               
The naturopath  was giving  the patient a  colonic to  remove her                                                               
body of  toxins.   These colonics  forced bacteria  that normally                                                               
live  in the  colon into  her bloodstream  which caused  a severe                                                               
infection call sepsis.  She  was hospitalized several days, where                                                               
she was  given IV medications to  get rid of the  infection.  Dr.                                                               
Urata  shared that  he has  now changed  his practice  and always                                                               
asks  his  cancer patients  if  he/she  is seeing  a  naturopath,                                                               
advises  patients  to  never  take a  colonic  when  receiving  a                                                               
therapy, and  advises patients not  to take treatments  and herbs                                                               
because  of   the  potential  for   drug  interaction   with  the                                                               
chemotherapy.  It  could make the chemotherapy  less effective or                                                               
more toxic, Dr. Urata explained.                                                                                                
Number 0781                                                                                                                     
DR. URATA  pointed out that  it is  now found that  Chinese herbs                                                               
can   cause  liver   damage.     This  experience   reflects  the                                                               
differences  in  ideas in  how  a  naturopath believes  the  body                                                               
works, and  how a medical  doctor believes the body  works, which                                                               
is based on medical training.                                                                                                   
DR. URATA  shared that  another problem  he has  experienced with                                                               
safety issues is related  to ineffective naturopathic treatments.                                                               
A common  example is the  drug Laetrile,  which was a  big cancer                                                               
treatment by  naturopaths a  few years  ago.   It has  since been                                                               
found to  be ineffective and toxic,  he said.  He  explained that                                                               
it builds  up cyanide and the  result is cyanide poisoning.   Dr.                                                               
Urata  told the  members that  he  believes his  patient who  had                                                               
stomach cancer  suffered and died  from cyanide poisoning.   What                                                               
occurred is  that the patient  would stop his medical  therapy to                                                               
go get Laetrile therapy, he said.   Unfortunately, he died on his                                                               
way from Mexico to Alaska.                                                                                                      
Number 0877                                                                                                                     
DR.  URATA said  that  this example  illustrates  a problem  with                                                               
naturopathic science.   When naturopaths do research  it does not                                                               
necessarily involve good scientific  methods which employ double-                                                               
blind studies  and also sometimes  using placebos.   Naturopathic                                                               
studies involve cases that have  been "successful."  There are no                                                               
long-term  double-blind studies,  so individuals  know what  they                                                               
getting and  what they  are not getting,  he explained.   Medical                                                               
research done  by naturopaths does  not follow the same  rules of                                                               
medical science  and he said  he believes  it can lead  to safety                                                               
issues, he reiterated.                                                                                                          
DR. URATA commented that naturopath's  diagnosis methods are also                                                               
different.   For example,  naturopaths use  electro-diagnosis and                                                               
hair analysis  to check mineral  levels [in  the body].   Some of                                                               
their diagnosis methods for chronic  yeast infections and toxemia                                                               
are also different.  Naturopaths'  theories of why diseases occur                                                               
include  things like  toxins  in the  body, so  they  like to  do                                                               
things  to clear  the  body  of toxins,  he  explained.   Medical                                                               
science has  developed theories over  the past  century including                                                               
germ  theory  and   genetic  theory  of  diseases.     Dr.  Urata                                                               
acknowledged that  there are also  toxins so in that  way medical                                                               
doctors' diagnosis  may be similar  to naturopathic doctors.   He                                                               
summarized  that medical  science  is  different, developed  over                                                               
many  years of  research, and  treatment by  a medical  doctor is                                                               
different than that of a naturopath.                                                                                            
Number 0950                                                                                                                     
DR.  URATA pointed  out that  medical  doctors train  differently                                                               
than naturopathic  doctors.  He  stated that medical  doctors are                                                               
exposed to much more rigorous  training with sick patients.  That                                                               
is true particularly in medical  hospital and medical centers, he                                                               
said.  Medical  doctors do four years of  pre-medical school, and                                                               
four years  of medical school.   In the  first or second  year of                                                               
medical  school students  are exposed  to sick  patients, and  it                                                               
gets more  intense until the  student is spending 100  percent of                                                               
his/her time  with sick  patients in  the hospital.   It  is then                                                               
required to do an internship  and residency which now blends into                                                               
what  is called  a residency.   The  shortest residency  is three                                                               
years  long.   Dr. Urata  shared  that during  the residency  the                                                               
doctor is  taking care of  patients with supervision  at multiple                                                               
levels.   For example,  a surgeon  takes at  least five  years of                                                               
this intensive training, he commented.   He told the members that                                                               
he  did three  years of  intensive  training to  become a  family                                                               
physician.   In Alaska medical  doctors are required to  have two                                                               
years of  an internship  in order  to get  a license  to practice                                                               
medicine,  to do  minor surgery,  and prescribe  medications, Dr.                                                               
Urata said.                                                                                                                     
Number 1053                                                                                                                     
DR.  URATA  reiterated  that naturopath  and  medical  physicians                                                               
approach  the human  body in  different ways.   Naturopaths  have                                                               
different  theories  of   diseases,  treatments,  and  diagnosis.                                                               
Physicians  have their  own which  has been  developed over  many                                                               
years  in  a very  scientific  way,  he  emphasized.   Dr.  Urata                                                               
commented that  it is  puzzling to him  that naturopaths  want to                                                               
expand  their scope  of practice  to include  medications without                                                               
the same education  and training that physicians  are required to                                                               
have.   In  addition, he  said he  believes that  naturopaths who                                                               
wish to  expand their  scope of practice  need to  accept medical                                                               
science's point  of view and  approach to  prescribe medications,                                                               
treatments, and diagnosis.  Dr. Urata  stated that if that is not                                                               
the case it  is his opinion that  it would not be safe.   He said                                                               
he  believes it  would work  better  for naturopaths  to stay  in                                                               
their own  arena and worked cooperatively  with physicians rather                                                               
than copying them.                                                                                                              
DR. URATA  pointed out that  there is  a model of  that happening                                                               
today.   The University of  Washington Cancer Center has  hired a                                                               
naturopath who works  on staff and who does research  on a lot of                                                               
the naturopathic  medications.   It is important  to have  a good                                                               
understanding  of  what  these  medications  do,  what  the  side                                                               
effects  are,  and  what  the  drug  interaction  might  be  with                                                               
medications  that  are  prescribed.    Dr.  Urata  said  that  he                                                               
believes that  may be  the direction of  the future;  however, he                                                               
does  not  support  giving naturopaths  the  power  to  prescribe                                                               
medications and  collaborate at this point.   It is too  early in                                                               
the development  of these two  different specialties.   Dr. Urata                                                               
stated that  he does not believe  it is right to  force the issue                                                               
because he believes it is unsafe.                                                                                               
Number 1158                                                                                                                     
REPRESENTATIVE  WOLF  asked  if  it is  normal  practice  to  ask                                                               
patients if they are taking anything for an illness.                                                                            
DR. URATA asked  if he is referring to the  example he posed with                                                               
the breast cancer patient.                                                                                                      
REPRESENTATIVE WOLF noted that the  patient did not inform him of                                                               
her actions.                                                                                                                    
DR. URATA replied that is correct,  she did not inform him and he                                                               
did not ask.                                                                                                                    
REPRESENTATIVE WOLF asked if it is fair to blame the naturopath.                                                                
DR.   URATA  questioned   that  his   example  was   blaming  the                                                               
naturopath.   He said he wonders  if the naturopath knew  that he                                                               
was giving  her chemotherapy.   Dr. Urata emphasized that  he was                                                               
not  blaming the  naturopath.   He said  he believes  naturopaths                                                               
have  a role  in caring  for patients,  just as  he accepts  that                                                               
chiropractors can help people with back pain.                                                                                   
DR.  URATA stated  that if  everyone  sticks to  what they  know,                                                               
everyone  should  be safe.    By  mixing  and matching  areas  of                                                               
expertise, philosophy,  and culture  there will  be trouble.   He                                                               
stated that  he does not  give Chinese  herbs or colonics  to his                                                               
patients because he does not  understand those practices.  By the                                                               
same token, why  would a naturopath want  to prescribe penicillin                                                               
to  patients, he  asked.    If a  naturopath  wants to  prescribe                                                               
medication  then  they  should  be  required  to  have  the  same                                                               
training that  medical doctors go  through, which is  seven years                                                               
of education and training after  college.  He commented that this                                                               
does not make sense to him.                                                                                                     
DR. URATA said  that he would be happy to  work with naturopaths,                                                               
but does  not want to work  in a collaborative arrangement  as is                                                               
provided in [SB 306].                                                                                                           
Number 1304                                                                                                                     
REPRESENTATIVE  SEATON  pointed out  that  surgery  is no  longer                                                               
included  in this  bill  and  that drugs  must  be prescribed  in                                                               
collaboration with  a medical doctor.   He acknowledged  that Dr.                                                               
Urata does not  want to work in a  collaborative arrangement with                                                               
naturopaths, but asked if he  wishes to prohibit other physicians                                                               
who might wish to have this kind of arrangement.                                                                                
Number 1337                                                                                                                     
DR.  URATA replied  that  there  is no  model  for  that kind  of                                                               
arrangement, and would  not want to see it become  legal until it                                                               
is determined  that it would work  well.  He acknowledge  that it                                                               
may be happening  in other states, but it would  be an experiment                                                               
in  Alaska.   He  offered that  doctors  have collaboration  with                                                               
nurses,  nurse  practitioners,  and physician's  assistants,  but                                                               
those  people are  trained very  similarly to  the way  a medical                                                               
doctor is trained.  There understanding  of how the body works is                                                               
very  similar,  he  commented.   For  example,  if  a  naturopath                                                               
determined that a patient has strep  throat, he would not be sure                                                               
how it was diagnosed.  Dr. Urata  said he would have to work with                                                               
a  naturopath  and understand  how  he/she  works and  develop  a                                                               
trust, but is not ready for that now.                                                                                           
REPRESENTATIVE SEATON  pointed out  that this legislation  has no                                                               
requirement  that  any  physician  would have  to  enter  into  a                                                               
collaborative  agreement.   He said  he does  not understand  one                                                               
physician saying he does not  trust another physician to exercise                                                               
his/her  responsibility in  forming  that  kind of  collaborative                                                               
DR.  URATA  said he  understands  what  Representative Seaton  is                                                               
saying.   He told  the members  that he  cannot answer  for other                                                               
doctors because  he has never  asked other physicians  about that                                                               
point.  Dr.  Urata emphasized that he is speaking  for himself in                                                               
answering these questions.                                                                                                      
Number 1431                                                                                                                     
REPRESENTATIVE CISSNA asked for  more information about the model                                                               
at the University of Washington Cancer Center.                                                                                  
DR. URATA  replied that he  does not know  how it is  being done.                                                               
He told  the members that  an oncologists and naturopath  came to                                                               
Alaska and gave  a lecture on upgrading cancer therapy.   He said                                                               
he  has not  heard anything  since and  is not  even sure  if the                                                               
naturopath is still there.  Dr.  Urata said he is very curious to                                                               
see how it goes as it could be the wave of the future.                                                                          
REPRESENTATIVE GATTO  asked if he practices  at Bartlett Regional                                                               
DR. URATA responded yes, that's correct.                                                                                        
REPRESENTATIVE GATTO asked if he also has his own office.                                                                       
DR. URATA said yes.                                                                                                             
Number 1486                                                                                                                     
REPRESENTATIVE GATTO  asked if  he has  a nurse  practitioner and                                                               
physician's assistant who operate within earshot of him.                                                                        
DR. URATA said yes.                                                                                                             
REPRESENTATIVE  GATTO surmised  that  it is  no  problem for  the                                                               
nurse  practitioner  and  the physician's  assistant  to  get  an                                                               
approval to write a prescription  because they are within earshot                                                               
of him.   He  asked if  he understands  correctly that  this bill                                                               
would  permit a  naturopath  to  be at  a  separate location  and                                                               
request  approval  for  a  prescription.    Representative  Gatto                                                               
questioned if that is the source  of Dr. Urata's problem with the                                                               
DR.  URATA acknowledged  that distance  may play  a role,  but in                                                               
Alaska where there  are a lot of rural areas,  and there are many                                                               
nurse  practitioners   practicing  in   rural  areas   without  a                                                               
physician onsite.   A physician is a phone call  away, and by law                                                               
chart reviews  are required to  ensure that the standard  of care                                                               
is maintained.   The relationship between a medical  doctor and a                                                               
naturopathic  doctor is  so far  apart because  the sciences  are                                                               
different, that he believes it would  be difficult to have a good                                                               
healthy  collaborative   relationship.     Dr.  Urata   told  the                                                               
committee that if the work  at the University of Washington works                                                               
and  other states'  collaborative  agreements work,  then in  the                                                               
future this may  be a good idea.   At this point he  said he does                                                               
not believe it is safe to do this.                                                                                              
Number 1624                                                                                                                     
CHAIR WILSON announced that due  to time constraints she would be                                                               
limiting testimony to three minutes.                                                                                            
SHARON  FISCHER, M.D.,  testified  in opposition  to  HB 434  and                                                               
answered questions from  the members.  She told  the members that                                                               
her  testimony  would focus  on  the  patient safety  issue  with                                                               
respect  to prescription  medications.   Dr.  Fischer  said as  a                                                               
physician she is aware that  prescribing medications is a complex                                                               
task.   Most have read  about the incidents of  medication errors                                                               
and  the potential  consequences  of these  errors which  include                                                               
things like allergic  reaction and in some cases death.   If that                                                               
happens  when  medications  are  prescribed  by  people  who  are                                                               
extensively trained  in prescription  medications then  those who                                                               
are not as well trained are  even more likely to make those sorts                                                               
of errors, she added.  Dr.  Fischer shared that what she believes                                                               
makes  a  good physician,  whether  a  naturopathic physician  or                                                               
medical    doctor,   is    appreciating   his/her    limitations,                                                               
understanding the  scope of  his/her practice,  and understanding                                                               
when something  is outside of  that scope.   She said  she thinks                                                               
that  prescription  of  medications   is  outside  the  scope  of                                                               
practice of  naturopathic physicians, and therefore,  the ability                                                               
to prescribe  should not  be granted  to them  because it  is too                                                               
much of a safety issue.                                                                                                         
Number 1720                                                                                                                     
REPRESENTATIVE SEATON  commented that  while Dr. Fischer  may not                                                               
want to have  a collaborative relationship with  a naturopath, if                                                               
a physician was comfortable  with that collaborative relationship                                                               
how would  it be different from  that of a nurse  practitioner or                                                               
physician's assistant [prescribing medications].                                                                                
DR. FISCHER clarified that a  nurse practitioner does not have to                                                               
have a collaborative  agreement with a physician in  the state of                                                               
Alaska; however, a  physician's assistant does.   She shared that                                                               
she  has been  in a  collaborative agreement  with a  physician's                                                               
assistant  and said  it  is difficult  to  provide the  oversight                                                               
because  of distance  and weather.    A lot  will happen  because                                                               
often  it   is  not   possible  to   give  oversight   for  every                                                               
prescription that is  written.  It would be less  of a concern if                                                               
the  collaborative  agreement  were  with  someone  in  the  same                                                               
office, she said.                                                                                                               
REPRESENTATIVE SEATON  asked if  a collaborative  agreement works                                                               
with a physician and a physician's  assistant that are not in the                                                               
same  locality,  why  wouldn't it  work  between  a  naturopathic                                                               
physician  and  a medical  doctor.    Perhaps, all  collaborative                                                               
agreements  between  doctors  and physician's  assistants  should                                                               
also be prohibited, he commented.                                                                                               
DR.  FISCHER responded  that  she  believes it  is  the scope  of                                                               
practice that  is the  issue.   It is fully  within the  scope of                                                               
practice for  a physician's assistant to  learn about prescribing                                                               
medications, infections,  blood pressure,  etc., but that  is not                                                               
within the scope  of practice for a naturopathic  physician.  She                                                               
emphasized that  is not  what naturopaths learn  in school.   The                                                               
training  in  pharmacology  is  more extensive  than  that  of  a                                                               
naturopathic physician.  Naturopath  school's focus is on natural                                                               
healing techniques,  not prescription  of medicines,  Dr. Fischer                                                               
REPRESENTATIVE  SEATON  asked  if  it  is true  that  it  is  the                                                               
physician's oversight  that allows that prescriptive  ability for                                                               
physician's assistants.                                                                                                         
Number 1844                                                                                                                     
DR. FISCHER  replied that is correct.   She said she  would argue                                                               
that  is okay  because the  physician's assistant  is trained  to                                                               
prescribe medicine.                                                                                                             
Number 1853                                                                                                                     
REPRESENTATIVE KAPSNER  asked how  different is  the naturopath's                                                               
education.    It is  not  like  someone  who  is educated  as  an                                                               
engineer  or   someone  with  completely   different  educational                                                               
background prescribing  medicine.   She pointed out  that medical                                                               
doctors  not  only  collaborate with  physician's  assistants  in                                                               
Alaska,  but also  with  health  aides.   In  Rural  Alaska if  a                                                               
community has a health aide it  is fortunate.  She said she knows                                                               
health  aides are  provided with  huge algorithms  and questioned                                                               
whether medical  doctors would be  required to  create algorithms                                                               
for naturopaths if this legislation were to pass.                                                                               
DR. FISCHER  said she believes that  is what would happen  if she                                                               
understands the  bill correctly.   In response to  an affirmative                                                               
answer by an unidentified person,  Dr. Fisher suggested that some                                                               
of her colleagues  might be better able to address  some of these                                                               
Number 1945                                                                                                                     
JOY  DO NEYHART,  M.D., testified  in  opposition to  HB 434  and                                                               
answered  questions from  the committee.   She  told the  members                                                               
that  she  is  a  pediatrician  in Juneau  and  agrees  with  her                                                               
colleagues  that have  testified in  opposition to  HB 434.   She                                                               
said she  is concerned that  expanding the scope of  practice for                                                               
these  health  care practitioners,  whom  are  less educated  and                                                               
trained, would not  enhance patient care, but could  very well be                                                               
unsafe for  those seeking  health care from  naturopaths.   To be                                                               
able   to  safely   and   effectively  prescribe   pharmaceutical                                                               
substances it  is essential  to be trained  in the  diagnosis and                                                               
treatment of  diseases.   Dr. Neyhart told  the members  that she                                                               
found  in  her  review  of several  curriculum  of  schools  that                                                               
educate individuals to become naturopaths  only one school listed                                                               
pharmacology  as a  course offering.   She  read a  definition of                                                               
naturopathy  that  was  published  by  one  of  the  colleges  as                                                               
     Naturopathy  is  a  system   of  therapy  that  employs                                                                    
     natural  forces such  as light,  heat, air,  water, and                                                                    
     massage.   This system differs most  significantly from                                                                    
     allopathy by  focusing on  building health  rather than                                                                    
     treating disease.  The  techniques used are noninvasive                                                                    
     and  may  include  foods, herbs,  fasting,  nutritional                                                                    
     supplements,    bodywork,   hydrotherapy,    forms   of                                                                    
     exercise, body movement and/or meditation.                                                                                 
DR.  NEYHART   said  that  given  that   definition,  prescribing                                                               
pharmaceutical  substances is  beyond  the scope  of practice  of                                                               
naturopathy.  As a physician  who has earned, through seven years                                                               
of  education  and  training,  the   privilege  to  diagnose  and                                                               
appropriately treat patients  who choose me as  their health care                                                               
provider, she urged the members not to approve this legislation.                                                                
REPRESENTATIVE GATTO  asked if  Dr. Neyhart  would oppose  any of                                                               
the remedies that she quoted in the definition of naturopathy.                                                                  
DR. NEYHART replied no.                                                                                                         
REPRESENTATIVE  GATTO asked  if she  would choose  to incorporate                                                               
them in her own practice.                                                                                                       
DR. NEYHART responded  that if she chose to learn  about them she                                                               
could incorporate them in her practice.                                                                                         
Number 2066                                                                                                                     
KIM  POOLE,  Registered  Pharmacist,  testified on  HB  434,  and                                                               
answered questions from  the members.  She told  the members that                                                               
she  has   a  lot  to  lose   no  matter  how  this   bill  goes.                                                               
Economically to allow naturopathic  physicians to prescribe would                                                               
boost business.  She commented that  there is a bill to take away                                                               
the privilege of collaborative agreements  with pharmacists.  Ms.                                                               
Poole  said she  has a  problem with  one group  being given  the                                                               
privilege  of  having a  collaborative  practice,  while her  own                                                               
profession is being called into  question.  She acknowledged that                                                               
she  believes naturopathic  and  allopathic  medications are  not                                                               
mutually exclusive, but not mutually  inclusive either.  For that                                                               
reason, she  opposes the  bill.   Ms. Poole  said that  drugs are                                                               
very  different than  herbs.   Homeopathic  medications are  very                                                               
different than the medications that  pharmacists go to school [to                                                               
learn  about].   To  be  an  entry-level  pharmacists it  is  now                                                               
necessary to  graduate with a  doctor of pharmacy degree  for six                                                               
years.   During  that  time  only medications  and  the body  are                                                               
learned,  not   the  diagnostic   skills  of  a   physician,  she                                                               
MS. POOLE  explained that for  many years the simple  practice of                                                               
homeopathy has been  to take a substance and dilute  it into very                                                               
small portions to get the body  to heal itself.  Medications that                                                               
pharmacists prescribe  do not  work like that  and many  are very                                                               
toxic and dangerous.   She told the members  that physicians make                                                               
errors in prescribing as well.   Ms. Poole said that she does not                                                               
believe the training  in homeopathic field is to  the level where                                                               
safety  of the  public can  be assured  and for  that reason  she                                                               
opposes HB  434.  She told  the members that she  agrees with Dr.                                                               
Urata's statement  that the future  may be in  collaborative work                                                               
with naturopaths,  but not yet.   In  summary she said  she would                                                               
not feel  comfortable filling  a prescription  that comes  from a                                                               
homeopathic physician.                                                                                                          
Number 2179                                                                                                                     
REPRESENTATIVE  GATTO  asked if  pharmacists  have  an option  to                                                               
refuse to  fill a prescription if  the doctor is not  someone the                                                               
pharmacist is comfortable with.                                                                                                 
MS. POOLE  replied yes.   If a  prescription is presented  that a                                                               
pharmacists does  not feel is good,  it will not be  filled.  She                                                               
told the members that she  has refused to fill prescriptions from                                                               
a licensed provider in Alaska.                                                                                                  
REPRESENTATIVE  GATTO  asked  Ms.  Poole what  she  says  to  the                                                               
MS. POOLE  responded that she  tells the  patient that it  is her                                                               
opinion  that the  prescription  would be  dangerous for  his/her                                                               
best interest.   She  said she  would explain  that she  needs to                                                               
talk with the  prescribing physician.  The patient is  free to go                                                               
elsewhere to get the prescription filled, however.                                                                              
REPRESENTATIVE GATTO asked where she works.                                                                                     
MS. POOLE responded that she works in the city of Juneau.                                                                       
Number 2221                                                                                                                     
REPRESENTATIVE   SEATON  clarified   that   this  bill   requires                                                               
collaboration with  an M.D.  and N.D.   He asked  Ms. Poole  if a                                                               
prescription  comes to  her  from a  health  aide or  physician's                                                               
assistant who works  with the oversight of a  medial doctor, does                                                               
she  view  the prescription  in  the  same way.    Representative                                                               
Seaton asked if she would have philosophical problem with that.                                                                 
MS.  POOLE replied  that she  would have  both a  philosophic and                                                               
ethical problem with  it.  However, she agreed that  the only way                                                               
to  provide  health   care  for  all  Alaskans  is   to  move  to                                                               
collaborative orders for many of  the health fields.  She pointed                                                               
out that Alaska  is too small a state, without  a medical school,                                                               
dental school,  pharmacy school, or  law school.  There  needs to                                                               
be  trained  professionals  in Bethel,  Wrangell,  Gustavus,  and                                                               
Petersburg.    It  is  almost impossible  to  sustain  a  medical                                                               
practice in  those areas, she said.   Ms. Poole told  the members                                                               
that if  there is  a health professional  who wishes  to dedicate                                                               
his/her time to  a community it is important to  allow him/her to                                                               
do that.   She asked the members  not to rush this  through.  Ms.                                                               
Poole suggested next year the  bill be reintroduced and more work                                                               
could be  done.  In that  case, she might speak  differently, she                                                               
Number 2310                                                                                                                     
KATHERINE  GRIESEL,  Advanced  Nurse Practitioner,  testified  in                                                               
opposition to HB 434.   She reiterated some statements by earlier                                                               
speakers by  saying that  she is  concerned that  naturopaths are                                                               
not trained  in the use  of conventional pharmaceuticals.   It is                                                               
important  for  the  committee  to  be  aware  that  there  is  a                                                               
difference between  a collaborative relationship  and supervisory                                                               
relationship,  she commented.   A  collaborative relationship  is                                                               
much looser.   The bill  refers to a  review at six  months, then                                                               
once a  year, she said.   This is much  loser that what  a health                                                               
aide has  with a supervising  physician in a medical  center such                                                               
as  Anchorage.   For example,  a health  aide at  Fort Wainwright                                                               
will speak  with the  supervising physician on  a daily  basis so                                                               
all his/her actions are closely monitored, she said.                                                                            
TAPE 04-41, SIDE B                                                                                                            
MS. GRIESEL  summarized that  there are only  four states  in the                                                               
country   that   allow   naturopaths  to   prescribe   controlled                                                               
substances.    Three of  those  four  states significantly  limit                                                               
which those  controlled substances  are, she  said.   Ms. Griesel                                                               
told  the  members  that Arizona  allows  naturopaths  to  widely                                                               
prescribe drugs  and has a  regulatory oversight board  in place.                                                               
If  this  bill is  passed  she  urged  the  members to  create  a                                                               
regulatory board.                                                                                                               
Number 2278                                                                                                                     
DONALD  LEHMANN, M.D.,  testified in  opposition to  HB 434.   He                                                               
told the  committee that he  has practiced in sports  medicine in                                                               
Fairbanks, Bethel,  and Sitka.   He  said he  believes HB  434 is                                                               
unnecessary, unsafe, and not in  the best interest of the welfare                                                               
of Alaskans.   Naturopaths prescribe  herbs, and do not  have the                                                               
training necessary to do what  medical doctors do, nor should the                                                               
legislature give  it to  them.   He said he  has listened  to the                                                               
discussions  concerning  collaborative  relationships  physicians                                                               
have  with  nurse   practitioners,  physician's  assistants,  and                                                               
health aides.   It is  important to  note that these  health care                                                               
professionals are all singing off the same page.                                                                                
DR. LEHMANN  commented that  naturopaths have  said that  a four-                                                               
year  undergraduate  degree  is  required for  admission  into  a                                                               
naturopathic  college; however,  the facts  speak otherwise.   He                                                               
told  the members  that  his  nephew is  currently  a first  year                                                               
student in naturopathy at Bastyr  University in Seattle.  That is                                                               
one  of the  premier naturopathic  schools in  the country.   His                                                               
nephew was accepted without a four-year degree, he said.                                                                        
DR.  LEHMANN  told the  members  that  his medical  training  has                                                               
reinforced his belief  in science and the  scientific methods and                                                               
the  value  of  double  blind studies.    Naturopathy  relies  on                                                               
antidotal reports.   If  naturopaths wish  to prescribe  drugs or                                                               
perform surgery  then he believes  they should be required  to go                                                               
to medical school.                                                                                                              
DR. LEHMANN  summarized that  it does  not make  sense to  have a                                                               
collaborative   relationship  with   naturopaths  because   their                                                               
training is  so different than  physician's assistants  and nurse                                                               
Number 2188                                                                                                                     
JOHN TROXEL, M.D., Plastic Surgeon;  Member, Alaska State Medical                                                               
Board, testified in  opposition to HB 434  and answered questions                                                               
from the  members.   He told  the members  that the  Alaska State                                                               
Medical Board discussed HB 434 and  sent a letter to the governor                                                               
in  which its  position on  the bill  was presented.   It  is the                                                               
Alaska State  Medical Board's position  not to support  this bill                                                               
because  of   the  training  of   naturopaths.    He   said  that                                                               
naturopaths are trained to rid the  body of toxins and the use of                                                               
natural medicines.                                                                                                              
DR.  TROXEL commented  that since  he is  a surgeon  he was  most                                                               
interested in  that element  of the  bill.   He told  the members                                                               
that  he  called  [Bastyr  University] in  Seattle,  one  of  the                                                               
largest naturopathic  medicine schools in the  country, and found                                                               
that neither its  students nor residents are trained  in any type                                                               
of surgical procedures.                                                                                                         
CHAIR  WILSON  advised  Dr.  Troxel that  there  is  a  committee                                                               
substitute  before  the committee  which  has  removed the  minor                                                               
surgical provision.                                                                                                             
DR.  TROXEL said  that the  last  he heard  there was  discussion                                                               
about collaborative  agreements with physicians and  asked if the                                                               
prescriptive  authority is  the basic  issue of  the bill  in its                                                               
current form.                                                                                                                   
CHAIR WILSON replied that is correct.                                                                                           
Number 2055                                                                                                                     
REPRESENTATIVE SEATON  explained that  the current  bill requires                                                               
an ongoing collaborative  agreement, not one that is  for a short                                                               
period  of   time,  between  medical   doctors  and   doctors  of                                                               
naturopathy.    The  bill  also  includes  a  requirement  for  a                                                               
formulary to be  part of that collaborative agreement.   There is                                                               
also  a requirement  that the  agreement be  in writing  with the                                                               
extent  of  supervision  required by  the  physician  delineated.                                                               
Representative Seaton clarified that  no physician is required to                                                               
enter into  this kind of  agreement.  With those  requirements in                                                               
place, he asked  if he trusts physicians to enter  into this kind                                                               
of  agreement   and  protect  themselves  with   respect  to  the                                                               
supervisory function that would be incurred.                                                                                    
DR.  TROXEL commented  that his  sense  is that  the board  would                                                               
probably  still  be  opposed  to  collaborative  agreements  with                                                               
naturopaths.   Speaking only for himself  he said if he  had been                                                               
asked  this question  a year  ago  he would  have considered  the                                                               
request pretty reasonable.   In the physician  community there 95                                                               
percent  of  the  medical doctors  are  in  mainstream  thinking;                                                               
however, there  probably are about  5 percent of  medical doctors                                                               
that are  outside the mainstream.   Dr. Troxel  acknowledged that                                                               
there   probably  are   doctors  who   would  enter   into  these                                                               
collaborative agreements,  but he said  he is not  convinced that                                                               
the collaborative  agreement would  guarantee that  good medicine                                                               
would be practiced.                                                                                                             
REPRESENTATIVE SEATON surmised that what  Dr. Troxel is saying is                                                               
that  if there  are  doctors  that cannot  be  trusted, then  the                                                               
collaborative agreements cannot be trusted either.                                                                              
DR. TROXEL responded  that it is a difficult  question to answer.                                                               
He  emphasized that  he is  not  saying there  are a  lot of  bad                                                               
doctors out there, there are not.   He explained that there could                                                               
be one physician  who would enter into  a collaborative agreement                                                               
who  is  not in  that  mainstream.   There  is  a  risk with  any                                                               
collaborative agreement, Dr. Troxel said.                                                                                       
Number 1873                                                                                                                     
DOUGLAS   EBY,   M.D.,   Physician   Executive,   South   Central                                                               
Foundation, Alaska  Native Medical  Center, testified on  HB 434,                                                               
and answered  questions from  the committee.   He  explained that                                                               
part  of the  reason  the foundation  has a  lot  of interest  is                                                               
because it has  worked on a great deal of  integrated health care                                                               
service delivery.   The Alaska Native Medical  Center now employs                                                               
allopath,   osteopaths,    chiropractors,   massage   therapists,                                                               
acupuncturists, and Native traditional  healers.  Naturopaths are                                                               
also  employed   under  contract  as  the   center  explores  how                                                               
naturopathy might fit  into the health care delivery  system.  He                                                               
read the following statement into the record:                                                                                   
     The Southcentral  Foundation is very interested  in the                                                                    
     integration    of   allopathic    and   other    health                                                                    
     professionals as  much as possible.   To this  point we                                                                    
     have  integrated   allopath,  osteopath,  chiropractic,                                                                    
     massage  therapy, acupuncture,  and Native  traditional                                                                    
     healers.   We employ  naturopaths to  incorporate their                                                                    
     skills and knowledge into the  system.  We feel they do                                                                    
     add to the additional value  to spectrum of services we                                                                    
     offer, but the details we  are still working out.  With                                                                    
     the  question regarding  prescriptive authority,  which                                                                    
     is  currently  under  discussion   and  debate,  we  at                                                                    
     present, do  not have a  position.   We think it  is an                                                                    
     important  conversation  and  one   that  we  are  very                                                                    
     interested in being  part of.  However, we  do not have                                                                    
     a position  yet and at present  we do not feel  that we                                                                    
     will be able to arrive  at one in the immediate future.                                                                    
     Our  request would  be  that we  opt  for any  decision                                                                    
     particularly around  prescriptive authority  be delayed                                                                    
     for a  number of  months to allow  for a  more thorough                                                                    
     evaluation  of the  various possible  options, and  for                                                                    
     the medical community and the  community at large to be                                                                    
     able to give more informed  input and have the time and                                                                    
     opportunity  to  have  an informed  debate.    We  look                                                                    
     forward to continue to participate in this process.                                                                        
DR.  ELY summarized  that Alaska  Native Medical  Center is  very                                                               
supportive of  integrated health  care.   The center  is becoming                                                               
recognized as one  of the national leaders  in funding integrated                                                               
health  care.   He said  that  prescriptive authority  is not  an                                                               
issue the  center has addressed  and said that he  believes there                                                               
needs to be more time to deal with this in an informed manner.                                                                  
Number 1713                                                                                                                     
CHAIR WILSON  asked Dr.  Ely to comment  on the  naturopaths that                                                               
have recently been hired at the Alaska Native Medical Center.                                                                   
DR. ELY  replied that two  naturopaths have recently  been hired.                                                               
One  has been  there  for six  months,  and it  has  been a  slow                                                               
process  to  determine how  the  naturopath  might fit  into  the                                                               
system effectively.   There has  been a significant shift  in the                                                               
way  the  center  is  operating.   There  is  a  more  systematic                                                               
approach to cost effective decisions  and quality health care, he                                                               
REPRESENTATIVE SEATON asked if he has  a copy of the most current                                                               
version of the bill that  removes the minor surgery provision and                                                               
also provides for an  on-going collaborative relationship between                                                               
medical doctors  and naturopaths, established formulary,  and the                                                               
extent of supervision  delineated in writing.  He  asked if those                                                               
provisions  were   what  he  was   testifying  on  or   only  the                                                               
prescriptive authority issue.                                                                                                   
DR. ELY said that  he has a copy of [SB 306],  which was given to                                                               
him  today and  assumes  it  is the  most  current  version.   He                                                               
commented  that more  oversight is  always  a good  idea for  any                                                               
profession.   It is the  prescriptive piece that needs  more time                                                               
and processing  before an  informed decision can  be made  by all                                                               
the people  weighing in  on the  conversation.   He said  that he                                                               
does applaud  having a physician  involved in the  oversight, but                                                               
it is very broad prescriptive authority.                                                                                        
REPRESENTATIVE KAPSNER asked Dr. Ely to  tell her how many of the                                                               
professions prescribe medicine at this point.                                                                                   
DR.  ELY  responded  that only  the  allopathic  and  osteopathic                                                               
doctors prescribe medicines.   He told the members  that there is                                                               
a  credentialing and  privileging  process by  which the  medical                                                               
center controls the scope of practice within the system.                                                                        
Number 1518                                                                                                                     
JOSEPH  KLEJKA, M.D.,  Medical  Director, Yukon-Kuskokwim  Health                                                               
Corporation,  testified on  HB 434.    He told  the members  that                                                               
their  main  concern is  about  prescriptive  authority.   It  is                                                               
important that more thought go into  this issue.  Dr. Klejka said                                                               
serious problems  could occur.   He  explained that  health aides                                                               
are trained  by physicians  to think  as they  do.   Health aides                                                               
work  under very  specific algorithms  which  spells out  exactly                                                               
what can and cannot be done;  if there is any variation, then the                                                               
health aide must  speak with the physician.  The  health aides do                                                               
speak with  the physician  every day, he  commented.   Dr. Klejka                                                               
said  he  would be  very  cautious  about providing  prescriptive                                                               
authority to naturopaths.                                                                                                       
Number 1447                                                                                                                     
ELIZABETH  ROLL, M.D.,  Medical Staff  President, Yukon-Kuskokwim                                                               
Health Corporation, testified in opposition  to HB 434.  She said                                                               
she  is  concerned  about  providing  prescriptive  authority  to                                                               
naturopaths at this  time.  When reviewing  education received by                                                               
naturopaths  it  does  appear  that  they  do  not  receive  much                                                               
pharmacology training.   There could  be serious side  effects by                                                               
prescribing  the  wrong  medication.   Dr.  Roll  encouraged  the                                                               
members not to vote in favor of this bill.                                                                                      
REPRESENTATIVE KAPSNER asked  if she could provide  copies of the                                                               
e-mails sent  her from Dr. Roll  and Dr. Klejka.   In response to                                                               
their affirmative response she thanked them.                                                                                    
CHARLES  STEINER,  M.D.,  Tanana   Valley  Clinic,  testified  in                                                               
opposition to HB  434.  He told the members  that there are three                                                               
doctors at  the clinic who  would like to  testify.  He  told the                                                               
members that  they share  the same  main point  and that  is that                                                               
naturopaths do  not have  the same  training as  medical doctors.                                                               
It  is  a  public  health   issue  because  the  opportunity  for                                                               
misadventure  are huge,  simply out  of ignorance.   Dr.  Steiner                                                               
summarized  that  he has  not  seen  or  heard of  anything  with                                                               
respect to training  of naturopaths that would  convince him that                                                               
they are  capable of managing medications  safely or effectively.                                                               
He urged the members not to support HB 434.                                                                                     
Number 1325                                                                                                                     
DONALD IVES, M.D., Tanana Valley  Clinic, testified in opposition                                                               
to HB 434.   He told the  members that his main  concern with the                                                               
bill is  related to public  health.  Once  prescriptive authority                                                               
is open there is  the ability to do great harm.   Dr. Ives shared                                                               
that he  has personally  cared for patients  who have  been under                                                               
naturopathic  care for  hypertension that  was poorly  controlled                                                               
and not  referred properly.   Some of  these patients  had kidney                                                               
failure.  He encouraged the members not to support HB 434.                                                                      
Number 1231                                                                                                                     
CLAY  TRIPLEHORN,  M.D.,  Tanana   Valley  Clinic,  testified  in                                                               
opposition to HB 434.  He told  the members he opposes HB 434 for                                                               
two reasons.   The current bill is similar to  one written in the                                                               
state  of Arizona  in  which  there was  a  board of  naturopaths                                                               
providing  oversight for  themselves.   Dr. Triplehorn  explained                                                               
that  what  happened  is that  naturopathic  physicians  actually                                                               
increased  the   scope  of  their  care   without  notifying  the                                                               
legislature  to get  authorization to  do  so.   There were  some                                                               
disastrous  consequences  of this.    Subsequently  the state  of                                                               
Arizona had  to significantly  modify the  scope of  practice for                                                               
the  naturopaths.   Dr.  Triplehorn told  the  members that  this                                                               
report could  be viewed  on the  Internet.  It  is the  [State of                                                               
Arizona, Office  of the Auditor General,  Naturopathic Physicians                                                             
Board of Medical  Examiners (June 2000, Report  No. 00-9)], which                                                             
requires   naturopaths  to   have  direct   observation  with   a                                                               
collaborating  physician and  substantially increases  the amount                                                               
of therapeutic training that naturopaths receive, he said.                                                                      
DR. TRIPLEHORN said he is  also concerned with statements made by                                                               
naturopaths that  their training is  equivalent or adequate.   He                                                               
said   he  would   dispute  that   statement.     The  state   of                                                               
Massachusetts  actually  reviewed  naturopaths  training  in  the                                                               
United States and the findings  were that naturopathic physicians                                                               
only received  about two-thirds  the amount  of material  that is                                                               
provided  to  traditionally   trained  osteopaths  or  allopathic                                                               
students.   As a  result the state  of Massachusetts  declined to                                                               
allow  naturopathic  physicians  to prescribe  medication.    Dr.                                                               
Triplehorn said  he agrees with  the comments made by  the family                                                               
practice physician who  spoke earlier.  Dr.  Triplehorn asked the                                                               
members  to  look  at  the  experience of  other  states,  as  he                                                               
believes they  will find  that Alaska would  be unusual  to allow                                                               
naturopaths to practice in the  state of Alaska with prescriptive                                                               
rights.    He encouraged  the  members  to look  at  naturopathic                                                               
training, as  he believes it  is substantially less than  what is                                                               
being represented.                                                                                                              
Number 0942                                                                                                                     
ROSEMARY HEWITT, testified in support of  HB 434, version W.  She                                                               
questioned  why physician's  assistants  can write  prescriptions                                                               
without adequate supervision and naturopaths cannot.                                                                            
Number 0893                                                                                                                     
PATRICIA  SENNER,  Past  President,  Alaska  Nurses  Association,                                                               
testified on HB  434.  She told the members  that the association                                                               
agrees  with  Dr. Eby's  comments  that  it  is important  to  be                                                               
deliberate and systematic in approaching  this issue.  The nurses                                                               
association   believes  there   are   four   criteria  that   the                                                               
legislature  should apply  to all  instances.   First, the  basic                                                               
education that the  health care provider receives  should be from                                                               
an accredited institution and cover  the areas that the providers                                                               
are  allowed to  practice.   Second, the  licensure/certification                                                               
exams that the  health care providers must pass  are conducted by                                                               
a  reputable entity  and cover  the  area in  which the  provider                                                               
wishes to  practice.   Third, the provider  should be  engaged in                                                               
continuing education  to ensure continued competency.   Fourth, a                                                               
regulatory  board  should  be   established  which  oversees  the                                                               
profession  and  ensures  that   complaints  by  the  public  are                                                               
addressed  and   that  individual   providers  can   seek  advice                                                               
concerning the change in scope of his/her practice.                                                                             
Number 0813                                                                                                                     
MS. HEWITT told the members  that she has some concerns regarding                                                               
the way the  collaborative model is set out in  this bill.  Under                                                               
this  bill  the  individual  physician that  is  supervising  the                                                               
naturopath  could decide  which medication  the naturopath  could                                                               
prescribe.   She  questioned how  the pharmacists  is suppose  to                                                               
know  what those  limitations are.   It  may be  a nightmare  for                                                               
pharmacists in  determining what  the individual's scope  is, Ms.                                                               
Hewitt added.                                                                                                                   
MS.  HEWITT shared  that another  concern  is that  the board  of                                                               
three  naturopaths will  overseeing  their own  profession.   She                                                               
said that  the association believes  there should always  be room                                                               
for  the  consumer  to  be involved  in  regulating  health  care                                                               
professions.  Since physicians have  a significant role in all of                                                               
this she  suggested that  perhaps the  oversight should  go under                                                               
the Alaska State Medical Board.                                                                                                 
MS. HEWITT  summarized that she  believes the  legislature should                                                               
take its time on this; address  some of these issues by involving                                                               
other health care  professionals, and come back  with a committee                                                               
substitute that protects the public next year.                                                                                  
Number 0740                                                                                                                     
MEGAN LeMASTERS,  M.D., testified in  opposition to HB 434.   She                                                               
told the  members that the  training received by  medical doctors                                                               
in  the field  of pharmacology  is  a 27-credit  course which  is                                                               
completed over  the course of  a year.   There is nothing  in any                                                               
naturopathic school that  comes close to that  level of training,                                                               
she said.   This  does not even  address the  additional training                                                               
medical  doctors  received in  residency.    Naturopaths have  no                                                               
residency  training,  only  clinical  trials  that  they  receive                                                               
during  their four  years of  medical  school.   She agreed  that                                                               
naturopathic medical  schools are  similar to medical  school for                                                               
M.D.s.   Dr. LeMasters shared that  she believes there is  a role                                                               
for naturopaths and was the  president of the integrated medicine                                                               
society at the medical school she attended.                                                                                     
DR.  LeMASTERS  acknowledged  that   Alaska  has  a  very  unique                                                               
situation with PAs being offsite  in remote situations.  She said                                                               
that actually  only about 10 percent  of what PAs do  is overseen                                                               
by a physician.  When physicians  come to review the paperwork it                                                               
is  usually a  quarterly  visit  to look  at  a  select group  of                                                               
charts.  Due  to the limitations in  care in Alaska it  has to be                                                               
done this way, she said.  If  the question is no care versus some                                                               
care it  is better  to have  a provider  with some  training, Dr.                                                               
LeMasters stated.                                                                                                               
DR. LeMASTERS  summarized her comments  by saying that  to spread                                                               
that collaboration even  thinner than it is  now would jeopardize                                                               
the safety of the public.                                                                                                       
Number 0570                                                                                                                     
LYNN HORNBEIN,  M.D., testified in support  of HB 434.   She read                                                               
the following statement into the record:                                                                                        
     I am a  board certified family physician  and have been                                                                    
     practicing mainstream  medicine in Anchorage  for about                                                                    
     14 years.   Over the  last three  to four years  I have                                                                    
     gotten to  know some of the  naturopathic physicians in                                                                    
     Anchorage   and   Eagle   River,  and   consider   them                                                                    
     colleagues in the care of  some of our mutual patients.                                                                    
     I gather  that some  of my allopathic  colleagues think                                                                    
     that  naturopathic  physicians  don't have  any  formal                                                                    
     training or  maybe got their training  through the mail                                                                    
     with a mail order degree.   The doctors or naturopathic                                                                    
     physicians  that I  know  are  graduates of  accredited                                                                    
     naturopathic  medical  schools.    I'm  not  sure  most                                                                    
     allopathic physicians  know what the course  content is                                                                    
     of a naturopathic medical education.   Before I went to                                                                    
     medical school  I was  considering going  to naturopath                                                                    
     medical school  so I researched  both of them  in great                                                                    
     detail.   My impression  was that  the training  in the                                                                    
     first two years  was very similar.   There were courses                                                                    
     in  radiology, lab  medicine,  and  pharmacology.   The                                                                    
     second two  years was  similar in  that there  were few                                                                    
     chances  to have  hands-on  experiences with  patients.                                                                    
     My training  was spent a  lot of time in  the hospital.                                                                    
     As  I  understand  it  naturopaths   do  all  of  their                                                                    
     training in an  out patient setting.   You are probably                                                                    
     wondering why  didn't I go  to naturopathic school.   I                                                                    
     decided  to attend  allopathic  medical  school at  the                                                                    
     University of  Washington so I  could pursue  a masters                                                                    
     in public health at the same time.                                                                                         
Number 0486                                                                                                                     
     Other  committees  have  heard  the  testimony  of  Dr.                                                                    
     Jensen  who  has  been  involved  in  the  training  of                                                                    
     osteopathic,  allopathic,  and naturopathic  physicians                                                                    
     for  many years.    I  heard him  speak  to the  Senate                                                                    
     Finance  Committee   and  he   pointed  out   that  the                                                                    
     pharmacology  courses that  are taught  in naturopathic                                                                    
     medical schools are taught by  Ph.D.s  in pharmacology.                                                                    
     Those are  the folks  that are trained  in conventional                                                                    
     allopathic pharmacology.   So it  seems to me  that the                                                                    
     basic knowledge  is the  same, how we  use it  later in                                                                    
     our   training  is   what  differs.     I   think  that                                                                    
     naturopathic physicians  are very adept at  using drugs                                                                    
     that  come  from  natural  sources  like  bio-identical                                                                    
     hormones, antibiotics, and  thyroid medications.  State                                                                    
     regulations  prevent  them  from  prescribing  them  to                                                                    
     their  patients.   I know  that and  have been  hearing                                                                    
     concerns that  naturopathic physicians  do not  have as                                                                    
     much training as allopathic physicians,  as they do not                                                                    
     do residency.   This is  true, but  I am not  sure that                                                                    
     that  necessarily  supports  disallowing them  to  have                                                                    
     prescriptive  rights.     Many   allopathic  physicians                                                                    
     actually  work with  and employ  physician's assistants                                                                    
     and nurse practitioners and they  do not have residency                                                                    
     training but do have prescriptive  rights.  As has been                                                                    
     discussed P.A.s  do have collaborative  agreements with                                                                    
     M.D.s and can practice independently.                                                                                      
     As  a  died-in-the-wool   allopathic  physician,  I  do                                                                    
     believe  in  the   scientific  process  and  practicing                                                                    
     evidence-based medicine, but  naturopathic physicians I                                                                    
     know do also practice  evidence-based medicine and they                                                                    
     keep up  with both  allopathic and  alternative medical                                                                    
     research.  They  have a clear vision of  their scope of                                                                    
     practice  and   know  when  to  refer   a  patient  for                                                                    
     allopathic  medical care.   I  have  heard some  horror                                                                    
     stories about harm to patients  by naturopaths.  I have                                                                    
     also  heard   some  horror  stories   about  allopathic                                                                    
     physicians.   I am not  aware of any  reliable evidence                                                                    
     based data that elucidates  whether patients are harmed                                                                    
     more often  by naturopathic physicians  than allopathic                                                                    
     physicians or any data  that suggests that naturopathic                                                                    
         physicians with prescriptive rights harm their                                                                         
    patients   more    frequently   than    do   allopathic                                                                     
DR. HORNBEIN  summarized her  comments by  saying that  there are                                                               
good reasons to  support HB 434 as it will  provide a possibility                                                               
of  oversight of  naturopathic medicine  and  will increase  more                                                               
primary care  available to  Alaskans.   It will  give naturopaths                                                               
the ability  to work  to the  full scope  of their  training, she                                                               
Number 0070                                                                                                                     
JANICE SHEUFELT, M.D., Medical Director,  SEARHC, testified on HB
434.  She told the members  that she is speaking in opposition to                                                               
HB 434 only on behalf of  herself.  Her specific objection is the                                                               
prescriptive authority  that would  be given to  naturopaths, she                                                               
said.    Much  of  the   discussion  has  been  on  collaborative                                                               
agreements.  Dr.  Sheufelt explained that she  believes the level                                                               
of collaborative  agreements that would ensure  patient safety in                                                               
Alaska would  have to  be for every  single prescription  for any                                                               
drug.  Without  that level of detail of oversight  there would be                                                               
a serious  risk of endangering  patient safety.  That  is clearly                                                               
not feasible.                                                                                                                   
DR. SHEUFELT summarized her comments  by saying that she does not                                                               
believe naturopathic  training covers a wide  scope of treatments                                                               
and she does not believe there  is adequate time in four years of                                                               
training to be adequately prepared to prescribe medications.                                                                    
Number 0023                                                                                                                     
JAMES  THOMPSON, M.D.,  testified in  opposition to  HB 434.   He                                                               
told  the members  that he  is an  emergency room  physician, has                                                               
worked with many health aides,  and has had over 25 collaborative                                                               
agreements in the  29 years he has been here.   Dr. Thompson said                                                               
he is  very concerned  about the  prescriptive authority  that is                                                               
provided for in this bill.   Collaborative agreements work not by                                                               
what is written  on a page, but how the  practitioner has learned                                                               
how  to  apply  it.    The practitioner  needs  to  know  his/her                                                               
limitations because  if they do  not it  does not matter  what is                                                               
written on the  paper, they can still make a  mistake.  He shared                                                               
that he  was on the  Alaska State  Medical Board for  eight years                                                               
and  has seen  instances where  there have  not be  tight quality                                                               
TAPE 04-42, SIDE A                                                                                                            
DR.  THOMPSON  explained the  process  of  recertification for  a                                                               
physician  and  noted  that  there   are  naturopaths  that  have                                                               
practiced in  Alaska for over 17  years.  He pointed  out if that                                                               
individual had a pharmacology class 17  years ago there is no way                                                               
that naturopath  is trained to  prescribe medicine today.   There                                                               
needs  to  be  some  kind  of mechanism  which  provides  for  an                                                               
internship with the collaborating  physician to ensure that there                                                               
is competency,  he suggested.   He said  it really does  not have                                                               
anything to do with training, but  really how it is applied.  Dr.                                                               
Thompson  summarized   that  he  believes  it   is  premature  to                                                               
authorize prescriptive authority and  should not be approved this                                                               
Number 0160                                                                                                                     
CAROLYN  BROWN, M.D.,  testified in  opposition to  HB 434.   She                                                               
told the  committee that she  is a practicing gynecologist.   She                                                               
came  to Alaska  in 1965  and  has spent  most of  her career  in                                                               
Alaska with  the exception  of 12  years when  she taught  at the                                                               
University of  Vermont School of  Medicine, she said.   Dr. Brown                                                               
shared  that  she  has  worked  with  health  aides,  physician's                                                               
assistants,  and advanced  nurse practitioners,  and that  in her                                                               
clinical experience she  has dealt in a collaborative  way with a                                                               
number  of naturopaths.   Dr.  Brown commented  that most  of the                                                               
naturopaths  she respects  highly and  believes that  there is  a                                                               
place for  naturopathy in  the care  of patients.   She  told the                                                               
committee  that while  she collaborated  with naturopaths  across                                                               
the years, she did not  interfere with their herbs and botanicals                                                               
and they  did not  interfere in allopathic  medicine.   Dr. Brown                                                               
stated  that she  would never  be comfortable  collaborating with                                                               
prescriptive authority  for naturopaths because they  do not have                                                               
the  same training  that  physicians have.    Physicians spend  a                                                               
great  deal  of  time  doing   intensive  inpatient  care,  while                                                               
naturopaths do not.                                                                                                             
Number 0254                                                                                                                     
DR. BROWN pointed to the section  of the bill related to services                                                               
excluded from  coverage [page  8, lines 21  and 22]  which states                                                               
that naturopaths  cannot provide  medical services to  persons in                                                               
the custody of the Department  of Corrections.  She questioned if                                                               
that is not discriminatory care.                                                                                                
DR.   BROWN   commented   that  she   sees   giving   naturopaths                                                               
prescriptive authority as a slippery  slope and urged the members                                                               
not to approve this bill.                                                                                                       
Number 0376                                                                                                                     
TIMOTHY PETERSON,  M.D., testified in  opposition to HB  434, and                                                               
answered questions  from the members.   He told the  members that                                                               
he  does  not  want  to  be  redundant,  but  keeps  hearing  the                                                               
discussion about education.  He shared  that he has a good friend                                                               
who is  a naturopathic  physician and they  have shared  notes of                                                               
their  training.     The   first  two   years  of   training  was                                                               
indistinguishable,  he  said.     At  that  point   there  was  a                                                               
divergence, where  he went into  the hospital and  started taking                                                               
care  of  sick people,  and  his  friend  went to  an  outpatient                                                               
setting.  In  comparing the training he said  he assumes everyone                                                               
went to college  and then there is a  naturopathic medical school                                                               
or  allopathic  medical  school,  but those  last  two  years  of                                                               
medical school and  three years of residency is a  period of time                                                               
when medical  doctors are  dealing with drugs  and patients  on a                                                               
daily basis.   During that  time medical doctors become  aware of                                                               
the many nuances of prescribing drugs.   Once a doctor has worked                                                               
in  that environment  a  healthy respect  is  developed when  bad                                                               
things happen and it is necessary to respond quickly, he said.                                                                  
DR.  PETERSON told  the  members that  he  has had  collaborative                                                               
agreements with midwives, health  aides, and nurse practitioners.                                                               
Dr. Peterson  pointed out that it  is most important to  know the                                                               
point  where  he/she  is  not   sure.    Representative  Seaton's                                                               
questions about collaborative agreements  was excellent, he said.                                                               
Any doctor  that is  willing can  have a  collaborative agreement                                                               
with  another person,  but the  difference  is that  in a  P.A.'s                                                               
training they work with the doctor.   They learn to work side-by-                                                               
side, as opposed to being an  independent entity where there is a                                                               
little  bit  of a  philosophical  disagreement  about how  things                                                               
should be done, he commented.                                                                                                   
Number 0603                                                                                                                     
DR. PETERSON  summarized that  the latitude  that is  being asked                                                               
for in  this legislation is huge.   Since Alaska does  not have a                                                               
medical school or  research facilities, he does  not believe this                                                               
is the place to try to  develop a program like this because there                                                               
is no way  to monitor what happens.  Dr.  Peterson said, however,                                                               
that he believes in the future it will happen.                                                                                  
DR. PETERSON explained  for example, that there is  a drug called                                                               
Celebrex that is used on a daily  basis that if used with a blood                                                               
thinner can  cause serious side effects.   Dr. Malter has  a copy                                                               
of a "PDR" that is very thick, he commented.                                                                                    
REPRESENTATIVE KAPSNER asked what a PDR is.                                                                                     
DR. PETERSON said a PDR is a physician's desk reference.                                                                        
Number 0699                                                                                                                     
SCOTT LUPER,  N.D., testified  on HB  434 and  answered questions                                                               
from the  committee.  He explained  that what is being  asked for                                                               
in HB  434 is not  new.  In  14 states that  license naturopathic                                                               
physicians  12 of  them have  some sort  of prescriptive  rights.                                                               
Only one of the 12 states  has a collaboration agreement; all the                                                               
others  have independent  formularies or  a broad  list of  drugs                                                               
that can  be prescribed, he added.   On a personal  note, he told                                                               
the committee  that he  was able to  write prescriptions  both in                                                               
Oregon and  Arizona.  He told  the members that he  only writes a                                                               
prescription once  every two  weeks because he  tends to  not use                                                               
drugs whenever possible.                                                                                                        
Number 0759                                                                                                                     
DR. LUPER  shared that in  Oregon and Arizona,  where naturopaths                                                               
have the broadest prescriptive rights  the safety record in those                                                               
states is  very good.   The mark  of safety in  this case  is the                                                               
number  of  disciplinary actions  that  have  been taken  against                                                               
doctors.   That includes letters of  reprimand all the way  up to                                                               
suspended licenses.   The rate in  Arizona is about half  of that                                                               
for N.D.s as it  is for M.D.s, he stated.  For  M.D.s it is about                                                               
one percent and for N.D.s it is  about .5 percent.  In Oregon the                                                               
rate is  better, the rate for  M.D.s is about .5  percent and for                                                               
N.D.s .3 percent.   Dr. Luper shared that the  rate of complaints                                                               
nationwide is about  one-third of a percent.   He emphasized that                                                               
N.D.s have been using prescription  medications for years safely.                                                               
The  reason  why prescriptions  are  being  used safely  is  that                                                               
naturopaths are well  trained and it is  a reasonable levelheaded                                                               
profession.   People  who become  naturopathic  doctors are  high                                                               
quality people with good strong backgrounds, he said.                                                                           
DR.  LUPER shared  his own  background.   He said  that he  got a                                                               
four-year  degree from  Portland State  University and  graduated                                                               
with honors  in history.   He then  taught school for  two years,                                                               
after which he went to  naturopathic school.  Dr. Luper commented                                                               
that he  could have  gone to medical  school, but  resonated with                                                               
the approach of  naturopathic medical school.  He went  on to say                                                               
that he  graduated from naturopathic  medical school  with honors                                                               
in  research.   The  area  of  research  that  he worked  on  was                                                               
hypothyroidism.   He told the members  that he knows a  lot about                                                               
thyroid disease.   In the state  of Alaska when someone  comes to                                                               
him  with  thyroid  disease,  he  can  diagnose  it,  but  cannot                                                               
prescribe medication  for it.   He shared that it  is frustrating                                                               
for his  patients to have  to go to  another doctor who  will run                                                               
the test  and say, "oh  yes, you do  have thyroid disease."   Dr.                                                               
Luper clarified  that it is  not that  he wants to  do everything                                                               
for everyone, it is that he  wants to give the best possible care                                                               
to  his patients.    He said  he is  here  testifying before  the                                                               
committee  because he  is frustrated  that he  has one  hand tied                                                               
behind his  back.   Dr. Luper  told the  members that  he doesn't                                                               
know  everything,  but  does  know his  limitations.    With  the                                                               
collaborative  agreement, which  provides  more  safety than  any                                                               
other state  with the exception  of California, the  patients are                                                               
well served.                                                                                                                    
DR. LUPER shared that for three  years he taught at the Southwest                                                               
College  of  Naturopathic  Medicine  where  he  was  chairman  of                                                               
diagnostics.  There were two M.D.s  and one D.O. on staff working                                                               
with them.   There  were two  M.D.s and  one D.O.  that presented                                                               
information at  a recent naturopathic  conference in Oregon.   It                                                               
was mentioned earlier  that one naturopath, Dr.  Dan Labriola, is                                                               
working with  oncologists in  Washington state.   The  quality of                                                               
people  and  the science  naturopaths  bring  can help  to  solve                                                               
problems, he said.  Dr. Luper  emphasize that he wants to provide                                                               
the best quality of care that he  can to his patients and that is                                                               
the  reason   why  he  is   asking  to  write   prescriptions  in                                                               
collaboration with medical doctors.                                                                                             
REPRESENTATIVE KAPSNER  asked Dr.  Luper if he  could collaborate                                                               
on every single prescription.                                                                                                   
DR. LUPER replied  yes, but it would  slow him down if  he had to                                                               
call every time  he wanted to do a prescription.   It is possible                                                               
he acknowledged.                                                                                                                
REPRESENTATIVE  KAPSNER commented  that he  said earlier  that he                                                               
does  not  like  to  prescribe  medication  and  only  prescribed                                                               
infrequently.     The   committee  heard   testimony  that   said                                                               
ultimately  that  would  be the  best-case  scenario  for  safety                                                               
DR. LUPER replied  that he believes it would  be more appropriate                                                               
to  create protocols.    For  example, if  someone  tests low  in                                                               
his/her  thyroid,  then you  prescribe  thyroid  medication.   If                                                               
someone  has a  bladder infection  then this  is the  appropriate                                                               
type of  antibiotic to use.   He added  that of course  a culture                                                               
and  sensitivity test  would  be done  which  would indicate  the                                                               
appropriate  antibiotic to  use.   With  protocols  in place  Dr.                                                               
Luper said he  believes it would be redundant  and unnecessary to                                                               
run every prescription  through an M.D.  That is  not to say that                                                               
if he  believes he is outside  of his area of  expertise, then he                                                               
would call someone  on the phone or refer the  patient to another                                                               
doctor.   Dr. Luper stated that  he is trained as  a primary care                                                               
physician and he knows his limitations.                                                                                         
Number 1052                                                                                                                     
REPRESENTATIVE  KAPSNER asked  Dr.  Luper if  he  believes it  is                                                               
appropriate to  limit what can  be prescribed or does  he believe                                                               
naturopaths should be able to prescribe everything.                                                                             
DR. LUPER responded  that he believes it is  appropriate to limit                                                               
the scope  of what  is prescribed.   There  should be  a rational                                                               
system that  takes into account  a physician's area  of expertise                                                               
or focus  of their practice.   He explained that he  believes the                                                               
best system would be one  in which the naturopathic physician and                                                               
the  collaborating  physician  sit  down and  create  a  list  of                                                               
medications  that is  appropriate for  that particular  practice.                                                               
It is  important for  the naturopathic physician  to make  a case                                                               
about wanting to use a particular kind of medication.                                                                           
Number 1097                                                                                                                     
REPRESENTATIVE KAPSNER asked  who would do the  oversight on that                                                               
kind of list.  It  sounds like an administrative nightmare trying                                                               
to  determine which  naturopath can  prescribe which  medication,                                                               
she commented.                                                                                                                  
DR. LUPER suggested that the  collaborative agreements be modeled                                                               
after  physician's   assistants  agreements.     He   added  that                                                               
naturopaths have much more  education that physician's assistants                                                               
and  nurse practitioners  and have  asked  for less  prescriptive                                                               
authority than  any of  the other profession.   Dr.  Luper shared                                                               
that  the  way he  envisions  it,  he will  send  a  list to  the                                                               
pharmacy  on what  drugs he  can prescribe,  and then  will write                                                               
prescriptions on rare occasions as he did in Arizona.                                                                           
REPRESENTATIVE KAPSNER  commented that  Dr. John  Troxel [Member,                                                               
Alaska  State  Medical   Board]  said  that  he   would  be  most                                                               
comfortable if this  legislation had more time to  go through the                                                               
system.  She  explained that one of the things  that concerns her                                                               
as a  public policy  issue is  that this  bill was  only recently                                                               
introduced  and it  is difficult  to push  legislation like  this                                                               
through  in  the  final  days of  the  session.    Representative                                                               
Kapsner  acknowledged that  a lot  of  energy has  gone into  the                                                               
legislation, but asked how Dr. Luper  would feel if it did not go                                                               
through this year.  She suggested  that it is worthy of seeing it                                                               
go through next session.                                                                                                        
Number 1199                                                                                                                     
DR. LUPER  replied that he  would be  disappointed.  He  said his                                                               
patients  would also  be disappointed  because  it would  require                                                               
them to go  to another doctor to get an  anti-biotic or estrogen.                                                               
He  said he  realizes  it is  a process,  and  the original  bill                                                               
requested prescription rights  and then as the  bill evolved more                                                               
and more  was negotiated away.   Dr.  Luper commented that  it is                                                               
now down  to the  thing we  care about the  most, the  ability to                                                               
provide the  best possible care  for our  patients.  He  told the                                                               
members  that  if  he  looses   the  ability  to  prescribe  some                                                               
medications, then  he looses  the ability to  help people  in the                                                               
best way he knows how.                                                                                                          
Number 1244                                                                                                                     
REPRESENTATIVE  CISSNA shared  that she  has been  through cancer                                                               
treatment this year.   She said when she looks  at the profession                                                               
of  naturopathy  she thinks  of  prevention;  the integration  of                                                               
ancient   knowledge,   and  the   way   to   keep  people   well.                                                               
Representative Cissna  stated that when she  thinks about disease                                                               
she wants the  latest knowledge.  She said she  thinks the health                                                               
system integration  is still in  its infancy;  there is a  lot to                                                               
learn; and it is okay if this process goes slower.                                                                              
Number 1389                                                                                                                     
DR. LUPER  responded that  his experience  with patients  is that                                                               
what works best is  for him to pay attention to  them, and to use                                                               
his  knowledge   and  experience  to  understand   the  patient's                                                               
particular problems.   As a naturopathic physician  he focuses on                                                               
the basic  foundations of health, diet,  circulation or exercise,                                                               
sleep, and purpose  in life.  Dr. Luper said  it is his abilities                                                               
to observe and understand, run  lab tests, and do physical exams,                                                               
which help  him to know patients  and that helps him  to find the                                                               
obstacles to  achieving health  on their own.   Everyone  has the                                                               
capacity to be  healthy, he said, it  is his job to  find what is                                                               
in the way.  Occasionally people  need a crutch.  For example, if                                                               
a  person twists  their ankle,  he/she may  need a  crutch for  a                                                               
while.  A naturopath's job at that  point is to find out what can                                                               
be done  with that ankle to  speed up the healing  so the patient                                                               
can throw the  crutch away.  Medications are a  crutch to used on                                                               
rare occasions  to assist  someone to manage  the symptoms.   Dr.                                                               
Luper  shared that  it  is in  that  way that  he  wishes to  use                                                               
prescriptions.  It  is an aide to buy time  while working to find                                                               
out what the real  problem is and solve the problem.   He said if                                                               
it  is  necessary to  spend  time  to  educate everyone  then  he                                                               
accepts that.   Dr. Luper said  he believes the time  is now, the                                                               
constraints  in this  bill ensure  Alaskans are  quite safe,  and                                                               
patients  are going  to  get better  care.   This  bill is  quite                                                               
appropriate today, he stated.                                                                                                   
Number 1510                                                                                                                     
JASON HARMON, N.D., Alaska  Association of Naturopaths, testified                                                               
in support  of HB  434 and answered  questions from  the members.                                                               
He told the members that he  is a fourth generation Alaskan, grew                                                               
up right  up the street from  the Capitol, and has  two beautiful                                                               
daughters.   Dr. Harmon  said he  understands the  perspective of                                                               
his  medical colleagues  who  are concerned  for  the welfare  of                                                               
Alaskans.   He commented that there  has been a lot  of testimony                                                               
against this  bill, and  many reasons to  vote against  this bill                                                               
have been  put forth.   He asked  the members to  understand that                                                               
for  example, his  education  included  an undergraduate  degree,                                                               
five years of  medical school at Bastyr  University in Washington                                                               
with  a degree  in biochemistry.   He  told the  members that  he                                                               
considers  himself a  scientist,  interested in  studies, and  he                                                               
does  not prescribe  natural remedies  that do  not have  science                                                               
based  substances.   He  does  not  do iridology  or  homeopathy.                                                               
There  are many  times  when  he has  to  require medication  for                                                               
patients.   Many times it  is not just  a case where  the patient                                                               
must be referred to another doctor  and it costs them more money,                                                               
it can be a life-threatening situation.                                                                                         
DR. HARMON commented  that he has heard some  testimony that says                                                               
naturopaths training  is not up  to par.   Much of what  has been                                                               
presented here  today is  actually incorrect, he  said.   He told                                                               
the committee  that naturopaths are well-trained  physicians.  He                                                               
commented  that  the term  "physician"  cannot  be used  in  this                                                               
state, but that is what naturopathic doctors are, he stated.                                                                    
Number 1628                                                                                                                     
DR. HARMON  responded to  Representative Cissna's  question about                                                               
the urgency  in pushing this  forward now.  Some  medical doctors                                                               
who  testified acknowledged  that there  is future  potential for                                                               
collaboration in these  areas, he said.  Dr. Harmon  said that he                                                               
believes  this bill  will encourage  collaboration.   The medical                                                               
community  does  not  have  to   move.    It  is  a  100-year-old                                                               
establishment.   Naturopaths  have  things to  offer the  medical                                                               
community through collaboration, and support.   What we offer can                                                               
help their patients.   Dr. Harmon told the members  that he has a                                                               
practice in  Anchorage and  works with many  M.D.s as  a referral                                                               
point.   He said these colleagues  work as a reference  point for                                                               
questions he  might have and  he works  as a reference  point for                                                               
them.   This  law not  only  protects Alaskans,  but also  offers                                                               
Alaskans  an opportunity  for health  care  that is  a very  high                                                               
standard of medicine.                                                                                                           
DR. HARMON commented that there may  be a perception that this is                                                               
being rushed  through, but  he suggested that  it is  not rushed.                                                               
For 18 years naturopaths have practiced in Alaska.                                                                              
Number 1697                                                                                                                     
DR. HARMON  told the members  that he works  collaboratively with                                                               
oncologists  in Anchorage.   In  response to  an earlier  comment                                                               
that  naturopaths  have  given Laetrile  to  their  patients,  he                                                               
stated that  to his knowledge  no naturopath has  ever prescribed                                                               
Laetrile  in this  state.   However,  it has  been prescribed  by                                                               
medical doctors.   He said  he has no  intention of using  a drug                                                               
that is in the  realm of an oncologists.  He said  his role is to                                                               
support those patients in any way he can.                                                                                       
DR. HARMON  shared one  point that had  not been  mentioned about                                                               
naturopaths'  training.   He told  the  members that  naturopaths                                                               
have externships of 1,000 hours.   Dr. Harmon urged the committee                                                               
to  support this  bill.    It will  bring  the medical  community                                                               
together through the collaborative provision, he emphasized.                                                                    
Number 1803                                                                                                                     
REPRESENTATIVE GATTO  commented that he  is sure that  Dr. Harmon                                                               
has heard the axiom "do no  harm.".  He commented that Dr. Harmon                                                               
said that  patients would be  unsafe if  the bill does  not pass.                                                               
Representative  Gatto stated  that he  does not  believe that  is                                                               
true.   At another hearing  Dr. Harmon  referred to himself  as a                                                               
naturopathic physician  and he  called him on  that at  the time.                                                               
That is a violation of a  statute.  Representative Gatto told the                                                               
committee  that these  issues  concern him  because  he gets  the                                                               
impression  that Dr.  Harmon wants  something and  wants it  now.                                                               
Representative Gatto  said he does  not believe that  a four-hour                                                               
conversation   with   naturopathic   doctors  and   a   30-minute                                                               
conversation with medical doctors that  a case has been made that                                                               
he could support.  In the  example of a patient with pneumonia it                                                               
seems it would be easy to  send the patient to the emergency room                                                               
or  a  medical  doctor.    If  naturopaths  are  only  writing  a                                                               
prescriptions  once in  two weeks  this is  not an  impediment to                                                               
their ability to practice medicine, he said.                                                                                    
DR.  HARMON  responded  that  he  does  not  recall  saying  that                                                               
patients would be "unsafe" and if  he did, he misspoke.  He posed                                                               
a hypothetical example  that it could be unsafe for  a patient in                                                               
a rural  setting that had  pneumonia, and  he had the  ability to                                                               
prescribe a drug for that patient,  but was unable to do so, that                                                               
would be  unsafe for that patient.   Dr. Harmon pointed  out that                                                               
it  depends on  the  setting.   He acknowledge  that  he has  the                                                               
luxury  in  Anchorage to  do  exactly  what Representative  Gatto                                                               
suggests which  is to send  patients to  the emergency room.   In                                                               
fact, that  is exactly what he  currently does.  There  are cases                                                               
in rural Alaska  where that is not an option,  he commented.  Dr.                                                               
Harmon said  that he  does not  see himself as  a "cowboy."   The                                                               
nature of naturopaths' medicine is to  first do no harm, but also                                                               
to choose the  least invasive therapy.  He emphasized  that if he                                                               
has the  option of using  something that is noninvasive  he would                                                               
use that first.                                                                                                                 
Number 1986                                                                                                                     
ALEX MALTER, M.D., President, Alaska  State  Medical Association,                                                               
testified on  HB 434,  and answered  questions from  the members.                                                               
He commented  that he has  already testified  on HB 434  and does                                                               
not  want  to reiterate  that  testimony.    He shared  that  the                                                               
medical  doctors  do   not  want  to  be   disrespectful  to  the                                                               
naturopaths, most respect them very  much, and think that they do                                                               
a  very good  job in  their scope  of practice.   The  concern is                                                               
centered on the  belief that the proposed expansion  of the scope                                                               
of  practice by  naturopaths  into a  sophisticated  area is  not                                                               
merited because  M.D.s do not  believe naturopaths  have adequate                                                               
DR. MALTER shared that he was  on faculty at the School of Public                                                               
Health at the University of  Washington before he came to Alaska.                                                               
He added that  he has an M.Ph. as  well as an M.D.   At one point                                                               
he brought in  the president of Bastyr University to  give two or                                                               
three  lectures  to a  course  he  was  teaching to  second  year                                                               
medical students so there could be  a clearer idea in how medical                                                               
doctors  and naturopaths  could interact.   He  said he  believes                                                               
that most  M.D.s are  comfortable with  naturopaths.   Infact, he                                                               
said he felt  comfortable enough to bring them into  the class to                                                               
help  raise awareness.   Dr.  Malter explained  that the  medical                                                               
community  is  still  uncomfortable with  naturopaths  broadening                                                               
their scope  of practice.  He  said he heard that  there was some                                                               
discussion about  limiting prescriptive  ability to  simply allow                                                               
anti-biotics and hormones.  Dr.  Malter stated that he would also                                                               
be  opposed to  that.   Even  though it  may  seem simplistic  to                                                               
prescribe anti-biotics  it really  can be a  complicated decision                                                               
in many cases.                                                                                                                  
DR. MALTER  referred to Dr.  Luper's statement  about prescribing                                                               
anti-biotics for a  urinary tract infection and  that culture and                                                               
sensitivity [tests]  should be done,  and explained  that current                                                               
guidelines  from  the  American  College  of  Physicians  say  no                                                               
culture and  sensitivity tests for  folks who have  urinary tract                                                               
infections should  be done.   He said he  does not mean  to imply                                                               
that  it is  criminal  to  do them  after  prescribing the  anti-                                                               
biotic,  his only  point in  mentioning this  is that  in general                                                               
M.D.s  do  not do  culture  and  sensitivity [tests]  to  further                                                               
define the  type of infection it  is.  He shared  another example                                                               
of a  misstatement and said the  important thing to note  is that                                                               
M.D.s' approach to medicine is based on science.                                                                                
DR. MALTER  commented on Dr.  Harmon's statement that he  went to                                                               
five  years  of  medical  school   at  Bastyr  University.    The                                                               
University  of  Washington is  a  medical  school; Oregon  Health                                                               
Sciences  University, where  he  went to  college,  is a  medical                                                               
school;  the  University  of Colorado,  Health  Sciences  Center,                                                               
where he did  his internship and residency, is  a medical school,                                                               
Bastyr University  is a naturopathic  school, Dr.  Malter stated.                                                               
He cautioned that  it is slippery slope when  referring to Bastyr                                                               
University as a medical school.                                                                                                 
Number 2124                                                                                                                     
REPRESENTATIVE GATTO asked  in the case of a patient  who came to                                                               
the  office  and  was diagnosed  with  hypothyroidism,  would  he                                                               
simply  prescribe  medication,  or  try  to  determine  how  that                                                               
condition came about.  Would  his approach be different than that                                                               
of a naturopath, he asked.                                                                                                      
DR. MALTER  responded that most  of the  well-trained naturopaths                                                               
would order  similar tests  that he  would order,  and ultimately                                                               
make the  same decisions that he  would make.  He  explained that                                                               
some of  the decisions are  not that  complex.  However,  he said                                                               
Dr.  Peterson  alluded to  something  important  to note  in  his                                                               
testimony,  and that  is if  a doctor  has not  seen some  of the                                                               
disasters  that can  happen when  prescribing  incorrectly, as  a                                                               
M.D. would  see during  residency, then  it is  possible to  be a                                                               
little cavalier  in the use  of medications.   Residency training                                                               
helps M.D.s be better physicians, he emphasized.                                                                                
Number 2170                                                                                                                     
REPRESENTATIVE SEATON referred to  materials that Dr. Malter gave                                                               
to the  committee on  training received in  a variety  of medical                                                               
schools  in which  there was  poor training  of naturopaths.   He                                                               
asked  if  Dr.  Malter  wants  to  correct  any  of  his  earlier                                                               
DR. MALTER  commented that Representative Seaton  is referring to                                                               
his  April   27th  testimony,  in  which   Representative  Seaton                                                               
believes  he misrepresented  naturopath  education and  training.                                                               
He admitted that he is not an expert in state law.                                                                              
REPRESENTATIVE  SEATON  interrupted Dr.  Malter  to  say that  he                                                               
wants it on  the record that the information  Dr. Malter provided                                                               
to the  committee at the  April 27th meeting was  on naturopathic                                                               
schools that  are not  accredited.   In order  to be  licensed in                                                               
Alaska  a  person  would  have to  graduate  from  an  accredited                                                               
naturopathic school, Representative Seaton emphasized.                                                                          
Number 2180                                                                                                                     
DR. MALTER agreed that is a fair point.                                                                                         
Number 2229                                                                                                                     
REPRESENTATIVE GATTO moved Conceptual Amendment 1.                                                                              
REPRESENTATIVE SEATON objected.                                                                                                 
REPRESENTATIVE GATTO explained that  Conceptual Amendment 1 would                                                               
remove sections of the bill dealing with prescriptive authority.                                                                
REPRESENTATIVE SEATON told the members  that he believes there is                                                               
good  language   in  HB  434  that   provides  for  collaborative                                                               
agreements in  prescribing drugs.   The bill  sets forth  that an                                                               
M.D. would  have to put  in writing a formulary,  procedures, the                                                               
amount  of supervision,  and reviews  that would  be part  of the                                                               
collaborative agreement.   Representative  Seaton said  that what                                                               
he thinks the members are dealing with is fear of bad doctors.                                                                  
TAPE 04-43, SIDE A                                                                                                            
[Due to technical difficulty recording  was not continued on tape                                                               
Number 0056                                                                                                                     
REPRESENTATIVE  KAPSNER  disagreed  with  Representative  Seaton.                                                               
She said  what she heard  is the concern about  collaboration and                                                               
the nature of  differences between the two professions.   One has                                                               
inpatient treatment,  the other outpatient treatment.   The other                                                               
difference mentioned  is that after  two years of  medical school                                                               
the  training is  very different.   Representative  Kapsner added                                                               
that  she  did  not  hear   any  concern  about  board  certified                                                               
physicians working  in Alaska.  Representative  Kapsner clarified                                                               
that her  comments are not  concerning the amendment,  but rather                                                               
the previous speaker's statements.                                                                                              
Number 0130                                                                                                                     
REPRESENTATIVE  WOLF  shared  that  his  wife  and  children  are                                                               
treated by a naturopath.  Dr.  Alan Kessler, a surgeon in Beverly                                                               
Hills, California, told him that  medical doctors are like anyone                                                               
else, very competitive.   He commented that the  medical world is                                                               
changing  and  it  is  difficult for  anyone  to  accept  change.                                                               
Representative Wolf said the naturopathic  world is new and it is                                                               
important to  keep an open mind.   He stated that  he opposes the                                                               
conceptual amendment.                                                                                                           
Number 0320                                                                                                                     
REPRESENTATIVE  SEATON clarified  that there  is nothing  in this                                                               
bill that  forces any  physician to  collaborate.   He emphasized                                                               
that the person  who has control is  the collaborating physician.                                                               
There appears to be a fear  that there will be many prescriptions                                                               
written  without any  supervision;  however, that  cannot be  the                                                               
case  since  the   supervision  is  outlined  in   writing  in  a                                                               
collaborative  agreement with  the  M.D.   Representative  Seaton                                                               
reiterated that he  does not understand how  anyone could believe                                                               
that there will be prescriptions written without oversight.                                                                     
REPRESENTATIVE  GATTO replied  that if  he were  a naturopath  he                                                               
would shop  for the best physician  to match his intentions.   He                                                               
said that  his intentions  would be to  get as  much prescriptive                                                               
drug rights  as possible with  the least amount of  opposition or                                                               
interference.     Representative  Gatto   commented  that   if  a                                                               
physician  were  assigned  to  a   naturopath  that  would  be  a                                                               
different story.   This bill  makes no  attempt to arrange  for a                                                               
board of physicians to assign  naturopaths and physicians.  It is                                                               
a free market.   In fact, all naturopaths  could collaborate with                                                               
a single physician under this bill.                                                                                             
CHAIR WILSON clarified that the bill  provides for a limit of six                                                               
collaborative agreements.                                                                                                       
REPRESENTATIVE GATTO  commented that the  members can see  how it                                                               
would be possible to defeat the intent of the bill.                                                                             
Number 0472                                                                                                                     
REPRESENTATIVE SEATON responded that  the entire argument that is                                                               
being made is  based upon the idea that naturopaths  are going to                                                               
want prescribe  many different drugs.   Naturopaths' entire focus                                                               
and training  in medicine  is based upon  whole body  medicine in                                                               
the least  invasive way.   This argument is in  direct opposition                                                               
to their discipline, he pointed out.                                                                                            
REPRESENTATIVE  CISSNA told  the members  that she  believes this                                                               
amendment is a  good idea.  The University of  Washington and the                                                               
Southcentral Foundation  are both currently working  on this very                                                               
issue.   She said she  believes it is  important to give  it time                                                               
and do it right.  The amendment would allow for that, she added.                                                                
Number 0640                                                                                                                     
REPRESENTATIVE COGHILL pointed  out that this is a  contract.  He                                                               
said  he believes  the  collaborative  agreement on  prescriptive                                                               
drugs should  stay in the  bill because  those who have  the most                                                               
experience are the ones who will be driving the issue.                                                                          
Number 0785                                                                                                                     
A roll call  vote was taken.  Representatives  Gatto, Cissna, and                                                               
Kapsner   voted    in   favor   of   Conceptual    Amendment   1.                                                               
Representatives Wolf,  Coghill, Seaton, and Wilson  voted against                                                               
it.  Therefore, Conceptual Amendment 1  failed to be adopted by a                                                               
vote of 3-4.                                                                                                                    
Number 0800                                                                                                                     
REPRESENTATIVE KAPSNER  moved Conceptual Amendment 2  which would                                                               
insert language that would require  that collaboration be done on                                                               
every single prescription.                                                                                                      
REPRESENTATIVE COGHILL objected.                                                                                                
REPRESENTATIVE GATTO commented that if  this is the initial stage                                                               
in  development  of  collaborative  agreements and  there  is  no                                                               
willingness to go  slow, then he said he  believes this amendment                                                               
would be important  to ensure no harm is done.   This legislation                                                               
is a major change in authority, he stated.                                                                                      
REPRESENTATIVE   SEATON  pointed   out  that   the  collaborative                                                               
agreement  as  it   is  set  out  is  to   develop  a  formulary,                                                               
procedures,  and  supervision.   This  amendment  basically  says                                                               
there will be  no formulary, but that every  prescription must be                                                               
called  in  to  the  medical  doctor  even  if  it  is  the  same                                                               
circumstance and the  same prescription that was  called in three                                                               
days earlier, he summarized.   Representative Seaton said he does                                                               
not see this benefiting the collaborative agreement process.                                                                    
REPRESENTATIVE COGHILL told  the members that one  of the reasons                                                               
he  felt comfortable  having the  collaborative agreement  in the                                                               
bill is  that it forces the  issue of having a  patient protocol.                                                               
It also establishes a formulary  in the arena that naturopath and                                                               
medical doctor will be working  on collaboratively.  He said that                                                               
if there is  going to be an interface between  two disciplines of                                                               
medicine then  there must  be agreement  on the  protocol between                                                               
them; not the legislature.                                                                                                      
Number 0928                                                                                                                     
REPRESENTATIVE  WOLF  said  that this  amendment  would  actually                                                               
define the contract.   He stated that he is  not comfortable with                                                               
REPRESENTATIVE KAPSNER  commented that  the members  are thinking                                                               
about a lot of issues right now.   She pointed out that the chair                                                               
is as close to a doctor as  anyone on the committee, and the Vice                                                               
Chair is  the next  closest to  a doctor.   She told  the members                                                               
that  she is  not  comfortable giving  prescriptive authority  to                                                               
naturopaths  since she  has  no background  in  medicine and  has                                                               
never even  been to a  medical board  meeting.  The  only medical                                                               
expertise  she has  is that  she's been  to a  doctor, she  said.                                                               
Representative  Kapsner  told the  members  that  when she  first                                                               
talked with naturopaths she did  not understand the issue at all.                                                               
She shared  that she believes  it would  be an abdication  of her                                                               
duty by  allowing individuals who do  not have the same  level of                                                               
medical   expertise  and   pharmacology  training   to  prescribe                                                               
REPRESENTATIVE  KAPSNER  said  that   perhaps  she  should  amend                                                               
Conceptual Amendment  2 to say that  naturopaths must collaborate                                                               
on every medication for a year.                                                                                                 
REPRESENTATIVE SEATON pointed out that  this is defining away the                                                               
authority  of  the medical  doctor  to  develop a  formulary  and                                                               
procedures.   What this  amendment says  is that  the legislature                                                               
does  not  trust  the  medical  doctor  and  naturopath  to  come                                                               
together  and collaborate  on these  points.   He summarized  his                                                               
comments by saying he opposes the amendment.                                                                                    
REPRESENTATIVE  KAPSNER   made  a  motion  to   amend  Conceptual                                                               
Amendment 2 to read as follows:                                                                                                 
     ...to collaborate for the first 10 prescriptions, with                                                                     
       monthly medical review of all prescriptions there                                                                        
Number 1136                                                                                                                     
REPRESENTATIVE COGHILL objected.  He  said he wants to review the                                                               
amendment after it is written up.                                                                                               
CHAIR WILSON  replied that  she believes  it can  be accomplished                                                               
with a  conceptual amendment.   Chair Wilson  restated Conceptual                                                               
Amendment 2 which  would say that naturopaths would  have to talk                                                               
with the  doctor for the first  10 prescriptions and then  have a                                                               
monthly review there after.                                                                                                     
A roll  call vote  was taken.   Representatives  Cissna, Kapsner,                                                               
Gatto,  and Wilson  voted  in favor  of  Conceptual Amendment  2.                                                               
Representatives  Wolf,  Coghill,  and Seaton  voted  against  it.                                                               
Therefore, Conceptual Amendment 2 was adopted by a vote of 4-3.                                                                 
Number 1236                                                                                                                     
REPRESENTATIVE  GATTO pointed  out that  there are  seven members                                                               
sitting on  the committee  making state  policy on  medical care,                                                               
and none  of the members are  [medical doctors].  He  pointed out                                                               
that one member returned to the  committee meeting who was out of                                                               
the room through  most of the debate and the  entire outcome of a                                                               
vote was  changed.  He said  he is appalled by  what has happened                                                               
in the  last three and a  half hours with respect  to this policy                                                               
decision.    Representative  Gatto  emphasized  that  this  is  a                                                               
horrible way to determine public policy.                                                                                        
REPRESENTATIVE KAPSNER  commented that  no insult is  intended to                                                               
the member.                                                                                                                     
REPRESENTATIVE  COGHILL said  he is  insulted and  will at  least                                                               
respond to what  has been said.  He acknowledged  that it is true                                                               
that the members are not  experts, this is a citizen legislature.                                                               
That is  true throughout this  room, halls, and building  he told                                                               
Representative Gatto.  If the members  are to be experts in every                                                               
field that  comes before us in  this body then he  suggested that                                                               
Representative  Gatto  quit  and  everyone else  along  side  him                                                               
should quit as well.  Legislators  are here on the citizen behest                                                               
to   look   at  the   principles   that   drive  public   policy.                                                               
Representative Coghill  rejected the notion that  members must be                                                               
experts in every  field in order to  make policy calls.   It is a                                                               
benefit when  someone is an  expert, but many times  experts come                                                               
before  us  in  testimony  that   have  an  agenda  that  it  not                                                               
principally  driven.   That  is  true  whether it  is  childcare,                                                               
speeding, or judiciary issues.  He  commented that he has been in                                                               
three  different  committees  with  the same  accusation  and  he                                                               
stated  he rejects  it.   Decisions are  made on  the floor  when                                                               
there are several bills per day,  and the members are not experts                                                               
on   those   issues,  but   are   making   those  policy   calls,                                                               
Representative Coghill pointed out.                                                                                             
REPRESENTATIVE COGHILL suggested that it  is a good idea to allow                                                               
collaborative agreements  by letting those involved  in different                                                               
areas of medical care work together.   By amending the bill there                                                               
is now a  bigger burden on the doctors, he  pointed out.  Without                                                               
this  amendment the  doctors could  have set  up a  protocol that                                                               
would have been more easily  and flexibly administered.  With the                                                               
passage  of this  amendment the  committee has  told the  doctors                                                               
what  to do  based  upon the  committee's  vote.   Representative                                                               
Coghill summarized  that when he  comes to the committee  he does                                                               
not do it with  the idea that he believes he is  an expert in all                                                               
Number 1384                                                                                                                     
CHAIR  WILSON  agreed  that  when   the  people  vote  for  their                                                               
legislators   it   is   done  with   the   knowledge   that   the                                                               
representatives are  not experts, just everyday  people trying to                                                               
do their best.                                                                                                                  
REPRESENTATIVE CISSNA  said it  is important  to note  that while                                                               
the representatives are human we need  to seek to do better.  She                                                               
commented that  she would like  to see this kind  of conversation                                                               
take place  at a  time when  it is  not the  closing days  of the                                                               
legislature.  The members are all  dealing with so many things it                                                               
is easy  to get  frustrated, but  it is  also important  to spend                                                               
time on issues this important, Representative Cissna stated.                                                                    
Number 1424                                                                                                                     
REPRESENTATIVE COGHILL  responded that he  has seen this  bill in                                                               
various  versions  not  only  this  session,  but  also  previous                                                               
sessions.    The  policy  call  has  been  discussed  before,  he                                                               
CHAIR WILSON  said for the  record that it  is her wish  that the                                                               
two  groups, medical  doctors and  naturopaths, get  together and                                                               
discuss these issues because there is  a place in our society for                                                               
both.   Work together to build  the relationship so the  trust is                                                               
there, she  urged.  It is  very frustrating for the  committee to                                                               
sit here  listening to both  sides, not knowing whom  to believe.                                                               
She pointed out that in the  not too distant future there will be                                                               
a shortage  of doctors.   By the year  2010 Alaska will  be short                                                               
4,000  nurses.   That  being the  case, the  same  thing will  be                                                               
happening with doctors.  Chair  Wilson suggested the president of                                                               
the Alaska Medical  Association take this message  back and begin                                                               
the process.   She  said a first  good step would  be to  place a                                                               
naturopath on the board.                                                                                                        
Number 1567                                                                                                                     
REPRESENTATIVE  SEATON   moved  to  report  CSHB   434(HES),  23-                                                               
LS1574\W,  Mischel,  5/4/04,  out of  committee  with  individual                                                               
recommendations and the accompanying fiscal notes.                                                                              
CHAIR WILSON objected.   She commented that  there was discussion                                                               
about  limiting   prescriptive  authority  to   anti-biotics  and                                                               
hormones.  Does  anyone wish to offer an amendment.   There being                                                               
no response, she order a roll call vote.                                                                                        
A roll call  vote was taken.  Representatives  Wolf, Coghill, and                                                               
Seaton   voted   in   favor  of   CSHB   434(HES),   version   W.                                                               
Representatives Kapsner, Gatto, Cissna,  and Wilson voted against                                                               
it.   Therefore, CSHB 434(HES) failed  to be reported out  of the                                                               
House Health,  Education and  Social Services  Standing Committee                                                               
by a vote of 3-4.                                                                                                               
CHAIR  WILSON  urged  the  naturopaths  not  to  give  up.    She                                                               
reiterated  her wish  that naturopaths  and medical  doctors work                                                               
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 6:03 p.m.                                                                                                      

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