02/27/2020 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB189 | |
| HB242 | |
| HB184 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 242 | TELECONFERENCED | |
| *+ | HB 189 | TELECONFERENCED | |
| *+ | HB 184 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 27, 2020
3:06 p.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Chair
Representative Ivy Spohnholz, Vice Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Lance Pruitt
MEMBERS ABSENT
Representative Sharon Jackson
COMMITTEE CALENDAR
HOUSE BILL NO. 189
"An Act relating to the identification, location, and
notification of specified family members of a child who is in
state custody."
- HEARD & HELD
HOUSE BILL NO. 242
"An Act relating to the prescription of opioids; relating to the
practice of dentistry; relating to the practice of medicine;
relating to the practice of podiatry; relating to the practice
of osteopathy; relating to the practice of nursing; relating to
the practice of optometry; relating to the practice of pharmacy;
relating to the practice of veterinary medicine; relating to the
state medical examiner; relating to the controlled substance
prescription database; relating to the duties of the Board of
Pharmacy; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 184
"An Act exempting veterinarians from the requirements of the
controlled substance prescription database."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 189
SHORT TITLE: CHILD IN NEED OF AID; NOTICE OF PLACEMENT
SPONSOR(s): REPRESENTATIVE(s) TALERICO
01/21/20 (H) PREFILE RELEASED 1/10/20
01/21/20 (H) READ THE FIRST TIME - REFERRALS
01/21/20 (H) HSS, JUD
02/27/20 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 242
SHORT TITLE: PRESCRIPTION OF OPIOIDS; DATABASE
SPONSOR(s): REPRESENTATIVE(s) JOSEPHSON
02/07/20 (H) READ THE FIRST TIME - REFERRALS
02/07/20 (H) HSS, L&C
02/27/20 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 184
SHORT TITLE: CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
SPONSOR(s): REPRESENTATIVE(s) TALERICO
01/21/20 (H) PREFILE RELEASED 1/10/20
01/21/20 (H) READ THE FIRST TIME - REFERRALS
01/21/20 (H) HSS, FIN
01/29/20 (H) BILL REPRINTED
02/27/20 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
REPRESENTATIVE DAVE TALERICO
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 189 as the sponsor of the
bill.
CHRISSY VOGELEY, Manager
Community Relations
Office of Children's Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 189.
REPRESENTATIVE ANDY JOSEPHSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 242 as the sponsor of the
bill.
CATHERINE REARDON, Staff
Representative Andy Josephson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the Sectional Analysis of HB 242
on behalf of the bill sponsor, Representative Josephson.
SARA CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 242.
LAURA CARRILLO, Executive Administrator
Board of Pharmacy
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 242.
REPRESENTATIVE DAVE TALERICO
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 184 as the sponsor of the
bill.
DR. SARAH COBURN, President
Alaska State Veterinary Medical Association (AKVMA)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 184.
DR. JIM DELKER
Alaska State Veterinary Medical Association
Soldotna, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
184.
DR. SCOTT FLAMME
Board of Veterinary Examiners
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 184.
ACTION NARRATIVE
3:06:53 PM
CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:06 p.m.
Representatives Zulkosky, Drummond, Spohnholz, and Tarr were
present at the call to order. Representatives Claman and Pruitt
arrived as the meeting was in progress.
HB 189-CHILD IN NEED OF AID; NOTICE OF PLACEMENT
3:07:33 PM
CHAIR ZULKOSKY announced that the first order of business would
be HOUSE BILL NO. 189, "An Act relating to the identification,
location, and notification of specified family members of a
child who is in state custody."
3:08:14 PM
REPRESENTATIVE DAVE TALERICO, Alaska State Legislature,
paraphrased from a prepared statement [Included in members'
packets], which read:
Ensuring Extended Family Members Are Contacted as
Potential Foster Parents Under Alaska law a youth who
faces the unfortunate circumstance of being placed in
foster care is entitled to a placement that is in his
or her "best interests". Federal law and rules
internal to the Office of Children's Services (OCS)
note that a search of family members and friends who
are akin to family members should be completed in a
timely manner, within 30 days. The main provision of
HB 189 makes sure a supervisor signs off that the
requirement of a diligent search for family members
has occurred. If it has not, the social worker is
directed to complete that search to the supervisor's
satisfaction in as timely a manner as possible. HB 189
puts into statute this additional protection, which is
not currently addressed by OCS statutes or policy but
is warranted due to the continuous high social worker
turnover rate. Some social workers are very new, and
many don't make it as social workers beyond one year
or two years. Having a supervisor sign off that a
family search has been thoroughly conducted will
ensure children are protected, and in the best foster
home possible. This provision is expected to be cost-
neutral. It is recognized in the area of foster care
that, where a good family placement is available,
keeping a child in their family is often the placement
that is the child's best interests.
3:10:23 PM
REPRESENTATIVE TALERICO explained Proposed Amendment 1, which he
read:
Page 1, lines 9 - 11
Delete "If circumstances prevent the department from
completing this due diligence search in 30 days, the
department shall complete the search as soon as
possible."
Insert "in this subsection, an adult family member
means a person who is 18 years of age or older and who
is related to the child as the child's grandparent,
aunt, uncle, or sibling."
REPRESENTATIVE TALERICO offered to deliver this to the
committee.
CHAIR ZULKOSKY asked about the existing Office of Children's
Services (OCS) relative search process.
3:11:46 PM
CHRISSY VOGELEY, Manager, Community Relations, Office of
Children's Services, Department of Health and Social Services,
pointed out that, as there was already a federal statutory
requirement that all adult family members need to be notified
regarding the removal of a child within 30 days, the proposed
bill without the amendment would just codify in state statute
what was already a federal requirement. She added that OCS
already had the policies and procedures in place to ensure that
this happened. She noted that there was an ongoing relative
search, with social media as an excellent source for finding
relatives. Any findings were then put into the data base under
the case file and all those relatives were automatically
notified. As this was ongoing, there was a question for when a
supervisor would sign off on this. She reminded the committee
that a requirement to sign off would become another
administrative task for the supervisor.
3:13:57 PM
REPRESENTATIVE SPOHNHOLZ asked whether there was the capacity
for this to be done in practice on a regular basis.
MS. VOGELEY acknowledged that, while OCS did have struggles, the
division had a 52 percent relative placement rate versus the
national average of 32 percent. She declared that, even though
this placement rate was one of the highest placement rates in
the United States, there was still room for improvement. She
offered her belief that OCS did have the capacity. She pointed
out that there was a difference for children who were defined by
the Indian Child Welfare Act (ICWA), as OCS had compacted with
the tribal co-signers for a much more extensive relative search.
She added that the tribal partners could find "an incredible
number of relatives." She noted that, for children not defined
under ICWA, OCS did "as much as we can with what we have because
it is a federal mandate, but it is unfunded."
REPRESENTATIVE SPOHNHOLZ asked if the children placed with
family members were more stable and there was less turnover.
MS. VOGELEY replied, "yes."
REPRESENTATIVE SPOHNHOLZ asked if it was already in the best
interest of OCS to be doing this work.
MS. VOGELEY replied, "yes."
REPRESENTATIVE SPOHNHOLZ expressed her agreement and shared an
anecdote about her adoption of a foster child who had initially
been placed with biological relatives who did not have the
capacity to care for her.
REPRESENTATIVE TARR asked if this was the same or similar to an
earlier bill by former Representative Les Gara.
MS. VOGELEY asked if this was a reference to House Bill 151.
REPRESENTATIVE TARR offered her belief that it was another bill.
REPRESENTATIVE SPOHNHOLZ stated that House Bill 151 required
that a supervisor sign off that a comprehensive relative and
family friend search had taken place within 30 days each time
there was a placement change, and then House Bill 27, in 2017,
required the court to confirm this at the status hearings.
CHAIR ZULKOSKY asked about the costs anticipated in the attached
fiscal note, noting that a portion of the proposed bill appeared
to codify what was already federally required.
3:18:28 PM
MS. VOGELEY reiterated that the federal mandate to contact all
adult family members within 30 days was an unfunded requirement
and that OCS did this to its best ability. She reported that,
in compacting with the tribes, OCS knew how long a relative
search would take and how much it would cost. She relayed that,
if the intent of the proposed bill were to contact all adult
family members, this would be an extensive relative search like
the tribal searches. She reported that this took about 10 hours
at a cost of $56.11 per hour. The fiscal note considered the
total cost considering the number of children removed, minus the
costs passed along to the tribes to conduct these relative
searches, and the remainder was the cost to do extensive
relative searches for children not defined by ICWA. She offered
her belief that the proposed amendment which specified a much
smaller search would eliminate the fiscal note.
CHAIR ZULKOSKY opined that the [Alaska] Tribal Child Welfare
Compact was beneficial to the State of Alaska in understanding
costs for OCS to do these extensive family searches.
REPRESENTATIVE DRUMMOND asked about the OCS responsibility if
family members were not in Alaska.
MS. VOGELEY replied that this could be an entire presentation.
She explained that OCS was still required to notify out-of-state
relatives and should a relative request placement of the child
with them, the Interstate Compact Replacement of Children would
dictate that Alaska work with that state. She emphasized that
it was a long process with many documents. There was the
possibility that a case worker would escort the child to their
relative in another state or OCS would pay for the relative to
come to Alaska to escort the child. She added that this was not
uncommon.
CHAIR ZULKOSKY referred to the fiscal note and asked about the
percentage of children covered by ICWA.
MS. VOGELEY said that she would research that information.
REPRESENTATIVE TARR reported that the proposed bill had "a
little bit of an overlap in terms of the language" to the
earlier bill referenced, and she read from that bill regarding
the department transfers of a child from one out-of-home
placement to another. She shared an anecdote of her work with
OCS and a constituent and asked whether being prescriptive was
more important than the child's safety.
3:24:25 PM
REPRESENTATIVE SPOHNHOLZ asked for the OCS definition of "adult
family members of the child."
MS. VOGELEY replied that there was not a federal definition for
the notification of adult family members; however, there was a
definition in Alaska statute. She stated that she would follow
up.
CHAIR ZULKOSKY asked about any overlap with earlier legislation
and requirements by the federal government. She asked which
component of the proposed bill was necessary for statutory
language versus the need for funding and a standardized internal
OCS policy and process. She asked if OCS promulgated its own
rules and regulations to guide this work and could be used for a
budget request. She opined that it appeared there was a lot of
policy overlap and asked if a gap existed in the policy.
MS. VOGELEY offered her belief that OCS currently had enough in
policy so there was not any gap. She reported that the concern
raised by family members who were not notified was mainly due to
the parents not sharing that information with OCS. She
acknowledged that, although it was not a perfect system, OCS did
try their best. She added that in these situations there were
clearly family dynamics that prevented timely notifications.
CHAIR ZULKOSKY opined that currently there was "enough policy
cover," although there was a large unfunded mandate.
3:28:01 PM
REPRESENTATIVE TALERICO offered his belief that it was important
to put in Alaska statute what was already in federal statute.
He offered to provide the proposed amendment which added the
definition for adult family members, and would include a child's
grandparent, aunt, uncle, or sibling. He shared an anecdote for
constituents who did not have that contact, and another anecdote
about a friend who was successfully raised by his sibling. In
response to Representative Spohnholz, he said that the
definition for "adult family member" was included in the
proposed amendment.
REPRESENTATIVE SPOHNHOLZ referenced the issue regarding a
relative not being notified and asked if there was a gap between
the law and practice.
REPRESENTATIVE TALERICO shared that the relative was ultimately
contacted, was approved by OCS, and the children were moved. He
expressed his concern that due process was "skipped over in
favor of an accusation."
REPRESENTATIVE SPOHNHOLZ asked about the timing for this episode
in question, as there had been legislation passed in 2017 and
2018 which addressed this topic.
REPRESENTATIVE TALERICO replied that most of this occurred in
August and September 2019.
3:33:12 PM
HB 189 was held over.
HB 242-PRESCRIPTION OF OPIOIDS; DATABASE
3:33:18 PM
CHAIR ZULKOSKY announced that the next order of business would
be HOUSE BILL NO. 242, "An Act relating to the prescription of
opioids; relating to the practice of dentistry; relating to the
practice of medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to the practice
of nursing; relating to the practice of optometry; relating to
the practice of pharmacy; relating to the practice of veterinary
medicine; relating to the state medical examiner; relating to
the controlled substance prescription database; relating to the
duties of the Board of Pharmacy; and providing for an effective
date."
3:33:30 PM
The committee took a brief at-ease.
3:34:36 PM
REPRESENTATIVE ANDY JOSEPHSON, Alaska State Legislature, stated
that there was a problem which needed to be addressed, and,
although the proposed bill presented some ideas, he was open to
solutions. He paraphrased from a prepared statement [Included
in members' packets], which read:
The purpose of this bill is to reduce addiction and
overdose death from opioids prescribed by health care
professionals, by improving the effectiveness of the
State's controlled substance prescription database by
requiring healthcare licensing boards to set
prescription standards for their professions.
Alaska's controlled substance prescription database
was created and placed under the responsibility of the
Board of Pharmacy in 2008. The database was designed
as a tool to help healthcare providers identify
patients who were "doctor shopping" or deliberately
obtaining prescriptions from multiple unknowing
providers to feed addictions.
As opioid addition has increased in Alaska and the
nation so has our understanding of links between legal
prescription, addiction and illegal use of controlled
substances. Healthcare providers and policy makers are
looking for ways to turn the tide of addiction and
death. Strengthening the prescription database system
is one positive step we can take.
HB 242 will improve the prescription practice of
Alaska's many great healthcare providers and help
identify and remove the small minority of prescribers
who deliberately or negligently over prescribe
controlled substances.
I encourage you to support this legislation and to
reach out to my office with any questions and
suggestions.
REPRESENTATIVE JOSEPHSON paraphrased a KTUU news story [Included
in members' packets], which addressed a doctor from Soldotna and
a nurse practitioner from Eagle River who were accused of
illegally overprescribing opiates for years, raising questions
about how the state tracked prescription drug abuse. He
reported that the news story ended by noting the state had no
prescription limit flags that automatically alerted licensing
boards when someone appeared to be overprescribing. He reported
that his office had done exhaustive research, acknowledging
there was a problem, and that he wanted to discuss a solution.
He said that making changes to prescriptions of controlled
substances and the use of the database required reviewing the
statutes of each of the five professions that were able to
prescribe controlled substances: physicians, advanced practice
nurses, dentists, optometrists, and veterinarians. He added
that it was also necessary to review the pharmacy statutes.
REPRESENTATIVE JOSEPHSON stated that the basis of the proposed
bill: (1) gave each of the five licensing boards explicit
responsibility to adopt regulations establishing opiate
prescription standards for their respective professions,
referred to as MMEs; standards would enable the Department of
Commerce, Community & Economic Development employees who staff
the licensing boards to proactively identify prescribers who
deviated from standards, share that information with the
practitioners and the boards, and investigate when appropriate;
(2) addressed the problem of prescribers who failed to register
with the database or failed to review the patient information
before prescribing. He opined that the boards did not enforce
registration by the prescribing physicians. The proposed bill
(3) upgraded the database software to record when a prescriber
enters the database and reviews the patient records, and (4)
required licensing boards to take disciplinary action against
licensee who fail to register a review; To require pharmacists
to check the data base before filling a prescription to confirm
that the prescriber reviewed the patient's record in the
database as was required by law.
REPRESENTATIVE JOSEPHSON suggested that, as two pharmacy
organizations had submitted concerns regarding this, there may
be a database solution. He went on to state that the proposed
bill required the state medical examiner to inform the Board of
Pharmacy when a death was caused by an overdose, as that board
was responsible for managing the database. The Board, in turn,
would inform healthcare providers and their licensing boards if
a provider prescribed a controlled substance during the three
months preceding death; this provision was intended to educate
prescribers who may not be aware that a patient had addictions
and to bring investigators' attention to events. He reiterated
that he was receptive to suggestions on this proposed
legislation. He acknowledged that there were important medical
practices such as pain clinics which prescribed more controlled
substances, and that he wanted to develop a system as seamless
as possible. He pointed out that not only was there patient
addiction, but that there also existed "pill mills."
3:42:12 PM
CATHERINE REARDON, Staff, Representative Andy Josephson, Alaska
State Legislature, presented the Sectional Analysis [Included in
members' packets], which read:
Section 1: Amends the powers and responsibilities of
the Dental Board to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 2: Amends the powers and responsibilities of
the State Medical Board to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 3: Amends the powers and responsibilities of
the Board of Nursing to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 4: Amends the powers and responsibilities of
the Board of Optometry to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 5: Adds a new subsection to the Board of
Pharmacy statutes requiring pharmacists to confirm,
before filling a prescription for a Schedule II-IV
controlled substance, that the prescriber reviewed the
patient's prescription records in the controlled
substance prescription database before prescribing.
Section 6: Amends the powers and responsibilities of
the Board of Veterinary Examiners to require the board
to adopt regulations establishing opioid prescription
dosage standards for practitioners licensed by the
board.
Section 7: Adds a new subsection to the statutes
governing investigation of death by the State Medical
Examiner, directing the Medical Examiner to report to
the Board of Pharmacy when a person's death was caused
by an overdose of a schedule II-IV controlled
substance. The Medical Examiner shall report the
deceased person's name, address and date of birth to
the Board of Pharmacy which shall act as directed in
Section 15 of the bill.
Section 8: Amends the statutes governing the
Controlled Substance Prescription Database to specify
that the database will identify healthcare
practitioners who fail to review patient information
in the database as required by law and that the
database will identify each occurrence of failure to
review.
Section 9: Clarifies that security and confidentiality
of the database is a requirement rather than an
aspiration by deleting the words "undertake to" on
page 8 line 11.
Section 10: Requires licensing boards to take
disciplinary action against practitioners who fail to
register with the database or review patient
information as required by law.
Section 11: Removes protection from civil liability
for healthcare practitioners who fail to access
information in the database.
Section 12: Deletes the requirement that prescription
information in the database be purged after two years
and removes the requirement that the Board of Pharmacy
establish a "time frame" for healthcare practitioners
to register with the database.
Section 13: Makes mandatory rather than optional, the
notification by the Board of Pharmacy, to the relevant
practitioner, licensing board and pharmacist when a
patient receives a prescription for controlled
substances in quantities or frequency inconsistent
with generally recognized standards of safe practice.
Section 14: Makes mandatory rather than optional, the
issuance of annual reports that compare individual
healthcare practitioner's opioid prescribing practice
with other practitioners of the same occupation and
similar specialty. Section 14 also requires copies of
the reports to be sent to the practitioner's licensing
board and to the medical director of a group practice.
Those copies will exclude information that identifies
patients. Recipients of reports may only disclose
information to other individuals who have access to
the database.
Section 15: Directs the actions of the Board of
Pharmacy when the board receives notice from the
Medical Examiner as required by Section 7 of the bill,
that a person's death was caused by an overdose of a
schedule II-IV controlled substance. The board shall
review the database to identify healthcare
practitioner who prescribed a schedule II-IV
controlled substance to the person during the three
months preceding death and notify the practitioner and
relevant licensing board.
Section 16: Requires the six licensing covered by this
bill boards and the Department of Commerce, Community
and Economic Development to adopt necessary
regulations within one year of the January 1, 2021
effective date of Sections 1-15.
Section 17: Establishes an immediate effective date
for the regulation adoption authority required to
implement Section 16.
Section 18: States the bill takes effect on January 1,
2021 with the exception of the authority to adopt
regulations contained in Sections 16 and 17 of the
bill.
3:55:56 PM
REPRESENTATIVE TARR directed attention to the fiscal note for
business and professional licensing and asked about the request
for two investigators and a paralegal for enforcement.
MS. REARDON replied that she had not heard anything about the
fiscal note, but that she was not surprised that it could take
those resources for effective enforcement.
3:58:15 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development, reported that the proposed fiscal note was
extremely conservative, and it leaned toward a best-case
scenario. She stated that the worst-case scenario would
necessitate a doubling of the investigative team in order to
close the gap and fulfill the proposed bill.
REPRESENTATIVE TARR asked about the increase to the participant
fee in order to pay for the proposed cost.
MS. CHAMBERS replied that the current fee was $25, although the
intent language for the database had declared that it is not
funded by user fees. She stated, "we're in a pickle right now.
There isn't grant funding for enforcement." She stated that
there was a policy call for the Legislature on whether to change
the fee or use another model for payment, as there was less than
100 percent compliance with registration.
REPRESENTATIVE SPOHNHOLZ asked about the delta for the number of
registrants and the number of licensees.
MS. CHAMBERS said that she would supply that specific data but
pointed out that there were many medical professionals who did
not have the authority to prescribe controlled substances.
REPRESENTATIVE PRUITT reflected on the passage of the bill, and
relayed that the intent of the bill had been to make the
database mandatory. He asked what had been done to ensure
compliance, and would the proposed bill be fulfilling any gaps.
He then asked about the security and confidentiality.
4:05:18 PM
LAURA CARRILLO, Executive Administrator, Board of Pharmacy,
explained that the rationale for removing the two years was in
consideration of Senate Bill 74 to allow the assessment of
prescription data over time. She reported that removal of the
requirement to purge the data would not allow Department of
Health and Social Services to analyze the data.
MS. CHAMBERS stated that this database was complex and only two
people were authorized to view it. She declared that it was
used as a research tool to attack the opioid crisis, and that
the spirit of Senate Bill 74 was for this to be an educational
tool to allow prescribers to make better decisions, and not to
be used as an enforcement tool. She stated that there was
another delta between expectations and reality for the database.
She pointed out that to maintain security and confidentiality,
it had to be determined how many state employees would have
access to certain levels of data. She declared that the biggest
expense was for the technology behind this.
CHAIR ZULKOSKY asked how many states had this Prescription Drug
Monitoring Program (PDMP) database.
MS. CARRILLO said there were 43 states using this same platform
connected through [indisc.] health.
CHAIR ZULKOSKY asked for more context to how a more mature PDMP
was using that information.
MS. CARRILLO said that she would research the evolution of the
PDMP in other states.
CHAIR ZULKOSKY expressed her agreement that there was a policy
call for how to use this collected data and added that more data
would allow for better understanding for risks in the community.
She asked for more information as to how other states utilized
this data within their systems.
4:09:54 PM
REPRESENTATIVE PRUITT offered his belief that there had been a
positional shift from, in 2008, "if you want to," and no one
did, to "you're going to." He opined that there was an
insistence on wanting this to be mandatory, but there was not
any enforcement. He asked why this position had changed and
what was an appropriate balance of pressure.
MS. CHAMBERS replied that boards, as was put into Title 17 and
into Title 8 as a requirement for each separate board, could
determine within the scope of their existing authority what the
penalty might be. She shared some examples for the allowable
civil authority. She reported that the Alaska State Legislature
was interested in "taking the temperature" of the position to
the opioid crisis. She pointed out that data had not been
mandatory, and that during a presentation by then-Chief Medical
Officer, Dr. Butler, it had been noted that it wasn't even known
what was being prescribed. She reported that current review of
the data indicated there was inadvertent misuse of the PDMP, as
well as over-prescription. She pointed out that, as there was
not even a definition for over-prescription, it was difficult to
set a threshold for any red flags. She noted that only the
State Medical Board had set in regulation a threshold, which
could be "squishy" depending on the type of practice. She
declared the need for determining what Alaska wanted from the
PDMP, and that each board had existing authority to determine
discipline. She added that the Alaska State Legislature could
set penalties in statute.
REPRESENTATIVE PRUITT asked if there was a need for the
legislature to make a larger statement to the boards for a
certain level of enforcement.
4:17:03 PM
MS. CHAMBERS explained that the MME requirement in the proposed
bill had not been asked of the boards, although it made sense if
a definition for over prescription was a concern. She pointed
out that the State Medical Board had taken a leadership role,
even though the other boards had not been asked to determine a
definition. She reported that some of the boards had set
extremely long time periods for allowance of non-registration as
they did not want to be "heavy-handed." She pointed to some of
the problems for registration. She reiterated that, if this was
the expectation of the Legislature, this proposed bill was a
good vehicle to offer more tools.
REPRESENTATIVE DRUMMOND referenced a report [Included in
members' packets] which stated that 49 states, as well as Guam
and the District of Columbia, had fully operational PDMPs. She
asked if the DEA (Drug Enforcement Administration) authorized
the prescribers of Schedule II to IV controlled substances and
questioned whether this information could be included in the
PDMP. She asked whether the pharmacies were aware of
prescribers who were DEA-authorized for controlled substances.
MS. CHAMBERS expressed her agreement that there was this list
and that they did work with the DEA. She pointed out that one
state, Missouri, had the PDMP as the municipal, not the state,
level. In response to Representative Drummond, she said that
Missouri used a different software.
REPRESENTATIVE SPOHNHOLZ offered her belief that the PDMP
history was good for context but did not matter for her current
decisions. She shared a list of topics she would like to hear
addressed in a future hearing.
4:22:41 PM
REPRESENTATIVE SPOHNHOLZ referenced a section of the bill which
asked pharmacists to review whether the original prescriber had
checked the database and asked whether this policy would turn
pharmacists into monitors of other providers.
REPRESENTATIVE JOSEPHSON reported that this concern was shared
by the sponsor, as he wanted that both the providers and the
pharmacists treat the patients, prescribe medication, and focus
on the job. He shared an anecdote for a pharmacist being
rebuked for refusing to fill a prescription. He pointed out
that, although the Board of Pharmacy was the ultimate decider,
it did not want to be involved in calling other boards regarding
other providers. He suggested that a system should contact the
boards when a provider had not registered or had not checked
that a patient had recently received a prescription from another
provider. He reiterated that he was "wedded to solving the
problem not to any particular solution." He pointed out that
these burdens were placed on the pharmacist because they were
"in the catbird seat, they're the ones who are entering the
data." He questioned the timing for when the data was entered
into the data base.
4:27:07 PM
HB 242 was held over.
HB 184-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
4:27:34 PM
CHAIR ZULKOSKY announced that the final order of business would
be HOUSE BILL NO. 184, "An Act exempting veterinarians from the
requirements of the controlled substance prescription database."
4:27:59 PM
REPRESENTATIVE DAVE TALERICO, Alaska State Legislature,
introduced HB 184 and paraphrased from the Sponsor Statement
[Included in members' packets], which read:
HB 184 is proposed to exempt Veterinarians from
Prescription Drug Monitoring Programs (PDMPs).
Prescription Drug Monitoring Programs (PDMPs) were
designed for use in human medicine to identify doctor
shopping by human patients and monitor trends in
prescribing practices by health care providers.
Veterinarians want to be part of the solution of the
opioid crisis, but PDMPs have not been an effective
mechanism to do this.
By mandating that veterinarians query and report the
owner's name and date of birth, there are significant
concerns about potential violations of privacy of
human medical information. Veterinarians are not
trained in privacy regulations concerning human
medical data, nor are they trained in appropriate
medications, doses, or prescribing practices for human
medicine. As we have talked informally with pet owners
and others in the general public, they are not aware
that their veterinarian would have access to any part
of their medical information and are dismayed to learn
this.
Animal patients themselves cannot be effectively
tracked through PDMPs. Animals do not have a unique
identifier such as a social security number or even
date of birth. The animal's name may be changed over
time, the date of birth is often not known, and the
owner may change over time.
One national survey found that fewer than 10 cases of
veterinary shopping occur annually in the United
States and concluded that "veterinarians are a de
minimus source of controlled substances." Even those
few cases of veterinary shopping are typically
identified by the veterinarians themselves, not
through PDMPs. In 2017 veterinarians prescribed 0.34%
of all the opioids dispensed by retail pharmacies in
the country (source IQVIA National Prescription
Audit).
Exempting veterinarians from the PDMP will not
diminish the judicious use of controlled substances
that is already practiced by veterinarians and
regulated by the Drug Enforcement Agency and the state
licensing board. Exempting veterinarians from the PDMP
will allow veterinarians to provide timely and
appropriate medical management for each individual
patient. It may save state funds and increase the
efficiency of the PDMP for its intended purpose by
allowing for more accurate interpretation of
prescription data and prescribing trends in human
medicine.
Over 30 states currently exempt veterinarians from
PDMP requirements. Several of those states originally
required veterinarians to report to the PDMP but have
since exempted veterinarians for many of the same
reasons described above.
4:31:04 PM
CHAIR ZULKOSKY asked about the percentage rate in commercial
pharmacies.
REPRESENTATIVE TALERICO stated that, in 2017, veterinarians
prescribed 0.34 percent of all the opioids dispensed by retail
pharmacies in the country. In response to Chair Zulkosky, he
said that he did not have the hard number for this percentage.
4:32:00 PM
REPRESENTATIVE SPOHNHOLZ asked what percentage veterinarians
were of the total prescribers in the country.
REPRESENTATIVE TALERICO deferred to later testifiers.
REPRESENTATIVE CLAMAN asked about the percentage of prescription
dispensing veterinarians in Alaska relative to the rest of the
country.
REPRESENTATIVE TALERICO replied that he did not know.
REPRESENTATIVE CLAMAN asked whether the veterinarians were also
the dispensers.
REPRESENTATIVE TALERICO offered his belief that it was necessary
to be a licensed pharmacy to dispense an opioid.
4:34:52 PM
DR. SARAH COBURN, President, Alaska State Veterinary Medical
Association (AKVMA), stated the AKVMA was "a professional
association dedicated to promoting the excellence and
professionalism of Alaska veterinarians in advancing the health
and well being of animals in the public." She declared support
of the proposed bill, as it would exempt veterinarians from
participating in the state Prescription Drug Monitoring Program
(PDMP). She stated that the veterinary community wanted to
contribute to solutions to the opioid crisis, but participation
in a program designed for use by humans was not appropriate.
She reported that more than 30 states exempted veterinarians
from the PDMP requirements, and some states have now enacted
legislation which removed veterinarians from participation
because their inclusion has not proven to be helpful in
addressing the human opioid epidemic.
DR. COBURN listed numerous reasons for not requiring
veterinarians to search or report information into the PDMP,
including that animal patients cannot be effectively tracked,
and veterinarians are not trained to evaluate human prescription
information or in privacy regulations concerning human medical
data. She added that most pet owners were not aware that the
licensed veterinary technician was the delegated person to
access the personal medical prescription history, considered an
invasion of privacy by many people. She expressed concern that
information entered the PDMP for animal patients would skew the
data and place a disproportionate cost and burden on veterinary
clinics as small business owners. She pointed out that the
information had to be submitted manually as the veterinary
software did not interface with the PDMP. She pointed out that
exempting veterinarians would not diminish the effectiveness of
the PDMP program. She acknowledged that although opioids were
used by veterinarians, these were used for surgical procedures
and anesthesia. She pointed out that veterinarians still had to
meet strict security, record keeping, and storage requirements
of controlled substances. She added that the DEA monitored the
flow of controlled substances. She concluded, offering her
belief the exemption of veterinarians from using the PDMP would
not weaken the success of the program or affect the judicious
and highly regulated use of controlled substances by
veterinarians. She reiterated that the AKVMA supported HB 184.
REPRESENTATIVE CLAMAN asked if the statistics she referenced
were for Alaska.
DR. COBURN said that these were recent statistics from the PDMP
annual report for each profession in Alaska.
REPRESENTATIVE CLAMAN asked if veterinary clinics were
considered retail pharmacies.
DR. COBURN said, "they are not."
4:42:53 PM
DR. JIM DELKER, Alaska State Veterinary Medical Association, in
response to Representative Claman, he said that a prescription
for a pet could be filled either by the veterinarian or a
pharmacist. He declared that most veterinarians had the
pharmacy fill the prescription for opiates to relieve the
veterinarian of the pressures to report. In response to
Representative Claman, he said that who dispensed a medication
would depend on the drug. He pointed out that the drugs
indicated in more drug overdoses such as oxycontin, Percocet,
and Vicodin were not commonly dispensed by veterinarians.
REPRESENTATIVE CLAMAN asked for clarity for the difference
between prescribing and dispensing.
DR. DELKER said that he would write a prescription to the
pharmacy for a medication they did not carry, noting that a
controlled substance had to have a written prescription, whereas
an antibiotic did not.
REPRESENTATIVE CLAMAN asked if veterinarians dispensed small
quantities of opioid medication from their clinic.
DR. DELKER replied that the majority of those were sent to a
retail pharmacy.
CHAIR ZULKOSKY asked if Alaska veterinarians could dispense
opioids within the clinic.
DR. COBURN said, "yes."
CHAIR ZULKOSKY asked about the percentage of opioids dispensed
from a clinic before using a commercial pharmacy.
DR. COBURN said that she would follow up for the number. She
stated that opioids were in limited use as take-home
medications, that most opioids were used in the hospital related
to surgical procedures and were not to be dispensed.
CHAIR ZULKOSKY pointed out that the PDMP illuminated the data
for opioid prescriptions. She expressed her understanding that
there were conditions for opioids dispensed in a clinic. She
asked how often Alaska veterinarians used commercial pharmacies
versus directly dispensing controlled substances.
DR. COBURN said that she would research that.
CHAIR ZULKOSKY shared an anecdote that animal owners had
intentionally harmed an animal in order to drug shop for
controlled substances, and she asked if there was mandatory
reporting in Alaska for suspicion of animal abuse.
DR. COBURN stated that there was not mandatory reporting but
that it was authorized to report without any privacy concerns.
She declared that animal abuse was illegal in Alaska, and that
ethical conduct would lead a veterinarian to report to an
appropriate authority if there was concern for intentional
injury. She stated that, as it was necessary to have a
veterinarian-client/patient relationship, the standard of care
in veterinary medicine was for an in-person physical examination
of the animal to establish that relationship. She shared that
the PDMP was not designed for animal data.
CHAIR ZULKOSKY asked about the training or guidance provided to
veterinarians to utilize the PDMP.
4:52:23 PM
MS. CHAMBERS explained that when the PDMP became mandatory for
all prescribing professions and pharmacists, which included
veterinarians, the Board of Veterinary Examiners had the
authority and ability to work with the Board of Pharmacy to
write the regulations to figure these out. She declared that it
had been a struggle for the Board of Veterinary Examiners to
wrestle with these issues for how to make it work. She reported
that these efforts to make it work did not progress, and, since
2018, there had not been an attempt at a regulations project or
a move to adapt the technology.
CHAIR ZULKOSKY reiterated that there was not broad support
provided to users of the PDMP by the Department to ensure they
had what was necessary to access or provide information.
MS. CHAMBERS pointed out that the PDMP was primarily designed
for human use. When the Board of Veterinary Examiners reviewed
the statutes, they realized that, with the way the law was
written and the way the technology was set up, it was necessary
for more work to understand how to advise their licensees. She
stated that it was not possible for her department to train
licensees until the Board of Veterinary Examiners worked through
these problems with regulation and technology changes.
4:55:49 PM
DR. SCOTT FLAMME, Board of Veterinary Examiners, reported that
he had been practicing in Fairbanks for the past 17 years. He
declared that 38 states had now exempted veterinarians from the
PDMP. He acknowledged the difficulty for using a data base for
animal data that was designed for humans, and shared that other
states had this same struggle. He emphasized that it "just does
not work." He declared that veterinarians cared about the
opioid epidemic and wanted to do their part to help prevent
addiction and to prevent any harm to Alaskans. He pointed out
that veterinarians in Alaska only prescribed 0.34 percent of the
controlled substances. He offered an analogy of buying a
$60,000 pickup truck to plow a driveway that was 12 feet long
and 5 feet wide., adding that it did not make any sense as the
data was not helpful.
DR. FLAMME stated that the PDMP was costly to the public, and
that the public was shocked when it learned that veterinarians
who had no training in human medicine or privacy laws were
mandated to access the private health data before prescribing to
an animal patient. He added that the public was equally
dismayed when their PDMP risk scores were altered because of an
animal prescription, as the assessments included a mix of human
and animal data. He stated that the cost to the public would be
borne out with an increase in the shortage of veterinarians. He
pointed out that the Board of Veterinary Medical Examiners was
mandated to investigate and discipline veterinarians who failed
to correctly use the PDMP, while paying for those
investigations. He noted that Alaska had the highest licensing
fees for veterinarians in the United States. He urged support
for HB 184.
5:00:21 PM
HB 184 was held over.
5:01:05 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:01 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 184A 02.17.2020.PDF |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Veterinarian Medical Association PP.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Sponsor Statement.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Legislative Alert PDMP exemption for veterinarians 12.21.2019.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Board of Veterinarian Examiners Letter.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Fiscal Note DCCED.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 189 ver A 1.24.20.PDF |
HHSS 2/27/2020 3:00:00 PM |
HB 189 |
| HB 189 Sponsor Statement 1.24.20.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 189 |
| HB 189 Fiscal Note DHSS.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 189 |
| HB 242 Sectional Analysis.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Pharmacy Board Audit 2017.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 PDMP 2019 Legislative Report.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Sponsor Statement.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Audit of the Medical Board 2019.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242.PDF |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Fiscal Note DCCED.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Fiscal Note DHSS.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Overprescription by Spayd & Davidhizar.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |