Legislature(1997 - 1998)
03/21/1997 03:19 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE LABOR AND COMMERCE STANDING COMMITTEE March 21, 1997 3:19 p.m. MEMBERS PRESENT Representative Norman Rokeberg, Chairman Representative John Cowdery, Vice Chairman Representative Joe Ryan Representative Tom Brice MEMBERS ABSENT Representative Bill Hudson Representative Jerry Sanders Representative Gene Kubina COMMITTEE CALENDAR *HOUSE BILL NO. 135 "An Act relating to dental licensing; extending the termination date of the Board of Dental Examiners; and providing for an effective date." - MOVED CSHB 135(L&C) OUT OF COMMITTEE *HOUSE BILL NO. 137 "An Act relating to veterinarians; extending the termination date of the Board of Veterinary Examiners; and providing for an effective date." - HEARD AND HELD *HOUSE BILL NO. 136 "An Act relating to the regulation of physical therapists and physical therapy assistants; extending the termination date of the State Physical Therapy and Occupational Therapy Board; and providing for an effective date." - HEARD AND HELD *HOUSE BILL NO. 134 "An Act relating to regulation of barbers and hairdressers; extending the termination date of the Board of Barbers and Hairdressers; and providing for an effective date." - HEARD AND HELD (* First public hearing) PREVIOUS ACTION BILL: HB 135 SHORT TITLE: DENTISTS: LICENSING & EXTEND EXAMINING BD SPONSOR(S): RULES BY REQUEST OF BUDGET AND AUDIT COMMITTEE JRN-DATE JRN-PG ACTION 02/13/97 334 (H) READ THE FIRST TIME - REFERRAL(S) 02/13/97 334 (H) LABOR & COMMERCE 03/21/97 (H) L&C AT 3:15 PM CAPITOL 17 BILL: HB 137 SHORT TITLE: BOARD OF VETERINARY EXAMINERS; LICENSE SPONSOR(S): RULES BY REQUEST OF BUDGET AND AUDIT COMMITTEE JRN-DATE JRN-PG ACTION 02/13/97 334 (H) READ THE FIRST TIME - REFERRAL(S) 02/13/97 334 (H) LABOR & COMMERCE 03/21/97 (H) L&C AT 3:15 PM CAPITOL 17 BILL: HB 136 SHORT TITLE: PHYSICAL THERAPY AND OCCUPATIONAL THERAPY SPONSOR(S): RULES BY REQUEST OF BUDGET AND AUDIT COMMITTEE JRN-DATE JRN-PG ACTION 02/13/97 334 (H) READ THE FIRST TIME - REFERRAL(S) 02/13/97 334 (H) LABOR & COMMERCE 03/21/97 (H) L&C AT 3:15 PM CAPITOL 17 BILL: HB 134 SHORT TITLE: BARBERS AND HAIRDRESSERS SPONSOR(S): RULES BY REQUEST OF BUDGET AND AUDIT COMMITTEE JRN-DATE JRN-PG ACTION 02/13/97 333 (H) READ THE FIRST TIME - REFERRAL(S) 02/13/97 333 (H) LABOR & COMMERCE 03/21/97 (H) L&C AT 3:15 PM CAPITOL 17 WITNESS REGISTER CATHERINE REARDON, Director Division of Occupational Licensing Department of Commerce and Economic Development P.O. Box 110806 Juneau, Alaska 99811-0806 Telephone: (907) 465-2538 POSITION STATEMENT: Answered questions regarding HB 135, HB 137. KENNETH L. CROOKS, DDS Chairman, Board of Dental Examiners P.O. Box 1610 Dillingham, Alaska 99576 Telephone: Not provided POSITION STATEMENT: Testified on HB 135. ROBERT WARREN, DDS 625 East 34th Avenue, Suite 202 Anchorage, Alaska 99703 Telephone: (907) 274-7691 POSITION STATEMENT: Testified in support of HB 135. RICHARD COOK, DDS President of the Juneau Dental Society 712 West 12th Street Juneau, Alaska 99801 Telephone: (907) 586-1188 POSITION STATEMENT: Testified on HB 135. RANDY WELKER, Legislative Auditor Legislative Audit Division P.O. Box 113300 Juneau, Alaska 99811-3300 Telephone: (907) 465-2347 POSITION STATEMENT: Explained HB 137 and HB 136. PAM TUOMI, DVM Alaska State Veterinary and Medical Association 2036 East Northern Lights Boulevard Anchorage, Alaska Telephone: (907) 274-5623 POSITION STATEMENT: Testified on HB 137. DEANNA THORNELL, DVM P.O. Box 61263 Fairbanks, Alaska 99706 Telephone: (907) 479-2800 POSITION STATEMENT: Testified on HB 137. PAULINE BENNETT-GANNON, President Alaska Occupational Therapy Association 1076 Willow Grouse Road Fairbanks, Alaska 99712 Telephone: (907) 457-6127 POSITION STATEMENT: Testified on HB 136. MARY MELISSA ROBINSON, Therapist Committee Chair, Licensing Committee Alaska Occupational Therapy Association 13350 Westwind Drive Anchorage, Alaska 99516 Telephone: (907) 345-1004 POSITION STATEMENT: Testified on HB 136. MARY VAIL, Physical Therapist Legislative Liaison for the Alaska Chapter of the American Physical Therapy Association Address and telephone number were not provided POSITION STATEMENT: Testified on HB 136. ACTION NARRATIVE TAPE 97-26, SIDE A Number 001 CHAIRMAN NORMAN ROKEBERG called the House Labor and Commerce Standing Committee to order at 3:19 p.m. Members present at the call to order were Representatives Rokeberg, Cowdery, Ryan and Brice. HB 135 - DENTISTS: LICENSING & EXTEND EXAMINING BD Number 137 CHAIRMAN ROKEBERG announced the first order of business would be HB 135, "An Act relating to dental licensing; extending the termination date of the Board of Dental Examiners; and providing for an effective date." Number 168 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Commerce and Economic Development, was first to come before the committee. She said the bill was introduced by the Legislative Budget and Audit Committee (LB&A). She explained all the bills the committee would deal with today contain elements of legislative audit recommendations in addition to the extension of the board's sunset dates. She said while the department agrees with most of the suggested changes, the ideas were brought forward from LB&A rather than initiated by the Department of Commerce and Economic Development. She said HB 135 extends the sunset date to 2003, but it is her understanding that four years is what is probably considered more appropriate by the Senate. MS. REARDON informed the committee members that Section 2 increases the number of public members on the board and decreases the number of dentists. This was a recommendation of the legislative audit, as Mr. Welker testified to in the Senate the previous week. The purpose was that with a nine member board, it was the feeling of the auditor that two members might bring a more effective public voice to the board and that perhaps in other times in history they might have benefited from more public voice. She said currently there are six dentists, two hygienists and one public member on the board. The bill would make it five dentists, two hygienists and two public members. Number 358 MS. REARDON referred to Section 3 and said it removes a requirement that the photograph submitted with an application be autographed. She said it is good idea to remove that requirement since the application forms are signed anyway. MS. REARDON referred to Section 4 and said it gives the board more leeway in allowing dentists to come in by credentials, these are people who are licensed in other states as dentists. The current law says that the other state in which the person is licensed has to have licensing requirements, that are generally equivalent to those of this state. She said the issue has come up that Alaska is part of the Western Regional Examining Board, they give what is called the "WREB" dental exam. There are also several other regional exams in the country that are not identical. She said she believes California has its own exam. When it comes to determining what is equivalent, there are occasions where someone may be coming from another state and the test they took doesn't have the same elements as the WREB that Alaska uses, and therefore, the person isn't eligible for coming in by credentialing. The new language on page 2, starting on line 20, says that if the reason that the licensing requirements aren't equivalent because something was missing on the other state's test that the board may allow the person to come in for licensure if they demonstrate that they've had continuing education or hold specialty certification or provide proof of successful practice in those areas, so as to not exclude people from practice in Alaska unnecessarily. Ms. Reardon explained the board currently has a regulation out for public notice which would give some leeway to the situation. She noted the public comment period ends June 6. Number 517 MS. REARDON said Section 5 is a transition section which deals with the replacement of one of the dentists by a public member. The transition section says that the next dentist whose term expires will be replaced by a public member instead of kicking someone off the board for immediate replacement. Ms. Reardon informed the committee the bill has a zero fiscal note and was done slightly different than in the past for board sunset extensions due to a request from the Senate. She said the department used to show the ongoing costs of programs. There were usually positive fiscal notes that showed the money was already in the budget, but was leading to the necessity of Finance Committee referrals. The department is doing fiscal notes and it is shown in the analysis that there is an ongoing cost of regulating dentists which is already in the budget. Ms. Reardon said in this case, the department is saying the cost is about $163,200 a year for licensing dentists. Number 592 REPRESENTATIVE JOE RYAN asked if dental hygienists are licensed. MS. REARDON indicated dental hygienists are licensed under the Board of Dental Examiners. REPRESENTATIVE RYAN asked if they have to meet national criteria. MS. REARDON explained there is a national exam. The licensing is similar to the one set up for real estate or dentists where in statute there are qualifications for training and examination. It is very similar to all of their licensing sections. REPRESENTATIVE RYAN explained the reason he is asking is he has some friends that are dentists and a circumstance he has heard is that they were having to pay a lot of people a lot of money who they didn't feel were qualified to do the job. They wanted more qualifications and expertise. REPRESENTATIVE RYAN said a common complaint from people in Alaska was that there weren't enough dentists or enough competition and the prices are very high. A lot of people go to Whitehorse or Seattle. The board is very restrictive in allowing other people to come into the state. Representative Ryan noted a friend of his in Fairbanks, Dr. Helmbrick, after six or seven times of taking the exam before he could qualify, graduated from an accredited school. He felt it was a case of an old Alaskan tradition, "I'm here, close the door, don't let anybody else in." He asked if there has been anything to eliminate that. MS. REARDON said she wasn't sure what time period Representative Ryan's friend was having this difficulty. She said she believes the committee would see in some previous audits and legislative committee hearings regarding credentialing or licensure that there have been similar concerns expressed. She said she thinks that some of the board members, who are on-line, would say that is not their perspective or way of behaving and that they have been trying to find ways within their statute to let in qualified people. Ms. Reardon said if the test his friend was taking was the Western Regional exam, that is a test that involves not just Alaska, but is written for all states. She noted the Dental Board members participate in meetings and examinations by the Western Regional and are familiar with how the test is written. Number 847 KENNETH L. CROOKS, DDS, Chairman, Board of Dental Examiners, testified via teleconference. Dr. Crooks informed the committee members he has been practicing dentistry since 1971. He said he left private practice in California in 1977. He then moved to Alaska and has spent the last 20 years with the Indian Health Care, Bristol Bay Health Corporation, Dillingham. He was appointed to the Board of Dental Examiners in February, 1995, and was elected chairman in December, 1996. Dr. Crooks referred to HB 135 regarding the addition of a second public member and said the board has discussed this and they are in favor of the idea. He noted the board has experienced problems with the single public member not being able to attend all of the meetings. Prior to that person's resignation, she had difficulty making it to half of the meetings. Dr. Crooks said personally, he was not aware of reducing the number of dentists on the board in order to add a second public member and he doesn't believe that any of the current board members realize that was even a possibility. Dr. Crooks suggested an additional position be created in order to add a second public member. He said he would further suggest that in the last two years, they have had a budgetary (indisc.) which would make this possible without any additional funding. He said he knows there was a fee reduction this year which Catherine Reardon could speak to. Dr. Crooks said he believes that even with the fee reduction, they could still (indisc.) being able to pay the travel costs or whatever is involved with an additional board member. DR. CROOKS said as far as the second change to the statute dealing with the problem of the definition of "generally equivalent" in offering statutory relief from some dilemmas they've had he feels the current board would embrace this change. It is sympathetic or symbiotic with the regulation change that they proposed at their December board meeting. He said, "I think they're fully compatible and are designed to accomplish the same purpose which is to get out of a situation where we have had to actually -- within the last year we have tabled applications from at couple of dentists, at least two, because we felt that by all our standards and our background check that these were qualified dentists, eligible for licensure by credential, but because of the language of the statutes and regulations, we were not able to grant licensure. We've tabled those licenses rather than deny them in the hope that changes could be made. We envisioned it through regulation in order to all them to get licensure." Number 1124 CHAIRMAN ROKEBERG asked if the change would satisfy the problem. DR. CROOKS indicated he would like to see both things happen. He said he thinks the statute would certainly help, but if the regulation change goes through it would make more things black and white where it wouldn't be up to the board to make value judgements. He said, "The language where (indisc.) demonstration of continuing education or proof of satisfactory successful practice involved, no matter how you look at it that calls for subjective judgement." Number 1192 CHAIRMAN ROKEBERG said there has been some discussion of prohibiting the use of amalgam fillings. He asked Dr. Crooks to comment. DR. CROOKS said the board has not had discussion about prohibiting the use of amalgam fillings, but would be confident that the board would be unanimously against any idea like that. It is the best material available for a lot of common dental restoration needs. Number 1254 REPRESENTATIVE RYAN said a couple of dentists have felt that the qualifications of dental hygienists weren't up to speed for what they were having to pay them in that they weren't professional enough. They felt though there should be some stricter standards set for hygienist's educational background. DR. CROOKS said the licensure for hygienists in Alaska is very similar in process to the licensure for dentists, including the fact that they use a component of the Western Regional Examination Board for testing of hygienists. He said if the dentists have questions about the standards of the exams or reviewing, he would like to hear from them. Dr. Crooks said as far as the specifics of the Western Regional exam, Dr. Warren who is also on-line, is much more familiar with the make-up of that exam. Number 1338 REPRESENTATIVE RYAN said it was a concern that was expressed to him and he wanted to bring it to Dr. Crooks' attention. He noted he doesn't know that much about the profession. Representative Ryan informed the committee he has received complaints from the public that it is extremely difficult for people who want to come to Alaska and practice to get licensed. The public opinion is that there is an "old boy network," kind of protecting the territory. He said he knows a lot of people in Alaska who have gone somewhere else where the fee for service was tremendously less expensive than it is in Alaska. DR. CROOKS said, "This board, and I'm speaking of the people who have been there the last two years, were appointed, most of them anyway, were appointed by the current governor, with the understanding that the law is -- we could expect (indisc.) to follow it as closely as possible and the credentialing was a process that we were encouraged to develop. And as I heard you say, we have tabled two licensure applications purely because we could not find it in ourselves to deny licenses to these people who have appeared qualified. I do not believe that there is any sort of protection being exercised by the Board of Dental Examiners in the state." Number 1455 ROBERT WARREN, DDS, testified via teleconference from Anchorage. He said he is a practicing dentist and has been in practice for 21 years. He was appointed, under the Sheffield Administration, to the Board of Dental Examiners in 1981, to fill an unexpired term and then was reappointed for two additional terms. He noted his last term expired in 1991. Dr. Warren said he was chairman of the board in 1987, when Alaska joined the Western Regional Examining Board. Recently, he has been involved in the American Association of Dental Examiners which is the national organization that Alaska's board queries when there are disciplinary questions about credentialing candidate for licensure. He noted he is the president-elect. He said the national organization was the clearinghouse for disciplinary information as it is the agency that all licensing agencies in the United States report to. Dr. Warren said he is in favor of the legislature extending the termination date for the board, but would strongly suggest that if the numbers on the board have to be changed to make room for a public member that the board be increased by a member rather than eliminating an existing dentist position. Dr. Warren explained he was the president of the board when Alaska joined Western Regional. The legislative audit report of 1986 and 1987 strongly urged that Alaska stop giving their own state licensing exam which they had done for a decade before statehood and since statehood. He said he believes that is where the Dental Board got "the good old boys" reputation. DR. WARREN explained that to affiliate the Dental Board with the Western Regional Examining Board took statutory changes. Representative Curt Menard, a dentist from Wasilla, was in the House at the time and his staff and Dr. Warren helped write the current statute. He explained what they elected to do, aside from putting the WREB language in the statute, was to increase the board of seven members, five dentists, one hygienist and one public member, to nine members adding another dentist and hygienist. Dr. Warren said, "The reason for it at the time was in the past we'd given the examination here in Anchorage. Now our members, because we are a member of Western Regional, were being asked to be in the WREB examining pool. And by that, what I mean is at the time the members of WREB were Arizona, Utah, Montana, Idaho and then also Alaska, and then New Mexico joined. And at the time, there were six states and none of these states had dental schools, so the board members were asked to give the examination on a rotating basis. Frequently, these exams are two to three days from the day of travel so it meant as much as a week out of the office, out of your productive time in your office, if you volunteer to give these exams out of state. They were frequently given in states that had dental schools like Loma (Indisc.) in Southern California or University of Oregon. And so we felt the time constraints on the Dental Board members, be the hygienists, who also had to get exams out of state or dentists who (indisc.) out of state. We needed a few more people to kind of spread that load a little bit more equally. I think it has served the public well and the citizens of the state well for a decade and I can see no reason why to change it at this time." DR. WARREN informed the committee that WREB has now expanded to ten states. Several years ago Oregon rejoined. The state of Washington is currently a member of WREB. The latest states that have joined are Texas and Oklahoma which almost doubled the amount of candidates. Dr. Warren said in response to Representative Ryan's question, this year the WREB is going to examine 1,000 candidates in 12 different exams meaning that if 1,000 pass, they will be eligible to apply for a new license in Alaska. Dr. Warren explained Dr. Crooks has been involved in the credentialing process longer than he has. He said they were just transitioning into the process when the original statute was written. Number 1747 REPRESENTATIVE RYAN indicated that he is having his amalgam fillings replaced with plastic as he has read several articles discussing different diseases that amalgam fillings can cause. He said a few years ago he can remember an appointment to the board when Representative Menard was in the House and this person thought along the same lines as he does. There was opposition to this person's appointment because he dared breach the orthodoxy at the time. He asked Dr. Warren if there is going to be a move again to chastise people who want an alternative replacement rather than using a mercury based product in their mouth. DR. WARREN explained that one of the originators of this philosophy was a Dr. Hal Hungens from Colorado. He said this past year, Dr. Hungens' license was revoked by the state of Colorado and after that the Colorado State Medical Board of Examiners filed a complaint against a physician (indisc.) and she voluntarily surrendered her medical license and moved to Alaska. There has also been a revocation of a license of a dentist in Minnesota doing the same thing. Dr. Warren said that there has been historical judgement in California where a California superior court judge would not receive any testimony portraying that dental amalgam was a serious health threat. A researcher at the University of Nebraska has found that there is no evidence to link Alzheimer's disease to amalgam. He said there is a lot of anecdotal evidence out there regarding amalgam fillings. Number 1895 REPRESENTATIVE RYAN said, "My concern is that I would like to see an individual option be allowed and I would hate to see that anyone who is practicing and offered this service to the public that there would be people ganging up on them." Number 1920 CHAIRMAN ROKEBERG asked Dr. Warren if he would prefer that the committee amend the bill to the year 2001, for a four year cycle and then return to the six licensed dentists and one public member. DR. WARREN said he would recommend that. Number 1993 RICHARD COOK, Dentist, President of the Juneau Dental Society, said he thinks most dentists, in general, support the bill as written or with the modifications. He said he personally doesn't have strong feelings if another public member is added or not. Number 2026 CHAIRMAN ROKEBERG closed the public hearing on HB 135. He said he would like to make an amendment to change the date of 2003 back to 2001. He said he would also like to maintain the six dental members because of the importance of them being in the (indisc.) for the actual examination process and maintain the one public member. REPRESENTATIVE COWDERY moved the amendment. CHAIRMAN ROKEBERG asked if there was an objection to the amendment. Hearing none, the amendment was adopted. Number 2075 REPRESENTATIVE HUDSON moved and asked unanimous consent to move HB 135, as amended, out of committee with individual recommendations and a zero fiscal note. Hearing no objection, CSHB 135(L&C) was moved out of the House Labor and Commerce Committee. HB 137 - BOARD OF VETERINARY EXAMINERS; LICENSE Number 2102 CHAIRMAN ROKEBERG announced the next order of business would be HB 137, "An Act relating to veterinarians; extending the termination date of the Board of Veterinary Examiners; and providing for an effective date." He asked Mr. Welker to come forward and explain the bill. Number 2125 RANDY WELKER, Legislative Auditor, Legislative Audit Division came before the committee. He said HB 137 works on two sections of statute. The first relates to the extension date of 2003. He indicated he expects the committee to amend that for consistency. The second section of the bill addresses concerns raised on credentialing. Mr. Welker said the language in HB 137 needs some work. He said in the Senate Labor and Commerce Committee they found out that there were more intricacies in credentialing. Mr. Welker said, "We're at the decision point now of making a policy call of elevating the standards and the tests that we require of applicants for credentialing. As it sits now in statute, it is a very difficult match of requirements in the state you were licensed in equal to requirements in this state at the time you are licensed. So it's a very difficult process of matching up requirements. The board is headed more towards the requirement of passage of national examinations for continued competency type of tests. I don't have any problem with that. There is some language that is being worked on. I don't know whether it has gotten to you, Mr. Chairman, yet, but there is probably some preferable language for substituting in this section that would better address, I think, the needs of credential applicants and also the concerns of the board." Number 2229 PAM TUOMI, Member, Alaska State Veterinary and Medical Association, testified via teleconference from Anchorage. She said she found the wording relating accrediting awkward. The members of the Anchorage veterinary community that she has spoke with have all expressed concern about the elimination of requirements for graduation from an accredited school of veterinary medicine. She said they are sympathetic with the need to make the process more uniform and to recognize the use of the national board's examinations. She said they feel that the wording in the present Senate bill is considerably simpler and addresses the credentialing problem as well as cleaning up (indisc.) in the basic license provisions. Dr. Tuomi explained a Veterinary Medical Association meeting is scheduled for the following Tuesday. She said they are hoping to poll those members and give further testimony at a later date. Dr. Tuomi said, "We should continue to include the requirement for graduation from a school of veterinary medicine. Entirely conceivable, a good academic student might be able to get sufficient information from (indisc.) medical classes and reading old tests and other information to pass the national board exam, but accredited schools of veterinary medicine add the requirement that those individuals will have had clinical experience and actually had an opportunity to do surgery and medicine under supervision. Eliminating that requirement might mean that someone could simply have book knowledge would be allowed to have a license." Number 2410 DEANNA THORNELL, Veterinarian, testified via teleconference from Fairbanks. She said she agrees that the Senate bill is much better, but there are also some flaws in it. Dr. Thornell said she agrees that all veterinarians should graduate from an accredited veterinary school. That process needs to be kept intact and we shouldn't step backwards in our qualifications. She discussed the difficulties with researching a person's credentials that had graduated in the 1960s. TAPE 97-26, SIDE B Number 025 DR. THORNELL explained the National Examination Committee is actually trying to design clinical competency tests that are species specific and they should be available by the year 2000. Dr. Thornell said, "We were feeling that the people that come in here with credentials should graduate from an accredited school, pass the NVE and also pass (indisc.) competency test on top of having some kind of clinical experience or (indisc.) years for credentials." DR. THORNELL referred to page 3, line 3, of the Senate's version of the bill, "Pass a written examination of the state," and said they need to take the state exam. She said she was hoping that they would be required to have taken NVE, CVT and have practiced for the last five or seven years. There will be a few people who have not taken the clinical competency test who graduated prior to 1981. She indicated she would be more than willing to work with the committee on the bill. Number 137 REPRESENTATIVE BRICE asked if the bill would impact temporary licenses for veterinarians who come to Alaska for the Iditarod for the Yukon Quest. DR. THORNELL said it won't. These are courtesy licenses. The organizer of the race usually handles the lists of the veterinarians that they have coming up. She said they are required to have a current license in another state or in Canada and that they haven't any disciplinary actions against them. Number 166 REPRESENTATIVE HUDSON asked how a veterinarian can practice in Alaska if they are from Washington. DR. THORNELL explained they would get a courtesy license. She said the reason they came up with the courtesy licenses is because of the Exxon oil spill. There were veterinarians coming into the state that were high priced and really weren't qualified and they had a lot of disciplinary action in other states. She noted there weren't a lot. There were very good qualified people that also came. DR. THORNELL said, "If you (indisc.) outside and want to come up and come to one of the races, it's pretty easy not to go ahead and get one of the courtesy licenses. (Indisc.) know that you're not any disciplinary action and we'll allow you to come up here and work. If you want to actually come up and practice in the state of Alaska and you've practiced in the state of Montana for 20 years, this is the credentials we're looking at in this particular House bill. In the past, the wording was so confusing. If you were in Montana and graduated from veterinary school back in 1970, our statutes stated that we had to go back to 1970, look up what our state regulations were on licensing veterinarians at that time and then that's how you got in. It's whatever the state required at that time. The problem is nobody put it on record, what 1970 (indisc.) are and the archives are having a difficult time looking it up. So it's very difficult to answer folks that are calling up here for credentials exactly what they have to do before they get up here. So what we're trying to do is make it very simple and easy and just say have your NVE scores, which everybody has passed if they are already practicing in another state. If you graduated from a veterinary school, that's very important. Once again, everybody should have done is pass the clinical competency test which everyone is required now from here on out, will be required from veterinary schools to take, and also have practiced in the last five or seven years." Number 319 CHAIRMAN ROKEBERG informed Dr. Thornell that he was reading the statute and didn't see anything regarding the courtesy license. He asked if it is in regulation. Number 342 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Commerce and Economic Development, came before the committee. She explained the centralized licensing statute says that boards may set up systems for courtesy licenses if they choose to, by regulation, and this board has. She noted other boards may not have chosen to set up curtesy licensing systems. CHAIRMAN ROKEBERG said there is temporary permit provision currently in statute that is different. DR. THORNELL explained a temporary permit is designed for someone that is coming out of school, hasn't taken a national board exam, are waiting to take our state exam and they have employment here. She noted the state exam is only offered twice a year, so it's very difficult for them to wait six months before they start work. If they have a veterinarian that's going to employ them, the temporary permit will allow them work until the next test is available for them to take. That's mainly designed for graduating students just out of school where they have a way to practice until the exam is given. CHAIRMAN ROKEBERG asked Dr. Tuomi and Dr. Thornell to provide some written comments, particularly relating to CSSB 92. He closed the public hearing and said it is not the intention of the Chair to move HB 137 at this time. HB 136 - PHYSICAL THERAPY AND OCCUPATIONAL THERAPY Number 425 CHAIRMAN ROKEBERG announced the next order of business would be HB 136, "An Act relating to the regulation of physical therapists and physical therapy assistants; extending the termination date of the State Physical Therapy and Occupational Therapy Board; and providing for an effective date." Number 456 RANDY WELKER, Legislative Auditor, Legislative Audit Division, explained HB 136 addresses two elements of statute. The first is the sunset extension date in Section 1. He explained Section 2 is a provision that requires applicants to pass an oral examination administered by the board. When this was put into place, it was put in to basically demonstrate an ability to speak English. He said we were often times being mandated to give an oral examination to Canadians who were very capable of speaking English. Mr. Welker said at a minimum it has been changed to, "at the discretion of the board." An option would be to simply delete this requirement as we don't require doctors and others to demonstrate that they have the ability to speak English, but we are requiring it of the physical therapists and occupational therapists. He sat they felt at a minimum, it would be best left to the discretion of the board on the various applicants. Number 539 PAULINE BENNETT-GANNON, President, Alaska Occupational Therapy Association, testified via teleconference from Fairbanks. She said she is testifying to amend HB 136 and has also testified earlier in the week to amend the Senate's version of the bill. She said she believes the Senate has a committee substitute which incorporates her suggestions. Ms. Bennett-Gannon said the suggestions that she will make are in addition to the changes that the committee already has made. She said the word "or" would be changed to "and" when speaking of the agency that approves curriculum for occupational therapists. Ms. Bennett-Gannon said the statute relating to occupational therapists in this area had "and," whereas statutes relating to physical therapists, which has very similar wording had "or." She said, "The reason for this is that in the past, say when I went to school, the AMA (American Medical Association) was involved in certifying all their (indisc.) professional curriculums and it is no longer that professional agencies dealing with (indisc.) professions has -- part of their organization that does that credentialing and so we really aren't doing `and' because `and' really isn't available." MS. BENNETT-GANNON explained that under AS 08.84.030, section (b)(1), "and" should be changed to "or." She noted on the committee substitute there is something left off. CHAIRMAN ROKEBERG indicated the committee doesn't have the Senate version of the bill and asked Ms. Bennett-Gannon to address the House bill. Number 584 MS. BENNETT-GANNON said her suggestion was that the wording about the discretion of the board that foreign trade therapists demonstrate the ability to speak effective English during an interview also be included for occupational therapists. Currently, it is only located in the language of the statute that refers to physical therapists. She referred to discussion earlier in the meeting about another board and said they have a lot of physical and occupational therapy foreign schools that do send people to the United States and they have concerns about whether or not training is adequate. Ms. Bennett-Gannon said in the past when she served on the Physical Therapists and Occupational Therapist Licensing Board they had a case where a foreign-trained therapist was doing her interview that we require and did not have that ability to understand an English prescription written by a doctor, etc., and wasn't able to finish her internship. That (indisc.) would require some renumbering on that page. She suggested the wording "under this chapter" be added where it speaks of being licensed as an occupational therapist. There was a case where someone licensed in a different health profession decided that what they were doing could be constituted as occupational therapy. The new wording would help clarify that situation. MS. BENNETT-GANNON said, "I also believe that in addition to this (indisc.) of the board by the (indisc.) trained therapists for English that perhaps wording to the effect that "testing could be done if necessary" might be useful. Again, when I served on the board, it was sometimes frustrating not to adopt a regulation and not be able to because there wasn't a place to hook it on in the language in the state." Number 852 MARY MELISSA ROBINSON, Therapist, Committee Chair, Licensing Committee, Alaska Occupational Therapy Association, testified via teleconference from Anchorage. She indicated she is in favor of the extension of the Licensing Board. The present copy of HB 136 states that the extension would be 2003 and she prefers that date. She said her organization would be in favor of extending the board even if it was changed to 2001. Ms. Robinson said she also supports the change in the language for the effective speaking of English which is very important when you're relating to a patient's need when they are describing symptoms. They need to relate not only to other medical personnel, but to the client and that is an important piece of being competent in a profession. She said she would also like to support some of the items outlined in SB 91 (B). The additional language indicates that a person may not provide occupational therapy services without being licensed under this chapter seems self explanatory, but perhaps it is not without the addition of that under this chapter. She said it couldn't be a driver's license, they have to be licensed as an occupational therapist. She said she would like to support the change that would identify that the American Medical Association no longer is part of the curriculum approval with the American Occupational Therapy Association. Although that was in the past, it no longer is and hasn't been for a few years. She thanked the committee for listening to her. CHAIRMAN ROKEBERG asked Ms. Robinson to explain the difference between physical therapists and occupational therapists. MS. ROBINSON explained physical therapists treat physical disabilities differently than occupational therapists do. The philosophy of an occupational therapist requires they use adaptation. She they look at what a person is occupied with during the day. Ms. Robinson said, "The word `occupational therapy' comes from the things which occupy their day and looks specifically at what it is in their day that they need assistance to be modified, to be remediated, to be relieved, to be more functional. We take a very very functional approach rather than total exercise or (indisc.) who work with the person of need is one reason why it's very critical to be able to (indisc.) the receiver of the services to know what his needs are and how that applies to his life, not what our goals are, but what the client's needs are." Number 1159 MARY VAIL, Physical Therapist, Legislative Liaison for the Alaska Chapter of the American Physical Therapy Association, came before the committee to testify on HB 136. She said she would like to endorse the extension of the termination date which she believes will be 2001 in the final version of the bill. Ms. Vail said she would also like to support the proposed changes by the occupational therapists. She said so much of what she does is education as she needs to educate people on how to take care of themselves and she does feel that English is a strong part of their communication to teach patients in what they need to do. Ms. Vail said she agrees to the changes in the Senate bill. Number 1224 CHAIRMAN ROKEBERG indicated HB 136 would be held to await the adoption of changes from the occupational therapists. HB 134 - BARBERS AND HAIRDRESSERS Number 1230 CHAIRMAN ROKEBERG announced the committee would address HB 134, "An Act relating to regulation of barbers and hairdressers; extending the termination date of the Board of Barbers and Hairdressers; and providing for an effective date." Number 1246 RANDY WELKER, Legislative Auditor, Legislative Audit Division, came before the committee to explain HB 134. He informed the committee members that the bill makes two changes to statutes. Section 1 relates to the sunset extension date. Mr. Welker said in Section 2 requests a change in the make-up of the board to delete one of the barber members and replace it with a cosmetologist. Currently, the board regulates barbers, hairdressers and cosmetologists and there is no representation on the board from the cosmetology profession. He said as of June 30, 1996, there were 260 licensed barbers, 482 licensed cosmetologists and 2,127 licensed hairdressers. So with almost a two to one ratio between cosmetologists and barbers, they did not think it was unreasonable to reduce the current two barber members to one and provide for a cosmetologist member. There is a transitional section that would allow for the current barber member to continue until a term expires or when there is a vacancy for the appointment of a cosmetologist. Number 1336 CHAIRMAN ROKEBERG said, "Mr. Welker, I'm trying to look at the audit. The figures you gave about the various members..." MR. WELKER explained they are not in the audit. He said he got the futures from the Division of Occupational Licensing's FY 96 annual report. CHAIRMAN ROKEBERG referred changing the membership from a barber to a cosmetologist and asked if he has received any input from the board. MR. WELKER said he would defer the question to Ms. Reardon. CATHERINE REARDON, Director, Division of Occupational Licensing Department of Commerce and Economic Development, informed the committee that the board discussed this at their last meeting. They agreed it would be a good idea to have a cosmetologist on the board, but they would prefer to achieve that in another manner. She said as she understands their preference is to retain the two barbers, but require that one of the two hairdressers also be a cosmetologist. There are a number of licensees that are both hairdressers and cosmetologists. She said in this case "cosmetologist" means the care of the skin, facials, etc. The board thought they could retain their two barbers, keep their one public member and have one of their two hairdressers serve the duel role of being both the cosmetologist and the hairdresser. Number 1456 CHAIRMAN ROKEBERG questioned what the name of the board is. He asked if it is Board of Barbers and the Board of Hairdressers and Beauty Culture Examiners. MS. REARDON responded that it is called the Board of Barbers and Hairdressers. CHAIRMAN ROKEBERG said, "That is what it is now, but also it does the licensure for cosmetologists?" MS. REARDON answered, "It does, skin care as well." CHAIRMAN ROKEBERG said, "Representative Brice is not here. Maybe even eventually manicurists - trying to get that bill through." MS. REARDON said, "There is specifically in statute right now a prohibition against the board moving into the area of licensing manicurists. That bill would have changed that instead of licensure of manicurists." CHAIRMAN ROKEBERG indicated there seems to be some controversy about the nature of the bill and the recommendation of the board. MS. REARDON said she doesn't know if it is a major controversy because she doesn't know how strongly Mr. Welker feels about the need to actually remove a barber. She said she thinks both the board and the sponsor agrees that having a cosmetologist on the board to offer the expertise about skin care and help with testing of that subject would be a good thing. She said it hasn't erupted into a major controversy at this point. Number 1570 CHAIRMAN ROKEBERG said he has a copy of the January 27 and 28, 1997, minutes from the board where they say that the board felt that a member could hold both a cosmetologist and a hairdressers license. Therefore, the board would have two hairdressers, two barbers and a cosmetologist without losing a barber or hairdresser. He said there would be two hairdresser, two barbers and a cosmetologist. MS. REARDON pointed out one of the hairdressers would also be the identical person as the cosmetologist. She said if she were to draft an amendment, on page 1, line 12, it might be changed to read, "one person licensed as a hairdresser under this chapter." Then line 13 could read, "one person licensed as both, a cosmetologist and a hairdresser under this chapter." Number 1642 REPRESENTATIVE HUDSON said he was looking at the reason why we have this board in the state and asked if the state assumes any kind of a liability for all of the occupational licenses. He said if somebody meets the statutory standards and they turn out be somebody really dangerous, would the state have any liability. MS. REARDON responded somebody from the Department of Law could best answer that. She said her belief is that the state wouldn't be liable as long as we are, in good faith, carrying out the statute or attempting to carry out the statute and aren't being grossly negligent in our behavior. Ms. Reardon noted that issue has come up in marine pilotage because much more money is at stake. When a cruse ship is involved in an accident, the insurance company and the cruse ship company have raised the issue that perhaps the state is liable for having given the license and required us to take on this person who was not competent. She said Gail Horetski has had to look into that topic in more detail. Ms. Reardon said the state has never been held liable for that purpose to this point. REPRESENTATIVE HUDSON suggested maybe that should be included in statute. He said he would presume that all of the boards essentially pay for themselves. He asked Ms. Reardon how her costs in administrating the program are covered. Number 1810 MS. REARDON said they have both a centralized licensing statute and individual chapters for each occupation. The centralized licensing statute applies to all of them. Ms. Reardon said AS 08.01.065, which is the centralized statute, says that each occupation will pay for itself. She read from the statute, "The department shall establish fees so that the total amount of fees collected for an occupation approximately equals the actual regulatory costs of the occupation." It then goes on to say that the division will review and move the fees up and down. She said in this section, regulatory costs means the costs of the department that are attributable to regulation of an occupation plus all the expenses of the board. Ms. Reardon explained that previous to FY 93, there used to be some general fund support - oil money, and that's all been withdrawn over time as budget realities hit. So at this point, the division tracks and bills programs for everything from attorney general costs of reviewing regulations to the actual board meeting, travel costs, and the cost of employing her and her entire division. Ms. Reardon explained the costs of her salary are billed out on a per capita basis to each of the 35,000 licensees. The people who actually do more specific work on a specific board area, such as licensing examiners, keep time sheets. When long distance phone calls are made, they key in what occupation they are making the call on. She said it is true that over time the sense of what costs are caused by regulating occupations has been expanding. Attorney General regulation review costs used to be something that was paid out of pure general fund oil money and now it is all program receipt user fees. The costs of the computer system in the Division of Administrative Services and some of the costs of the commissioner's office are being billed out to occupations. That is a sore part with some of them because some of them feel that the public protection that is provided, perhaps by enforcement activities such as legal fees, are not fairly placed on just those licensees because everyone was protected when they removed an unsafe doctor. She said the licensees covers all of those costs and it is about a $5 million budget. Ms. Reardon discussed charts that she had given the committee members. She noted she would say that probably an average of four professions come to the legislature every two years wanting to be licensed. Number 2038 REPRESENTATIVE HUDSON asked how many people are in Division of Occupational Licensing. MS. REARDON responded approximately 62 people. A fair number of those people are involved in business licensing, which is a tax that generates surplus. The fee for that is set in statute at $50 every two years. She explained ten people are involved in investigations of citizen complaints of competence and that type of things. REPRESENTATIVE HUDSON referred to when people are investigated and asked if there is a penalty structure. MS. REARDON informed the committee that in every occupation there is grounds for disciplinary sanctions which varies occupation to occupation. They use the Attorney General to review a charge document and represent the division in administrative hearings. She noted they can be appealed to the superior court. Ms. Reardon said unlicensed activity is a criminal matter because the boards don't have jurisdiction over people who aren't licensees. If it is a matter where the division finds out that somebody is practicing without a license, the district attorney would take the case through a criminal misdemeanor. If it is a licensee who is performing incompetently, then it is through the Civil Section of the Attorney General's office with the department's hearing officer and the board ultimately decides. Number 2420 MS. REARDON said the division has a lot of regulations. She said they follow the APA for their disciplinary procedures. In terms of each profession, there are a substantial number of regulations fleshing out requirements, definitions, etc. TAPE 97-27, SIDE A Number 001 REPRESENTATIVE HUDSON said, "...I presume at any rate they pretty much, again, preview the regulations and make certain that the standards and the procedures and all that type of stuff are ones that they want, but do you find any complaints against the regulatory regimen and the various licensures?" Number 041 MS. REARDON responded, "When there is a board, we have 35 programs, 20 of them have boards, 15 we run on our own and make all the licensing decisions without the benefit of boards. When there are boards, it's the board itself that has the regulation writing adoption authority the department just has a ministerial role and, so there it's always what the board wanted because they wrote it, except sometimes the AG's office says `no.' But I suspect that in every profession there are people out there who don't agree with all the regulations the way they are written. There are 35,000 licensees. In general, our statutes are very specific meaning - compared to something like the Department of Health and Social Services where they might have something saying `You can adopt regulations to promote the health and welfare of the citizenry of Alaska,' and they can set up whole programs like AFDC through their reg authority. With ours, if you look at them, almost always the legislature has been very specific about exactly what exams people have to pass, exactly what kind of education they need. So there really isn't too much leeway to decide there will be new requirements to be a real estate agent, for example. So we don't have the opportunity to perhaps go way overboard and overstep legislative intent the way you might be able to in another area. But I'm sure that there are people who don't believe credentialing statute requirements or the regs that go with them are right for different programs. You think that the wrong amount of education is being required -- all this type of thing. And in general, if there is a frustration with the system, I must say it's probably that people believe our investigations and disciplinary actions are too slow, not enough disciplinary action." REPRESENTATIVE HUDSON asked, "Is that because you don't have enough people?" MS. REARDON responded, "What bureaucrat would not say `yes' to that question." REPRESENTATIVE HUDSON said, "It seems to me like you can draw your own revenues. I mean we've given you (indisc.) authority to go ahead and increase -- in most cases." MS. REARDON said that although it's true that the department could choose to raise fees and generate $10 million, the check is that the legislature sets their expenditure authority. If the legislature says she can spend $5 million, there is no good reason for her to collect $10 million. She said that is where the check is. Ms. Reardon explained that in the Governor's budget, a new medical investigator has been requested. She hope that will be approved because the division has about 140 open complaints at any one time. They receive between 500 and 600 new complaints every years for all of the licensees. Ms. Reardon explained there are two things that seem to be slowing things. One is investigations and the other is attorney general time. It has evolved into a process where most people are accused of things have attorneys representing them and it becomes a full blown legal process. Number 340 CHAIRMAN ROKEBERG asked Ms. Reardon to provide the committee with the numbers of complaints by the boards and the numbers of license revocation actions. He also asked to provide numbers on the how many barbers, hairdressers, etc., there are. MS. REARDON said she would forward the information to the committee. REPRESENTATIVE HUDSON said he would also like sort of a budget breakdown. He asked how much of the total collection goes to the citizen board member's activities at board meetings. He also asked how much is paid out in per diem. Representative Hudson said if the division collects $6 million, how much of that goes towards board meetings, etc. MS. REARDON said she would also provide that information. Ms. Reardon said, "If I could mention one small issue which I will deal with in the Senate and then perhaps come to you. When it came to the issue of disciplinary action, in the barbers and hairdressers statute there is very little language about grounds for disciplining any licensee. We have this whole structure and very little enforcement capability for incompetence so -- in fact what it says is the board may suspend or revoke a license - another type of permit, for failure to comply with the chapter, but then the chapter just requires licensing. So I would propose that we add `or incompetent or unsafe practice' because for example, when someone comes, which doesn't happen often, but says `I was burned by some chemical' or something, you look and say well `what part of the chapter did it say be safe' and legally, it starts crumbling in front of you. And so if we're going to license 3,000 people and have this whole set up, I think it might be a good time to just...." Number 526 CHAIRMAN ROKEBERG said he has been reviewing Title 8 and is a little bit disturbed because some of the penalty provisions for revocations, board memberships and removal of boards, there are a lot of inconsistencies. There are certain sections in the front part of the chapter that provides for some general things that could apply to almost all of the boards and commission. Some of them have redundant provisions. He said the whole chapter could use some review. MS. REARDON said because they way that Title 8 has been developed with each occupation coming with its own bill over 20 or 30 years, there are a great number of inconsistencies within it. She informed Chairman Rokeberg that she does have a draft omnibus occupational licensing bill in which they are looking for a sponsor for. She said the bill provides for about 50 percent clean-up. Number 685 REPRESENTATIVE HUDSON said, "I would just like to say that I believe of all the testimony that I have heard in the Administration that this young lady is the most forthcoming honest and easy to work with that I've run into and I really appreciate that." CHAIRMAN ROKEBERG indicated HB 134 would be held. ADJOURNMENT Number 728 CHAIRMAN ROKEBERG adjourned the House Labor and Commerce Standing Committee meeting at 5:05 p.m.