Legislature(1999 - 2000)
04/12/2000 03:25 PM House 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 April 12, 2000 3:25 p.m. MEMBERS PRESENT Representative Norman Rokeberg, Chairman Representative Andrew Halcro, Vice Chairman Representative Lisa Murkowski Representative John Harris Representative Tom Brice Representative Sharon Cissna Representative Jerry Sanders MEMBERS ABSENT All members present COMMITTEE CALENDAR CS FOR SENATE BILL NO. 177(L&C) "An Act relating to insurance trade practices; and providing for an effective date." - MOVED HCS CSSB 177(L&C) OUT OF COMMITTEE CS FOR SENATE BILL NO. 34(FIN) "An Act relating to tattooing, body piercing, and ear piercing; relating to other occupations regulated by the Board of Barbers and Hairdressers; relating to fees charged by the Board of Barbers and Hairdressers; and providing for an effective date." - MOVED HCS CSSB 34(L&C) OUT OF COMMITTEE HOUSE BILL NO. 121 "An Act relating to patients' rights under a health care insurance plan or contract providing coverage for dental care, and prohibiting certain practices by health care insurers relating to dental care." - MOVED CSHB 121(L&C) OUT OF COMMITTEE CS FOR SENATE BILL NO. 297(L&C) am "An Act relating to the licensing of chiropractors and to disciplinary actions against chiropractors." - MOVED CSSB 297(L&C) am OUT OF COMMITTEE PREVIOUS ACTION BILL: SB 177 SHORT TITLE: INSURANCE TRADE PRACTICES & ACTS Jrn-Date Jrn-Page Action 5/16/99 1517 (S) READ THE FIRST TIME - REFERRAL(S) 5/16/99 1517 (S) L&C 1/18/00 (S) L&C AT 1:30 PM BELTZ 211 1/18/00 (S) Heard & Held 1/18/00 (S) MINUTE(L&C) 2/29/00 (S) L&C AT 1:30 PM BELTZ 211 2/29/00 (S) Moved CS(L&C) Out of Committee 2/29/00 (S) MINUTE(L&C) 3/01/00 (S) RLS AT 11:30 AM FAHRENKAMP 203 3/01/00 (S) MINUTE(RLS) 3/01/00 2476 (S) L&C RPT CS 1DP 3NR 1AM SAME TITLE 3/01/00 2476 (S) NR: MACKIE, TIM KELLY, HOFFMAN; 3/01/00 2476 (S) DP: DONLEY; AM: LEMAN 3/01/00 2476 (S) ZERO FISCAL NOTE (DCED) 3/22/00 2692 (S) RLS TO CALENDAR AND 1 AM 03/22/00 3/22/00 2693 (S) READ THE SECOND TIME 3/22/00 2693 (S) L&C CS ADOPTED UNAN CONSENT 3/22/00 2693 (S) ADVANCED TO THIRD READING UNAN CONSENT 3/22/00 2693 (S) READ THE THIRD TIME CSSB 177(L&C) 3/22/00 2693 (S) PASSED Y19 N1 3/22/00 2694 (S) EFFECTIVE DATE(S) SAME AS PASSAGE 3/22/00 2697 (S) TRANSMITTED TO (H) 3/23/00 2661 (H) READ THE FIRST TIME - REFERRALS 3/23/00 2662 (H) L&C, JUD, FIN 4/10/00 (H) L&C AT 3:15 PM CAPITOL 17 4/10/00 (H) Heard & Held 4/10/00 (H) MINUTE(L&C) 4/12/00 (H) L&C AT 3:15 PM CAPITOL 17 BILL: SB 34 SHORT TITLE: BD OF BARBERS ETC/TATOOS; BODY PIERCING Jrn-Date Jrn-Page Action 1/21/99 49 (S) READ THE FIRST TIME - REFERRAL(S) 1/21/99 49 (S) L&C, FIN 4/22/99 (S) L&C AT 1:30 PM BELTZ 211 4/22/99 (S) MOVED CS(L&C) OUT OF COMMITTEE 4/22/99 (S) MINUTE(L&C) 4/23/99 1061 (S) L&C RPT CS 3DP 1NR NEW TITLE 4/23/99 1061 (S) DP: MACKIE, HOFFMAN, LEMAN; NR: DONLEY 4/23/99 1061 (S) ZERO FISCAL NOTE (DEC) 3/21/00 (S) FIN AT 9:00 AM SENATE FINANCE 532 3/21/00 (S) Heard & Held 3/31/00 (S) FIN AT 9:00 AM SENATE FINANCE 532 3/31/00 (S) Moved CS(Fin) Out of Committee 3/31/00 (S) RLS AT 12:00 PM FAHRENKAMP 203 3/31/00 (S) MINUTE(RLS) 3/31/00 2812 (S) FIN RPT CS 3DP 1DNP 3NR NEW TITLE 3/31/00 2812 (S) DP: TORGERSON, PHILLIPS, LEMAN; 3/31/00 2812 (S) DNP: GREEN; NR: PARNELL, PETE KELLY, 3/31/00 2812 (S) WILKEN 4/03/00 2838 (S) FISCAL NOTES (DEC, DCED) 4/04/00 2856 (S) RLS TO CALENDAR 04/04/00 4/04/00 2857 (S) READ THE SECOND TIME 4/04/00 2858 (S) FIN CS ADOPTED UNAN CONSENT 4/04/00 2858 (S) ADVANCED TO THIRD READING UNAN CONSENT 4/04/00 2858 (S) READ THE THIRD TIME CSSB 34(FIN) 4/04/00 2858 (S) PASSED Y15 N4 E1 4/04/00 2859 (S) EFFECTIVE DATE(S) SAME AS PASSAGE 4/04/00 2859 (S) TAYLOR NOTICE OF RECONSIDERATION 4/05/00 2887 (S) RECON TAKEN UP - IN THIRD READING 4/05/00 2888 (S) PASSED ON RECONSIDERATION Y18 N1 A1 4/05/00 2888 (S) EFFECTIVE DATE(S) SAME AS PASSAGE 4/05/00 2888 (S) TRANSMITTED TO (H) 4/06/00 2884 (H) READ THE FIRST TIME - REFERRALS 4/06/00 2885 (H) L&C, FIN 4/12/00 (H) L&C AT 3:15 PM CAPITOL 17 BILL: HB 121 SHORT TITLE: DENTAL CARE INSURANCE Jrn-Date Jrn-Page Action 3/03/99 341 (H) READ THE FIRST TIME - REFERRAL(S) 3/03/99 342 (H) L&C, FIN 3/19/99 (H) L&C AT 3:15 PM CAPITOL 17 3/19/99 (H) HEARD AND HELD 3/19/99 (H) MINUTE(L&C) 3/24/99 (H) L&C AT 3:15 PM CAPITOL 17 3/24/99 (H) FAILED TO MOVE OUT OF COMMITTEE 3/24/99 (H) MINUTE(L&C) 1/26/00 (H) L&C AT 3:15 PM CAPITOL 17 1/26/00 (H) <Bill Hearing Canceled> 4/12/00 (H) L&C AT 3:15 PM CAPITOL 17 BILL: SB 297 SHORT TITLE: BOARD OF CHIROPRACTIC EXAMINERS Jrn-Date Jrn-Page Action 3/27/00 2746 (S) READ THE FIRST TIME - REFERRALS 3/27/00 2746 (S) L&C 4/04/00 (S) L&C AT 1:30 PM BELTZ 211 4/04/00 (S) Moved CS(L&C) Out of Committee 4/04/00 (S) MINUTE(L&C) 4/05/00 (S) RLS AT 11:30 AM FAHRENKAMP 203 4/05/00 (S) MINUTE(RLS) 4/05/00 2871 (S) L&C RPT CS 4DP NEW TITLE 4/05/00 2871 (S) DP: MACKIE, TIM KELLY, LEMAN, HOFFMAN 4/05/00 2871 (S) ZERO FISCAL NOTE (DCED) 4/06/00 2904 (S) RLS TO CALENDAR AND 1 OR 04/06/00 4/06/00 2906 (S) READ THE SECOND TIME 4/06/00 2906 (S) L&C CS ADOPTED UNAN CONSENT 4/06/00 2906 (S) AM NO 1 ADOPTED UNAN CONSENT 4/06/00 2906 (S) ADVANCED TO THIRD READING UNAN CONSENT 4/06/00 2907 (S) READ THE THIRD TIME CSSB 297(L&C) AM 4/06/00 2907 (S) PASSED Y20 N- 4/06/00 2909 (S) TRANSMITTED TO (H) 4/07/00 2909 (H) READ THE FIRST TIME - REFERRALS 4/07/00 2909 (H) L&C 4/12/00 (H) L&C AT 3:15 PM CAPITOL 17 WITNESS REGISTER SENATOR DAVE DONLEY Alaska State Legislature Capitol Building, Room 508 Juneau, Alaska 99801 POSITION STATEMENT: Testified as sponsor of SB 177, Version K. SENATOR JOHNNY ELLIS Alaska State Legislature Capitol Building, Room 9 Juneau, Alaska 99801 POSITION STATEMENT: Testified as sponsor of SB 34, Version V. JANICE ADAIR, Director Division of Environmental Health Department of Environmental Conservation 555 Cordova Street Anchorage, Alaska 99501 POSITION STATEMENT: Testified on SB 34, Version V. DAVID LLOYD Alaska Hepatitis C Coalition P.O. Box 3372 Anchorage, Alaska 99510 POSITION STATEMENT: Testified on SB 34, Version V. GAIL MCCANN, Owner/Operator Electrolysis Clinic 532 Lee Drive Fairbanks, Alaska 99709 POSITION STATEMENT: Testified on SB 34, Version V. CATHERINE REARDON, Director Division of Occupational Licensing Department of Community and Economic Development P.O. Box 110806 Juneau, Alaska 99811-0806 POSITION STATEMENT: Answered questions on SB 34, Version V and testified on CSSB 297(L&C) am. JANET SEITZ, Staff to Representative Norman Rokeberg Alaska State Legislature Capitol Building, Room 24 Juneau, Alaska 99801 POSITION STATEMENT: Answered questions on SB 34, Version V. PATRICIA SWENSON, Staff to Representative Con Bunde Alaska State Legislature Capitol Building, Room 501 Juneau, Alaska 99801 POSITION STATEMENT: Presented HB 121 on behalf of sponsor. SHARON CLARK, Staff to Senator Mike Miller Capitol Building, Room 119 Juneau, Alaska 99801 POSITION STATEMENT: Read sponsor statement for CSSB 297(L&C) am. DR. LOREN MORGAN, President Alaska Chiropractic Society 541 West Thirty-sixth Street Anchorage, Alaska 99524 POSITION STATEMENT: Testified on CSSB 297(L&C) am. MITCH GRAVO, Lobbyist Alaska Chiropractic Society 170 Botanical Circle Anchorage, Alaska 99515 POSITION STATEMENT: Testified on CSSB 297(L&C) am. ACTION NARRATIVE TAPE 00-47, SIDE A Number 0001 CHAIRMAN NORMAN ROKEBERG called the House Labor and Commerce Standing Committee meeting to order at 3:25 p.m. Members present at the call to order were Representatives Rokeberg, Halcro, Harris and Brice. Representatives Murkowski, Cissna and Sanders arrived as the meeting was in progress. SB 177-INSURANCE TRADE PRACTICES & ACTS CHAIRMAN ROKEBERG announced the first order of business would be CS FOR SENATE BILL NO. 177(L&C), "An Act relating to insurance trade practices; and providing for an effective date." REPRESENTATIVE HALCRO made a motion to adopt the proposed committee substitute (CS), Version K [1-LS0902\K, Ford, 4/11/00], as a work draft. There being no objection, it was so ordered. Number 0102 SENATOR DAVE DONLEY came forward to testify as the sponsor of SB 177, Version K. He stated that he does support Version K of the bill. There are two changes in the bill. The first changes the standard for a third-party claimant. This change occurs on page 3, lines 3 through 6, and reads: (B) a third-party claimant regarding a claim in which liability is not at issue to litigate for recovery of an amount due under an insurance policy by offering an amount that does not have a reasonable basis in law and fact [THOSE INSUREDS]; SENATOR DONLEY explained that it is a different standard, suggested by representatives in the industry, who wanted it to also apply to a first-party [claimant]. However, he supports its applying to a third-party claimant, the change made [in Version K]. He indicated the second change occurs in Section 6, which adds "or imply" on page 3, line 29. Section 6 now reads: (b) The provisions of this section do not create or imply a private cause of action for a violation of this section. SENATOR DONLEY commented, "We all agree that we're not trying to create a private cause of action by any of these changes." CHAIRMAN ROKEBERG pointed out that SB 177, Version K, has two further committees of referral, and he would like to move the bill out of committee. Number 0290 REPRESENTATIVE BRICE made a motion to move the proposed House CS for SB 177, Version K, out of committee with individual recommendations and the attached fiscal note. CHAIRMAN ROKEBERG objected for the purpose of discussion. He said he had asked the commissioner of the Department of Community and Economic Development to draft some language regarding "sideboards on the single-act investigation." Due to the limited time, he indicated he would take the issue up in the House Judiciary Standing Committee. He withdrew his objection. REPRESENTATIVE HALCRO also objected for the purpose of discussion. He said: I know the hour is late, and the days in the session are late, but, ... like I said yesterday on the floor, I've got a real hard time when we put these things in the laundry chute and let them go, and we don't have time to digest before they move out of committee. And it's becoming increasingly on a regular basis that we do that in this committee, and I just have some real hard times with that. I'd like to spend some more time on this bill. CHAIRMAN ROKEBERG restated that the bill has two more committees of referral. REPRESENTATIVE HALCRO said he understands, but he does not sit on either of those two committees. He withdrew his objection. [There being no further objection, HCS CSSB 177(L&C) moved from the House Labor and Commerce Standing Committee.] CHAIRMAN ROKEBERG called an at-ease at 3:34 p.m. He called the meeting back to order at 3:37 p.m. SB 34-BD OF BARBERS ETC/TATOOS; BODY PIERCING CHAIRMAN ROKEBERG announced the next order of business would be CS FOR SENATE BILL NO. 34(FIN), "An Act relating to tattooing, body piercing, and ear piercing; relating to other occupations regulated by the Board of Barbers and Hairdressers; relating to fees charged by the Board of Barbers and Hairdressers; and providing for an effective date." Number 0453 SENATOR JOHNNY ELLIS came forward to testify as the sponsor of CSSB 34(FIN). He said he would make some brief introductory remarks and then cover the highlights of the new proposed committee substitute (CS). REPRESENTATIVE HALCRO made a motion to adopt the proposed CS for SB 34, Version V [1-LS0279\V, Lauterbach, 4/12/00]. There being no objection, SB 34, Version V, was adopted. SENATOR ELLIS explained: A constituent of mine came to me. She's a mother of two then-15-year-old girls, and she was horrified to learn that her daughters had received body piercings in what were described to me as very unprofessional and unsanitary conditions. Some serious infections ensued. It was a crisis within this family and, needless to say, the parents were outraged. I was disturbed and frustrated to find that there was really no recourse. We're one of the last states in the Union to have any health and safety standards or licensure procedure in place for this growing industry of body art; body piercing and tattooing. We have, in the work here, taken into account the health and safety issues, the transmission of HIV [Human Immunodeficiency Virus], hepatitis, syphilis, other infections that should be of concern to us all. We've taken our guidance in regulating the body arts from the National Environmental Health Association's Body Art Model Code and Guidelines. So, we've taken the best from other states and from this national organization to avoid some of the mistakes that have been made elsewhere. We're adopting the standard procedure for licensure and regulation here. We handle that in our state for the professions and vocations through the Division of Occupational Licensing to license practitioners and shop owners to ensure that they have the knowledge and good practice of sanitation, aseptic techniques, sterilization and aftercare procedures to prevent transmission of disease or other injury to the consumer. We're also using the standard practice of having the Division of Environmental Health regulate the proper sterilization of equipment and inspection of the licensed facilities. And, again, Alaska is one of the last states to address this important public health issue. In fact, there are some good operators in our state and there are some bad operators, and we're interested in making sure that the public health is protected. Number 0654 Now, for a quick summary of the changes. ... I'm skipping around a bit, but there are some requests from the Division of Occupational Licensing that are of a technical nature and housekeeping nature that can be explained by the division director. There are also changes here in the committee substitute [Version V] that were requested by the industry. I'll mention one specific example. There's a woman in Fairbanks who heard about this bill. She practices what we're calling permanent coloring. Some people have referred to that as cosmetic tattooing. It's a growing thing in our country. There's one person we know of in Alaska that practices this, and without this committee substitute, she would be operating outside of the law. So, permanent coloring referenced here in the CS relates to the experience in Oregon, their statutes that have been received very well for the license of permanent coloring as part of body arts. There also were some other industry requests from the legitimate operators in terms of training and apprenticeships. That's a complicated issue; how long people should apprentice for body piercing and tattooing and we're leaving that up to the board to decide the correct number of hours for those different situations. The industry also wants to be able to hold conventions, or get-togethers, where they talk to each other about the best practices in terms of sanitation and other considerations, and we wanted to make sure that they, the folks who get together for the conventions, are licensed and that the premises are sanitary for these get togethers of folks in the industry. There was also an industry request to modify the definition of tattoo, and we've taken the standard definition there, as well. So, with that, Mr. Chairman, I do have a staff member with me who's an expert in these details and, again, Catherine Reardon is here from the Division of Occupational Licensing, and I know there's a representative from DEC [Department of Environmental Conservation]. Number 0789 REPRESENTATIVE MURKOWSKI asked what the difference is between tattooing and permanent coloring. She wondered, "They're both through injection or through a needle, aren't they?" SENATOR ELLIS responded that they are. The cosmetic tattooing is being referred to as permanent coloring, but it is the same procedure as tattooing. Permanent coloring entails permanent eye lining, eyebrows, blush, etcetera. REPRESENTATIVE HALCRO wondered: Senator Ellis, going through the Senate committee meeting minutes, there was a question about creating an "under 18, you had to get permission." Was there any further discussion on that? SENATOR ELLIS indicated there were some folks concerned, and a number of suggestions were incorporated into the final Senate version of the bill. One of those concerns dealt with parental permission to do body piercing and tattooing. The national industry standard was adopted, which states that no one under the age of 18 can be tattooed because it is a permanent procedure. He explained: It's a permanent situation, and the standard industry practice says no one under 18 is tattooed by legitimate operators in our state today. The illegitimate operators do tattoo people under 18, and that's what led to the outraged parents. SENATOR ELLIS said body piercing is a serious procedure, as well, but it is not permanent. People under the age of 18 can be body- pierced with the permission of their parents. People between the ages of 15 and 18 can, in the presence of a parent or legal guardian, receive a body piercing. Under the age of 15, body piercing is not allowed. Currently, the largest tattoo artist in Anchorage, Larry's Tattoo, tattoos over 10,000 people a year. The owner of Larry's Tattoo has his employees licensed in Hawaii because he is committed to high industry standards and public safety. Number 0988 REPRESENTATIVE MURKOWSKI asked, "When I was younger, we would go over to somebody's house and take a raw potato and a needle and pierce your girlfriend's ear. What does that do to those slumber parties?" SENATOR ELLIS said that is an excellent question. People are being allowed to continue to do the ear piercings. Piercing of the lobe and outer cartilage of the ear continues to be legal. He added: The choice that we've made here in this legislation is that there are a limited number of people who do body piercing in Alaska, but there's literally thousands of retail stores and jewelry stores that do the ear piercing when you buy jewelry at their retail outlet across the state. ... Those piercings are usually done with the guns. We are giving DEC the authority, on a complaint-driven basis, to inspect those premises to make sure that the piercing guns are sanitized to a certain level of public health standards. But if people want to their own tattooing [piercing] on their ears, that remains legal. It's sometimes called "hacking and scratching" when people do this to themselves and it's not for profit. That will continue to be a legal practice in Alaska. But with the guns, we're not saying that the folks who operate the guns in the retail have to go through the apprenticeship process and be licensed. The gun has to be sanitized, and DEC can inspect them to see that they're clean, if there are any complaints that arise. REPRESENTATIVE MURKOWSKI wondered if there is any penalty if the guns are not clean. SENATOR ELLIS responded that DEC will develop regulations under this legislation in order to cover those health standards. CHAIRMAN ROKEBERG said: A number of us were attending an Anchorage caucus a month or so ago in Anchorage. There was a witness that brought this subject up to the Anchorage caucus because he was a sufferer of hepatitis C. He indicated that he had contracted the disease from tattooing. It really hit ... home because I have a brother-in-law that's basically dying of hepatitis C and the treatment is not working. ... Do you have any comments on that? SENATOR ELLIS replied that it is a very serious concern, which is why the Alaska Hepatitis C coalition is in support of this bill [letter included in bill packet]. Hepatitis is one of the biggest concerns. There are no reported cases of HIV transmission in Alaska. He commented, "The good operators are very quick to point that out. So, I want to protect their reputation." He indicated this bill will go a long way to rein in bad operators. Number 1218 JANICE ADAIR, Director, Division of Environmental Health, Department of Environmental Conservation, testified via teleconference from Anchorage. She said she was available to respond to questions. CHAIRMAN ROKEBERG asked what the fiscal impact of the bill is on the Division of Environmental Health. MS. ADAIR replied that there would be some additional burden. She said: The fiscal impacts will be paid by ... the tattoo artists and the body piercers. So, our fiscal note will reflect interagency receipts. I neglected to include, in the last fiscal note I did, some minor costs for ear piercers. The cost there is going to be associated with public notice and just getting information out to what we expect to be hundreds of facilities that pierce ears, and the regulations will not be complicated. ... Representative Murkowski, I had my ears pierced exactly that same way, with a potato and a needle. It won't be complicated regulations, but we do need to really make an effort to make sure those people who are regulated understand what the proposal will be. REPRESENTATIVE SANDERS wondered what the connection is between this bill and the environment. MS. ADAIR explained that DEC deals with issues related to environmental health as well as the resource environment. The department deals with bacteria and the kinds of things in the environment that can affect public health. Number 1343 DAVID LLOYD, Alaska Hepatitis C Coalition, testified via teleconference from Anchorage. He stated: I'm here today on behalf of the Alaska Hepatitis C Coalition. We are a grassroots organization [composed] of people infected with the hepatitis C virus, family members and the professionals who care for us. Hepatitis C is a disease that is at epidemic proportions in the U.S. There is no cure and no vaccine. It is conservatively estimated that one in 55 people [has] it. That translates to 11,000 Alaskans. We are not against tattoos but support a public health standard that would decrease the liklihood that years from now there'll be an outcry to demand why we knew of this disease yet did nothing to prevent its spread. The National Centers for Disease Control have established the correlation between tattoos and body piercing with hepatitis cases, and we are being presented with the means to bring Alaska alongside the other states that have enacted sets of controls to protect their citizens in the manner proposed by SB 34. For instance, North Carolina's legislation stipulates a method of infection control in which all human blood and bodily fluids are treated as if they were known to be contaminated with HIV and other infections that can be transmitted by blood. Because the disease may often have no symptoms for the first decade or two, many of the people infected have no idea they carry the virus. It is currently the leading indication for liver transplantation in the United States, and each year 8,000 to 11,000 people die from HCV [hepatitis C virus] related disease. Unfortunately, it is estimated that the number of deaths will triple over the next two decades as large reservoirs of infected people become sicker. As treatment outcomes improve, however, experts predict that we have window of opportunity to turn those grim statistics around. Some of the doctors I've spoken with about this tell me the durability and the ease of transmission of this virus make HIV look like a weak sister by comparison. Its means of transmission cross into every demographic segment of the population. Some of these includes sports and body building through the use of injectable steroids, internasal cocaine use, tattoos, body piercing and transfusions - until 1989, the nation's blood supply wasn't even tested for it - as well as IV [intravenous] drug use. So, obviously, this bill will not halt the spread of hepatitis C in Alaska, but it is a start. And as a person who was infected with the virus at an Anchorage tattoo [parlor] in 1979 - which I assumed to be safe because of the license on the wall - I would like to applaud Representative Croft and Senator Ellis for their concern with the health and safety of Alaskans. Number 1523 GAIL MCCANN, Owner/Operator, Electrolysis Clinic, testified via teleconference from Fairbanks. She has been in business for the past 18 years. Since 1991, she has been practicing another form of tattooing called permanent cosmetics. It is essentially tattooing the skin. However, it has a totally different outcome and goal. She said: What I do with permanent cosmetics, there are what we call glamour applications, which have to do with enhancing the eyebrows, eye liner, lip liner, full lip color, blush. Then there's another aspect of this that deals with reconstruction of facial features for, say burn survivors and people that are afflicted with facial abnormalities and disfigurements. So, I didn't know about this bill until just recently and sometimes feel a little unprepared for what's going on here, so please bear with me. I do want you to know, however, that as a professional, I had to go out of state to come back with the pertinent and accepted credentials that the industry has to recognize, except we are not offering them to people like me in Alaska. So, we do have to seek outside education and testing to show that we are competent in our field. (Indisc.) plan was to go to Oregon and sit for the state boards so that, again, I could show that I am a qualified and competent professional in the application of my skills and knowledge for permanent cosmetics. I am glad to see that SB 34 is out there on the floor. It does need to be massaged and brought up to standard so that not only is it a bill that would protect the public, but will also guarantee that we are giving them competent applications of color to their skin, in whatever realm we're doing it. So, I am in total support of SB 34. I would like to see that only qualified professionals practice any of these devices, the figurative tattooing, which is what you would know as traditional tattooing, or cosmetic tattooing, which is what I primarily do, which technically includes, as I said, the glamour applications, repigmentation and camouflaging. Another one of the applications for what I do is to work with women who have had mastectomies who are not only having had a radical mastectomy but, in reconstruction, they no longer have a nipple. So, they would come to see someone like myself, and I would, through implantation of pigment, help to normalize the appearance of this individual. So, there are many applications that maybe you haven't thought about or just weren't aware of. And I hope that I've enlightened you to the point that it is something that, there definitely is an image situation here that needs to be dealt with. Through enlightenment and education and information, we can let people know what they should be looking for in qualified professionals, and what they should looking for, in order to not go to individuals that don't fall in that realm. I hope to be involved all the way to the end with this bill, and certainly would like to leave myself open for any questions that you might have. CHAIRMAN ROKEBERG asked if Ms. McCann is aware of anyone else in Alaska who performs permanent coloring. Number 1710 MS. MCCANN answered that there are other people. It is a profession that is growing. She said it seems to her that electrologists, like herself, are naturally transitioning into this area and adding it to their repertoire of services. There are other people in Alaska that are practicing what she calls permanent cosmetic tattooing or cosmetic tattooing. She would like to see this term changed in the bill. She explained: There's a difference between the outcome in traditional or figurative tattooing versus what I do, which is, by our industry standards, called permanent cosmetics or cosmetic tattooing, not cosmetic coloring. I'd like to just see that wording changed from "cosmetic coloring" to either "permanent cosmetics" or "cosmetic tattooing." SENATOR ELLIS clarified: I appreciate the input, and I know my staff has been working with this practitioner to come up with some good language. We chose to take what Oregon had adopted in their statutes, the permanent coloring, because there are a number of things here that it could be: permanent cosmetics, permanent makeup, interdermal pigmentation, or micropigmentation. We thought that "permanent coloring" was the more expansive, inclusive term that covered those things that this practitioner may do or that some of the other practitioners may do. We wanted it to be a flexible, all-encompassing definition and not one so specific that it wouldn't incorporate other folks as body arts move on through time here. CHAIRMAN ROKEBERG asked whether there was consideration of using "permanent cosmetic coloring." SENATOR ELLIS said that is not the specific thing he considered. CHAIRMAN ROKEBERG asked Ms. McCann if using the term "permanent cosmetic coloring" would make her happier. MS. MCCANN responded: We could be a little more definitive, I think. ... From the state of Kansas they have a very succinct and, I think, clear definition of what figurative tattooing is versus cosmetic tattooing. Cosmetic tattooing is to include eyeliner, eyebrows, lipliners, full lip color, repigmentation or camouflage. So, that encompasses it, I think, very well, rather than just "tattooing coloring," as it is in SB 34, simply because my industry has been in existence for probably close to 15 to 20 years, and our industry standards were describing ... having it recognizable, ... to go with either "permanent cosmetics" or "cosmetic tattooing." Even in the phone books there are categories under the definitions that I just mentioned. I think, for clarity's sake and for continuity throughout my profession, that would be more understandable and acceptable. CHAIRMAN ROKEBERG said, "I noticed, Senator, you have a license for permanent coloring and a license for tattooing, but you've got a joint definition. Is it one license?" SENATOR ELLIS answered that it is one license. There are two separate licenses for body piercing and tattooing. CHAIRMAN ROKEBERG asked Ms. McCann if she does figurative tattooing. MS. MCCANN replied yes. She said there is a difference and explained: If you wanted to transfer over and start to do what they call cosmetic tattooing, if you have not gotten the proper information about the anatomy of the eye, et cetera, it could be a problem. So, cosmetic tattooing takes your traditional tattooing techniques into a different realm, because there's just a little more information and education that you would need to know to be able to do cosmetic tattooing - although the application of the skills and knowledge is pretty much the same, when it comes to the practical aspect of the profession, both of them. In other words, we're not using guns, ... we're using machines. I'm using the same tattooing or implanter that somebody who's doing figurative tattooing is using. ... There are a couple of avenues that can be explored here when it comes to the equipment that we use. Basically, we're all doing the same thing by inserting pigment into the dermal layer of the tissue in the attempt to leave some permanent color there. CHAIRMAN ROKEBERG wondered if Ms. McCann's testimony is that a person has to have more skill to be a permanent cosmetic or a cosmetic tattooing artist. He also wondered if the word "artist" is correct. MS. MCCANN stated that a person who practices permanent cosmetics is usually called a technician or practitioner. She said there is certainly artistry involved. She commented: As far as our skills, we require the same skills; however, you require a little more education and knowledge when you're going into the eye areas, because you haven't learned about the anatomy in your regular figurative or traditional tattooing. In that respect, it just requires a little more knowledge, which can be easily attainable. SENATOR ELLIS wondered what the suggestion is for the term of art to be used. CHAIRMAN ROKEBERG answered that Ms. McCann's suggestion is to use "permanent cosmetics" or "cosmetic tattooing". He indicated that he earlier asked rhetorically about "permanent cosmetic coloring". There are three terms to choose from. He said he was a little confused by the definition of "tattooing and permanent coloring" on page 12, lines 26 through 29. He did not think a distinction had been made between the two definitions. Number 2052 SENATOR ELLIS explained that there is no difference in the bill between the licensing requirements because they are similar activities with the same health ramifications. He said: There would be an argument here if we brought everybody in about who has more training in certain skills and the apprenticeship requirement and on and on. That's not really an argument that's very productive. SENATOR ELLIS specified that his suggestion would be to consider adding "figurative and cosmetic" before "tattooing" on page 14, line 25, of the proposed CS. He wondered if he could have a moment to discuss this with his staff. CHAIRMAN ROKEBERG suggested having Catherine Reardon come forward and testify first. Number 2111 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Community and Economic Development, came forward to answer questions on SB 34, Version V. She indicated the sponsor of the bill has been working with her to make all the necessary, conforming changes. CHAIRMAN ROKEBERG asked what the barbers and hairdressers think about this. MS. REARDON explained that the Board of Barbers and Hairdressers, which would be overseeing this program, voted last year to support the concept. The bill puts one member of the tattooing and body piercing professions on the board. This will assist the board in making good quality regulations. CHAIRMAN ROKEBERG referred to page 2, subsection 2, which states: the department shall establish fee levels under (a) of this section so that the total amount of fees collected by the Board of Barbers and Hairdressers approximately equals the total regulatory costs of the department, the board, and the Department of Environmental Conservation for all occupations regulated by the board. CHAIRMAN ROKEBERG said it seems that a whole new area of regulatory responsibility of DEC has been added, but that the board ends up paying for it. Number 2180 MS. REARDON said she does not think of it as such a large thing. She expects a $5,400 fiscal note from DEC, which would ask the Division of Occupational Licensing to "interagency receipt" that money over, every year. The purpose of that money would be to fund DEC's basic adoption of regulations governing these professions. CHAIRMAN ROKEBERG asked, "How many of these people do you think there are in this state?" MS. REARDON surmised that there are 10 to 25 establishments. She stated: It's mostly the regulation adoption process - you know, public noticing, advertising, all that kind of thing - I think that DEC's most concerned about. And there is precedent for this. For example, we "interagency receipt" construction contractor funds to the Department of Labor for their enforcement activities regarding those professions and electrical mechanical administrators. So, personally, I think it works well for DEC to have the responsibilities to adopt the regulations and this is a way of allowing it to happen and still have the costs go where they ought to go which is to the professions involved. This part of DEC is the part that does restaurant inspections, other kinds of health inspections. CHAIRMAN ROKEBERG said that is what he is worried about. He commented: We see these bills all the time here in this committee, and we've got another whole entire department here where we're taking funds to be collected from the licensees and shipping them over to another department into their health inspector area or whatever. I'm not sure I'm warming up to this idea here. MS. REARDON clarified that she would be concerned if she felt that there were going to be a "blank check and ... there'd be no limit on what I might have to take out of my budget and be sending to my neighboring department." CHAIRMAN ROKEBERG interjected, "It's not coming out of your budget. It's coming out the fees of these people." MS. REARDON explained that she meant out of her expenditure authority. She said: When I send fees to another agency, it does count against what I'm spending. So, I feel comfortable because what's in the fiscal note is that they can receive $5,400. They can't suddenly bill me for $20,000. ... I'm sure that if there were any concern about how the money was being used -- I get audited on my fee-setting with some frequency. And so, people could look and see that, yes, indeed, the costs that I was getting billed and transferring the money for were related to adoption of the regulations for body piercing, tattooing and, probably, ear piercing. Number 2316 CHAIRMAN ROKEBERG pointed out that the present committee has to look at licensure costs. He asked again how many people were used to calculate the licensure fee. MS. REARDON responded that she is expecting 10 to 25 people. She referred to page 2, Section 2, and indicated this is almost identical language to that in the architects, engineers and Land Surveyors statute right now. This language says that revenue from the entire board area must cover regulatory costs of the entire board area rather than its being occupation-by-occupation. CHAIRMAN ROKEBERG asked, "Why do the body piercers that are regulated have to pay for the regulation of the unregulated body piercers?" MS. REARDON said Ms. Adair could respond to that question. She said she understood the $5,400 was primarily for the adoption of the regulations. SENATOR ELLIS interjected: The retail locations that have the guns, that's a complaint-drive system. DEC, ... they'll do an annual inspection of the body piercing and tattoo shops, but they won't go out to every retail operation and inspect those annually, just if a parent complains about [that] they didn't a disinfectant of the gun before or after the procedure, they could complain to DEC. And DEC would have the authority to check it out and make sure they're cleaning their equipment. So, that was the balance we tried to make between the licensed shops and the places using the guns to pierce ears. CHAIRMAN ROKEBERG referred to the fiscal note from DEC for $3,100. MS. REARDON said she believes there will probably be a new fiscal note for $5,400 if Version V passes out of the committee. CHAIRMAN ROKEBERG stated that he has a concern about having the licensees pay for "stuff that's not in their area". He wondered if he is mistaken. SENATOR ELLIS said that argument can be made, but added: I would make the argument that the public health concerns here are great - and I know we share those - that the relative amount of money is tiny and that the good operators, the legitimate folks in the industry that have come to us asking for -- it's not very often that you get industries coming forward and [saying], "We want to be licensed and regulated because there's some bad operators out there." I think the good operators feel like they are tarnished by the bad guys that are infecting people, and it gives a taint and a negative impression to the public of tattooing and body piercing. CHAIRMAN ROKEBERG commented that the first fiscal note is for $2,000 and states that there will be annual inspections of the tattooing establishments. [Senator Ellis's response was not on tape because of the tape change.] TAPE 00-47, SIDE B Number 0005 MS. REARDON stated, "If you're particularly concerned about the ear piercing portion ...." CHAIRMAN ROKEBERG interjected and said he is trying to look after licensees. He does not think they should be paying for any more than what they are already responsible for in their area. He said, "They shouldn't be paying for the DEC to inspect jewelry shops that are not under their licensure." He wondered if he is on the right track. MS. ADAIR said she had a question for Ms. Reardon regarding whether or not the fees for adopting the ear piercing regulations should be shown as interagency receipts or general funds. She said: For the same questions that you're asking right now, we do not intend to inspect ear piercing places. We may get complaints about them, and we will follow up on those complaints as we can. It is a low-risk activity. There is no known epidemiological risks that have been identified with ear piercing, even though there can be some blood that occurs when ears are pierced. It's just a variable-risk operation. It's not the same as body piercing. It's not the same as tattooing. This bill does require that we do annual inspections of body piercers and tattoo shops, and our fiscal note reflects the costs to do those annual inspections. I have gone through the Yellow Pages here in Anchorage and have found about five permanent cosmetic places listed in the Yellow Pages. So, our fiscal note will change as a result of that. We will have to add ... some kind of money for developing regulations for ear piercing. Number 0091 SENATOR ELLIS indicated the easy way to address the chairman's concerns and the $2,000 of extra cost for adopting the regulations would be to eliminate the requirement that DEC have regulations for the exclusive ear piercing shops that use the guns. They would still be on a complaint-driven basis, and DEC could go in and inspect those facilities for sanitary conditions, but would not be required to adopt these regulations. He stated: The way I got into this was the tattoo artists believed that the guns are not routinely sanitized to their standards, which is to use an autoclave, which doesn't exist in most retail stores or jewelry shops, and that those should be banned. I thought that was a drastic step that would upset a lot of people and wasn't really necessary based on the health risk, and that we thought DEC adopting regulations was the way to go. But we can address your concern by taking out that requirement of DEC. REPRESENTATIVE BRICE asked where that is referenced in the bill. MS. REARDON pointed out that it appears on page 13, line 22, of Version V. SENATOR ELLIS said "ear piercing" would be eliminated on page 13, line 22. He stated, "This would reduce things by a few thousand dollars and address the concern of the chairman." MS. REARDON commented that a conforming amendment should be made on page 2, line 21, by removing "ear piercing". Number 0162 CHAIRMAN ROKEBERG asked Ms. Adair if DEC is presently inspecting barber shops and hairdressers. MS. ADAIR replied that DEC does have a statutory responsibility for having regulations for those type of shops. Only complaints are responded to, and a plan is signed off on, for the initial occupational license. SENATOR ELLIS stated: That's a pretty easy way that I don't think would be a problem to address your concern. I do know that we at some point want to go back to Ms. McCann's concern, and I have a proposal for that, as well. CHAIRMAN ROKEBERG asked Ms. Reardon what the biennially license fee would be. MS. REARDON responded: It'll be the same biennial license fee for all of these barbers, hairdressers, all of this. And there'll be 3,000 people we're talking in that area. So, I don't expect it to make a very substantial difference in the fee. CHAIRMAN ROKEBERG asked what the "ramp-up" costs of the regulations are for the Division of Occupational Licensing. MS. REARDON wondered if he meant the amount of the fiscal note. CHAIRMAN ROKEBERG replied yes. MS. REARDON responded that the division doesn't usually include the cost of writing regulations in its fiscal notes. CHAIRMAN ROKEBERG asked, "So, you're just going to basically charged these people what the barbers and hairdressers are paying now?" MS. REARDON answered affirmatively. In further response to Chairman Rokeberg, she said it is $125 for a two-year license. There are 3,800 licensees, which is one reason the costs are low. The amount of $3,000 is being requested to cover the costs of printing, postage, communications and advertising. The regulation writing would be "buried in there." The first-year cost being asked for is $15,100. She said, "It increases as DEC changes, then mine will be adjusted. So, now, I'd probably be asking for $18,500." Number 0281 REPRESENTATIVE MURKOWSKI referred to Section 4, on page 3, line 17. She noted that this section gives the board the authority to develop oral and written instructions. She wondered what the benefit is of having oral instruction. SENATOR ELLIS said he believes this language was taken from other states. It is pretty standard language in other states and allows the board to develop the best ways to provide information. He added, "It's flexible language for it to be an oral or written instructions. I suppose we could tighten it down, if you so choose." REPRESENTATIVE MURKOWSKI responded: Every time I see the word "oral" instruction or giving somebody the leeway to not put it down in writing, there's room for miscommunication, misinterpretation, on down the road because you didn't have the requirement that it be put in writing. MS. REARDON said she believes these instructions are the notices and instructions that the practitioners need to be posting and giving to their clients. Number 0389 MR. LLOYD noted that quite often a person will go 20 years before the disease manifests any symptoms. There is a longevity factor of the virus also. He explained: Outside of the human body, most viruses die almost immediately, whereas this virus can live for up to five days. It has a dormant state in dried blood. The point is, is that the inside of the tattooist guns or the ear piercing equipment could possibly be infected. There is some spore testing equipment that's available through the medical community, and I was wondering if, perhaps, the health department would be the appropriate community to address that concern. CHAIRMAN ROKEBERG said he agrees with Mr. Lloyd's comments. He stated, "You should leave the regulatory DEC on the ear piercing, but don't charge the licensees for it. Can you do that? Would that create another separate GF [general fund] fiscal note?" SENATOR ELLIS replied yes. He indicated he has been under pretty clear instructions from majority members to make these things pay for themselves. REPRESENTATIVE CISSNA asked if the licensees benefit greatly by having that oversight because it provides a lot of confidence from the community. CHAIRMAN ROKEBERG said no, it is just the opposite. He is concerned about public health. Number 0507 REPRESENTATIVE CISSNA wondered, "If you're concerned with the public health, what is the cost on this again?" CHAIRMAN ROKEBERG clarified that he is talking about having licensees paying for DEC to inspect unlicensed premises or jewelry shops that pierce ears. He does not think it is fair to ask them to pay for a duty that should be the state's duty. He pointed out that Senator Ellis is correct that it causes a dilemma. Number 0535 SENATOR ELLIS indicated that they got to the point of having the ear piercing shops in the bill and not going through the premises and not being licensed, but being under DEC's regulation. It does cost a little bit of money. He does not mind its being general fund money since it is only a few thousand dollars, and he hopes that a few thousand dollars would not kill the whole bill. CHAIRMAN ROKEBERG said they could redraft it like that. He recommended that Senator Ellis bring it up in the House Finance Committee if he comes up against resistance. SENATOR ELLIS responded that he would be happy to do that. He indicated he wanted to revisit Ms. McCann's concern. He referred to page 14, line 25, and asked whether adding the word "cosmetic" between the words "permanent coloring" - so that it would read "permanent cosmetic coloring" - would satisfy her concern. MS. MCCANN responded that they could just remove the word "coloring", so that it would read "permanent cosmetics" or it could just read "cosmetic tattooing." She said for them, it has to with the industry standard. SENATOR ELLIS responded: We're up against a drafter who insists on ... a gerund: "tattooing and permanent cosmetic coloring". We can't say "tattooing and permanent cosmetics" in this sentence, unless we want to have that. So, Ms. McCann is putting forward her opinion. I'm trying to accommodate the drafter and Ms. McCann in the way this should be stated. Otherwise, it'll be the subject of a Revisor's bill next year, and I think we should avoid that if possible. CHAIRMAN ROKEBERG clarified for Ms. McCann that the legislature has a drafting manual on how to use the English language to put laws together. They have to put an "ing" on the end of it. MS. MCCANN stated that it would satisfy her to see the bill get passed, so for the sake of time and expediency she is willing to make that concession. SENATOR ELLIS reiterated that the suggestion before the committee is to change the wording to "tattooing and permanent cosmetic coloring" throughout the bill. He said he appreciates Ms. McCann's input, but it is hard to balance all of the issues. REPRESENTATIVE BRICE made a motion to adopt the conceptual Amendment 1, to place "permanent cosmetic coloring" throughout the bill where "permanent coloring" currently exists. There being no objection, conceptual Amendment 1 was adopted. SENATOR ELLIS indicated there should be a conceptual amendment with regard to the fees. CHAIRMAN ROKEBERG made a motion to adopt conceptual Amendment 2: "the fees for that are not paid for by the licensees' general fund obligation for the DEC inspection of the non-licensed ear piercing establishments." REPRESENTATIVE BRICE asked about authority for inspection fees for DEC. CHAIRMAN ROKEBERG pointed out that they already have it. JANET SEITZ, Staff to Representative Norman Rokeberg, Alaska State Legislature, restated conceptual Amendment 2: "inspections of the non-licensed ear piercing establishments will be paid by the general fund." CHAIRMAN ROKEBERG asked if there were any objections. There being none, conceptual Amendment 2 was adopted. CHAIRMAN ROKEBERG made a motion to adopt conceptual Amendment 3, to delete "oral and" from line 17, page 3. There being no objection, conceptual Amendment 3 was adopted. Number 0801 MS. REARDON indicated that as part of Amendment 3, a conforming amendment would be needed on page 11, line 9. CHAIRMAN ROKEBERG made a motion to amend Amendment 3 to also change the wording on page 11, line 9. There being no objection, conceptual Amendment 3 [already adopted] was amended. REPRESENTATIVE BRICE made a motion to move SB 34, Version V [1- LS0279\V, Lauterbach, 4/12/00], as amended, out of committee with individual recommendations and accompanying fiscal notes. There being no objection, HCS CSSB 34(L&C) moved from the House Labor and Commerce Standing Committee. HB 121-DENTAL CARE INSURANCE Number 0880 CHAIRMAN ROKEBERG announced that the next item of business would be HOUSE BILL NO. 121, "An Act relating to patients' rights under a health care insurance plan or contract providing coverage for dental care, and prohibiting certain practices by health care insurers relating to dental care." REPRESENTATIVE HALCRO made a motion to adopt the proposed CS for HB 121, Version K [1-LS0454\K, Ford, 4/12/00] as the working document before the committee. REPRESENTATIVE BRICE objected and asked that it be clarified for the record whether Version K was the same as Version M. PATRICIA SWENSON, Staff to Representative Con Bunde, Alaska State Legislature, testified on behalf of Representative Bunde, the bill's sponsor. She confirmed that Version K and Version M are exactly alike. REPRESENTATIVE BRICE withdrew his objection. CHAIRMAN ROKEBERG declared that Version K was before the committee. Number 0919 MS. SWENSON read: HB 121 sets out the rights of dental health care consumers. This bill specifically allows consumers to choose any dentist they wish to see including a specialist, prohibits insurers from reimbursing a covered person at a different rate because of the person's choice of dentist, gives covered people the right to receive full information regarding their care options without fearing adverse actions from insurance companies, and allows patients to take civil action against health care insurers to enforce their rights, and requires any dental treatment plan review or utilization review to be conducted by a dentist. MS. SWENSON said that is what the bill did last year, and that there has been some language change this year. She asked if there was previous committee action that needed to be rescinded. CHAIRMAN ROKEBERG said the committee had adopted a [proposed] CS, and asked her to proceed with reviewing the changes. Number 1010 MS. SWENSON said this bill seems to satisfy the objections of the labor unions and "everybody else involved last year." The changes were brought to Representative Bunde. She had been told that everybody has agreed to the changes and signed them. MS. SWENSON explained that the first change was on page 2, lines 8 through 13. This allows people to choose a dentist outside the plan and the dentist can be reimbursed at the same rate as a provider in the preferred provider organization (PPO), but depending on the plan, the person may have to pay a higher deductible because the dentist is not in the PPO. MS. SWENSON said the next change is on page 2, lines 24 through 26. It says a dentist who treats a covered person may not waive uncovered dental expenses for which the person has liability because a covered person chooses a dentist outside the network or preferred provider organization. The other changes, she said, are in the definitions section. CHAIRMAN ROKEBERG observed that this is similar to another bill. MS. SWENSON concurred. CHAIRMAN ROKEBERG explained that this is basically a point-of- service provision that allows for a slight adjustment in the copayment. Number 1170 REPRESENTATIVE HALCRO moved to rescind the committee's failure to move HB 121 out of committee. There being no objection, it was so ordered. REPRESENTATIVE HALCRO again moved to adopt HB 121, Version K, as the working document before the committee. There being no objection, it was so ordered. REPRESENTATIVE HALCRO made a motion to move the CS for HB 121 out of committee with individual recommendations and the accompanying (updated) fiscal notes. There being no objection, CSHB 121(L&C) moved out of the House Labor and Commerce Standing Committee. SB 297-BOARD OF CHIROPRACTIC EXAMINERS Number 1229 CHAIRMAN ROKEBERG announced that the next item of business would be CS FOR SENATE BILL NO. 297(L&C) am, "An Act relating to the licensing of chiropractors and to disciplinary actions against chiropractors." [The bill was sponsored by the Senate Health, Education and Social Services Committee, chaired by Senator Mike Miller.] Number 1252 SHARON CLARK, Staff to Senator Mike Miller, Alaska State Legislature, specified that the committee was working from CSSB 297 (L&C) am. She explained that this bill, requested by the Board of Chiropractic Examiners, amends the licensing statute for Alaska chiropractors. She read from the sponsor statement: Section 1 allows for a temporary permit to practice chiropractic in Alaska. The temporary license initially is for 60 days and may be extended by the Board of Chiropractic Examiners. It is subject to the same terms and conditions of a regular license. This section also provides for a licensee who does not practice in the state to hold an inactive license. The section finally provides for a retired licensee. A person holding a retired license may not practice chiropractic in the state. A person holding a retired license may apply for an active license subject to terms and conditions set by the board. Section 2 provides for new reasons why the Board of Chiropractic Examiners may refuse to issue a license in the state. These include conviction of a felony or other crimes that would affect the person's ability to practice competently and safely. Conviction of crime involving the unlawful procurement, sale, prescription, or dispensing of drugs, and attempting to practice after becoming unfit due to an infectious or contagious disease. Your consideration of this bill is appreciated. Number 1336 MS. CLARK explained that CSSB 297(FIN) am had been passed unanimously by the Senate. One amendment was adopted before the bill was passed. A concern had come up in committee about the word "physiotherapy." Senator Ellis had offered an amendment: On page 2, line 22, after the word "board," delete "physiotherapy examination" and insert "physiological therapeutic examination; and on page 2, line 23, after the word "examiners," insert "required by the board." That amendment was adopted, and the amended bill was passed by the Senate. MS. CLARK mentioned that someone had asked what "locum tenens" means. According to Black's Law Dictionary, it means "holding the place of deputy; a substitute, a lieutenant or a representative." Webster's Dictionary defines it as "one holding a place; a person, a physician or a member of the clergy who substitutes for another." CHAIRMAN ROKEBERG asked the intent behind having a retired license status. MS. CLARK said she would prefer to have Catherine Reardon from the Division of Occupational Licensing speak to that. Number 1500 DR. LOREN MORGAN, President, Alaska Chiropractic Society, testified by teleconference from Anchorage. He said he supports the bill, which provides continuity for the profession, locum tenens, and grounds for suspension. There has been no provision for temporary licensing or for retired licenses until now. CHAIRMAN ROKEBERG asked if there has been a need for temporary chiropractors. DR. MORGAN explained that a solo practitioner has difficulty taking care of his patients' needs while he or she is out of time. Right now, the only alternative is not to provide any care. CHAIRMAN ROKEBERG asked, "So you can't take a vacation?" DR. MORGAN agreed, "Yes, you're kind of stuck." CHAIRMAN ROKEBERG asked about the retired license. Number 1583 DR. MORGAN said a retired licensee would be for a person who has been licensed in the state and who leaves the state but may want to come back. This lowers the fees while he/she is not here in active practice, but maintains all of his/her continuing education and other credits while he/she is away. Number 1612 REPRESENTATIVE MURKOWSKI asked about the inactive license. Number 1630 DR. MORGAN said they are almost the same. A retired licensee would be for someone who is not going to practice but wants to remain involved in chiropractic activities. It would be a like a retired person maintaining some type of affiliation with his or her professional associates. REPRESENTATIVE MURKOWSKI said she was looking at the language of the bill, which says that if a person practices at all, even infrequently, he/she has to have to have an active license. She asked: If I am only going to practice four times a year, would I have an active license or a retired license? DR. MORGAN said she would have an active license. REPRESENTATIVE MURKOWSKI said she still did not understand why it is necessary to have an active, an inactive and a retired status. Number 1710 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Community and Economic Development, explained that the retired license status is basically for someone who does not intend to return to the profession, but who would like to continue to get to "call themselves a chiropractor" for emotional reasons. It acknowledges the professional credential one had during one's working life. It doesn't do anything other than that. The person cannot work. The reason for an inactive license is that one has have to keep up his/her continuing education because he/she may want to return to active practice. [The division] wants to ensure that when the person does [return to active practice], he/she is ready to practice competently. Number 1805 REPRESENTATIVE MURKOWSKI asked, "We get money from them for a retired license fee and they don't get to do anything?" MS. REARDON said that is correct. Some people want to pay to be a former chiropractor, more or less. REPRESENTATIVE BRICE, referring to discussion of another bill, said he thinks it is important, given that [the legislature] can use the fees coming in for retired licensing to pay for the inspections of unlicensed body piercers. [Laughter] Number 1844 MS. REARDON said she thinks the big motivation for the inactive status is because it is also a lesser price than for an active license, although it is not the one-time fee for retired status. The feeling of the board is that people who move elsewhere and do think they might return to Alaska are more likely to keep paying even though it is a lesser [license]. This will help the overall financing. REPRESENTATIVE MURKOWSKI asked what the retired license fee would be. MS. REARDON said she doesn't know; the fee would be set by regulation. She has no stake in having them be very high. The fee is not repeated and would not bring in a great deal of revenue. She indicated she would look for public comment on that point. REPRESENTATIVE MURKOWSKI wondered if this is done in other areas. MS. REARDON replied yes. She explained that physicians also have retired status. REPRESENTATIVE MURKOWSKI asked, "Do you give them some kind of a licensure or an endorsement?" MS. REARDON responded that they are given a retired license. REPRESENTATIVE MURKOWSKI stated that she is trying to equate this to the practice of law: When "you are ready to retire, you stop paying your bar dues - and that's a good thing - and you still get to call yourself a retired lawyer." MS. REARDON answered that for some reason, some people like to continue to pay and be on the roster. Number 1977 CHAIRMAN ROKEBERG commented: I've actually thought about this in the real estate statute - in expanding that section, repealing a sabbatical leave-type of a provision. Because of the licensure - continuing education - there's a lot of problems around that. Plus, usually a professional, not only do they pay the great State of Alaska that licensing fee biennially, they usually belong to a number of other professional associations and societies and so forth. And that may be one reason they want to have a retired status, so they can keep up their license, to keep up their national affiliation. REPRESENTATIVE MURKOWSKI referred to Section 2, page 4, lines 16 through 17, relating to the refusal to issue a license due to an infectious or contagious disease. She said she guessed that this makes sense, but she was trying to think of infectious diseases that one would want to "stay away from or that you would deny somebody a license based on the disease." She wondered what the thought was behind adding that to the bill. Number 2131 DR. MORGAN explained this was included to reduce any risk to the public. It is a public safety issue. REPRESENTATIVE BRICE and REPRESENTATIVE MURKOWSKI expressed curiosity regarding how it is defined. REPRESENTATIVE BRICE commented: Somebody in the early stages of HIV [Human Immunodeficiency Virus] infection obviously might not be ... contagious or a problem or anything else. Are they unfit at that point in time, or [at] what point in time do they become unfit? CHAIRMAN ROKEBERG replied: The board can impose disciplinary sanctions or refuse to issue a license, but it doesn't indicate revocation. There may be quirk in their licensing law. On the other hand, that's a question I'd direct to Ms. Reardon. I'm not sure this is legal under the Americans with Disabilities Act [ADA], depending on what the infectious disease was. REPRESENTATIVE BRICE said for a physical disability, that is already in statute. MS. REARDON added that it seems to be a subset of physical disabilities already included in statute. She said it is her assumption is that the board would have to find that the person was unfit to perform chiropractic work, not just that the person had an infectious disease of some type. This is why it would not violate the ADA. If it did not impact one's ability to practice as a chiropractor, she thinks it probably would be against the law. She does not know of any problems encountered that would have to led to the inclusion of this language in the bill. Number 2333 REPRESENTATIVE MURKOWSKI said she thinks the language is a "red flag." REPRESENTATIVE BRICE asked Ms. Clark, "Where did that come from? Did that just come from the chiropractors?" MS. CLARK said that is correct. MS. REARDON clarified that the language came from the board. It is her personal belief that elimination of the language would not create a problem. If there is some physical issue that makes someone unfit, "we're going to be able to do something about it under the current statute." She suspects the language came from the board's desire to be very consumer-protection-oriented. She does not know of any specifics. CHAIRMAN ROKEBERG referred to page 4, line 15, which adds "person's" and removes "licensee's". He pointed out that "licensee" is referenced throughout the entire bill. MS. REARDON explained, "It now applies to refusing a license, and so the person that they want to refuse a license to won't be a licensee yet." TAPE 00-48, SIDE A Number 0016 MITCH GRAVO, Lobbyist, Alaska Chiropractic Society, came forward to testify on CSSB 297(L&C) am. He said he hadn't talked to the board members who put this together. However, he thinks it is probably modeled after the other health care provider legislation in the state. If the committee changes it, he would suggest keeping either "infectious" or "contagious" because he does not think anyone would want a health care provider who had a contagious disease treating him or her. He believes there is a difference between being infected and having a disease that is contagious. A person can be infected without being able to transfer the infection. But he doesn't believe that anyone would want to be treated by a health care provider who had a contagious disease. That would be a public safety issue. REPRESENTATIVE BRICE said the question is whether infectious or contagious diseases are a subset of a physical disability. Number 0114 DR. MORGAN explained that "infectious and contagious" regarding with the licensee or the individual is if those things affect the doctor's ability to practice safely, not that he/she has the disability. It is a hands-on profession. MR. GRAVO pointed out that a change would require concurrence by the Senate, an additional step. REPRESENTATIVE BRICE said he does not know whether it is a big deal or not, but he is comfortable leaving it like it is. REPRESENTATIVE MURKOWSKI said she does not like it. She agreed with Ms. Reardon that it is contained within "physical disability." She thinks it is more problematic leaving it in. MS. REARDON stated: I did look up ... dentistry and medical licensing. ... They just refer to physical or mental disability. So, probably we're able to make responsible decisions without having this language here. REPRESENTATIVE MURKOWSKI made a motion to amend the bill by deleting "or an infectious or contagious disease" on page 4, lines 16 and 17. Number 0502 CHAIRMAN ROKEBERG asked Ms. Clark what the sponsor's representative would say about deleting that from the bill. MS. CLARK said, "He would probably be in support of whatever the sponsor wanted." She said that interestingly enough, this didn't come up in any of the discussions. CHAIRMAN ROKEBERG said, quite frankly, he thinks it runs the risk of running afoul of the ADA. Number 0553 MR. GRAVO said he did not think he could argue against [the amendment]. It just might complicate the bill's passage this session. Number 0574 MS. REARDON pointed out that there is a good public health and safety reason for the whole bill. She stated: It's not just the inactive, retired, locum tenens status. The really important thing about having this bill pass into law is that without it, it retains a giant loophole in chiropractic licensing, which is that there is a list of things you can discipline a license holder for, but there is nowhere where it says you can deny a license. That's the really important part of this whole bill, is where it says you can also deny a license. ... This is a bill that matters. And this has been a problem for the board, where they had people with fairly significant criminal backgrounds. And when they went to see why they could deny a license to that person, they found out they couldn't. Number 0626 REPRESENTATIVE HALCRO asked whether, if the bill were left unamended, the board couldn't create more specific rules regarding "Section C, physical or mental disability," to more closely reflect the physical or mental disability goal that the committee is trying to reach. Number 0661 MS. REARDON said: If what you are asking is, "Could the board write regulations that said that 'physical or infectious diseases' wording only applies to diseases that impact your ability to practice safely" or something like that, I would think that they probably could. I also think that even in the absence of that type of regulation, if we tried to actually discipline, to file an accusation against someone, or to deny a license and they appealed, that if it conflicted with the ADA, that the Department of Law would immediately yank us back and say, "No, you can't charge someone with something that doesn't relate to their ability to practice." CHAIRMAN ROKEBERG asked if any more regulations would have to be written because of this bill. Number 0712 MS. REARDON said there is the opportunity to write regulations. If they [the department] cared to write some regulations about how one could get back one's retired license, into active status, then the bill says they can write regulations on that. But there isn't any mandate. CHAIRMAN ROKEBERG reminded members that there was a motion before the committee. Number 0739 REPRESENTATIVE BRICE said he was going to oppose the motion for the simple reason that he would like a clearer definition of what this [legislation] has to do. He suggested that the bill could still be amended on the floor. CHAIRMAN ROKEBERG asked Representative Murkowski if she wished to maintain her motion or wanted to call Legislative Legal Services and asked for a legal opinion. REPRESENTATIVE BRICE urged the committee to withdraw the amendment. He said: It's not going to be on the floor tomorrow or even the next [day], at which point in time we can get this completely cleared up as to exactly how important that section is - whether there are actually areas where there have been infected chiropractors that are spreading disease and contagion and causing a problem, or whether or not this is just something people wanted to see (indisc.). CHAIRMAN ROKEBERG stated: My concern on the subject is that it may run afoul of some legal problems with the ADA. On the other hand, I believe it should be (indisc.) if there is unfitness on the part of the practitioner because of a disease. ... That's my concern. I would prefer to leave it in, also. MS. REARDON asked if a letter of intent would make people feel comfortable. CHAIRMAN ROKEBERG replied no. He said that he is concerned about the legal aspect of this issue. REPRESENTATIVE MURKOWSKI withdrew her motion. Number 0918 REPRESENTATIVE BRICE made a motion to move CSSB 297(L&C) am out of committee with individual recommendations. There be no objection, CSSB 297(L&C) am moved out of the House Labor and Commerce Standing Committee. ADJOURNMENT Number 0953 There being no further business before the committee, the House Labor and Commerce Standing Committee meeting was adjourned at 5:23 p.m.