Legislature(2019 - 2020)BUTROVICH 205
03/13/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): State Medical Board | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 13, 2020
1:35 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Tom Begich
MEMBERS ABSENT
Senator Mike Shower
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
State Medical Board
Christopher Gay - Anchorage
Steve Parker - Palmer
Richard Wien - Sitka
- CONFIRMATIONS ADVANCED
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
CHRISTOPHER GAY, M.D., Appointee
State Medical Board
Department of Commerce, Community and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Testified at appointee to the State Medical
Board.
STEVE PARKER, M.D., Appointee
State Medical Board
Department of Commerce, Community and Economic Development
Palmer, Alaska
POSITION STATEMENT: Testified at appointee to the State Medical
Board.
RICHARD WEIN, M.D., Appointee
State Medical Board
Department of Commerce, Community and Economic Development
Sitka, Alaska
POSITION STATEMENT: Testified at appointee to the State Medical
Board.
ACTION NARRATIVE
1:35:00 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:35 p.m. Present at the
call to order were Senators Giessel, Begich, and Chair Wilson.
Senator von Imhof arrived as the meeting was in progress.
^CONFIRMATION HEARING(S): State Medical Board
CONFIRMATION HEARING(S)
State Medical Board
1:35:24 PM
CHAIR WILSON announced the confirmation hearings for the
governor's appointees to the State Medical Board.
He informed members that Dr. Abbate notified his office that
morning that he was withdrawing his name. He turned to the first
appointee on the agenda and asked Dr. Gay to speak to why he
wants to serve on the board.
1:35:56 PM
CHRISTOPHER GAY, M.D., Appointee, State Medical Board Department
of Commerce, Community and Economic Development (DCCED),
Anchorage, Alaska, said he has a background in interventional
pain management. Opioids and pain management are a big issue
across the country, especially in Alaska. He said he brings his
expertise in opioids and pain management to the board. He is
interested in making sure that patients in the state are safe
and that providers are following the law. Legislators spent time
crafting statutes that the board interprets and enforces. The
board's duty is to help police medical professionals and provide
good, safe access to care for all Alaskans.
DR. GAY said that he grew up in eastern North Carolina with
people similar to the ones he meets in Alaska. He performed his
medical training in anesthesiology and pain management at
Columbia University and worked at one of largest pain management
practices in northern Virginia. He has lived in different parts
of the country and has observed different laws. He said he is
excited to be an asset to the board in terms of providing
specific background information for some of the pain-related
issues the state faces.
CHAIR WILSON asked if he had read the last review from the state
ombudsman. One of its findings was the lack of regulations
regarding the PDMP [Prescription Drug Monitoring Program], the
number of physicians not registered with the PDMP, and no follow
through on registration. He said the expectation is for the
board to develop regulations to address this finding. He asked
about his general philosophy about the PDMP.
DR. GAY replied he finds the PDMP useful. His patients are in
pain and some were on prescription pain medication before seeing
him. Being able to review his patient's history, including the
number of providers the patient has seen is invaluable for him
or anyone prescribing controlled substances. He said there are
different categories of controlled substances and one of the
biggest complaints he hears from physicians is that some
controlled substance medications are not necessarily addictive.
Prescribing controlled substances puts an onerous burden on
physicians. In general, the registry is very useful, but some
things could be tweaked.
CHAIR WILSON said there is some discussion of removing
veterinarians from the PDMP requirement.
DR. GAY replied his initial reaction is mixed because some
veterinarians are prescribing controlled medications that can be
diverted. It could be useful to make a list of medications to be
used with the PDMP. Certain antiseizure medications do not have
a high addictive value but are still controlled. To have to
check the registry every time those are prescribed can be an
undue burden on veterinarians and physicians alike.
1:42:01 PM
SENATOR GIESSEL asked if had served on a health care regulatory
board before.
DR. GAY answered no.
SENATOR GIESSEL asked why he was interested in serving on this
board.
DR. GAY answered that during his five years in the state, he has
seen instances of providers engaged in behavior that is less
than the standard of care. He and his family plan to be in
Alaska a long time and he wants the state to have providers who
will do the right thing for him, his family members, and other
Alaskans.
SENATOR GIESSEL said that is a great reason. She asked if he
applied for the position out of interest or if he was solicited
to apply.
DR. GAY indicated he was not solicited to apply.
SENATOR GIESSEL asked him to describe the role of the board.
1:44:20 PM
DR. GAY responded that he views the board as an interpreter.
Statutes are made by the legislative body and the board
translates those into actionable items for providers and ensures
that the laws are enforced. The board determines whether
statutes and regulations are violated and ultimately decides if
a response is needed.
SENATOR GIESSEL said he seems to be aware that the board is a
quasi-adjudicatory body with investigators who work under
board's guidance. The board itself makes judgements, similar to
a jury. She relayed that the state is in a quandary about
veterinarians dispensing from their clinics for animals. One of
the common medications veterinarians prescribe is a controlled
substance, tramadol, which in rural villages sells for a high
price per pill. She said tramadol has been listed as a
controlled substance and veterinarians have asked if the owner
or the pet name should be entered in the PDMP. She asked him to
ponder that issue and pass along any advice he may have.
DR. GAY said he would think about it. He offered that given the
structure of the PDMP and the way it is queried, there could be
an issue either way.
SENATOR GIESSEL, noting that every person on the State Medical
Board will be new, asked if he has been offered any orientation.
DR. GAY answered nothing formal but he understands that there
will be some orientation at the next board meeting. Also, some
resources have been made available so board members could orient
themselves on policies, procedures, and regulations related to
the board.
1:48:08 PM
SENATOR BEGICH referenced his statement about bad provider
performance and asked if he referred those bad providers to the
board.
DR. GAY replied the short answer is no. The longer answer is
that he sometimes finds out about them after the fact or through
hearsay. He expressed interest in finding out more about the
avenues in which the providers have been brought to justice.
SENATOR BEGICH asked if he was familiar with the issue of
[transferring oversight of paramedics from the State Medical
Board] and if he had an opinion.
CHAIR WILSON clarified that emergency medical technicians (EMTs)
are under the State Medical Board. Under SB 173, that authority
would be moved to the Department of Health and Social Services
(DHSS), where all the rest of the Emergency Management System
(EMS) is housed. The only thing not handled by the EMS is the
issuance of licenses for medical technicians, which is done
through the medical board. The previous State Medical Board
supported this change, but the committee was interested in the
views of the new board.
DR. GAY said he was not familiar with the proposed change, but
given the information just provided, it makes sense to have the
licenses regulated by DHSS. He added that he reserves the right
to change his opinion.
CHAIR WILSON clarified that it is for licensed mobile intensive
care paramedics.
SENATOR BEGICH expressed surprise that Dr. Gay was not familiar
with the issue. He offered that Dr. Gay's credentials looked
great and he appreciated the comments about his intentions and
reasons he applied.
CHAIR WILSON noted that SB 173 was in the Finance Committee.
That would be a question to follow up on in the Senate Finance
Committee.
SENATOR GIESSEL reported that at noon President Trump declared a
national emergency or disaster and referenced removing the
regulatory restrictions on physicians providing care across
state lines, regardless of licensure in those respective states.
She asked Dr. Gay if he had an opinion on that.
DR. GAY replied the board will need to make a state-level
assessment of what Alaska needs. If it is in the best interest
of the state, he would be in agreement with that proposal, but
he would certainly impose a time limit.
SENATOR GIESSEL agreed there are some elements of concern. She
characterized Alaska is as an end-of-the-road location and
sometimes people come to Alaska to escape their records in other
states. She offered her belief that having the door wide open
can be a double-edged sword.
1:54:48 PM
CHAIR WILSON thanked Dr. Gay for putting his name forward.
1:55:06 PM
STEVE PARKER, M.D., Appointee, State Medical Board, Department
of Commerce, Community and Economic Development (DCCED), Palmer,
Alaska, said he has a family medical practice that offers a wide
spectrum of care, including veteran care at the Palmer Pioneer
Home. He was raised in Michigan and studied at Michigan State
University College of Human Medicine. He served nine years of
active duty in the U.S. Army. He practiced obstetrics in
Michigan and in 2009 moved to Alaska where he continued in
obstetrics until about 2012. At that time he opened his own
clinic.
DR. PARKER said the military provided lots of opportunity for
leadership. He has served as a medical and clinic director and
has been involved in numerous committees through the military.
He has been active in hospital committees in Michigan and at
Mat-Su Regional Hospital. His current interest in the medical
board was sparked by his own interaction with the board. After
30 years of practicing medicine, he had his first patient
complaint. He thought it was frivolous, yet it took two years to
complete the process and the outcome was confusing. Through this
process, he realized that the board could have significant
impact on medical providers and patients. He said he hoped to
assist his colleagues by making accurate and efficient
investigations and by focusing on complaints that have a strong
potential for improving patient care. He said his experience
with the board could adversely affect attracting quality medical
talent to the state. That is an important issue since Alaska
needs more physicians. When the state attracts good medical
talent, it protects patients from poor medical practices.
DR. PARKER said the PDMP can be burdensome for some of the less
scheduled medications. He would encourage a focus on the highly
addictive medications, as previously discussed by Dr. Gay. Using
the PDMP creates a record, which shows usage.
DR. PARKER said he does not have a lot of insight into the EMT
issue, although he agreed with Dr. Gay that there did not seem
to be any reason not to transfer paramedic licensure to DHSS.
CHAIR WILSON said the issue with the PDMP is that a number of
physicians are not registered to use the PDMP but are licensed
through the DEA. The audit concern was that the board needs to
develop regulations to enforce registration with the PDMP by
those licensees. He asked the appointees to think about that
issue. The second issue related to veterinarians using the PDMP
and whether they should track the controlled substance through
the animal's name, the radio frequency tag, or the owner. He
asked Dr. Parker for his initial reaction.
DR. PARKER said he thinks the only way to track the controlled
substance would be through the dog owner, but he would need to
consider it further.
2:01:28 PM
SENATOR VON IMHOF said this is an example of the interesting
conundrums this board will be facing. She noted his motivation
for joining the board and offered her belief that there will be
different challenges and consequences to consider.
SENATOR GIESSEL asked how he would describe the role of the
State Medical Board.
DR. PARKER responded that the State Medical Board must license
good, talented physicians and other medical personnel to make
sure these professionals regulate their practices in a way that
meets a level of care. The board looks for practices that fall
out of line and either corrects or disciplines those medical
professionals. At the same time, the board potentially helps
medical providers who are out of the norm to effectively be
rehabilitated to a better mode of practice.
SENATOR GIESSEL said she particularly appreciated helping MDs
out of the norm to get rehabilitated because health care
professionals are just as susceptible to addictive behaviors as
the general population and sometimes the board must deal with
that issue. She asked his opinion of the emergency regulation to
allow physicians to move from state to state without requiring
further licensure from the states.
2:05:16 PM
DR. PARKER said if there is a true emergency and someone can
review the other state's licensing board, he dd not see any
difficulty with bringing people in for a short period of time,
but the timeline should be well delineated.
SENATOR GIESSEL noted the lack of experience in the new board
and suggested he review the State Medical Board's most recent
sunset audit. She explained that all boards and commissions have
sunset audits, which scrutinize and evaluate how well the board
fulfills its mission. Audits highlight board deficiencies as
well as positives, which can be useful.
CHAIR WILSON asked about his role at the Palmer Pioneer Home.
DR. PARKER answered that he is the medical director. About 15
patients are veterans. His contract is through the state. The
vast majority of these veterans have dementia, but he also has
some private patients at the Pioneer Home.
CHAIR WILSON asked if he generally sees the veterans at the
Palmer Pioneer Home, which is a Veterans home.
DR. PARKER answered yes; he sees just one wing.
CHAIR WILSON asked what the Pioneer Home is doing to ensure the
health and safety of the residents during Covid-19.
DR. PARKER replied people who are sick are not coming to the
Pioneer Home; there are sanitizer stations throughout the
building; and sick people are quarantined. He said he does not
believe that has changed from the influenza season to the
coronavirus season.
2:09:15 PM
CHAIR WILSON thanked him for being willing to serve on the board
and invited Dr. Richard Wein to testify.
2:09:40 PM
RICHARD WEIN, M.D., Appointee, State Medical Board, Department
of Commerce, Community and Economic Development (DCCED), Sitka,
Alaska, gave his adoptive Tlingit name and said he is a member
of the Wolf house and his moiety is Eagle. He is a physician and
surgeon and has spent more than 20 of his 40 years of clinical
and administrative experience in Sitka. He is board certified by
the American Board of Surgery and a fellow of the American
College of Surgeons. He has a Doctor of Medicine from Tufts
University School of Medicine, a bachelor's degree from Columbia
University, and a master degree in journalism from the
Colombia Graduate School of Journalism. Throughout his career,
he has been a strong patient advocate. Through his many years of
clinical practice, he has a strong background in quality
assurance. He is well versed in reviewing medical charts. He
learned how to review credentials. That is one of the major
things a board member does as far as credentialing. He has been
chief of staff at a hospital with more than 520 physicians. He
has been director of surgery for more than 125 surgeons. He has
been a division chief of general surgery for 26 surgeons, and he
has been on the executive committee of the board of a large
hospital group.
DR. WEIN said he is aware of the issues facing the board and
looks forward to helping it address and solve these issues and
move forward to promote the highest health care standards for
the state and its citizens. The board members are all new so
they are on a steep learning curve. As far as orientation, the
board met and had an excellent presentation on constructing
emergency regulations. These orientations will be regularly
scheduled. Clearly, the major portion of training will be board
members reviewing various regulations and statutes governing how
the board functions.
DR. WEIN said that as far as the PDMP, he remembers the old days
when the pharmacist would advise him if patients had
surreptitiously been getting prescriptions. The PDMP is
excellent and needs to be optimized. As far as veterinarians
using the PDMP, he believes that any controlled substance is a
substance that can be abused and veterinarians need to be
registered. One way to handle a veterinarian situation is to get
a urine test from the dog or cat to ensure that the medications
are being utilized. In Sitka, ketamine, which is an abused
substance, was stolen from a vet clinic. At that time, he
thought the regulation should require that any controlled
substances must be handled in same way that a hospital or clinic
does, including a lockup with records of distribution.
DR. WEIN said as far as EMS, it is not necessarily a good idea
to fragment health care administration. He would need to take a
closer look at that since paramedics deliver medications and
perform procedures in the field.
DR. WEIN said regarding moving practitioners across state lines,
the board needs to develop a "hyperpath to get licensed. The
state must have documentation that someone is duly licensed in
one state. These days that is easily done. The board needs to
recognize the emergency nature of this and allow appropriately-
licensed physicians to come to the state.
DR. WEIN said he is aware of the challenges facing the board and
looks forward to helping it be the best it can be.
2:17:40 PM
SENATOR GIESSEL asked him to talk about being placed on
administrative leave from the Sitka Community Hospital, as
reported in an article from February 28, 2017.
DR. WEIN clarified that he was not placed on administrative
leave; it was that his contract was not renewed. He said it was
a situation involving employment aspects and that none of the
issues were about patient care or his interactions with
patients.
SENATOR GIESSEL thanked him for his answer.
2:19:41 PM
SENATOR BEGICH asked how many times he has referred someone to
the board for bad practice.
DR. WEIN said he has not done that individually in Alaska. In
New Jersey, as chief of staff, he routinely had to deal with
physicians who were having difficulties and he suspended three
to five of them. In New Jersey, by statute, someone suspended is
automatically reported to the board. In Alaska, he has had great
difficulty in moving things forward as he tried to go through a
chain of command.
SENATOR BEGICH asked if there were any other times when his
contract was not renewed.
DR. WEIN answered that he worked for SEARCH [Southeast Alaska
Regional Health Consortium] for about 10 years. He signed a
nondisclosure agreement and when he left SEARCH gave him a
generous severance. He said he cannot speak of the matter. After
he left Sitka Community Hospital, he served as an assemblyman in
Sitka. Seven of his 10 years at SEARCH, he was on call 24/7. For
many years he was only the surgeon at Sitka Community Hospital.
He treats his patients well, enjoys the practice of medicine and
sometimes things happen and people move on.
SENATOR BEGICH said legislators are charged with the
responsibility of determining that people appointed to
regulatory boards, especially those that regulate professionals
who manage life decisions, are fair and equitable. He said I
hope you understand the reasons committee members must ask these
questions.
DR. WEIN replied he appreciates it and welcomes it. He would be
happy if SEARCH released him from the nondisclosure agreement so
that he could speak freely about it, but there are no health
care issues. He worked diligently and cared for tens of
thousands of people. He has nothing to be concerned about in
relation to his professional care. He has a great knowledge
about how medicine works.
SENATOR GIESSEL asked where his clinical practice is currently.
DR. WEIN answered that he is retired from surgery. He serves on
the Sitka assembly. Patients still come to him and ask him for
advice about their current care. He advocates for them when
patients have trouble understanding what their physicians have
told them. He will speak with their physicians and help guide
them through what is sometimes a complicated maze. After more
than 40 years of practice, it is still important to advance the
cause of patient advocacy.
2:27:05 PM
CHAIR WILSON opened public testimony and after ascertaining no
one wished to testify, closed public testimony on the
confirmation hearings.
2:27:25 PM
At ease
2:27:40 PM
CHAIR WILSON reconvened the meeting and solicited a motion.
2:28:20 PM
At ease
2:28:26 PM
CHAIR WILSON reconvened the meeting.
SENATOR VON IMHOF stated that in accordance with AS 39.05.080,
the Senate Health and Social Services Standing Committee
reviewed the following and recommends the appointments be
forwarded to a joint session for consideration:
State Medical Board
Christopher Gay - Anchorage
Steve Parker - Palmer
Richard Wien - Sitka
[Signing the reports regarding appointments to boards and
commissions in no way reflects individual members' approval or
disapproval of the appointees; the nominations are merely
forwarded to the full legislature for confirmation or
rejection.]
2:29:20 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee at 2:29 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HSS Medical Board Abbate #1.pdf |
SHSS 3/13/2020 1:30:00 PM |
Governor's Appointees to State Medical Board |
| HSS Medical Board Parker #1.pdf |
SHSS 3/13/2020 1:30:00 PM |
Governor's Appointees to State Medical Board |
| HSS Medical Board Wein #1.pdf |
SHSS 3/13/2020 1:30:00 PM |
Governor's Appointees to State Medical Board |
| HSS Medical Board Gay #1.pdf |
SHSS 3/13/2020 1:30:00 PM |
Governor's Appointees to State Medical Board |