HB 115-NATUROPATHS: LICENSING; PRACTICE  2:25:00 PM CHAIR SUMNER announced that the next order of business would be HOUSE BILL NO. 115, "An Act relating to the practice of naturopathy; establishing the Naturopathy Advisory Board; relating to the licensure of naturopaths; relating to disciplinary sanctions for naturopaths; relating to the Department of Commerce, Community, and Economic Development; and providing for an effective date." 2:25:51 PM REPRESENTATIVE PRAX, as prime sponsor, stated that the purpose of HB 115 is to allow naturopaths to practice to the scope of their training. He stated that currently they are trained to prescribe drugs and do minor, in-office surgeries; however, they are not allowed to do these things in Alaska. He explained that the discussion to allow naturopaths to practice in this way in the state has been ongoing for ten years. He pointed out that in other states this is allowed, and evidence suggests that this practice is viable. He deferred to the invited testimony. 2:27:40 PM NATALIE WIGGINS, ND, Alaska Association of Naturopathic Doctors (AKAND), gave invited testimony on HB 115. She stated that she is representing AKAND in support of HB 115. She expressed the opinion that this is in the best interest of Alaskan residents, as medical costs are rising, which is directly affected by the accessibility of care and the shortage of medical providers. She said that naturopaths are ready to address this shortage; however, their practice is hindered by limitations in the state. She addressed the concerns of their qualifications by discussing naturopaths' educational requirements. She stated that after completing a bachelor's degree, a naturopath in the state would then complete an accredited four-year doctoral program. She stated that the training includes 140 hours of pharmacology and 1,120 hours of clinical training, which includes prescriptive management and minor office procedures. She stated that this training is commensurate with nurse practitioners, who have a less restrictive scope of practice in the state, and it is more training than physician assistants receive. She pointed out that both nurse practitioners and physician assistants have prescriptive authority. She argued that these restrictions prohibit naturopaths from fully using their skills in the state. She pointed out that HB 115 mirrors legislation in other states, adding that she had practiced for many years in Arizona in the full scope of her training. She stated that in Arizona she also provided training to medical students and nurses and oversite to physician assistants. DR. WIGGINS stated that she returned to Alaska to raise her family; however, this meant that she had to give up her practice to the extent of her training. She argued that when she moved back to Alaska, her certified medical experience did not go away. She stated that in Alaska she is forced to refer patients when they need medications. Because of the limited availability of providers, she pointed out the long wait time for patients before being seen, and she argued that this is an unnecessary burden to the state's health care infrastructure. She argued that the patients of naturopaths in the state need their doctors to have the ability to prescribe medications and perform minor office procedures; otherwise, these patients would need duplicative office appointments. She reiterated that the proposed legislation would help cushion the overwhelming health care burden. In summary, she stated that there are about 45 licensed naturopathic doctors in the state who are qualified and trained for prescriptive needs and minor office procedures. 2:35:34 PM REPRESENTATIVE SADDLER questioned who trains the naturopaths. DR. WIGGINS explained that clinical training is led by medical doctors and naturopathic doctors. 2:37:08 PM REPRESENTATIVE WRIGHT questioned whether there were any instances during her work in Arizona which required another doctor. DR. WIGGINS stated that in Arizona her prescriptive authority did not include chemotherapy. In response to a follow-up question, she stated that in a primary care setting, there are always times when patients need to be referred to other specialists. 2:39:01 PM CARRIE BALDWIN-SAYRE, ND, Director of Advanced Community Engagement, National University of Natural Medicine (NUNM), gave invited testimony on HB 115. She addressed the education and training completed by naturopathic physicians at NUNM. To become a licensed naturopathic physician, she said that an individual must attend an accredited naturopathic medical school overseen by the US Department of Education. She added that NUNM is overseen by both programmatic accreditors and a regional institutional accreditor. She stated that this regional institutional accreditor sets the standards for curriculum delivery, performance outcomes, financial stability of the institution, and more. She added that this is the same accreditor which oversees the University of Alaska's program. DR. BALDWIN-SAYRE stated that the naturopathic medical program at NUNM is a four-year graduate program, and it includes approximately 5,047 hours of education and 1,254 hours of direct clinical exposure. She said that this program is comparable to the education requirements for many other medical providers, and admissions requirements are nearly identical to the prerequisites for any other medical doctor program in the country. DR. BALDWIN-SAYRE described the first two years of academic education at NUNM for naturopaths, which includes a foundation in human sciences and extensive study in diagnostic methods and procedures. She stated that students are measured by the biomedical science national board exam. She stated that the second two years of the program focuses on clinical applications, with courses providing a framework for developing graduates into primary care physicians. Students also take courses on disease management and prevention using nutrition, lifestyle counseling, botanical medicine, pharmaceutical prescribing, and minor surgery. Students complete nearly 1,300 hours of direct clinical training and must pass three hands-on clinical examinations to graduate, and this includes a full year with their own patient load. In addition to graduation from an accredited institution, to become eligible for licensure, all candidates must pass two national board examinations. DR. BALDWIN-SAYRE, in summary, highlighted that naturopathic medical colleges prepares graduates to be competent, safe, and effective healthcare providers who can assess the primary care needs of their patients, particularly in medically underserved states. She advised that allowing naturopaths to have prescriptive authority and the ability to perform minor office procedures would be a low risk in relation to the existing scope of their practice, as this is well within the confines of their training. She added that this would help keep the cost for patients down, as it avoids multiple office visits. 2:45:32 PM CLYDE JENSEN, PhD, MS, Professor of Pharmacology, College of Osteopathic Medicine, Rocky Vista University, provided invited testimony on HB 115. He shared his credentials, which includes being a professor of naturopathic medicine. He said he was present today to offer his expertise. He explained that pharmacology is the study of how drugs work, when the drugs should be used, and any side effects the drugs may have. He stated that medical professional study pharmacology in preparation for prescribing drugs. He testified that the pharmacology taught to medical doctors, naturopaths, and osteopaths is identical in quality, hours, and intensity. From his experience, he stated that he has an overview of not only the instruction but how the instruction will be utilized. 2:48:36 PM SEAN HIGGINS, MD, Emergency Room Physician, Alaska Regional Hospital, provided invited testimony on HB 115. He shared that before his practice in Alaska he had worked in Seattle, where naturopaths are permitted to work in a broader scope which better represents their skill set and training. He addressed the shortage in health providers in Alaska, and he advised that this results in more trips to the emergency room. He stated that about 30 percent of cases seen in emergency rooms should be handled by a primary care physician, and he listed many of these conditions. He pointed out that this equates to expensive and unnecessary bills for patients and a strain on emergency room resources and staff. He argued that this is forcing emergency room doctors to practice primary care, which is outside of their scope of practice. He continued that allowing naturopaths to practice to the extent of their training would increase the number of primary care givers in Alaska. He reiterated the qualifications of naturopaths. He noted that he has witnessed naturopaths prescribe medications and perform minor procedures safely and effectively in Washington, and he said that he is "baffled" that they cannot do this in Alaska. He referenced the preventative medicines that naturopaths provide. 2:53:19 PM ROB DOWNEY, MD, Seaworthy Functional Medicine, South Peninsula Hospital, provided invited testimony on HB 115. He shared that he has worked alongside many naturopathic doctors for the past 17 years, and he conveyed respect in speaking on behalf of these doctors. He reiterated naturopaths are properly trained to administer prescription drugs and perform minor procedures. He recommended that the proposed legislation be passed. He shared that he has been a medical doctor with 23 years of experience in family practice and 17 years of experience providing functional medicine, which is like naturopathic medicine for medical doctors. He added that he has also been a medical facility administrator. He expressed respect for his colleagues who are naturopaths in Alaska. He noted the irony in withholding these privileges from naturopaths, as these doctors tend to be more careful in recommending the use of medication. DR. DOWNEY estimated that only 35 percent of existing medical care needs are being met in Alaska. Referencing the 65 percent of medical needs in communities not being met, he provided examples of how naturopaths could help. He expressed understanding why members of the conventional medical community could be alarmed by the proposed legislation, as this medical community culture is philosophically conservative and "feel the safest protecting the status quo." However, he continued that this attitude is leaving needs unmet, failing to match available resources with qualified providers. He expressed the opinion that the medical community would be "relieved" once this service is witnessed. He argued that it is time for naturopathic doctors to be able to prescribe medicine and to do the minor procedures that they are trained for. 2:59:49 PM SCOTT LUPER, ND, Alaska Association of Naturopathic Doctors, provided invited testimony on HB 115. He stated that he has been practicing for 35 years in the state. In reference to students studying naturopathic medicine, he said that these students are required to be supervised by licensed naturopathic doctors and medical doctors. He argued that the passage of HB 115 would bring the practice of naturopaths in line with their training and education, which is in primary care, and this is important because of the need of primary care doctors in Alaska. He expressed the opinion that the competency of naturopaths is reflected in the low rate of complaints across the nation and the low cost of malpractice insurance in licensed states. He said that the opposition to the proposed legislation comes from the Alaska State Medical Association. He pointed out that other medical providers, such as nurse practitioners and osteopaths, have all stood in this same position against the medical association in the state. He urged the passage of HB 115. 3:03:23 PM REPRESENTATIVE PRAX thanked the committee. He said work was done to provide documentation around the legislation, and he encouraged members to review these materials. 3:04:35 PM CHAIR SUMNER announced that HB 115 was held over.