HB 115-NATUROPATHS: LICENSING; PRACTICE  3:28:47 PM [Due to technical difficulties, some audio following the call back to order was not captured on the recording but information from the secretary's log notes was provided.] 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." REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 1 to HB 115, labeled 33-LS0631\A.2, Bergarud, 4/10/23, which read as follows: Page 1, line 1: Delete "Advisory" Page 2, line 16: Delete "Advisory" Delete "Advisory" REPRESENTATIVE PRAX objected for purposes of discussion. 3:33:22 PM REPRESENTATIVE RUFFRIDGE spoke to Amendment 1. He explained that a full-fledged board would better suit the ability of naturopaths to function in line with other medical providers in the state. The amendment simply would remove the word "advisory" and would propose establishing a full functioning board for naturopaths. 3:33:59 PM CHAIR SUMNER noted that the Director of Division of Corporations, Business, and Professional Licensing, Sylvan Robb, was available to answer questions. 3:34:16 PM REPRESENTATIVE CARRICK asked whether Ms. Sylvan could enumerate some of the differences between an advisory and a full board. She queried Representative Ruffridge regarding whether there are any professional boards in the state of Alaska that are of this type that are advisory right now and where this board would fall with this amendment in relation to other boards of this type. 3:34:59 PM REPRESENTATIVE RUFFRIDGE deferred to Director Robb but commented that advisory boards are within her capacity to manage. However, as far as medical provider status, there is no advisory board that allows full prescriptive authority. 3:35:28 PM SYLVAN ROBB, Director of Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community, and Economic Development, in answer to Representative Carrick's question stated that her division currently did not have any advisory boards in the division. REPRESENTATIVE CARRICK requested that Ms. Robb enumerate the differences between an advisory board and a full board in terms of authority that is granted. MS. ROBB explained that the division has 21 regulatory boards invested with the powers that are given to them in statute. She provided examples of the powers granted by statute. An advisory board on the other hand, is less of a policy making body and more of an advisory body. 3:36:59 PM REPRESENTATIVE SADDLER pointed out the amendment proposes changing the name, but there apparently are no other changes in function, so it is unclear what changing the name actually accomplishes. MS. ROBB deferred to the maker of the amendment. 3:37:47 PM REPRESENTATIVE PRAX asked whether the department has any opinion or recommendation regarding the advisability of a policy making board as opposed to an advisory board. He questioned whether the department can take on the regulatory power of the board. 3:38:22 PM MS. ROBB explained that currently there are 21 different programs covering approximately 80 professions where there is no board, and the division provides regulatory oversight. This would be similar, but it would be an enhanced situation because there would be a formal advisory board. She discussed concerns with a board in a small profession. In 2023 there were only 56 licensed naturopaths in Alaska. The expenses incurred by the board would fall on the members of the profession. She commented that although Alaska is a large area, it is like a small town where people in a particular profession know each other. She gave an example of a board of similar size where the members "conflicted out" of a disciplinary matter because they all knew each other. REPRESENTATIVE PRAX asked whether decisions get delayed because of lack of a quorum. MS. ROBB explained that some boards have struggled to achieve a quorum, so business is delayed. Licensing and discipline matters are similarly delayed. REPRESENTATIVE PRAX questioned whether that would generally be weeks or months. MS. ROBB stated that the frequency depends on the composition of the board and changes in the board over time. A meeting can't be scheduled for the next day because of the Open Meetings Act. REPRESENTATIVE PRAX asked whether the department is accountable to the governor, an elected official, and to the legislature, a group of elected officials, whereas boards are less accountable. MS. ROBB replied in the affirmative. 3:42:07 PM REPRESENTATIVE RUFFRIDGE asked whether there are any professions with prescriptive authority in the state that do not have a regulatory board. MS. ROBB said there are none. 3:42:44 PM REPRESENTATIVE SADDLER explained that he was still not sure that changing the name from advisory board to board imparts any regulatory authority and at this point seems like window dressing. REPRESENTATIVE RUFFRIDGE stated that there were big differences between an advisory board and a naturopathy board. Moving forward, depending on the wishes of the committee, they could clean up language in section B regarding the commissioner having oversight. REPRESENTATIVE SADDLER asked Ms. Robb whether there was a definition of board versus advisory board. He mentioned that he did not see a change in the function of the two boards. 3:44:19 PM MS. ROBB explained that without giving the board powers, the board would remain mostly advisory. REPRESENTATIVE SADDLER reiterated that it seemed there was no real effect to the amendment. 3:44:49 PM REPRESENTATIVE PRAX commented that he supposed the answer was literally "no," but if someone starts to think about this somewhere in the future, the intent needs to be clear. He explained his real concern is that boards could make it more difficult to get into the profession. He doesn't mind seeing a board advising an official that works for the government that works for elected officials. He reiterated his concern that a board would, to some degree, have a conflict of interest with people who might want to get into the profession. 3:46:00 PM REPRESENTATIVE FIELDS pointed out that if the legislature were to create a board with real powers, then the intent would be clear. If it is a board, then implicitly the costs would be user fees rather than coming from the general fund. 3:46:28 PM REPRESENTATIVE RUFFRIDGE explained that the intent is to make this a full regulatory board with prescriptive authority similar to other medical professions in the state. In response to Representative Saddler's questions, he suggested the possibility of adding to the amendment a removal of the language in [subsection](b) which would clarify that. Then in [subsection](c), changing the language from, serving "at the pleasure of the commissioner" to, serving "at the pleasure of the Governor". He added he thought this was an appropriate place to have the discussion of what is an advisory board versus what is a full-fledged regulatory board. 3:47:40 PM REPRESENTATIVE FIELDS said the bill significantly expands the scope of naturopathy as it overlaps with doctors and pharmacists. Therefore, it seems that creating a more expansive, almost new profession, it would seem strange to have regulatory authority over two professions but not over naturopaths who in some cases do the same procedures. For that reason, he supports Amendment 1. 3:48:19 PM The committee took an at-ease from 3:48 p.m. to 4:01 p.m. 4:01:41 PM REPRESENTATIVE RUFFRIDGE moved Conceptual Amendment 1 to Amendment 1, to delete [subsection (b) in Section 2 on page 2 line 18-21 and inserting the following: "The board may adopt regulations necessary to carry into effect the provisions of this chapter." Then, on page 2, line 23, delete "commissioner" and insert "governor". The intent would be to form a naturopathy board as a regulatory board instead of an advisory board. 4:02:37 PM REPRESENTATIVE SUMNER asked about making conforming changes. REPRESENTATIVE RUFFRIDGE replied that it would be open to Legislative Legal Services to make any conforming changes as needed. 4:02:53 PM REPRESENTATIVE PRAX objected to Conceptional Amendment 1 to Amendment 1. He did not think spending only five minutes considering the issue in a committee hearing was a good idea. As a matter of process, if the committee or someone else wants to make these changes, they could be considered in the House Rules Standing Committee. He opined that it should be the elected officials or somebody under the authority above the elected officials that should be making the rules, not a specific group which "the boards end up being." He suggested that a group of citizens could advise, but it should be the commissioner or the director who have the legal authority to do this. He noted that the governor has sent the legislature several executive orders to get rid of boards which, he opined, are slowing down opening Alaska for business and protect their own interest first. That is not necessarily in the public's interest. He advocated limiting the board to an advisory function rather than giving regulatory authority. 4:05:50 PM REPRESENTATIVE SADDLER spoke to his colleague's objection, explaining that his reading of the statutes is that other boards that are regulatory boards have fully defined powers and duties. This rather expansive bill purports to expand the scope and practice for naturopaths. He suggested that there should be some side boards regarding the duties and responsibilities for this board rather than simply allowing it to adopt regulations. He explained that was the source of his discomfort for this bill. 4:06:35 PM A roll call vote was taken on Conceptual Amendment number 1 to Amendment 1. Representatives Ruffridge, Wright, Carrick, Fields, and Sumner voted in favor of Conceptual Amendment 1 to Amendment 1. Representatives Prax and Saddler voted against it. Therefore, Conceptual Amendment 1 to Amendment 1 was adopted by a vote of 5-2. 4:07:34 PM A roll call vote was taken on Amendment 1 as amended. Representatives Carrick, Fields, Ruffridge, Wright, and Sumner voted in favor of Amendment 1, as amended. Representatives Prax and Saddler voted against it. Therefore, Amendment number 1, as amended, was adopted by a vote of 5-2. 4:08:03 PM CHAIR SUMNER opened public testimony on HB 115, as amended. 4:08:50 PM BRUCE CAMPBELL, representing self, spoke in support of HB 115. He explained that he values naturopathic care and believes the bill is an important update to statutes allowing naturopathic doctors (NDs) to practice at their level of training. He described a personal experience regarding using pre- and post- surgery supplements following the instructions of an ND. 4:10:14 PM WAYNE ADERHOLD, representing self, spoke in support of support HB 115. He explained that he has used NDs in collaboration with other licensed medical providers since 1993. He also served on the state chiropractic board. He is a strong advocate of patient-centered care. He described the process for applications and the statutes regulating naturopathic doctors. He opined that HB 115 is in the public's interest. 4:12:48 PM MARY ANNE FOLAND, MD, representing self, Alaska State Medical Association, explained that she is a family practice physician, and she opposes this expansion of scope of practice. She said that the Alaska State Medical Association, the Alaska Academy of Family Physicians, and the American Medical Association (AMA) all oppose expansion, but there has never been an effort to restrict collaborative use. It is about patient safety. An apprenticeship is not the same as a post-graduate residency. She gave three scenarios in which naturopathy had negative results. She described HB 115 as a Pandora's box with irreversible impact on patient safety. 4:15:38 PM ANNETTE O'CONNELL, representing self, spoke in support of HB 115. She explained that NDs are trained in the use of prescriptive drugs and referenced several states that use this format. She also pointed out the opioid epidemic was brought about by well-trained MDs. She shared her personal experiences regarding when physicians didn't help but naturopaths did. 4:18:03 PM 4:18:41 PM PAM VENTGEN, Executive Director, Alaska State Medical Association, explained that the association opposes the expansion of naturopath scope of practice in HB 115 to include minor office procedures and prescriptive authority. She compared the number of hours and types of training and residency of physicians versus naturopathic doctors. She noted the lack of specifics in the bill regarding what constitutes minor office procedures. She questioned the safety of patients under a naturopath's care. 4:20:29 PM LISA MARTSOLF, representing self, explained that her family's naturopath has been their primary care physician for 25 years. She is confident of this model as a standard of care. She appreciates the therapeutic care and wealth of information her ND provides as well as the proactive care and treatment as opposed to more invasive models of care. 4:21:39 PM CHRISTINE SAGIN, representing self, described her work as a family nurse practitioner for 17 years. She collaborates with naturopaths and finds them to be competent and great primary care physicians for their patients. She pointed out that there are different personalities and different types of medicine for different people. She finds that people who want naturopathic medicine aren't getting what they need from traditional medicine. She said HB 115 would allow more access to care. 4:23:36 PM CHAIR SUMNER, after ascertaining there was no one else who wished to testify, closed public testimony on HB 115, as amended. 4:23:39 PM REPRESENTATIVE RUFFRIDGE moved to report HB 115, as amended, out of committee with individual recommendations and the accompanying fiscal notes, and to allow Legislative Legal Services to make any conforming changes, as necessary. There being no objection, CSHB 115(L&C) was reported out of the House Labor and Commerce Standing Committee.