HB 122-NATUROPATHS  3:53:13 PM CHAIR OLSON announced that the next order of business would be HOUSE BILL NO. 122, "An Act relating to naturopaths and to the practice of naturopathy; establishing an Alaska Naturopathic Medical Board; authorizing medical assistance program coverage of naturopathic services; amending the definition of 'practice of medicine'; and providing for an effective date." 3:53:34 PM TOM GOODE stated he has been treated by a Naturopathic Doctor (ND) for the past eight years and expressed his preference for the naturopathic approach to medicine. He related that scientific research has been discovering the role nutritional deficiencies plays in disease. The ND is one who has extensively studied nutrition whereas 50 percent of medical schools do not require any nutritional courses to graduate as a medical doctor (MD). The other 50 percent of medical schools only require one semester in nutrition, he said. The ND uses prescription drugs as a last resort, but if all else fails and they are necessary he would prefer the drugs were prescribed by his ND. He related a scenario in which he went to the doctor but was treated by a physician's assistant. He finds it ironic that physician assistants can treat and prescribe drugs whereas NDs cannot. He suggested an independent board consisting of skilled NDs should govern the practice of Naturopathic profession in Alaska. 3:55:17 PM KATY SHERIDAN, Physician; Member, Alaska Academy of Family Physicians (AKAFP), stated she is a lifelong Alaskan who has practiced family practice medicine in Soldotna for 15 years and also represents the AKAFP today. She identified three areas she would address, including patient safety, issues raised during the prior hearing, and the future of health care in Alaska. She advised that the AKAFP opposes HB 122, primarily due to concerns for patient safety and quality of care in Alaska. She recalled in medical school the saying, "You won't make the diagnosis if you don't think of the disease." He expressed concern with the limited training that Naturopaths receive especially in disease process and treatment of chronic disease. She said it is one thing to optimize health with nutrition and exercise but it is another to be ruling out serious disease and planning treatment for chronic problems. While she would be the first to admit that allopathic medicine does not have all the answers and complementary and alternative medicine also have a place, she thought this bill goes too far to empower naturopaths to practice beyond their training. She referred to a graph in members' packets that shows the different in training between family physicians and naturopaths. She pointed out that family physician's training is similar to pediatricians and internists, who also practice primary care medicine. She expressed significant concern since the bill would allow naturopaths to prescribe medications, perform preventative and screening physicals, all of which are opportunities to identify diseases and develop protocols for preventive care for patients. She related that the lack of hours of education in disease process and chronic disease management limits the naturopaths' ability to provide comprehensive care. 3:58:08 PM DR. SHERIDAN offered her belief that HB 122 would compromise health care in Alaska. She recalled earlier testimony on the bill suggesting that other states have similar bills pending to allow for NDs to prescribe medicine. She clarified that only eight states have policies for prescribing and only for natural substances pursuant to a physician's protocol. Several states do allow NDs with "birth privileges" to administer some that deliver can prescribe pitocin and antihemorrhagic drug drugs pursuant to protocols. In fact, only a few states allow prescription ability for NDs and then only with limited guidelines. She recalled testimony that naturopaths focus on preventive care. As a family physician, she spent considerable hours of training and continues to provide many hours providing preventive care counseling and education for her patients. She recalled testimony that some patients did not have good experiences with allopathic medicine, but she did not think this is the norm. The future of health care and the concept of health care homes necessitate the care that must be given when considering dispensing rights. She stressed the importance of considering what constitutes a quality provider to provide full spectrum health care home needs. She emphasized that empowering health who are only qualified to care for a portion of a person's health and not necessarily all aspects could set ourselves up for reduced levels of health care homes for the future. She urged members to examine who they would want caring for their families. DR. SHERIDAN summarized that the AKAFP strongly oppose the bill as written primarily on the basis of patient safety and quality care issues and for the future of health care systems that will be established for the health care delivery system in Alaska. 4:01:43 PM REPRESENTATIVE MILLER asked how much training a medical doctor has in pharmacology or prescribing drugs in the market. DR. SHERIDAN answered that the number of classes in medical school addressing pharmacology and medications varies but medical school also addresses diseases and medications. Physicians frequently address medical management during their residency, experience, and continuing education. She related that medications continually change in health care so MDs must keep current on the latest medications and potential side effects. She reported that medical doctors must have 50 hours of continuing education each year to keep their medical license current and spend a large portion of their time reviewing medications. 4:03:15 PM REPRESENTATIVE MILLER asked for clarification on the source of information that MDs use to keep current on medications. DR. SHERIDAN related that the sources of information physicians use varies but many physicians use electronic sources and pocket information with the latest downloads. Many physicians confer with pharmacies and keep current on medications through ongoing continuing education. She also performs research at the bedside using technology since medications continually change. She concluded that the reality is that physicians spend a lot of time addressing medications. 4:04:47 PM REPRESENTATIVE MILLER asked where the "body of information resides" and whether that information would also be available to all MDs or NDs. DR. SHERIDAN answered probably much of the information is available to the public. Many MDs subscribe to UpToDate, which is an electronic scientific information resource. However, she stressed the importance that the person reading the information must have some understanding of how a medication works on the body or on a particular disease process. Some of this information can be pretty difficult and challenging to understand, she said. REPRESENTATIVE MILLER asked for clarification on the source of information. DR. SHERIDAN answered that some scientific forum called "UpToDate" collects and compiles it. 4:06:28 PM REPRESENTATIVE SADDLER asked for clarification on the current standard of care for MDs and NDs in society. He asked how this would change under the bill. DR. SHERIDAN answered that would happen through peer pressure. She related a scenario in which in which someone has a stroke in Soldotna and ends up in the hospital. The standard of care would be that the physician would perform an appropriate stroke work up, including disease modifying treatment for that patient, depending on the findings. If the patient resides in a more remote place in Alaska it may be that the standard of care may also be different. She explained that some communities may have certain tests readily available or not available, such as a CAT scans. Thus, the standard of care depends on the resources available in a community and the other physicians available. DR. SHERIDAN elaborated that if someone did not provide the standard of care, mechanisms are available in the hospital to review and address the matter. She stated that NDs are not lay midwives. In Soldotna, some people practice midwifery and their standards may be different from physicians delivering babies in hospital settings. She highlighted her concern that if NDs are empowered to prescribe and provide preventive screening the standard may be lowered since the NDs may provide a different level of care. She said she has observed this happen with lay midwives since treatment is given that would not be considered medically appropriate by MDs, but the physicians have limited recourse over midwifery practice. She said, "That's a very serious concern of those of us practicing medicine, especially in smaller communities in Alaska." 4:09:20 PM REPRESENTATIVE SADDLER related his understanding that the standard of care is a community-based descriptive rather than an objective standard. DR. SHERIDAN agreed. She stated that Americans have developed a level of care based on television and the Internet so they have expectations for a higher level of care. However, it can be community dependent, she said. REPRESENTATIVE SADDLER asked whether the standard of care as practiced by NDs would be factored in to the overall standard of care and would possibly tend to dilute the level of the standard of care. DR. SHERIDAN agreed that would be the AKAFP's concern. 4:10:23 PM MARION GRANDHOME, Physician, Family Practice Physician, related that she wanted to echo Dr. Sheridan's comments. She stated that she is speaking in opposition to HB 122. She expressed concern about patient safety. She said, "We support supervision. We support naturopaths but we also strongly believe in aligning medical providers' scope of practice appropriately to their training." She indicated that naturopaths and family physician's training are different in volume and substance. The average family physician has completed approximately 21,000 hours of training prior to practice whereas naturopaths have only completed approximately 6,000 hours. The typical family physician has had five years of clinical practice in the clinic, hospital, and emergency room ordering, interpreting labs and X-rays, performing procedures, and prescribing medication. The typical naturopath spends a year or less in clinical training, which is necessarily focused on naturopathic treatments. She questioned whether they have experience to safely order intravenous therapy or IV therapy or X-rays. This bill would leave the door open to prescribing medications which she also questioned. She related that her specific concerns surround pre-employment school and workplace physicals, since someone without adequate training could miss risks. She highlighted that bus drivers and pilots may have deficits in vision or hearing or low-blood sugar caused by diabetes or seizures from an uncontrolled seizure disorder. She pointed out that school sports physicals must evaluate students for heart disease before sports participation. She remarked on the tuberculosis outbreak in Southwest Alaska and questioned whether NDs could identify these risks for personal and public safety. 4:12:42 PM DR. GRANDHOME stated that she received five years of training in IV therapy. She related that starting IVs, prescribing IV therapy, has serious potential and could easily kill a person by giving IV saline solution at too high a concentration or too fast a rate. She referred to a letter from the Osteopaths in members' packets that indicated 93 percent of the public prefer the term physician to be limited to licensed medical doctors. She indicated that it is critical patients know the qualifications of the person treating them. She concluded by stating that traditional and naturopathic practices can be complementary can coexist. However, it is critical for public safety that all providers are appropriately limited to the scope of practice consistent with their training. 4:13:35 PM CHAIR OLSON, after first determining no one else wished to testify, closed public testimony on HB 122. [HB 122 was held over.] 4:13:55 PM The committee took an at-ease from 4:13 p.m. to 4:15 p.m.