HB 282-NATUROPATHS  4:12:35 PM CO-CHAIR HERRON announced that the next order of business would be HOUSE BILL NO. 282, "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." [In front of the committee was CSHB 282 (L&C), 26-LS1208\T.] REPRESENTATIVE CATHY MUNOZ, Alaska State Legislature, said that HB 282 would establish a naturopathic board, and she paraphrased the sponsor statement [original punctuation provided] [Included in the committee packets.] which read: House Bill 282 creates a Naturopathic Medical Board for the purpose of expanding allowed practices and procedures of Naturopathic Doctors (NDs) and regulates the practice of naturopathic medicine. The board will consist of three naturopaths, one licensed pharmacist, and one public member. The board will work with the Division of Occupational Licensing to issue licenses, and will have authority to investigate and discipline as required. In addition, the state will authorize prescription endorsement which will be offered for the first time for NDs who have practiced for five years; participated in 60 hours of pharmacology education from an approved program; and met all the requirements relating to administration and prescription of drugs, vaccinations, hormones, and medical devices. The prescription endorsement must be renewed every two years. The bill mandates continuing medical education of 35 hours bi-annually, 15 of which must be in pharmacy education. Prescribing authority will give flexibility to NDs to provide necessary medical treatment to patients. Prescription rights, which are already permitted for advanced nurse practitioners, will allow access to a range of commonly prescribed medicines that can be used in correlation with naturopathic treatment to improve patient care. HB 282 will align the definition of a naturopathic physician with the U.S. Department of Labor which released a new definition of naturopathic physician to include job titles of "Naturopathic Doctor, Physician, and Doctor of Naturopathic Medicine." This is an important step in recognizing NDs as qualified doctors and primary care physicians. Naturopathic doctors are highly trained medical professionals. NDs attend a four-year post-graduate professional naturopathic medical program and are educated in the same basic sciences as conventional medical students. Studies concentrate on holistic and traditional approaches to therapy with a strong emphasis on disease prevention and optimization of wellness. Naturopathic doctors take similar rigorous professional board exams for licensure and continue educational training each year. As Alaska continues to face shortages in the healthcare professions, HB 282 provides an avenue to help fill the gap of primary care physicians. This bill will reasonably expand the services of naturopaths and follow the responsibilities set forth by the board while providing the important services for keeping Alaskans healthy. 4:16:32 PM CO-CHAIR HERRON asked to clarify that Representative Munoz had requested to adopt a proposed Committee Substitute (CS) for HB 282. 4:17:23 PM CO-CHAIR KELLER moved to adopt proposed Committee Substitute (CS) for HB 282, 26-LS1208\W, Bullard, 3/30/10, as the working draft. REPRESENTATIVE SEATON objected for discussion. 4:17:55 PM KENDRA KLOSTER, Staff to Representative Cathy Munoz, Alaska State Legislature, explained the differences between CSHB 282 (L&C), Version T, and the proposed Committee Substitute (CS) for HB 282, Version W. She referred to Version T, and directed attention to page 3, line 13, which she pointed out had been moved to page 5, line 14 in Version W. She stated that the language, "establish a list of prescription drugs", was removed. She explained that it would have been problematic for a pharmacist to refer to a list of medications, but that it still included the prescription rights for non-controlled legend drugs. 4:19:41 PM MS. KLOSTER, in response to Representative Seaton, said that the proposed prescription rights were not more expansive, but the wording and the placement in the bill had required editing. She explained that the original intent had included the non- controlled legend drugs. 4:20:52 PM REPRESENTATIVE MUNOZ added that the intent was to allow naturopaths to prescribe common, non-addictive pharmaceuticals, including antibiotics, immunizations, and hormones. 4:21:57 PM REPRESENTATIVE T. WILSON relayed that she had received a lot of letters from doctors who were upset about the bill, and she inquired if there would be the opportunity to work with the sponsor to resolve these issues. 4:22:37 PM CO-CHAIR HERRON asked Representative Munoz about the physician concerns. 4:23:07 PM REPRESENTATIVE MUNOZ, in response, said that they were referred to as naturopathic physicians under federal law. She opined that there was some misinformation and some fear of the expansion of prescriptive rights. She directed attention to advanced nurse practitioners, who were now also allowed "to prescribe commonly prescribed drugs that has resulted in better opportunities, easier working relationship with their patients, broader access to care for Alaskans." She pointed out that naturopathic physicians had considerably more training, so that it was appropriate to offer limited prescriptions of pharmaceuticals. She opined that Alaskans would benefit. 4:24:44 PM REPRESENTATIVE MUNOZ asked Representative T. Wilson if the concern was for the term "physician" or about the prescriptive rights. REPRESENTATIVE T. WILSON replied that it was both. REPRESENTATIVE MUNOZ explained that the original bill had been more expansive for the ability to prescribe, but that this was refined to commonly used prescriptions, and that the proposed CS was much more restrictive. REPRESENTATIVE T. WILSON, in response, said that the comments had been about the proposed CS as well. REPRESENTATIVE MUNOZ recalled that they were probably opposed to the advanced nurse practitioners prescriptive rights, as well. 4:26:29 PM REPRESENTATIVE SEATON removed his objection. There being no further objection, Version W was adopted as the working draft. REPRESENTATIVE CISSNA pointed to the shortage of caregivers in Alaska and opined that this was another solution for care. 4:27:59 PM REPRESENTATIVE MUNOZ related a personal story about her son and a naturopathic physician. 4:30:09 PM WAYNE ADERHOLD, read from his submitted written testimony [Included in the committee packets.]: Most people can agree that our medical system is broken and in need of an overhaul, but getting agreement on the solution is another story. HB 282 is one step in the right direction and should be pushed through into law now. According to the March 8th issue of Newsweek in a piece titled, "We the Problem," "our leaders are paralyzed by the very thought of asking their constituents to make short term sacrifices for long term benefits. They cannot bring themselves to raise taxes on the middle class or cut social security and medical benefits to the elderly. They'd get clobbered at the polls. So, any day of reckoning gets put off and put off again, and debts pile up." I agree with this assessment that a majority of the populace seems locked into an entitlement and instant gratification mentality and believe that it applies equally to our medical and financial woes. I don't envy your job when most of the right decisions nowadays involve sacrifice, but I have some good news for you. There is a significant and growing segment of your constituents who are willing to take responsibility for their own medical issues and deal with the root causes of their problems. They neither respect nor trust a quick fix. This same attitude carries over into finances, so please know that some of us understand your need to make unpopular decisions just as we may take the harder road toward better overall health. We are the patients who choose our primary care doctor based on their ability to teach us how to take better care of ourselves, not simply dole out the latest sample of something that a magazine ad says we should ask about, and will only bury our symptoms. We work with naturopathic physicians in a collaborative way, and to go in knowing that we will be given homework and the medicines prescribed will be paid for out of own pockets. So we pay attention and use them judiciously, because we truly believe we are doing ourselves some good. When I checked recently with the office of the two ND's who serve us here on the Kenai Peninsula there were approximately 1200 active patients at the Homer practice and 1800 in the Kenai- Soldotna office. These are very significant numbers and they are growing steadily. These are everyday working people who are only different because they make a conscious decision to take personal responsibility for their health and commit to delayed gratification, if necessary. My own personal journey that has taken me from the allopathic to the naturopathic model of treatment began in 1993 with the slow but very successful treatment of the herniated lumbar disc which avoided surgery. Seventeen years later, and sixty years old, I will add, I'm mobile and active in all sports I care to participate in, which is basically bicycling and cross country skiing. In the meantime, I have dealt with an array of the mundane, like flu, to the more complicated, anxiety and adrenal fatigue, to the downright scary, malignant melanoma, ie. cancer. All with a near total and ever increasing reliance on ND's and naturopathic medicine. And when I say ND, by the way, I'm thinking physician for that previous discussion. I'd be happy to share specific details with anyone who wants to know more about my experiences and how it consciously committed to naturopathic treatment, particularly if you are at all skeptical of the need to pass HB 282. The last thing I want to speak to the safety and the "first do no harm" aspect, for this is the strongest argument for allowing ND's to deal with minor surgery and prescription drugs, if anyone is going to use them. I would much rather trust these tools to someone who would use them as a last resort than have had firsthand experience with both MDs and NDs. Please do not be swayed by last minute scare tactics from the ASMA that usually come under the guise of "patient safety." ASMA is mainly concerned with the safety of the members' financial status, not my health. When I sat on the board of my local hospital a few years ago, and we were in the process of instituting a requirement for malpractice insurance for the medical staff, I learned that the insurers were charging about ten times more for MDs versus NDs. Our local hospital doesn't credential NDs so it was a moot point, and that's another story. It certainly spoke to how insurers viewed risk and practitioners likelihood for doing harm. The recent $1.8 million jury verdict in a trial here in Homer which found malpractice against both the MD and the hospital tells me that the Alaska State Medical Board and ASMA could devote more time to governing their own membership. The naturopaths deserve their own board and governance. Please move HB 282 out of committee and pass it into law this session. Thank you. 4:35:52 PM ASHLEY MAY, Naturopathic Doctor, said that he supported HB 282 as it would better provide naturopathic doctors (ND) in Alaska the access to the tools necessary to be efficient, primary care doctors. He opined that more primary care NDs would now practice in Alaska, which will be vital to Alaskan health care. He pointed out that currently only about 30 percent of medical doctors entered primary care. He noted the significance for Alaska, as 15 percent of Alaskans had difficulty finding primary care doctors, which was twice the national average. He said that this was where NDs would fill that gap. He declared support for a naturopathic board, in order to implement continuing education requirements and adopt regulations necessary to provide a high level of medical care to Alaskans. He opined that the current bill was an "extraordinary compromise on the part of naturopathic doctors." He compared the proposed naturopathic board membership to that of the Alaska State Medical Board and the Alaska Board of Pharmacy, both of which had a higher medical membership on its boards. He stated his support for HB 282. 4:38:27 PM PATRICK NEARY, ND, read from his prepared testimony. [Included in the committee packets.] He stated that HB 282 clarified the Naturopathic licensing statutes, and would bring Alaska up to the current standard of Naturopathic medical care offered in the other licensed states. He pointed out that HB 282 would provide Alaskan families with increased access to care and increased freedom of choice to health treatment while also increasing safety and oversight of the profession. He clarified that the bill included Naturopathic Medical services within Medicaid and Denali KidCare, would align the prescriptive authority of Naturopaths in Alaska with the national norms, and would create a Naturopathic Medical board to protect public safety. He spoke about the shortage of primary healthcare providers both nationally and in Alaska, and that Naturopaths would help assist those unmet needs. He spoke about the opposition to licensure for 15 classes of midlevel providers, which included naturopaths, by the American Medical Association (AMA). He explained the current educational standard for an ND, which included a 4-5 year doctoral program of basic and clinical medical sciences from nationally accredited Naturopathic medical colleges, in addition to a Bachelors degree. He spoke about the limits to Naturopathic training and knowledge, and agreed that the prescription abilities were not meant to be on a par with MDs. He spoke about the excellent safety record of NDs and that searches of the legal databases for both Oregon and Washington revealed no legal cases against Naturopaths. He stated the benefits to Alaskans, especially low income Alaskans, for more freedom of medical choice and access to care. He stated his support for HB 282. 4:47:22 PM CO-CHAIR HERRON asked that the committee hold its questions until the next meeting. 4:48:00 PM DAVID OTTOSON, paraphrased from his submitted written testimony [original punctuation provided]: [Included in the committee packet.] I am testifying as a consumer of health care. For the last 25 years, the primary health care providers for my family have been naturopathic doctors. We have been successfully treated for numerous ailments, including sinus infections, earaches, urinary tract infections, and insomnia. I have worked with a number of naturopaths and have found them all to be extremely competent and highly professional. As far as I am concerned, this legislation should be completely non-controversial. Every other state on the West Coast has a Naturopathic Board. Naturopaths are highly trained health care providers whose focus is on wellness, education and prevention. It seems to me that this is exactly the kind of health care that we need more of. I have heard that some members of the medical community are concerned that ND's might practice outside of their area of competence. I think this is a red herring. There is no evidence this has been a problem in other states. And I am not aware that it has been a problem in Alaska either. I can tell you from my own experience that the NDs I have worked with are well aware of their limitations, and have referred me to other providers when that was appropriate. In fact, a few years ago, I came back from a trip to Africa with a bad case of what I thought was traveler's diarrhea. I had been staying in a place with notoriously bad water and had gotten the runs from drinking the water earlier in my trip. After several days, I wasn't getting any better and was experiencing alternating fever and chills. It was a naturopathic doctor, Emily Kane, who recognized that I might have something more serious. So she came over to my house during her lunch hour and drew my blood and sent it away to be tested for malaria. It came back positive the next day. I went to Bartlett hospital and ultimately ended up at the University of Washington Hospital in Seattle to be treated for a nasty case of cerebral malaria. It was because of Dr. Kane's alert intervention that I was diagnosed with a life threatening condition in time to be successfully treated. Two things about this. Number one, it illustrates the highly personalize form of medical care that is typical of the naturopathic profession. How many doctors do you know who make house calls? Yet Dr. Kane is not the first naturopath to make a house call at my house. Number two, it is an example of a naturopath making a correct diagnosis and referring a patient to appropriate care. Dr. Kane did not suggest that I treat my cerebral malaria with colloidal silver or wormwood. She urged me to go to the hospital and get treated. and when it turned out that Bartlett Hospital did not have the appropriate drugs or expertise to treat my condition, I was transferred to the University of Washington, where I had the good fortune to be treated by one of the leading malaria experts in North America. ND's clearly have a role to play in our health care system. They are primary care providers who can treat many if not most of the common conditions that people go to a doctor for. The care they provide is personalized, cost effective, and prevention oriented. Perhaps most important, it is focused on individuals taking responsibility for their own wellness. I firmly believe that we will never get medical costs under control until we acknowledge that all of us need to start taking better care of ourselves. Helping people do this is one thing NDs do best. I urge you to support this legislation. 4:51:56 PM [HB 282 was held over.]