CSSB 71(RLS) am - PHYSICIAN LICENSURE CHANGES Number 0533 CHAIRMAN ROKEBERG announced the committee's next order of business is CSSB 71(RLS) am, "An Act relating to licensure by the State Medical Board." The chairman invited the sponsor's representative forward. Number 0559 SHARON CLARK, Legislative Assistant to Senator Mike Miller, Alaska State Legislature, came forward to present SB 71 as aide to the Senate Health, Education and Social Services Standing Committee (Senate HESS), the bill sponsor. Ms. Clark informed the committee SB 71 had been introduced by the Senate HESS Committee at the request of the State Medical Board, which fully supports this bill. This legislation resolves licensure problems for the board, updates the Alaska Statutes in relation to other states, and corrects unintended problems within the current law. Ms. Clark noted the members of the State Medical Board appreciate the scheduling of SB 71 before the House Labor and Commerce Standing Committee. She indicated Dr. Sarah Isto, Chair of the State Medical Board, and Dr. Martha Cotten [State Medical Board member], both instrumental in bringing this legislation to the Senate HESS Committee, are present. MS. CLARK explained the Senate version of SB 71 [CSSB 71(RLS) am] had been heard that morning in the House HESS Committee. A conceptual amendment was adopted to page 2, lines 12 and 13, of CSSB 71(RLS) am, and was probably in the committee members' bill packets. The conceptual amendment deleted the language, "; and (5) be a citizen of the United States or be lawfully admitted for permanent residence" [current statute, AS 08.64.200(a)(5)]. Ms. Clark indicated the bill sponsor had no problem with the amendment, and she stated, "The committee substitute was adopted and the amendment was adopted, and it moved out of committee." Ms. Clark noted Dr. Isto would speak on the legislation's specifics. Ms. Clark urged the committee to support the legislation; it is a good bill, it does what the State Medical Board wants. She informed the committee that Catherine Reardon of the Division of Occupational Licensing had also been behind the legislation. Ms. Clark indicated all involved had worked very hard. Number 0709 SARAH ISTO, MD, Chair, State Medical Board, Division of Occupational Licensing, Department of Commerce and Economic Development, came forward to testify in support of SB 71. Indirectly referring to her previous testimony in support of SB 29 at this same committee meeting, Dr. Isto said SB 71 also addresses the statutes which govern the State Medical Board. The legislation takes care of several housekeeping issues for the board. Currently the board cannot renew the 60-day temporary licenses for replacement physicians, so-called locums licenses [from "locum tenens"], unless a quorum of the board meets. Gathering a quorum together every 60 days to renew one or two licenses is awkward since the board meets quarterly. This change would allow the board to designate the staff to do renewals under a protocol. The legislation would allow the board to designate staff to handle issues of physicians who are late in turning in their continuing education credits. Currently, this is supposed to be handled at a board meeting, which is, again, an awkward issue. The legislation would also allow the board to consider an applicant's felony history. If an applicant has a Class A or unclassified felony, the board would be able to consider that when a person applies for licensure. DR. ISTO described that a person who had killed his/her partner by beating the partner to death while the partner was sleeping had applied for a license from prison. This felony was not in the practice of medicine and Dr. Isto noted Alaska Statute currently says "only if you commit that sort of crime during the practice of medicine." The State Medical Board was not allowed to consider that [felony] in the application. Dr. Isto commented she is thankful to say this application had other deficiencies. Finally, Dr. Isto informed the committee that SB 71 addresses postgraduate medical education for United States and Canadian [medical school] graduates. It would require new graduates - those who have graduated in 1995 or thereafter - to have two years of postgraduate training. This is because nearly all [medical] residencies are three to five years. The Canadian family practice residency is two years; the osteopathic residency is two years. Those are the only exceptions. Dr. Isto commented it is standard to expect that a medical school graduate will complete the residency before applying for a license. This provides the State Medical Board some guarantee of the person's quality. Physicians who graduated in 1985 and have been practicing in the state of Washington for 10 years are no problem for the State Medical Board; these people have a practice history the board can rely on. Dr. Isto indicated this would only apply to new graduates. Number 0873 REPRESENTATIVE MURKOWSKI questioned if there is a requirement for something like an FBI [Federal Bureau of Investigation] background check prior to licensure of a new applicant. DR. ISTO indicated there is the National Practitioner Data Bank (NPDB) [Health Resources and Administration, U.S. Department of Health and Human Services], a data bank that includes all malpractice actions, board disciplinary actions, medical school disciplinary actions, residency disciplinary actions, and negative hospital actions. That is the background check. As it happens, if an individual has committed some sort of crime, often the medical board in another state, a hospital, or other entity, has taken action and so some of that information comes into it. However, there is not an FBI check. Dr. Isto indicated the board does have fairly extensive information on applicants because it has an applicant's entire four-year medical school history, three years of postgraduate training, and any work history; therefore, the board feels it has a fairly good understanding of a person's doings for at least the past seven years. REPRESENTATIVE MURKOWSKI noted previous discussion in the committee of the case, she believes, involving a Dillingham pharmacist who was eventually charged with giving young boys drugs in exchange for sexual favors. Representative Murkowski believed the pharmacist had had a [criminal] background in another state. She said she was surprised to learn there is not the full FBI criminal background check. As a lawyer, they are checked out through that. Therefore, Representative Murkowski noted, unless it was a medical-related issue, it is not going to follow the person. DR. ISTO agreed that is correct; however, in the case of a doctor, if a doctor had some kind of conviction relating to sexual misconduct, a medical board would take action, and so that would enter the practitioner data bank. Dr. Isto said she does not know much about pharmacy, pharmacists, and how that kind of information is kept. She is fairly confident that drug issues and sexual misconduct would appear in the National Practitioner Data Bank. Other sorts of things like financial crimes, et cetera, probably would not. Number 1054 CHAIRMAN ROKEBERG noted the presences of Representative John Coghill, Jr. and Representative Eric Croft. REPRESENTATIVE HALCRO noted Dr. Isto's mention that the State Medical Board meets quarterly. He questioned what would happen in a case involving misconduct. DR. ISTO responded the board has emergency teleconference meetings and the board is very happy to do that. Indicating the board is made up of volunteers, she noted it is a little more difficult to energize the board to meet to renew a doctor's 60-day permit at the hospital's request when there are no problems with the person. Dr. Isto indicated the board considers this a non-emergency issue and would like to make this process work more smoothly for the board. REPRESENTATIVE CISSNA indicated she assumes drunken driving would probably catch a relevant entity's attention, but she asked about other alcohol-related items. DR. ISTO answered it is a state requirement for hospitals to report within 24 hours to the State Medical Board if they are concerned that a physician is coming to work drunk, misusing alcohol, is present using alcohol in the hospital. She thinks hospitals are quite careful and defensive about reporting. Dr. Isto indicated the board does receive these reports in the required manner. REPRESENTATIVE CISSNA asked about someone coming from another state, where perhaps there had been some real problems which reached the courts but not the hospital, [medical] board, et cetera. DR. ISTO noted each state has its own separate licensing laws, but there are many similarities. She thinks there isn't any state that does not concern itself with substance misuse. These are emergency issues because of the risk to patients from care by an incompetent provider. She thinks that most of those [cases] come to the attention of a board. REPRESENTATIVE CISSNA questioned if there is any way of checking the records, et cetera, of people coming from other countries. DR. ISTO responded she is hoping SB 29 will pass; SB 29 would require foreign medical school graduates to have been under close observation in a residency for three years. Dr. Isto indicated the State Medical Board would need to depend on that three years of close observation as protection if something arises. She further indicated that if someone has a problem, things usually do appear within three years, although not always. Number 1273 REPRESENTATIVE MURKOWSKI referred to Section 5 of HCS CSSB 71(HES). She expressed confusion with this ability of substituting. [HCS CSSB 71(HES), Section 5 read: * Sec. 5. AS 08.64.275(a) is amended to read: (a) A member of the board or its executive secretary may grant a temporary permit to a physician or osteopath for the purpose of substituting for another physician or osteopath licensed in this state. The permit is valid for 60 consecutive days. If circumstances warrant, an extension of the permit may be granted by the board or its designee.] DR. ISTO explained there is a temporary license, a locums license, which requires a person to have a clear existing license in another state. It is a somewhat faster licensing process but the license is for a much shorter period. This license would be used, for example, when a physician goes on vacation or becomes ill. Under this temporary license there must be a clinic, hospital, or someone, monitoring and vouching for the person's work. REPRESENTATIVE MURKOWSKI questioned if there is a maximum time period. DR. ISTO answered it is 60 days, but it may be renewed twice upon request of the hospital or the clinic - the supervising body - but not at the practitioner's request. She indicated this request from the supervising body had to be submitted to the State Medical Board in writing. Number 1356 CHAIRMAN ROKEBERG confirmed there were no further questions for Dr. Isto or further witnesses on SB 71. Therefore, the chairman closed the public hearing on the legislation. Number 1377 REPRESENTATIVE HALCRO made a motion to move HCS CSSB 71(HES) out of committee with individual recommendations and the attached zero fiscal note. There being no objection, HCS CSSB 71(HES) moved out of the House Labor and Commerce Standing Committee.