HB 122-NATUROPATHS  4:31:35 PM CHAIR OLSON announced that the final 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." 4:31:48 PM SANDY WILLIAMS stated she has been seeing a local naturopath (ND) for about 10 years. She said she generally spends an hour with the ND at each appointment and obtains knowledge to help improve her health. She offered her belief that her ND is interested in her well being. She would like to learn more about preventative care and believes her ND provides her with guidance that has helped her achieve lifestyle changes. She concluded by saying she believes she deserves an opportunity to choose an ND as her health care provider and spoke in support of HB 122. 4:33:14 PM REPRESENTATIVE SADDLER asked whether she thought her choices in selecting an ND were constrained. MS. WILLIAMS related she is a senior citizen and currently is not taking any prescribed medication. She related her experience with doctors has been that appointments are shorter and the opportunity to speak is limited to one or two things. She thought the first response for treatment is to take a pill, and medical doctors tend not to work on prevention or cause of the ailment. REPRESENTATIVE SADDLER asked how passage of this HB 122, establishing a ND's board would affect her life. MS. WILLIAMS answered that she was unsure, but she thinks it would expand her ND's ability to provide additional care. In response to Representative Saddler, she stated her ND is Dr. Emily Kane. 4:34:46 PM DAVID OTTESEN stated that for the past 25 years, the NDs have been the primary health care providers for his family. The NDs have treated his family for a variety of minor health problems, including ear, sinus, and urinary tract infection. He has worked with a number of NDs and finds them to be competent and professional. "I think this legislation really should be completely non-controversial since every other state on the West Coast does have a Naturopathic Board," he said. He stated he was aware some members of the medical community have expressed concerned that NDs might practice outside the scope of their competence, but he is unaware of any evidence to suggest this has happened in any other state, including Alaska. 4:36:48 PM MR. OTTESEN related a scenario which highlighted his experience. He stated that about five years ago he came back from Africa with an illness he initially thought was traveler's diarrhea, which he initially contracted during the trip. After four or five days he continued to experience fever and chills and was getting worse. His ND, Emily Kane, realized he might have something more serious. She went to his home and performed a blood test for malaria during a lunch hour. His test came back positive the next day. He went to Bartlett Memorial Hospital and was transported via Medivac to Seattle since he had concocted cerebral malaria, which is often fatal. He attributed his treatment to Dr. Kane's care. He related his experience points out the personalized care NDs provide. He reiterated she came to his house on her lunch hour to perform a blood test. He commented this is not the first house call he has received from an ND. Secondly, his experience provides an example of a ND making a good decision and referring a patient to appropriate care. She referred him to the hospital and did not attempt to treat his condition with any herbal remedy. She told him he needed to go to Bartlett Memorial Hospital and get treatment. It turns out the hospital did not have enough experience to treat his illness either so he was transferred to the University of Washington and treated by a specialist in tropical diseases. Primary care providers also work in that manner since not each provider has expertise in all areas of medicine. NDs work in the same way, are aware of their limitations, and refer patients when they are beyond their area of expertise. MR. OTTESEN pointed out that the U.S. including Alaska has a shortage of primary care providers. NDs help individuals take responsibility for their own illnesses, and work in partnership with their clients to help them take steps for wellness. He offered his belief that people eating better, exercising, and taking steps for wellness is precisely the key to get a handle on medical costs. He stressed that ND's excel at wellness. He urged support for HB 122. 4:41:12 PM JANE MADISON offered her belief that Alaskans deserve access to balanced approach of traditional medicine and ND treatment. She expressed gratitude for the services the medical community provides. Many medical conditions can be prevented or treated with diet, supplements, and hormones which represents a small part of the services an ND provides that traditional medical doctors do not have time for, she said. The NDs' hands are tied since they do not have a state board. While NDs have authorization to write prescriptions in other states, they are not authorized to write prescriptions in Alaska. She stated that HB 122 will solve many problems. She related that six years ago she began to have serious thyroid issues and complications. Representatives Olson and Chenault observed her downward spiral including huge weight gain. She said within one month the condition was cured with a natural thyroid medication that was not available through a traditional MD. Under the present regulations she must see the ND, followed by a visit to advanced nurse practitioner or MD who can write her prescription. MS. MADISON stressed that this bill could help others, such as those who suffer from the side effects of chemotherapy since ND's can help lessen the side effects significantly, particularly with prescriptions. She surmised that some people in Alaska are passing themselves off as NDs and sell products for profit. A board could help stop this and raise the standards. Her local hospital cannot hire MDs unless they are state certified. Therefore, her hospital cannot hire NDs. This bill would allow her hospital to hire both the MD and the ND, which would provide balanced care. She pointed out that the Mayo Clinic offers both NDs and physicians. This bill could help the state since it is self insured. She related a patient's history and her belief that NDs could have provided less costly care for the patient. She named a number of ailments that could be helped by NDs, including treating thyroid disorders or adrenal gland disorders. These health problems can be treated by either an MD or an ND, she said. 4:46:39 PM WAYNE ALDERHOLT spoke in support of HB 122. He stated he is a 36-year Alaskan resident with about 18 years of experience as a consumer/patient of naturopathic medicine. Traditional allopathic medicine and naturopathic medicine each has a role in Alaska and both are necessary for the health care system. He related that NDs excel in prevention and management of chronic conditions. Traditional medicinal doctors excel in emergent conditions requiring aggressive intervention and damage control. An unintentional but critical omission in the 1986 enabling legislation for NDs left the profession without a governing structure. This bill would provide an independent board to oversee NDs. Prescription ability should be allowed and managed by the respective boards. With respect to malpractice, once both boards are established it would be up to those bodies to create clear standards and enforce them. He served on his local hospital board and he learned two things. First, the majority of malpractice is generated by a few practitioners. Most malpractice incidents are preventable. The medical community can police themselves. He related that he previously submitted written testimony. He referred to a flyer he picked up at a conference. He read, "Members of both professional bodies meet to share experiences, ideas, and skills on specific areas of health care for the betterment of the participants and their patients." He shared that the national conference had seven MDs and four NDs who presented. He described his own diagnosis and ND treatment, noting he had to travel out of state and selected Arizona for treatment. He said the clinic he attended provided cutting edge treatment. 4:51:20 PM MARY ANN FOLAND, Physician, Immediate Past President, Alaska Academy of Family Physicians; President-Elect, Alaska State Medical Association, stated she was a family practice physician for over 34 years in Anchorage. She related that she has been in contact with other groups including the Physician's Assistant Association, the American Osteopathic Association, and the State Medical Board. All of the groups she has contacted think this bill is a bad idea. The goal of NDs is to expand their practice to be the same as primary care physicians. She expressed concern about this, not the least of which is the cost of a new regulatory board. Using doctor in the title or physician creates confusion and is misleading. She referred to a recent study that showed 90 percent of the people surveyed think only licensed medical doctors should use the term physician. She highlighted the difference in training, experience, and continuing education. She offered her belief that NDs do not have the breadth or depth in education provided in traditional medical school. The NDs are not required to have graduate residency that is essential for patient safety. The most dangerous thing she says she does every day is to pull out the pad from her pocket to write a prescription. Even if NDs do not have the ability to write prescriptions for controlled substances, she thought many drug interactions and contraindications and dangers in prescribing. She said, "There are no safe, simple drugs. I ask you to please to not simplify this or consider it just a matter of competition." She did not think there were enough naturopaths in the state to really be competition for physicians in Alaska. She cautioned members that this is about safety. This bill is a "wants" list and not a "needs" list. She did not think the NDs practice should be expanded. 4:54:20 PM DR. FOLAND characterized the public's trust of physicians as a sacred trust. She reiterated that the groups she previously mentioned think this is a bad idea. She read, "A physician is a person who has successfully completed the prescribed course of studies in medicine, in a medical school officially recognized by the country in which it is located and who has acquired the requisite qualifications for licensing in the practice of medicine." She then read the definition for naturopathy, "A system of treating diseases largely employing natural agencies such as air, sunshine, etc. and rejecting the use of drugs and medication." She concluded that this is about training, experience, and stated mission. She urged members to please vote no on HB 122. [HB 122 was held over.]