HB 91-NATUROPATHS: LICENSING; PRACTICE  3:43:04 PM REPRESENTATIVE WOOL announced that the next order of business would be HOUSE BILL NO. 91, "An Act relating to the practice of naturopathy; relating to the licensure of naturopaths; relating to the Department of Commerce, Community, and Economic Development; and providing for an effective date." 3:44:47 PM ERIN SHINE, Staff, Representative Jennifer Johnston, Alaska State Legislature, presented HB 91 on behalf of Representative Johnston, prime sponsor. She paraphrased parts of the sponsor statement [included in the committee packet], which read in its entirety as follows [original punctuation provided]: House Bill 91, by establishing a clear scope of practice for naturopathic doctors, aims to allow these primary health care providers in Alaska to practice consistent with their education and training. Alaska's nearly 60 licensed naturopaths provide valuable health care services and can play an important role in helping address Alaska's primary care provider shortage. However, current state statue is vague as to the specific authorities of naturopaths, which has led to the adoption of some of the most restrictive naturopathic medicine regulations in the nation. For example, despite being trained to perform a range of minor office procedures, such as sutures, wart removal, IUD placement and removal, naturopaths are prohibited from performing any of these routine procedures in Alaska. Similarly, many naturopaths have accredited pharmacological training, yet under current regulation are prohibited from writing prescriptions and must instead refer patients to other providers even though those providers may have less advanced training. These overly restrictive regulations are causing many naturopaths to rethink practicing in Alaska. HB 91 would correct this by outlining clear statutory guidelines, including, among other things, allowing licensed naturopathic practitioners to perform minor office procedures and to prescribe vitamins, minerals, and other non-controlled substance medications. This same scope is being practiced safely in other states and by other healthcare providers in Alaska with equal or lesser training. Naturopathic medicine can provide valuable and complementary care in the Alaska health care setting. Many Alaskans struggle with basic health care access. The ability for naturopaths to practice the scope of medicine consistent with their training would immediately expand the availability of primary care in the state. Many Alaskans face challenges with chronic diseases like obesity, diabetes, and hypertension. These are the sorts of issues for which naturopaths have clear tools to assist their patients. Naturopathic training focuses on disease prevention, rather than symptom and medication management alone. In the long-run, this type of care can provide cost-savings and improved health outcomes for consumers, insurers, and the state. HB 91 aims to let naturopathic medicine live up to this promise by allowing naturopathic doctors to practice within the scope of their training and education, thereby increasing competition in the healthcare sector and ensuring Alaskan's have a range of options when choosing the style of healthcare that's right for them. 3:51:14 PM CO-CHAIR WOOL asked for clarification on state regulation. MS. SHINE replied that in a regulated state, the governing body sets a criterion of qualifications that must be met; whereas in an unregulated state, it's possible for individuals to set up practices as naturopathic doctors (NDs) without oversight from the state. CO-CHAIR WOOL asked if NDs in unregulated states can prescribe drugs or do minor office procedures. MS. SHINE answered no. She offered her understanding that NDs must be registered or licensed within a state to be able to prescribe medications. Nonetheless, she noted that a ND who has set up practice in an unregulated state could be performing minor procedures without oversight from the state. 3:52:31 PM CO-CHAIR LEDOUX asked if NDs in Alaska are regulated even if they currently can't write prescriptions. MS. SHINE answered yes, they are regulated and cannot write prescriptions. CO-CHAIR LEDOUX questioned whether the current statute prohibits NDs from prescribing. MS. SHINE affirmed that. 3:52:58 PM REPRESENTATIVE FIELDS indicated that there is an advantage in state regulation in terms of transparency for consumers. He asked Ms. Chambers if there is currently adequate authority within the Division of Corporations, Businesses, and Professional Licensing for someone who sets up a naturopathic practice without any knowledge or proficiency in the field. 3:53:33 PM SARA CHAMBERS, Director, Division of Corporations, Businesses, and Professional Licensing, Department of Commerce, Community & Economic Development, explained that, currently, NDs are a licensed profession in Alaska which gives the division authority to enforce the existing statutory and regulatory restrictions on NDs and to regulate unlicensed practices. REPRESENTATIVE FIELDS established a scenario in which an individual insists on advertising themselves as a ND even though he or she doesn't have the proper training. He asked if the division would have the ability to shut down that business. MS. CHAMBERS replied that they typically have that authority for all their licensed programs and professions; however, it's individualized within each statute. She stated that there is a process for those who practice any of their professions without a license and if it extends beyond their civil authority it would include law enforcement for criminal authority if needed. 3:55:08 PM REPRESENTATIVE HANNAN inquired as to how long naturopathy has been a licensed profession in the state. MS. CHAMBERS answered since 1986. REPRESENTATIVE HANNAN questioned the level of consumer concern and frequency of complaints about the practice of NDs. MS. CHAMBERS said there has been 33 complaints over the last 20 years, adding that most of those have been low level or ultimately found to be unsubstantiated. 3:57:14 PM REPRESENTATIVE WOOL sought clarification on the prescriptive authority that the current bill is seeking to grant NDs. MS. SHINE replied that the prescriptive authority being sought is noncontrolled substances and nonchemotherapeutic agents - everything else that would require a prescription would be allowed for NDs under their scope. 3:58:10 PM CO-CHAIR LEDOUX offered her understanding that the focus of naturopathic medicine was nature-based. She asked why a ND would need to write prescriptions for antibiotics or things that aren't "natural." MS. SHINE acknowledged that NDs focus on holistic healing; however, they are still trained to be able to prescribe as a last resort. She noted that as the number of naturopathic primary care providers increases, this would allow them to address their patients concerns if it gets to the point that an antibiotic or a birth control prescription would be warranted. 4:00:12 PM ABBY LAING, ND, Thrive Integrative Medicine; President, Alaska Association of Naturopathic Physicians, added that sometimes antibiotics are needed. A child with an ear infection, for example, is situational - sometimes the infections don't need to be treated with antibiotics and others do. If someone would prefer to treat things naturally, there's also the "wait and watch approach," in which case they would get a supplement or a nutraceutical as well as an antibiotic prescription in case the infection doesn't get better. She also pointed out that if a woman wanted to get a refill on her birth control prescription, she would have to do that through a different provider. 4:02:49 PM CO-CHAIR LEDOUX questioned whether there is a difference between NDs and medical doctors (MDs). MS. SHINE offered her understanding that both MDs and NDs have four-year degrees; however, completing a residency is required of physicians and optional for NDs. She further noted that they take different approaches to medicine. DR. LAING, in response to Representative LeDoux, explained that MDs are trained in specialties, while NDs focus on primary care. She also affirmed that a residency is required of all MDs in order to be licensed, except for those working at an urgent care facility. MS. SHINE pointed out that nurse practitioners (NPs) and physician's assistants (PAs) are practicing within a greater scope than what's being requested by NDs because they can prescribe controlled substances. 4:06:49 PM CO-CHAIR WOOL offered his understanding that PAs and NPs only prescribe under the direct supervision of a MD. He asked if this was correct. MS. SHINE confirmed that PAs are under the supervision of a MD, while NPs are not. CO-CHAIR WOOL asked if hormone therapy, steroids, or high blood pressure medicine would all fall under the prescriptive authority of a ND if this bill were to pass. DR. LAING explained that testosterone is classified as a controlled substance and therefore excluded from NDs' prescriptive authority under HB 91. She noted that controlled substances are contentious and not necessary to practice effectively. 4:09:34 PM CO-CHAIR WOOL announced that HB 91 was held over.