SB 71-PHYSICIAN LICENSURE CHANGES CHAIRMAN MILLER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:32 p.m. and brought up SB 71. After SB 71, the committee would hear a briefing by the Alaska Food Coalition, followed by SB 21. Number 010 DR. SARAH ISTO, Chairman of the Medical Board, spoke on behalf of the board in support of SB 71, and expressed its appreciation of Senator Miller and the committee for introducing this bill which is important for the board's functioning and for Alaskans who are patients. As background she noted there are about 2,000 licensed physicians in the state, of whom about 400 are osteopaths and the remainder, medical doctors. The board also licenses paramedics and physician assistants, but this bill doesn't include those practitioners who are in an up-to-date statute. SB 71 deals with older provisions in the statute relating to medical doctors. There is no reciprocity for medical licenses in the U.S. which means each state sets its own standards, requiring people to apply in each state they practice. DR. ISTO said Alaska statutes should meet at least the same kind of standards that other states require in order to get competent practitioners in our state. DR. ISTO proceeded to explain the statute changes in SB 71 summarized in her letter to Senator Miller on April 7. She said she grouped items together by subject matter in paragraphs rather than by numerically following the statute. The italicized language in her letter explains the board's reasoning and concerns that led to these requested changes. Paragraph (1) relates to the current situation in Alaska when someone with a felony conviction applies for a medical license. The board can consider the conviction only if it occurred in the course of their practice of medicine or their duties as a physician. The board received an application for a medical license from penitentiary from someone who committed a brutal murder, and the statute did not allow consideration of that part of the applicant's history because it did not involve a patient and was it not committed in the office or the hospital. DR. ISTO stated, "Fortunately, there were other problems with that application and we did not grant that person a license, because we would have been very nervous, not being able to evaluate that part of the license." This change adds language on a felony or misdemeanor substantially related to the licensee's fitness to practice. A felony conviction for tax evasion might not be considered by the board, but a brutal murder should be. Paragraph (2) adds "or its designee," and is a housekeeping measure relating to licensed physicians who, when renewing their license, are required to have 34 hours of continuing medical education. The board sets up a plan, and physicians must wait until the board meets again and even suspend their practice. This language change would avoid having that delay built into a routine matter. Paragraph (3) refers to Section 5 in the bill, another housekeeping item relating to temporary or "locum physicians" replacing doctors on vacation. The temporary physicians cannot renew that permit without the board taking action at the moment the permit expires. The board feels the renewals could be handled by the board's staff. Paragraph (4) refers to Section 4 in the bill regarding physicians in training. The only training program in Alaska is the three-year Alaska Family Practice residency in Anchorage. Current statute allows a permit to practice under the supervision of a training program for only one year. By the time they complete their one year, they must take an exam and get the results before they can get an active license. If SB 71 passes, those who are foreign medical graduates would be required to complete their entire training before obtaining an independent license. This would enable the board to renew those permits. Paragraph (5) refers to Section 5. Currently the statute considers only a suspension or revocation in another state in a new applicant's file. But states also deny or have licenses surrendered while an applicant is under investigation for violations of law, or restrict or condition licenses, or place people on probation. The board wants to be able to consider those actions. This change would expand the language to include the kinds of actions that other boards use. Paragraph (6) refers to Section 1. Alaska is the only state that requires citizenship of an applicant or permanent residence. There are physicians legally here under visas allowing them to practice temporarily, but they are not citizens or permanent residents. A visiting specialist who is excellent couldn't be granted a license by the board. Foreign trained physicians will have already had three years of training according to this bill. Paragraph (7) refers to Section 3. Forty-three states require three years of post-graduate training for physicians who graduated from foreign medical schools. Alaska does not have a way to evaluate foreign education or, as in the case of Burma, even to get the records. To confirm competency, most states require foreign graduates to be trained in the U.S. in an accredited residency program where they will be supervised for three years. The board would like to do the same thing. Paragraph (8) refers to Sections 2 and 6 and relates to applicants who are U.S. and Canada trained and not considered to be from a foreign medical school. Currently Alaska requires one year of post-graduate training. There are few two-year programs, with most programs lasting three to five years. The board wants to recognize that situation and require those graduating after 1995 to have at least 2 years, in order to evaluate competency. On the other hand, if someone graduated in 1978, they have had a long work experience and the board can evaluate that they are competent. DR. ISTO concluded that in Alaska it's extremely important for practitioners to have good skills and judgment, especially in rural Alaska where there aren't a lot of specialists and equipment. Thirty people were licensed at the last board meeting, and only one would not have met these proposed criteria. Number 205 SENATOR PEARCE asked if the Medical Board is notified when a malpractice suit is filed or only if there's an actual judgment against a doctor. DR. ISTO replied a judgment or a settlement is required to be reported to the board. The attorneys are aware of that requirement and the board has sent out newsletters reminding the licensees of it. The malpractice companies are careful to ensure that reporting is done. She believed the board receives most of the reports. SENATOR PEARCE asked if the board requires doctors to have malpractice insurance. DR. ISTO answered "No, the board doesn't get into the insurance business. Someone can be uninsured, but they are still required to report." SENATOR PEARCE asked if there could be a number of reports before the board would evaluate a physician. DR. ISTO replied the board looks at certain types of malpractice issues involving alcohol or negligence. A pattern would concern the board, but there is no computerized system and each report is scanned on arrival. A patient can file a malpractice action and complain to the board. All complaints to the board are evaluated, and the board knows if there have been a number of complaints against a doctor. Number 258 SENATOR ELTON said he appreciated Dr. Isto's concise sectional analysis of the bill. SENATOR PEARCE asked if there is a companion bill in the House. DR. ISTO replied there is not, but the House expressed earlier interest in the issue. SB 71 has a zero fiscal note. SENATOR PEARCE asked if most hospitals require their doctors to carry malpractice insurance. DR. ISTO responded she believed that is true. CHAIRMAN MILLER interjected he believed Ms. Isto is correct, recalling that was an issue in tort reform a couple years ago. He asked for a motion to adopt the Committee Substitute. SENATOR WILKEN moved to adopt CSSB 71 (HES) Version D Lauterbach 4/7/99 in lieu of the original bill. Without objection, it was so ordered. Number 288 MS. CATHERINE REARDON, Director of the Division of Occupational Licensing, Department of Commerce & Economic Development spoke in support of the bill. She stated her division provides staff support to the state Medical Board. The department appreciates the time the committee has put into introducing and crafting the bill. Following up on the previous discussion, MS. REARDON clarified the board doesn't have statutory authority to require malpractice insurance, and it would require legislative action if the committee wanted to do that. CHAIRMAN MILLER asked the wish of the committee. SENATOR WILKEN moved to report CSSB 71 (HES) out with individual recommendations and attached zero fiscal note. Without objection, it was so ordered.