SB 92 BOARD OF VETERINARY EXAMINERS; LICENSE  CHAIRMAN LEMAN said they would set the confirmations aside and announced SB 92 to be up for consideration. MS. CATHERINE REARDON, Director, Division of Occupational Licensing, supported SB 92 which extends the sunset date of the Board of Veterinary Examiners. The bill reflects the recommendations made by the Division of Legislative Audit to extend the Board until 2003, a six-year extension. MS. REARDON said the other issue dealt with in the bill, the licensure by credentials for veterinarians, needed some discussion because the audit recommendations differed from what the Board advocated. The Division looks to the Board as experts in this professional area. MS. REARDON explained that the basic issue is whether the people who are trying to come in by credentials (holding a license in another state) should have the same requirements an Alaskan needed at the same time that person was licensed in the other state. Alaska now requires, by regulation, a clinical competence test (CCT) as well as a national board exam (NBE) for licensure. The auditors are recommending that perhaps the clinical competence test not be required of everyone who comes in by credentials. Her impression, however, is that the Board feels that is an important test to have taken. Number 267 SENATOR MACKIE asked her to clarify her position on the bill. MS. REARDON said she supported extension of the Board, the central theme of the bill; and she supported the Board's view of what should be required for licensure by credentials which is different from what is in the bill. CHAIRMAN LEMAN said he believed the six year extension is greater than the legislature has traditionally been extending the boards. Usually it is a four-year cycle. SENATOR MACKIE asked what was wrong with having to pass a national board exam that was in effect at the time the applicant became licensed. He said they have been trying to give boards the opportunity to upgrade and have a national standard to follow. MS. REARDON agreed that opportunities for licensure by credential are important and we don't want to keep people from coming to the State, particularly because we have Canadian veterinarians who need to be able to come and go and practice in Alaska. Lines 11 and 12 on page 1 are ungainly comparing periods of history in two states. The issue starts on line 14 with the requirement of graduation from an accredited school of veterinary medicine and the deletion of "or successfully passed the National Board Education Commission for Foreign Veterinary Graduates' test." It also appears that instead of having to pass both the National Board exam and the competency test, they are only going to have to pass the National Board exam. The issue focuses on a test called the Clinical Competence Test (CCT). This bill seems to remove that requirement from people coming in by credentials. DR. LEACH, Chairman, Board of Veterinary Examiners, said it appears to him that the proposed legislation is leaving out "that the applicant has graduated" which needs to be left in. The National Board examination should remain a requirement. It has been a national standard for over 20 years. They are also requesting that the CCT be made part of the required licensure for those applying for licensure by credentials. This is also a nationally given test and develops, at least, some indication of the clinical competency of that individual to practice veterinary medicine. He said they want to upgrade the requirements for licensure, but do not want to block any individual from having licensure. They want to assure that the public is protected. He said the two tests are not at all unknown and are required of all new graduates. The Board recommends they (or the equivalent of) be required of applicants by credentials. Number 364 MR. RANDY WELKER , Legislative Auditor, explained the language they are proposing comes from one primary source and for a couple of reasons. The primary source comes from their audit report on page 11 and model legislation that is currently being reviewed by the American Association of State Veterinary Boards. The current statute on credentialing doesn't require graduation. The Board is placing an emphasis on testing, but Legislative Audit thought it would be better to put the emphasis on credentialling by the examination process when it is not by definition now required. The reason for a broader definition is limiting entry into the profession, especially for people who may have been practicing for many years. They may not have passed the exams the Board is saying they have to have today to be licensed by credential. CHAIRMAN LEMAN asked Dr. Leach if he was proposing that graduation from an accredited school be placed in as an "and." DR. LEACH replied yes, he thought it should be "and" not "or." He said he graduated among the first of the National Board exams which started in most states in '62 or '63 and requiring the CCT is merely an improvement of testing standards. He didn't think taking the test was the issue. The Board is adjusting somewhat to maintaining a high standard of practitioner within the State. The CCT is a test he believes any practitioner who meets most of the other requirements should be able to pass. It isn't a test that goes back to the very basic sciences of the first year of undergraduate school as the NBE does. The CCT is a test for competency. It is the fairest way the Board has to make that assessment. Since it is put out by a nationally recognized organization separated totally from the State, it seems a very fair way to assess individuals who want to come and practice in the State, he said. SENATOR MACKIE said currently, as he reads the statute, it's not a requirement to have graduated from an accredited school of veterinary medicine. He's thinks that is probably a good idea, but he assumed that the Department, or by regulation, there is a requirement for graduation. The way it is written now is that there is at least the one requirement that you have to pass the Board's test. He added that he is open to including graduation from an accredited school, but he thought it was required somewhere already. MS. REARDON responded that the Board has all of the regulation writing authority, not the Department. That regulation authority does not extend to the point of being able to add qualifications that aren't listed in statute. The Board does not have the discretion to require graduation if it's not mentioned on the list of requirements in statute. Current law says you have to be a graduate of a school or have passed the test for foreign veterinary graduates. MS. REARDON thought the issue might be that the accreditation process for the schools may not extend to enough foreign countries. She thought the issue might be whether they are required to take the test for foreign veterinary graduates as well as the NBE and the CCT or just two of those. SENATOR MACKIE asked if there has been a problem, because in the version before the committee they aren't required to have graduated from an accredited school. He asked if we have any vets in the State who haven't graduated. MS. REARDON said she didn't know of any, but would check further. DR. SANDERS said she thought the "or" graduation from an accredited veterinary school should be changed to "and." She said most of the schools in Canada are accredited. Some of the European schools may not have accredited schools. In most other states those people are allowed to practice veterinary medicine in the U.S. if they pass a series of exams that takes several days to complete. She still thought that veterinary graduates of an accredited school should be a requirement. DR. SANDERS said there is some disagreement on the Board about the CCT, because it might be difficult for someone who has been in practice 15 or 20 years to pass, as it speaks to both small and large animals, exotics, and a variety of different types of practice. Someone may have been in one type of practice for the whole period of time and not had to deal with large animals or exotics. It's not that they are not competent in what they do. She said one thing the Association of Veterinary Boards is moving towards is more specific competency exams. CHAIRMAN LEMAN asked if the Board could make the distinction between small and large animals, exotics, etc. within the framework of the statutory provision in SB 92. MS. REARDON replied that each profession's statutory authority varies a lot and she needed time to look at it carefully. She explained that the committee was discussing the licensure by credentials qualifications statute and there is another statute, not under discussion, which is the regular qualification for licensure. Number 536 MR. WELKER asked if there were any states that don't require graduation from an accredited college to obtain initial license. If all jurisdictions require graduation for licensing, then the accreditation is almost a moot point in the credentialing process. MS. REARDON replied that it applies not only to other states, but to other territories or countries that one could be coming in by credential from as well. DR. LEACH commented that there are two factors here. There are the foreign graduates who come in through a very difficult, complicated process, for them, to be able to practice within the United States, period. There are a few schools, about four, that accept the foreign students, and they go through quite a procedure that requires months of their time, plus passing a special designated U.S. test for foreign graduates. Above and beyond that, they must take NBE and in almost all states the CCT before they can practice in an individual state. Beyond that, they require a state test before they can practice there. He knew of no other state that does not require the individuals to be graduates from an accredited veterinary school. Regarding the question of whether they could narrow the scope of competency tests and that would be a massive undertaking for our State Board to undertake. There are no single entity competency tests available. That will come five years or so in the future. Right now the CCT is the best that is available. SENATOR KELLY asked who does the accrediting at the various veterinary schools. DR. LEACH replied that the AVA has been doing it. SENATOR KELLY asked if they only looked at American schools. DR. LEACH replied that Canadian schools are accredited straight across the board, but some in Europe have lesser standards and cannot be accredited. SENATOR KELLY asked him if he thought German and Japanese veterinary schools have lesser standards than American. DR. LEACH replied that was true as far as the accreditation process goes. SENATOR KELLY said he didn't believe that; he thought the American Veterinary Association would choose to believe that. DR. LEACH suggested he would find visiting some foreign veterinary schools very interesting. TAPE 97-9, SIDE B SENATOR KELLY said he thought the problem was that they weren't distinguishing between the American resident and the foreign applicant and they needed to be dealt with differently. He thought it was easier to not accredit foreign schools and it might also cut down on the competition. SENATOR MACKIE thought there should be one standard. The current bill version concerns him because it doesn't require graduation from an accredited school, you just have to pass the test. He suggested an amendment on page 1, line 13 insert "graduated from an accredited school of veterinary medicine and has" after "has." SENATOR KELLY objected and said that he agreed that should be the standard for American veterinarians. However, he thought there were probably hundreds of veterinary schools throughout the world that are not accredited by the American accreditation bureau. So none of those people can come to the U.S., even if they are very competent, and practice veterinary medicine. Number of 554 SENATOR LEMAN thought a possible approach would be to not absolutely require graduation, but have a CCT as an alternative and demonstrate competence in the lab. SENATOR MACKIE said he understood Senator Kelly's concern, but he was concerned that giving an exception to foreign candidates would allow someone who has never gone to a school a chance to pass the test and practice in Alaska whereas the standard for our own American candidates would be more stringent. SENATOR KELLY said they would have to go to a school somewhere in the world, but it didn't need to be accredited by the Americans. But they needed to prove to us that that school was essentially competent. He said he was surprised that the existing language had worked all these years because it is so vague. SENATOR KELLY asked now, if you are licensed by examination, is it required to also attend an accredited school. MS. REARDON replied under AS08.98.165 it repeats the identical language. It says the applicant has to be a graduate of an accredited veterinary school or pass the NBE. SENATOR KELLY asked if there were any veterinarians in Alaska who hadn't gone to an accredited veterinary school. MS. REARDON said she would have to look back through the files to be certain. SENATOR KELLY asked why the system wasn't working right now. MR. WELKER explained the concern they have is that the Board has started placing increased emphasis on the CCT. The statute says to be licensed by credential the person has to meet or exceed the State requirements at the time they applied, but the focus is being narrowed and they are concerned with limiting the possibility of people to come into the State to practice veterinary medicine. He thinks they can require a broader range of tests. The language also provides that if they haven't passed one of those tests, the applicant can satisfy the examination requirement by demonstrating they have passed the type of licensing examination that was required for entry level licenses in this State at the time the applicant became licensed. DR. LEACH responded that no matter where they may have graduated from, there are strict test regulations set up by the AVA for foreign people to enter the United States and practice. He thought the foreign graduate portion of the bill could be resolved by inserting a statement "or graduates of foreign schools must have passed the specific test for foreign veterinarians." He thought this would certainly demonstrate that they would be fine practicing anywhere in the country. CHAIRMAN LEMAN noted that Mr. Welker hadn't included the CCT as one of the requirements for licensure by credentials for fear people who had been practicing for some time elsewhere might have difficulty passing it. Yet Dr. Leach says that most people have already passed it or could pass it by virtue of their experience. MR. WELKER said he was open to modifying the specific exams. Holding everyone to the higher standard at this point in time is a policy call. His concern is that the Board is headed in that direction, but the statute doesn't envision that narrowing right now. DR. SANDERS pointed out that the CCT is not a lab type of exam; it is a written exam. She thought the National Board of Examinations Committee's Education Commission for Foreign Veterinary Graduates' exam that must be taken in order to practice in the U.S., requires that they have to show they have graduated from a foreign veterinary school before taking it. Number 408 SENATOR MACKIE withdrew his amendment. SENATOR KELLY said he wasn't so sure he wanted to insert the language that is suggested here. Standards are increasing in every profession by leaps and bounds as more knowledge is becoming available, and he thought more consideration was needed. SENATOR MACKIE said as a matter of policy he didn't want to extend anybody for six years. MR. WELKER responded that the cycle has historically been four years and the Board has been trying to encourage a longer cycle. SENATOR HOFFMAN asked when was the last time they recommended a board be terminated. MR. WELKER replied that they haven't done that in a long time, because it never happened when they did recommend it. Today most of the boards are self-supporting as is the Division. CHAIRMAN LEMAN said they would hold the bill and see if coordinating language could be found.