SB 297-BOARD OF CHIROPRACTIC EXAMINERS CHAIRMAN MACKIE announced SB 297 to be up for consideration. MS. SHARON CLARK, Aide to Senator Miller, said this bill was introduced on behalf of the chiropractors. She said that SB 297 is an act relating to licensing of chiropractors. It amends the licensing statute for Alaskan chiropractors. Section 1 allows for a temporary permit to practice chiropractic in Alaska. It is for fifty days initially and may be extended by the Board of Chiropractic Examiners. It is subject to the same terms and conditions of a regular license. This section also provides for a licensee who does not practice in the State to hold an inactive license. It also provides for a retired licensee. A person holding a retired license may not practice chiropractic in the State. They may apply for an active license subject to terms and conditions set by the Board. Section 2 provides new reasons why the Board of Chiropractic Examiners may refuse to issue a license in the State. These include a conviction of a felony or other crime that would affect the person's ability to practice competently and safely. Commission of crime involving the unlawful procurement, sales, prescription or dispensing of drugs, and attempting to practice after becoming unfit due to an infectious or contagious disease. Ms. Mary Vaele, American Physical Therapy Association, said the bill is fine. They don't have any complaints with registering local chiropractors, but have one question on the first page on lines 21 - 22 and the use of the term "physiotherapy." She explained that many other English speaking countries a physiotherapist is a physical therapist. So they would like to keep that terminology out of the chiropractic legislation. She said that she understands that this is an optional exam for the chiropractors. She doesn't think it is required for the rest of the chiropractors in the State. MS. CATHERINE REARDON, Director, Division of Occupational Licensing, explained the exams are set in regulation (under statute) for the regular full licenses. Therefore, the Board has the authority to chose the exam. There are five parts to the chiropractic exam; the physical therapy exam is one of those parts. The current regulations on exams do require for people who passed after a certain date..."12 AC16.037: An applicant must pass each subject of the following parts of the examination: the National Board of Chiropractic Examiners and the elected physiotherapy examination." Her understanding is that it is not regulation that they are requiring that physiotherapy examination section now. It doesn't appear in the statute because that just says, "The Board can adopt by regulation...." CHAIRMAN MACKIE asked if that should be in the proposed statute or not. MS. REARDON said her personal opinion was that it should appear as it appears in the bill. SENATOR KELLY asked what physiotherapy was. He asked if it was addressed in statute. MS. REARDON responded that it is addressed in statute in that the definition of the practice of chiropractic in AS 08.20.900 includes the employment of physiological therapeutic procedures preparatory to and complimentary with the correction of the subluction. A further definition defines physiological therapeutic goes on for several paragraphs. She said it looks like it is the pushing, massaging, and maneuvering of someone to result in the subluction, which is out of alignment, being corrected. SENATOR KELLY asked Ms. Veale if she has training in this area. MS. VEALE said yes and added that her definition of physical therapy is different from a chiropractic definition of physical therapy. It's semantics, but the terminology concerns her. Number 2306 DR. LORAN MORGAN, President, Chiropractic Society, said there is concern with the use of the word "physiotherapy." In AS 08.20.120 the term "physiotherapy" is used by the National Board of Chiropractic Examiners as the name of the test. To be synonymous across the board, they use the same terminology so when someone from Washington D.C., for instance, comes to Alaska and takes the test, they know what exact test they need to take. It's being consistent with the Board of Chiropractic Examiners terminology. He said it is now in Alaska statutes as a National Board of Examiners requirement - 12AAC16.037. CHAIRMAN MACKIE asked him if he supports the bill. DR. MORGAN said yes. CHAIRMAN MACKIE asked Ms. Clark if the proposed CS in their packet was the one that Senator Miller was offering. MS. CLARK responded that it is the CS that came about this morning on behalf of the Department. She said that Senator Miller has no problem with it. TAPE 00-13, SIDE B Number 2300 MR. DAVE GRAY, Aide to Senate Labor and Commerce, informed the Committee that a letter from Catherine Reardon suggested "clean-up" language. There was also a letter from the Attorney General suggesting taking out one phrase. The CS deals with those concerns which seemed legitimate. SENATOR LEMAN moved to adopt the CS version G/Lauterbach4/4. There were no objections and it was so ordered. MS. KAREN GRAFTON, President, Alaska Physical Therapy Association, said one of their main concerns is line 21 which says "physiotherapy examination." In April 1999, the State of Alaska Physical Therapy Board and Occupational Therapy Board resolved that the Board declared its unanimous opinion that physical therapy and physiotherapy were identical in meaning and that physical therapist and physiotherapist are identical in meaning. To name an exam "physiotherapy examination" within the chiropractic statutes opens up the door to confusion for the public. Worldwide, physiotherapy is physical therapy. The United State is the only country where they are titled physical therapists. Austria, Australia, New Zealand, Germany, and Italy are all physiotherapists. She asked that the word "physiotherapy" be removed. In addition, AS 18.20.120, qualifications for a license, says "to have completed the exam by the National Board of Chiropractors". Her concern is that the locumpentum section is different than the permanent licensure section. She asked that the word "physiotherapy" be removed from line 21. SENATOR LEMAN noted that it was line 23 on the current version. SENATOR KELLY commented that they were getting caught up in semantics and asked if this door hadn't been open for years already. Haven't we been referring the physiotherapy examinations for several years in statute. CHAIRMAN MACKIE responded that was what the Department tells them. SENATOR KELLY asked Ms. Reardon if this wasn't just a status quo. MS. REARDON said it wasn't. MS. GRAFTON responded that she didn't see the word "physiotherapy examination" in the Chiropractic Practice Act. Currently, in her book page 3, says "the exam from the National Board of Chiropractors" which she has no problem with. She asked if the National Association changes the name of their exam, are they going to have to reopen the Practice Act to retitle the exam. MS. REARDON responded that was what the previous witness said about the standard license - "the exam of the National Association in regulation". So the word does not appear in statute, but it appears in regulations. But sprinkled through the actual statute, there are references to physiologic therapy. All that they achieve by removing this reference, is leaving the other four references to physiological therapy that are in the core definition of what is chiropractic. It doesn't fully resolve the issue. Also, if the committee chose to eliminate the term in this bill, she asked that they not take out the exam, because she thought the committee would want them to pass the exam. She supported saying, "the exams identified by the Board in regulations." SENATOR KELLY asked how long regulations have required passing a physiotherapy exam. MS. REARDON replied she thought that was relatively new, but the other references in statute have been there for years. MS. GRAFTON inserted that they have no problem with physiologic therapeutics as written in the current Act. They have a problem with the term "physiotherapy" which our State Board has stated and resolved is the same thing as physical therapy. SENATOR LEMAN said the examination of the National Board of Chiropractic Examiners probably has within it as physiologic therapeutics. The next section says, "...has passed to the satisfaction of the Board parts 1 and 2 of the examination." He asked whether a part of that examination deals with physiological therapeutics and, if so, could that part of the examination be referenced. MS. REARDON explained the problem is that part is called the physiotherapy examination. That is why it is capitalized on line 23. There are five parts of the National Board. Part 1 covers basic science subjects, part 2 covers clinical subjects, part 3 is the written competency exam, part 4 is the practical exam, and the physiotherapy exam. SENATOR LEMAN asked if part 5 is the physiotherapy exam. MS. REARDON replied the information she has does not refer to the physiotherapy exam as a part. Again, that is why it is capitalized because they do not have a good name for it. SENATOR LEMAN asked what she thought of suggesting to them that they call it part 5. SENATOR TIM KELLY asked who had the name first, the chiropractors or the physical therapists. He said he thought the chiropractors did, and that seems to be the problem. CHAIRMAN MACKIE asked if it changes the scope of the work anyone does. MS. REARDON said it does not but the very important concept that anyone else can call him/herself a physical therapist or physiotherapist still holds. This bill does not allow chiropractors to call themselves physiotherapists. CHAIRMAN MACKIE asked if that issue was addressed a few years ago. MS. REARDON said she thinks that was the origin of the Alaska Boards of Physical Therapy and Occupational Therapy's positions but those terms are synonymous to make sure nobody could call themselves a physiotherapist who was not a licensed physical therapist. She pointed out that is important to the Board. MS. BERNADETTE GILLET, representing the Providence Medical Center, made the following comment. "Just speaking in terms of differences between physiotherapy - physical therapy, that we have resolved that two are synonymous and, in speaking directly about that statement, it says the physiotherapy examination, as Karen just discussed, can be congruent with our language that describes about our profession of physical therapy. You ask who came first - the chiropractor or the physical therapist - but PT's came up in 1926 with the term 'physical therapist'. Chiropractic medicine started in 1895 with the 'chiropractor.' Those two differences split us and it maintains that with the way that this is stated. That's why we prefer to have this wording struck from that line." CHAIRMAN MACKIE asked the two groups if they could get together to resolve the differences. MS. GILLET replied yes. SENATOR TIM KELLY asked if he was referring to the physical therapists and the chiropractors. CHAIRMAN MACKIE said yes. He didn't think anyone wanted to change the scope of what they do, but they need to have consistency in our statutes. Number 2006 MR. GEORGE SALMON, Fairbanks Physical Therapist, agreed with Ms. Grafton's testimony that "physiotherapy" wording be deleted. He said there is a lot of confusion in the public about what physical therapists and chiropractors do. It opens the door for the public to start thinking of chiropractors and physical therapists. He thought they should call that part of the test "part 5." MS. CHERYL SACKETT, Fairbanks, agreed with Mr. Salmon and the need to remove "physiotherapy" and label the exam "part 5." SENATOR LEMAN said he had additional concerns. One on page 2, lines 4 - 13, the disqualification section, that they should consider being consistent throughout with health care providers as they update statutes. They have similar standards for dentistry, but he likes the wording in this bill better. It's a little shorter and has less repetition. His other concern was on page 3, line 21 where it appears to him that by deleting "after a hearing" the Board may impose a disciplinary sanction on a person without having a hearing. But in AS 18.08.075 it says they can't do it without a hearing. He thought it should be written so that the Board could refuse to issue a license without having to have a hearing. He suggested, "The Board may refuse to issue a license under this chapter, and after a hearing, impose a disciplinary sanction..." MS. REARDON responded that what Senator Leman said was fine. It's correct that the reason they are taking out "after a hearing" is because they want the Board to be able to deny without having a hearing first. It was their intention to comply with the Administrative Procedures Act which does apply to this Board's activities. It requires a hearing before taking disciplinary action. Senator Leman's suggestion is fine with her. CHAIRMAN MACKIE asked if that was a suggestion of the Attorney General. MS. REARDON answered yes. She added that this part of the bill is actually what the Division finds is the most important part. This increases public protection because it says the Board can deny licenses if you have done something wrong. As it is now, although the title of the section includes refuse to issue a license, they found the substance of this section would not allow them to deny licenses for very legitimate reasons. CHAIRMAN MACKIE said without the drafter there, they couldn't explain the language. MS. REARDON said probably what Senator Leman is referring to is the summary suspension option for discipline if there is a clear and immediate threat to public health. CHAIRMAN MACKIE asked her to have her legal people look at Senator Leman's wording. Ms. Reardon indicated her agreement. He said the only issue remaining is the physical therapist's concern with the language. Senator Leman suggested using the wording "part 5" and eliminating "physiotherapy examination." He asked for comments from the Department. MS. REARDON replied that would be a wonderful solution except that it's not called "part 5" by the National Board, so that wording would not actually have a meaning. SENATOR LEMAN corrected her saying that he suggested part 5 in a note to the chairman and then put (physiotherapy examination). That really doesn't do much more than give a nod to the physiotherapist that their's is a separate entity different from chiropractors and not confuse the public. CHAIRMAN MACKIE asked what Senator Miller's thoughts were on this. MS. CLARK replied he agreed with what the chiropractors want and whatever Occupational Licensing thinks should be in statute. He is in agreement with the CS. SENATOR MACKIE asked them to work together and resolve the issue when it goes to the floor. DR. MORGAN inserted that the Chiropractic Board has already said that physical therapy, physiotherapy, and physiological therapeutic are all synonymous terms. He thought the physical therapists had said that as well. It is a name given by the National Board of Chiropractors, not of physical therapists, to fulfill that basic requirement in the State. If the term changes, he didn't know how to change it on a national level. SENATOR MACKIE said there is obviously a conflict and that's why he has asked people to get together and work it out. Otherwise it will most likely remain like the sponsor has it. SENATOR KELLY said he was sympathetic to the arguments of the physical therapists, but he thought that was irrelevant to the bill in front of them. They will continue to struggle through that until they can reach an agreement. SENATOR KELLY moved to pass CSSB 297 (L&C) with individual recommendations. There were no objections and it was so ordered. CHAIRMAN MACKIE adjourned the meeting at 2:50 p.m.