SB 274-PHYSICIANS' LOCUM TENENS PERMITS  CHAIRMAN BEN STEVENS called the Senate Labor & Commerce Committee meeting to order at 1:37 p.m. and announced SB 274 to be up for consideration. SENATOR OLSON, sponsor of SB 274, said he would address version F. Section 1 that says a Member of the State Medical Board or its designee may grant a temporary permit to practice medicine to a visiting physician or osteopath for two new situations. Subsection (a)(2) allows for the temporary hire of a physician or osteopath by a licensed doctor for the purpose of valuation for permanent employment. Subsection (a)(3) allows a hospital or mental health facility to temporarily fill a staff vacancy through a locum tenens permit while seeking permanent employment of a licensed physician or osteopath. Section 2 changes the initial duration of a permit from 60 days to 90 consecutive days. It can be extended for an additional 60 days if the permittee completes an application for licensure and pays the associated fee. An individual's exercise of a locum tenens permit is limited in the aggregate to 240 days in any 24 consecutive months. Section 3 allows the board to further extend a permit if there is a medical necessity to protect public health and safety. SENATOR TORGERSON asked if the Medical Board supported this. SENATOR OLSON said talks with Jim Jordan, Executive Director, Alaska State Medical Association, HESS, API, and the State Medical Board have resulted in a consensus on section 2. SENATOR TORGERSON moved to adopt the CS to SB 274, Lauterbach. There were no objections and it was so ordered. MS. ANNE HENRY, Division of Mental Health, supported SB 274 and said she would answer questions. MS. CATHERINE REARDON, Director, Division of Occupational Licensing, said her division staffs the Medical Board. She said the different parties were able to get together and almost reach consensus on this issue. The only item in dispute at this point is section 3. The Medical Board does not want section 3 in the law, but the other parties do want it. It gives the Medical Board the ability to extend locum tenens licenses beyond the 90 days (plus 60 more days, if you apply for a permit), if the Board or its designee determines that the extension is necessary in order to provide essential medical services for the protection of public health and safety. The Board maintained their objection to section 3 because they are uncomfortable with open-ended amounts of time in which people can continue working under a locums and section 3 leaves it up to the Board's discretion, but they don't want it. This is simply a difference in philosophy between the different parties. DR. ROBERT SCHULTZ said he has been a psychiatrist practicing in Alaska for 16 years and has had plenty of opportunity to come up against the circumstances of unstaffed mental health centers and understaffing at API. He felt very strongly that improving their staffing would greatly help the state. He has often seen people who couldn't get into the understaffed hospitals end up getting hospitalized and getting an outpatient visit as an inpatient, which costs the state a great deal of money. Also, people having access to staff in a timely fashion means their medications get adjusted and rearranged so that they don't need hospitalization. He supported SB 274. MR. NICK KLETTI, Medical Director, API, supported SB 274, including section 3. He said: We are in the fortunate position currently of having a full-time medical staff - all of our doctors here being full-time employees, but API traditionally has gone through some periods where it's been difficult to recruit doctors who come up to Alaska first of all and, secondly, to work with a population that is hospitalized here…It is greatly to the hospital's advantage to have full-time psychiatrists or a physician and not to have locum tenens. In fact, it's looked at by regulatory agencies as also greatly desirable to have full-time physicians. Unfortunately, we're put in the position where often when there are vacancies, which many rural states have, because it's difficult to attract physicians to rural states. Of either providing less than optimal care using temporary physicians or having no care at all for those patients and given that choice, I would rather go with a locum tenens physician - even in an on-going fashion - even if the license has to be renewed because of patient care concerns in an on-going way without limitation. With Occupational Licensing overseeing that and of course all the credentialing matters a hospital would have to go through to make sure a physician is doing her job properly and safely. But I am in very strong support of this bill. I think this will greatly help Alaskans and the health care here. MS. SUSAN HUMPHRY BARNETT, Assistant Administrator, Providence Health System, supported CSSB 274. She said Providence Health System runs a community mental health center on Kodiak Island. They have had fairly continuous coverage, but it is very difficult to recruit psychiatrists in rural Alaska and there are times when there is no recourse, but to use locum tenens. She understands that the Medical Board opposes section 3, but it really needs to be there, because if you can't recruit a permanent person, you at least have coverage for people who really need this type of care. Other specialties have recruiting difficulties - for instance the Anchorage area has a shortage of internal medicine physicians and pediatric surgeons and neurologists. She concluded saying they very strongly support the committee substitute. MR. KARL SANDFORD, Assistant Administrator, Fairbanks Memorial Hospital, supported the CSSB 274, particularly section 3. He said it costs a lot of money to bring a locum tenens physician to Alaska and it is not in our best interest overall to have that turn over every one or two months. "Therefore, I would like to have the opportunity, if need be, to extend a locum tenens position if possible." MR. SANFORD said there is a national shortage in many areas of physicians and expecting it to be resolved in a two to three month period is unreasonable. CHAIRMAN STEVENS asked Ms. Reardon to explain what was meant by the Board's designee in section 3. MS. REARDON explained that the Board they could designate someone to serve this function. Generally, the physician they designate is the executive administrator of the Medical Board, but they might decide to designate a single board member. CHAIRMAN STEVENS asked if the board wanted to testify or was she delivering their position. MS. REARDON said she was delivering their position. SENATOR LEMAN moved to pass CSSB 274(L&C) from committee with individual recommendations. There were no objections and it was so ordered.