SB 247-EXTENDING BOARD OF PHARMACY  2:05:54 PM CHAIR PASKVAN announced SB 247 to be up for consideration. JIM COLVER, staff to Senator Olson, sponsor of SB 247, said this bill extends the Board of Pharmacy that will sunset on June 30, 2010. The fiscal note of $130,300 is to pay staff, board per diem and transportation for three board meetings a year. The Legislative Budget and Audit Division recently completed an audit of the board and concluded that the termination date for the Board of Pharmacy should be extended until June 30, 2018. He noted that the termination date in SB 247 says June 30, 2015, and he said the sponsor wanted the committee to amend that date to align it with the audit recommendation of June 30, 2018. 2:08:17 PM MR. COLVER said the audit also recommended that the department should improve administrative support (for various small accounting and staffing issues) and the department has responded that it is dealing with those issues. Additionally, it recommended that the board and staff need to work with the Office of the Governor to improve recruitment of qualified board applicants to ensure a full board. He said SB 247 is supported by the Alaska Pharmacists Association. 2:08:49 PM SENATOR THOMAS joined the committee. 2:09:37 PM PAT DAVIDSON, Division of Legislative Audit, Legislative Affairs Agency, Alaska State Legislature, said she conducted an audit of the Board of Pharmacy and recommended extending it to June 30, 2018, an eight-year extension as provided by law. The audit also found that administrative support by the department was insufficient for the board to get its work done; so this needs some correction. She remarked that her audits have found this issue as well as others exist with most of the other boards. Another issue, Ms. Davidson said, is that the Office of the Governor did not make timely appointments to the boards. These boards are voluntary and take peoples' time, and if a board doesn't have a full slate of members, that makes the other members work harder, which, in turn, decreases their willingness to be reappointed and makes it harder to get new members. 2:11:17 PM The last was a technical issue, she said, that had to do with collaborative protocols. She explained that typically one doesn't go to a pharmacist to get an injection, but in certain circumstances a pharmacist in association with a physician will go through a collaborative protocol that allows the pharmacist to dispense a flu shot, for instance. She explained that regulations require that an written agreement between the physician and the pharmacist and it has to be submitted to the board. She found that those protocols were for one length of time - one year, but the board allowed that protocol to exist for two years. She recommended that the board limit itself to approving those protocols for a time limited to what is reached between the pharmacist and the physician. CHAIR PASKVAN said he understands that the two requirements are that the doctors review the decisions made by the pharmacists at least once every three months and that the doctors would get the patient records. He asked if those protocols were the ones addressed in the audit. MS. DAVIDSON answered yes. Regulations identify those things, but the board wasn't necessarily following all those regulations in approving the protocols. CHAIR PASKVAN asked if some of the agreements were written for periods of time longer than the doctor had committed to and if that would result in the pharmacist dispensing flu shots beyond the period of time the doctor had agreed to. MS. DAVIDSON replied that she didn't see any evidence of the protocols actually being enforced beyond the written agreement between the pharmacist and the physician. However, in reviewing those protocols the board should make sure that everything that is required by regulation be written into the protocols and that the board limits itself to adopting it for the timeframe that is in the written agreement. CHAIR PASKVAN asked her to more fully explain the cooperative practice agreements. MS. DAVIDSON responded that those agreements were required so that the physician could review the decisions made by the pharmacist at least once every three months and so patient records could be provided to the physician. She found those were not always specifically spelled out in the written agreement. In regard to the timeframe, either the practitioner or the pharmacist could be confused as to how long they would be allowed; so to avoid those sorts of confusion, it is important that the board go through the written cooperative agreement process. And then limit their approval of that for the time frame indicated in the written agreement. 2:15:58 PM CHAIR PASKVAN asked if a template is followed for the protocols, whether it's for flu shots or something else, that is board approved and that regulations could be compared to. MS. DAVIDSON replied there is no template established for those. CHAIR PASKVAN asked if there is any reason they couldn't have a template to make it easier to compare protocols with the regulations. MS. DAVIDSON said because the written agreements could cover a wide range of what the practitioners and pharmacists are comfortable in delegating, she didn't know if creating a template would necessarily be beneficial. Practitioners would probably change things to fit their individual circumstances. 2:18:13 PM CHAIR PASKVAN found no questions on recommendation 1. SENATOR MEYER commented that he had already heard SB 247 in the Legislative Budget and Audit Committee and he was very familiar with it. CHAIR PASKVAN said recommendation 2 identified deficiencies and the first one was errors in license statistics; he asked her to more fully explain that. MS. DAVIDSON responded that an annual report is prepared for each of the boards to give an idea of its activities. It identifies how many new licenses were issued, how many renewals there were; some boards that have license by credentials versus examination will break those out. They will also talk about non licensing statistics like investigations and actions taken as a result of investigations, for instance. She said that she would talk about this recommendation a lot because she has found different types of licensing statistics errors in different boards. This is one of the things she saw when verifying statistics that were included in annual reports. CHAIR PASKVAN said a paragraph on page 8 addressed a key administrative staff member that was both unqualified and untrained. He asked how a key person could get that position. MS. DAVIDSON deferred that answer to the department. CHAIR PASKVAN asked if this board had more turnover than others. MS. DAVIDSON replied that her experience with boards in general is that they have a higher turnover rate because they are relatively entry level positions and better opportunities are available elsewhere. CHAIR PASKVAN said language on page 8 says "may provide policy makers with misleading information" and he wanted to know what types of information that would be. MS. DAVIDSON explained that goes back to the annual reports; various boards have issues come up that may rise to a very high level or may be dealt with at a board level. As an example, if insufficient pharmacists were a concern, and if their statistics were understated by 100 or 200 percent, a situation would be created where someone who is relying on that information would come to a bad conclusion. Or if someone was using the annual reports to monitor numbers of physician assistants or EMTs for the Medical Board, for instance, or to correlate the relationship between the number of licensees and what the university is doing, when you have bad statistics, you will get bad policy information. What she was trying to express is that these data get published and people will use it. She asserted also, "It comes from a state agency; it should be good data." CHAIR PASKVAN asked if misleading information extends to budgeting issues and if turnover of key administrative staff members was one of her concerns. 2:24:23 PM MS. DAVIDSON replied that she didn't look at staffing in particular; boards and commissions are financially self supporting. Their conclusion with regards to the Board of Pharmacy is that it has no financial deficits, because the licensees themselves pay for those things. 2:25:18 PM CHAIR PASKVAN asked if the fee that is being assessed isn't high enough, would that indirectly affect being able to hire enough people to do the work. MS. DAVIDSON replied that she hadn't looked at staffing enough to make any recommendations about it and maybe the department would want to address it. 2:25:48 PM CHAIR PASKVAN found no questions on recommendation 2 on page 8 and went to the last recommendation on page 9 and said the number of vacancies that are identified goes to the core issue of consumer protection and asked if she could add anything. MS. DAVIDSON replied that it goes back to maintaining good membership on the boards so that work can get done. You don't want the occupational boards to be so focused on what is good for the occupation. If the state is going to be involved in regulating an occupation, there has to be a good public need for it and that is where the public members, particularly, bring a valuable perspective. So when it's a public member vacancy, not only does everybody else have a bigger work load, but a different point of view is missing from deliberations. CHAIR PASKVAN asked if she has come across an "unwillingness or uneasiness" with either the public or professional members of a board about sitting on it because of APOC reporting requirements. MS. DAVIDSON answered that the members of the board that she talks to are already appointed and they would already be over that hurdle. But that might come up from people who decided not to apply to serve on a board. That might be a good question for the Governor's Office in terms of what sort of barriers they are having in getting board members. CHAIR PASKVAN asked if she has come across instances where there just wasn't an applicant for a board position or where a qualified applicant was just not being appointed. MS. DAVIDSON replied that the audit just looked at how many vacancies there were. 2:29:27 PM SENATOR MEYER remarked that one member resigned because of a direct financial interest in the health care industry. How big of an issue is that? He said you would want people who have knowledge of the pharmaceutical industry on the board. He then asked how they determine whether or not a conflict of interest is too great; is it a subjective call? MS. DAVIDSON answered that the generic law for public members is that they can't have a financial interest in that occupation. However, this board in particular has a requirement in statute that the public member cannot have direct financial interest in the health care industry. SENATOR MEYER asked how direct financial interest is defined. Is owning stock in a hospital a health care interest? MS. DAVIDSON answered that she didn't know the specific details on this one. However, what happened to this public member is he passed through when he was appointed, but then he changed jobs once he was a board member and that created a conflict with the statute. She explained that during the audit they ask public members to certify that they meet the requirements and this member was unwilling to do that. 2:31:45 PM JENNIFER STRICKLER, Operations Manager, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), said they would probably hear recommendation 2 repeated for every sunset audit report. She said unfortunately the division went through a couple of "rough years" with an administrative officer who was not "very accounting savvy" and he didn't educate himself. Since he moved on, someone with an accounting background was hired. Mistakes were corrected to such a degree that some of the boards are now pleased with the budget reports they are getting. MS. STRICKLER explained that the Board of Pharmacy, for example, gets direct support from the licensing unit, but an administrative unit handles all of the budgetary and accounting information. The enforcement unit does enforcement. The problems they ran into were in the administrative unit in the Professional Licensing area. She recalled that Ms. Davidson mentioned the entry level licensing examiners are range 13 and while they had tried to get them reclassed higher, they hadn't been successful. That is not where the issues lie, however; she said it was with the group that provides the licensing statistics to the administrative group. The problem came with the former administrative officer she had just mentioned who didn't educate himself about their accounting system. For several years, although the writing on the wall, this person was her peer and he was allowed to stay. She said it is a shame that this problem had to get such a level before he moved on. The report said that "known procedures were in place" and they were, but they had been "thrown out" by this individual, which made the problem worse. She has taken great strides to recreate the procedures and to correct a lot of the mistakes. CHAIR PASKVAN asked if some of the high turnover was a product of the unqualified and untrained person. MS. STRICKLER answered yes; she said there was great turnover in the administrative and licensing staff; but turnover in the licensing areas of all of the programs is because of the pay level of that job class. CHAIR PASKVAN asked if the fees being charged the professionals are sufficient for members of the board to operate in a responsible manner. MS. STRICKLER answered yes; in fact, the fees will be lowered by $100 across all categories that pay more than $200. 2:36:45 PM CHAIR PASKVAN asked how the fee can be lowered and services can still be adequately provided - focusing on the consumer protection aspect. MS. STRICKLER replied that because of posting errors in the cost accounting system (direct and indirect costs of expenditures) caused by the former employee she went back and compared that to what is in the state's accounting system. She found a big disparity; so everything was corrected and now matches the state accounting system to date. Fortunately, this board had accumulated a surplus which allows the fee to be lowered now. CHAIR PASKVAN found no questions regarding recommendation 2. 2:37:54 PM SENATOR THOMAS asked if this area is in good shape now. MS. STRICKLER replied "yes." 2:38:21 PM CHAIR PASKVAN went to the issue of policy makers receiving misleading information and he wanted to know if he was asking the right question. MS. STRICKLER responded that any information he sees from the boards to date will be accurate. The possible misleading information would be incorrect licensing statistics - not from the licensing staff that had accurate information - but from the financial person it was submitted to in the division that prepares the annual reports. 2:39:48 PM CHAIR PASKVAN found no further questions on SB 247 and concluded public testimony for the day. So SB 247 was held for further work.