HB 281-PRESCRIPTION WITHOUT PHYSICAL EXAMINATION  7:05:21 AM CHAIR DUNLEAVY announced the consideration of HB 281. "An Act relating to prescription of drugs by a physician without a physical examination." He noted that this was the first hearing. [CSHB 281(L&C) was before the committee.] 7:05:39 AM REPRESENTATIVE LYNN GATTIS, Alaska State Legislature Juneau, Alaska, speaking as sponsor stated that HB 281 is essentially Section 2 of Senator Dyson's SB 80, which this committee heard previously. HB 281 clarifies in statute that physicians may not be sanctioned for dispensing or administering prescription medications without a physical examination of the patient if the prescription drug is not a controlled substance, or if it is a controlled substance that a licensed medical provider is present with the patient during the examination. This practice, which is called telemedicine, will allow patients to obtain over the phone or online consultations from physicians that are located in Alaska who can diagnose an ailment and provide a prescription, if necessary. Telemedicine has worked well in Alaska for the Alaska Native Tribal Health Consortium, the Veterans' Administration, and the military. It would work well for anyone in the state. 7:07:34 AM SENATOR OLSON asked if the Alaska State Medical Association (ASMA) had voiced an opinion on the bill. 7:07:49 AM REID HARRIS, Staff, Representative Lynn Gattis, sponsor of HB 281, reported that ASMA supports the bill. SENATOR OLSON asked if the sponsor had solicited support from the chief medical officers in departments such as the Department of Health and Social Services (DHSS) and the Department of Corrections (DOC). REPRESENTATIVE GATTIS said yes, and that is why the bill provides an exemption for controlled substances. SENATOR OLSON asked if mid-level practitioners have a position on the bill. MR. HARRIS said a number of nurses have submitted comments, but the bill deals strictly with physicians. 7:09:47 AM LAURA BROOKS, Health Care Administrator, Department of Corrections (DOC), said she oversees inmate health care and appreciates the sponsor's efforts to ensure that the bill allows DOC to continue to practice as it has been. The changes that were made in the other body allow this. SENATOR OLSON asked if the bill allows something that wasn't allowed before or if it simply adds clarity to existing guidelines and regulations. MS. BROOKS replied the bill doesn't change anything about DOC's practice, but initially it didn't allow prescriptions for controlled substances. That was cause for concern because thousands of people enter the corrections system every year that require the prescription of controlled substances. The amendments made in the House allow the department to continue to prescribe controlled substances to these high needs, at-risk individuals without sending them to the local hospital or having to have a provider on site 24/7 in every facility in the state. SENATOR OLSON asked if Dr. Lawrence is in favor of the bill. MS. BROOKS answered yes. CHAIR DUNLEAVY opened and closed public testimony. 7:12:37 AM SENATOR MICCICHE said his office addressed questions nurses had about physicians being located out of state, confidentiality, post op care, and whether the bill was limited to physicians. Those nurses are satisfied with the bill and he personally supports it. SENATOR OLSON asked Ms. Chambers how to ensure that these physicians aren't adversely affected by inordinate investigations. 7:13:36 AM SARA CHAMBERS, Director, Division Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), said her understanding is that the Medical Board doesn't support the bill solely because they believe that a physician-to-physician relationship is in the best interest of the health care priorities of the state. Her perspective is that telemedicine would be regulated fairly and according to the same investigative boundaries as any medical practice. SENATOR OLSON expressed hope that she was aware that physician- to-physician interaction is not a reality in rural Alaska because health care is delivered by mid-level practitioners. SENATOR MICCICHE related his personal experience using Teladoc services for relatively minor conditions, and opined that it may add levels of care for people who tend to wait until their condition gets more serious. He asked Senator Olson if his constituents generally have the federal waiver. SENATOR OLSON confirmed that they're covered under federal tort. SENATOR MICCICHE restated his support for the bill as a means of reducing the cost of low-impact medical care. CHAIR DUNLEAVY found no further questions or comments and solicited a motion. 7:18:49 AM SENATOR MICCICHE moved to report HB 281, Version N, from committee with individual recommendations and attached fiscal note(s). CHAIR DUNLEAVY announced that without objection CSHB 281(L&C) was reported from the Senate Labor & Commerce Standing Committee.