JOINT HOUSE AND SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEES March 1, 1993 1:30 p.m. HOUSE MEMBERS PRESENT Rep. Cynthia Toohey, Co-Chair Rep. Con Bunde, Co-Chair Rep. Gary Davis, Vice Chair Rep. Al Vezey Rep. Pete Kott Rep. Harley Olberg Rep. Bettye Davis Rep. Irene Nicholia Rep. Tom Brice HOUSE MEMBERS ABSENT None SENATE MEMBERS PRESENT Sen. Steve Rieger, Chair Sen. Bert Sharp, Vice Chair Sen. Loren Leman Sen. Mike Miller Sen. Jim Duncan Sen. Johnny Ellis SENATE MEMBERS ABSENT Sen. Judy Salo OTHER MEMBERS PRESENT Rep. Curt Menard Sen. Randy Phillips COMMITTEE CALENDAR Confirmation Hearing: State Medical Board appointments Joint meeting with Senate HESS WITNESS REGISTER NOEL DEVRIES P.O. Box 1027 Palmer, Alaska 99645 Phone: (907) 745-3362 Position Statement: Appointee DR. JOAN JELINEK, M.D. 1305 21st Ave. Fairbanks, Alaska 99701 Phone: (907) 452-7524 Position Statement: Appointee DR. GARY JOHNSON, M.D. P.O. Box 80606 Fairbanks, Alaska 99708 Phone: (907) 479-3235 Position Statement: Appointee EILEEN BECKER P.O. Box 109 Homer, Alaska 99603 Phone: (907) 235-7526 Position Statement: Appointee DR. ROBERT ROWEN, M.D. 615 E. 82nd Ave. #300 Anchorage, Alaska 99518 Phone: (907) 344-7775 Position Statement: Appointee ACTION NARRATIVE TAPE 93-25, SIDE A Number 000 CHAIRMAN RIEGER called the meeting to order at 3:03 p.m. and noted members present. He stated that the Senate members had to return to a floor session at 3:00 p.m. He said the committee would consider the appointees in the following order: Noel DeVries, Joan Jelinek, Gary Johnson, Eileen Becker and Robert Rowen. He brought NOEL DEVRIES' nomination to the table and asked if members had any questions. NOMINATION OF NOEL DEVRIES Number 028 REP. TOOHEY asked Mr. DeVries how he would feel about making decisions about physicians who performed abortions. MR. DEVRIES said he would follow applicable Alaska statutes. He said the medical board did not usually deal with that issue, but did deal often with impaired physicians, disciplining those with drug or alcohol problems. He did not see it as an issue. Mr. DeVries remarked, "I can say this, I guess. I might may have a problem if there were lesser medical procedures and lesser-qualified people applied to, say, an abortion with other comparable surgery. I don't know as that's the case." REP. TOOHEY said she heard Mr. DeVries say his judgement would not be pre-clouded by a physician's involvement in providing abortions and asked if that were correct. Number 084 MR. DEVRIES said the medical board has been very lenient in terms of working with drug and alcohol problems. He said that his vote on suspension of a physician who performs abortions would not be swayed by that fact. CHAIR BUNDE referred to the case of Dr. Ake, an Anchorage physician convicted of sexually abusing patients, and how difficult it was for women to lodge protests. He asked what might have been done to speed the process of investigating Dr. Ake and what might be done to prevent continued sexual abuse. Number 109 MR. DEVRIES stated that he is not a physician, but a public member of the medical board. He said it was a little frustrating to sit on the board and go through a long, laborious process, but due process takes time. While he might like to see the process speeded up, he did not know if it was realistic. He did not think the board had a mandate to get involved in sexual harassment issues, but was mandated to look at medical competency. He said such complaints might better go to the Human Rights Commission or another commission. CHAIR RIEGER asked if the medical board had been too lenient and should be stricter in removing doctors from practice than it has been in the past. MR. DEVRIES answered that Dr. McGuire (a member of the medical board) was decisive, and other doctors on the board knew the need to vigorously discipline other doctors when necessary. He said such discipline was especially necessary when a doctor was abusing drugs or alcohol. (Rep. Nicholia arrived at 1:43 p.m.) NOMINATION OF DR. JOAN JELINEK, M.D. Number 174 SEN. RIEGER brought the confirmation of Dr. Joan Jelinek to the table and noted that she was on-line via teleconference from Fairbanks. REP. TOOHEY asked whether the knowledge that a physician performed abortions would influence her judgement of that physician in matters coming before the medical board. DR. JELINEK answered no, it would not. She said the duties of medical board members are well-defined, and any personal or religious preferences regarding abortion should be excluded from their judgement as board members. Number 192 SEN. RIEGER asked her opinion of the medical board's level of strictness in disciplining doctors. DR. JELINEK answered that it was a complex question. She said the medical board was effectively investigating the complaints brought to it, but there was often an excessive delay before the board could render an opinion and impose a sanction if necessary. That could be a function of the number of complaints, the level of support, and the limited attention which each board members could bring to a case. She said medical board sanctions had been appropriate, though she was frustrated at the size of the caseload and the delays before rendering decisions. She said the board was not lenient, but said the board sometimes lacks specific guidelines in dealing with imprecise areas of human and medical judgement. She said the medical board has drawn attention for its many disciplinary actions against doctors, though it might not be excessive, given the number of doctors in the state. Number 230 REP. BUNDE asked whether Dr. Jelinek felt the public was well-informed about how to file complaints against doctors and whether more information was necessary. DR. JELINEK answered that the medical board served the public, and while the public may need more education, it would probably greatly expand the board's caseload. Once the board hears of complaints, the investigators are prompt and thorough, she said, but there is often subsequent delay before action by the board. Number 255 SEN. LEMAN said he had received several comments from medical doctors on Dr. Robert Rowen's appointment, and asked Dr. Jelinek to comment on Dr. Rowen's performance on the medical board in the time she had been appointed to the board. DR. JELINEK responded that she could take no issue with Dr. Rowen's performance during the one or two board meetings since his appointment. She said she was familiar with the concerns from doctors and laymen that Sen. Leman had mentioned. She said the medical board would continue to operate under its governing statutes and said she hoped no individual nomination would alter the board's course. Number 279 REP. BUNDE invited Dr. Jelinek to share her opinions on Dr. Rowen's appointment. Number 280 DR. JELINEK said she was not offering specific information on Dr. Rowen's appointment, but recognizing the controversy over his alleged practice of unconventional medicine in Alaska. She said she felt that legislators, physicians and laymen must consider American medical practice, and offered to provide a recent JAMA (Journal of the American Medical Association) article which reviewed the prevalence, cost and patterns of use of unconventional medical practices, and judged that the nation was probably underutilizing them. The article suggested one in four Americans seek unconditional therapy in addition to other medical attention, often surreptitiously. She said the National Institute of Health was establishing an office to do research into unconventional medical practices, but in the interim the medical profession must continue to practice conventional medicine. Number 321 REP. NICHOLIA asked whether Dr. Jelinek believed the medical community was responding adequately to the problems of Fetal Alcohol Syndrome (FAS). DR. JELINEK said she had no sense of that and could not answer the question, as she practiced internal medicine, not pediatrics, obstetrics or gynecology. Number 337 NOMINATION OF DR. GARY JOHNSON, M.D. SEN. RIEGER brought the nomination of DR. GARY JOHNSON to the table, noted that Dr. Johnson was on-line via teleconference in Fairbanks, and invited committee members to question him. REP. TOOHEY asked Dr. Johnson if he could be an impartial judge of a peer professional if he knew that physician performed abortions. DR. JOHNSON answered yes. Number 345 SEN. RIEGER asked Dr. Johnson under what conditions he would consider suspending the license of a doctor in Alaska. DR. JOHNSON answered that he would do so if a physician was causing potential harm to patients, practicing unethical medicine, or breaking the law. SEN. RIEGER asked Dr. Johnson's opinion of the medical board's level of strictness or leniency in investigating and licensing. DR. JOHNSON said that, though he had been at only one board meeting, he shared Dr. Jelinek's desire that the process could be done faster, though he acknowledged it probably could not. He said the medical board was fairly balancing the interests of the public with the leeway needed for different styles of medical practice, and it must allow due process, which can be lengthy. Number 372 REP. BUNDE asked if the public needed more information about ethical medical practice. DR. JOHNSON said everyone, including physicians, needed more education on ethical medical practice. He said there was a lot of room for debate as to what constituted ethical practice. REP. BUNDE asked if he knew how to more clearly delineate what constituted ethical practice to improve the accuracy of such complaints. Number 385 DR. JOHNSON said it would take a massive public education campaign to do so. The effort would have to include determination of guidelines concerning ethics, including sexual harassment, consensus on which is now developing across the nation. Number 404 SEN. LEMAN noted that Dr. Johnson had signed a letter opposing Dr. Rowen's appointment. Sen. Leman invited him to express his displeasure in greater detail and to give his opinion of Dr. Rowen's work on the board to date. DR. JOHNSON said he felt it was inappropriate for appointees to comment on the appointments of others. As president of the Alaska Medical Association, Dr. Johnson said, he has obligations to communicate the members' feelings on issues of medical ethics, including appointments to the State Medical Board. He said he signed a letter from the state association's board expressing concerns about the appointment to the medical board of a doctor whose methods of practice were not scientifically proven. Dr. Johnson said ethics are debatable. Some might argue that a doctor should perform treatment he knew to be beneficial whether scientifically proven or not, while others might say doctors should use only treatment methods proven to be effective and safe. He said the AMA had outlined its concerns to legislators. Dr. Johnson said he had no basis of judging Dr. Rowen's performance on the medical board. Number 451 NOMINATION OF DR. EILEEN BECKER, M.D. SEN. RIEGER brought the nomination of DR. EILEEN BECKER to the table, noted that she was testifying via teleconference from Homer, and invited members to question her. REP. TOOHEY asked Dr. Becker if she could be an impartial judge of a physician if she knew that physician performed abortions. DR. BECKER said she would have no problem with that; she valued life, and she would consider all the factors involved in a case before making any judgement. (Sen. Rieger noted that Rep. Olberg, Rep. Kott, Rep. Nicholia, Sen. Ellis and Sen. Miller had joined the meeting. Number 462 REP. BUNDE asked if the medical board needed to play a role in educating the public on what constituted unethical behavior. DR. BECKER said she was not sure, as she had not looked at the materials she had received, was only appointed early in the year, and had been involved only in one short teleconference. But she said that, as a broadcaster involved in communications, she would be interested in working toward that sort of thing. If the board decided it needed to work toward that end, she would be willing to work toward that end, she said. She said she wanted to avoid disseminating so much knowledge as to encourage a witch- hunt, but she said it would be wise to make sure everyone knew how to get information to the authorities if necessary. There is always room for improvement of communications, she stated. REP. BUNDE said he was not criticizing, but asking for a layman's impressions. Number 480 NOMINATION OF DR. ROBERT ROWEN, M.D. SEN. RIEGER brought the nomination of DR. ROBERT ROWEN to the table, invited Dr. Rowen to testify before the committee in Juneau, and invited the committee members to question him. Number 486 REP. TOOHEY asked Dr. Rowen if his judgement of a physician before the medical board would be clouded by the knowledge that the physician performed abortions. DR. ROWEN answered no. REP. B. DAVIS asked how many meetings Dr. Rowen had attended since his appointment in July, 1992; what action he had taken as a board member; and how comfortable he felt in such action considering the controversy over his appointment. Number 492 DR. ROWEN said he had attended two board meetings, which dealt mostly with physicians impaired by addiction to drugs or alcohol. He said the board had taken no action on physicians for reasons other than drugs or alcohol. REP. B. DAVIS asked if he was comfortable on the medical board. DR. ROWEN said he was very comfortable. He offered an example of how he felt he had contributed to the board, saying he had helped the board develop a policy on the use of narcotic pain relief medication following complaints by patients about some physician's reluctance to administer strong pain medication. He suggested inclusion of a paragraph in the policy reminding doctors that there are philosophies outside of the medical profession, such as chiropractic and acupuncture, that should be considered. Number 513 SEN. LEMAN asked Dr. Rowen for his response to the feeling expressed by some in the medical profession who were leading the charge against his confirmation to the medical board. DR. ROWEN said the allegations had been that he is unethical because he did not practice "scientific medicine." He referred to books containing 3-4,000 references on nutritional therapy, including some stating that up to 80 percent of cases of a specific ear condition were due to allergies to milk or other substances. He read the abstract of an article dealing with chelation therapy, which showed the therapy brought marked improvement in 77 percent and good improvement in 16 percent. He cited other studies showing that bypass surgery is dangerous, ineffective, and in most cases, overdone. He said a letter from the medical association to members of the committee regarding a presentation he made on mercury, and accusing him of being unethical, contained knowing falsehoods. He asked what the association might have meant by conveying knowing falsehoods. Number 544 DR. ROWEN referred to an incident in which a nurse's error during an ultraviolet irradiation of blood treatment brought an allergic reaction from a patient. He said that in 10 years he did not know of any patient who suffered significant injury at his hands. He said few doctors have such a record. He said a 1942 article on the treatment showed the treatment brought complete recovery to 17 patients with only one treatment. He said 90 percent of his practice was related to nutrition and asked what he did that was unscientific. He said he felt it would be bad practice not to use vitamins, herbs or minerals before using petrochemical pharmaceutical because they pose no risk, have shown documentation in peer-reviewed medical literature, and are cheap. Number 573 DR. ROWEN said he does use drugs and prescribe surgery in his practice, but infrequently. He referred to the case of Mrs. Coghill, who had severe back pain and was scheduled for surgery despite negative back scans. He said he relieved her pain with injections of anesthetic into her root canals and sent her to a dentist for extraction of two teeth and a pus pocket, which brought relief of her back pain. He cited that treatment as a way to cut costs and treat patients without dangerous surgery. TAPE 93-25, SIDE B Number 000 SEN. LEMAN said he had read Dr. Rowen's health care cost containment proposal, called it an interesting proposal placing more responsibility on the individual, and invited him to comment further on why health care costs were high. DR. ROWEN said there were several reasons. The first was that third-party payment eliminates the incentive not to spend. The second is that the medical industry was a profit-making industry that obscures symptoms with expensive drugs, but does not cure disease. He cited his standing offer of $100 to anyone who could prove a drug cured a disease, except for antibiotics. He said many ailments can be helped through better nutrition. He said there is no way to contain health costs until the medical system paid more attention to the causes and prevention of diseases, not their symptoms. The third was the international pharmaceutical industry's efforts to eliminate alternatives to its methods, he said, citing cases in which doctors have lost their licenses and been harassed for their treatment philosophies. He said he spends up to 1,000 hours on research into his methods and decried doctors who refuse to consider them. Number 082 REP. BUNDE asked if Dr. Rowen's criticisms of conventional medicine would bar him from working with conventional doctors on the medical board, even though he did not respect their medicine. DR. ROWEN disputed that statement. He said he did respect their medicine, felt there was a place for drugs and surgery, and had directed such treatment for his patients. He said he did not want to judge other doctors for practicing conventional medicine. His interest in serving on the medical board was not to butt heads, but to contribute ideas or offer suggestions, such as while considering the case of a doctor performing a large number of back surgeries, that there may be more cost-effective treatments. Number 113 REP. BUNDE asked if Dr. Rowen viewed his role on the board as educating other doctors and encouraging them to follow his view of medicine. DR. ROWEN said he did not see his role as encouraging other physicians to follow his views. He said many doctors are terrified of straying from the party line for fear of losing their licenses or being reprimanded. He said many doctors are afraid to voice public support for him for fear that if they did so, "they would be taken out." Dr. Rowen said patients of his who had told other doctors of the results they had gotten with Dr. Rowen were dropped as patients by those doctors. He cited the "Annals of Internal Medicine," which has indicated that 40 percent of Americans would choose alternatives over conventional medicine. He said his natural medicine is not better than other doctors' medicine, or vice versa. He said doctors should serve their patients, not dogmas. Number 138 REP. BUNDE said he was implying no value judgement by the terms conventional and alternative medicine. He noted Dr. Rowen's criticism of the profits conventional doctors make from pharmaceutical, and asked whether Dr. Rowen did not make a profit from natural medicines he sold his patients. DR. ROWEN responded that he did not think that was a fair criticism. He said he and other natural doctors have homeopathic pharmacies for the convenience of their patients and direct patients to health food stores. He said he is motivated by concern for his patients. Other doctors, such as dermatologists, sell medicines, and surgeons make money from surgeries, he said. REP. BUNDE said he had not intended criticism in calling attention to the profit in selling herbs. Number 181 DR. ROWEN cited saw palmetto, an herb proven safe and effective in treating prostate enlargement and which cost pennies, but which the Food and Drug Administration (FDA) did not recognize for that purpose. But when Meurck pharmaceutical developed a more expensive, less effective and more dangerous synthetic analogue of the herb, it got FDA approval, he said. He noted the system works to make money. He cited the drug Halcion, banned in Great Britain as dangerous, but left on the U.S. market while tryptophan, a safe sleep aid is under pressure to be taken from the U.S. market because a contaminated batch made it to the market. If the nation does not look to such ways to lower medical costs, the nation will go bankrupt, he said. SEN. RIEGER asked if Dr. Rowen considered himself an advocate of alternative medicine. DR. ROWEN responded that he was an advocate for the patient. DR. ROWEN was asked if he practiced both alternative and conventional medicine. DR. ROWEN answered yes, but said not everything he did was alternative. He said providing nutrients was more scientific than prescribing drugs to cover up a symptom. He said he did not like the term "alternative." SEN. RIEGER asked if there were alternative medicines Dr. Rowen considered dangerous. DR. ROWEN asked him to define dangerous. SEN. RIEGER asked if he did anything dangerous. Number 214 DR. ROWEN answered that anything used to excess or improperly, even oxygen or water, was dangerous. Chelation therapy has a good safety record, though the medical community calls it dangerous. SEN. RIEGER asked if there were any medical practices that he would consider a generally dangerous practice. DR. ROWEN answered that all drugs or herbs are good if used correctly and are bad if used incorrectly. SEN. RIEGER asked if there were such a thing as experimental medicine, and asked his opinion on the level of scientific proof required before a practice should be permitted in the medical community. Number 232 DR. ROWEN responded, "Our statute added the word experimental medicine. And the reason why that was done was not for me. Unconventional was good enough. Chemotherapy and radiation are as experimental as they come. That's true human experimentation. And the studies have shown that chemotherapy and radiation usually gives people worse quality of life than if they did nothing at all..." He said The Lancet has published an article saying mammograms have no screening value for women under 50, but the legislature was bamboozled into getting insurance companies to pay for them. Experimental involves anything not proven, he said. A 1978 survey done for the Office of Technology Assessment by the McGovern Committee found that up to 80 percent of practices in orthodox medicine have no scientific basis, he said. Number 243 SEN. RIEGER asked Dr. Rowen under what conditions he would vote to pull another doctor's license. DR. ROWEN answered that, as he had been persecuted by the profession, he said he would bend over backwards to be fair and already has in one vote on a physician. If a doctor is harming patients, the medical board must take action, he said. He said he would like to educate other doctors about other philosophies, on behalf of the patients, and noted that he is but one of seven board members, and all would have to follow the statutory obligations in considering such action. He said the medical board should take action if a doctor were incompetent within the scope of his practice, if a physician were harming his patients or performing unethically according to the medical regulations. Number 278 REP. TOOHEY commented that the committee was not considering Dr. Rowen's competency and said she believed he had a place in the community and, as long as he was competent, was glad he was practicing. But his service on the medical board was another question. She said the board's function was to help doctors maintain a standard of practice to protect the public, not to further any individual physician's medical philosophy. She expressed displeasure that he evidently had a medical agenda and was inappropriately using his position on the medical board to pass judgement on other doctors. DR. ROWEN said he had spent a good deal of time in his testimony defending himself against medical association attacks as being allegedly too unethical to serve on the board and he was trying to present a different view of those types of ethics. He said differences of opinion and dissent are beneficial to making progress, denied trying to further any agenda, but to share ideas. He asked if it were proper for other doctors who might be prejudiced against his type of practice to sit in judgement of other physicians like him. SEN. RIEGER asked if there were a problem with alternative medical practitioners being harassed or persecuted by the medical boards. DR. ROWEN answered that in other states, many of his colleagues had been de-licensed at the complaints of other physicians, not patients' complaints. Three years ago, Dr. Rowen said he anticipated the trend would reach Alaska. He said the medical association brought a "quack-buster" to Alaska, Dr. Jennifer Christian, went on a "witch-hunt," and the association began a drive to purge the state. He said Russ Hoffman, M.D., past president of the association and now working in Bethel, could offer corroboration. He said the medical board was above that and recalled its obligation to serve the people, not the profession. A public outcry concerning a bill arising from that effort, plus Dr. Rowen's appointment to the board, indicated public desire for plurality of thought in the medical profession, he said. Number 336 REP. B. DAVIS asked what legislation Dr. Rowen had referred to. DR. ROWEN answered that Sen. Pat Rodey had introduced in the House, and Reps. Dave Donley, Max Gruenberg and Johnny Ellis carried forward legislation stating that the medical board could not base a finding of professional incompetence solely on the basis that a licensee's basis was unconventional or experimental. Dr. Rowen said he agreed to add the words, "in the absence of demonstrable physical harm to a patient." He said he was being held to a higher standard than orthodox doctors, but that was okay. Number 344 REP. BUNDE asked how many Alaska doctors practiced alternative medicine. DR. ROWEN answered there were five, though there may be six or seven. REP. BUNDE asked if he knew of any that had been brought up before the medical board. Number 358 DR. ROWEN answered that one doctor who performed an insulin tolerance test was reprimanded several years ago. He said the doctor thought the test was a good indicator of a patient's risk for coronary artery disease, but at another doctor's complaint, the issue went before the medical board, where the doctor in question was reprimanded. Dr. Rowen said several medical articles said the test was valid, but the medical board did not look at them. REP. BUNDE asked whether Dr. Rowen would have voted for censure if he had been on the board. DR. ROWEN said that he would have called the medical board's attention to those articles and not to the opinion of the complaining doctor. Number 364 REP. VEZEY referred to Dr. Rowen's standing $100 wager to find a drug that cured a disease and asked whether the doctor excluded vaccines or antibiotics that prevented disease. DR. ROWEN said he did not consider vaccines to be disease curing compounds, but disease preventing compounds. REP. VEZEY asked whether Dr. Rowen had criticisms of using vaccinations to prevent disease. DR. ROWEN said there was a controversy over vaccinations, in which he did not get involved. REP. VEZEY asked Dr. Rowen if he practiced alternative medicine or practices not taught in medical schools. DR. ROWEN said it depended on how the question was viewed. He cited his degree from the University of California, San Francisco, considered the nation's first- or second-best medical school, and said while he respected the value of that education and was utilizing it, he has added to it. Number 400 REP. VEZEY referred to the high cost of malpractice insurance and asked how the insurance industry viewed unorthodox physicians such as Dr. Rowen. DR. ROWEN answered that such doctors generally paid lower rates, as the insurance industry recognizes that such doctors do not injure people. He said his insurance rates as of two years ago were at least $3,000 lower than if he was a conventional doctor. He said his insurance company is geared to physicians practicing his kind of medicine. Number 409 REP. VEZEY asked if the insurance company had a name for that type of medicine. DR. ROWEN answered that they call it "preventative" medicine. Number 400 REP. VEZEY said the confirmation process was to judge Dr. Rowen's suitability for service on the medical board, not for his worth as a physician. He asked what Dr. Rowen felt the duties of the board were. Number 418 DR. ROWEN answered that his duties are prescribed by statute, the most important of which is to protect the public. The medical board achieved this aim by removing from practice physicians who are hurting people, or directing physicians impaired by drugs or alcohol to seek rehabilitation. The board must make sure that physicians, above all, do no harm. REP. VEZEY said the doctor and others view the function of the medical board differently. He said the board is, by statute, a licensing board that must determine competency, deal with rehabilitation of substance-abusing doctors and other charges, he said. He said the underlying qualification for licensure is a degree from a school accredited by the American Medical Association (AMA), of which Rep. Vezey said he believed Dr. Rowen was critical. He said the issue was who should sit on the medical board in judgement of other doctors. Number 448 DR. ROWEN agreed that the medical board is governed by statutes and regulations, not philosophies. He said he was not on the board to criticize, but to say there are shortcomings everywhere, and that there is a need for new approaches and new ideas, and, in the area of cost- containment, some bold and novel approaches. If the medical establishment, which admits it has established a system that is not working well, continues to dictate rules and practices, the public will continue to get more of the same. He did not mean to be critical but to point out that neither side had all the answers, and that neither should be held to different standards. Number 466 REP. VEZEY said he was confused because the statutes authorized licensing of physicians only according to standard medical practice as sanctioned by the AMA. DR. ROWEN objected to Rep. Vezey's statement. He said the statute did not say in accordance with the AMA, but listed specific requirements. REP. VEZEY said the statute specifically said a doctor must have a degree from an AMA certified school. DR. ROWEN asked whether the statutory requirement was for a degree from an accredited school, or a school accredited by the AMA. REP. VEZEY said there was another agency mentioned in the statutes, as well as the Council of Medical Education of the AMA. DR. ROWEN said he accepted the statutory requirement and he had gone to such an accredited school. REP. TOOHEY said the statute concerning the State Medical Board did not deal with medical costs, and she believed it was not the duties of the board to deal with such an issue, or many others that Dr. Rowen had raised. DR. ROWEN said he agreed that cost containment and licensing were separate issues, and that issuing and regulating licenses had to be done according to statute. REP. NICHOLIA asked whether Dr. Rowen had a malpractice suit pending against him. DR. ROWEN answered that a patient had an allergic reaction to the mistake of a nurse in his office, but he had not seen any papers filed. He said many physicians acknowledge that a doctor is lucky to get through a career without ever being sued for malpractice. He said it was well-known that the mistake was not his, that even medical people make mistakes, and that he had not fired his nurse for doing so. Number 500 SEN. RIEGER asked if the medical board has been too strict or lenient in censuring or de-licensing other physicians. DR. ROWEN said it was hard to answer, as he had only been with the board for two meetings. Number 520 REP. B. DAVIS asked Dr. Rowen whether he would be more concerned about patient rights or doctor's rights as a medical board member. She also recalled his statement that he would be less interested in judging doctors than in helping them see alternative treatments, and asked him to reconcile this statement with his professed concern for patients. DR. ROWEN said the medical board must work with physicians to make them better doctors; for example, when doctors were harming patients or were abusing drugs or alcohol. He said it was hard to answer her question as he had not seen the issue arise during his time on the board. He said he could see his role on the board as trying to educate physicians that approaches other than surgery, invasion or drugs might be used in treatment. But if a doctor was injuring patients, the board would have to take action as it saw fit. REP. B. DAVIS said she believed Dr.Rowen was qualified, and that she had once considered seeing him herself. But she said that did not affect his suitability as a medical board member. She said her main concern was that he might have to come before the board and therefore be removed from it, and that his serving on the board was a set-up for such a situation because a case against him was pending. Number 540 DR. ROWEN contradicted her, saying that the case in question (presumably the case concerning the nurse's mistake and subsequent patient's allergic reaction) had been investigated by the board, which had exonerated him. A negligence case against his nurse, in which he was a co- factor, was a totally different case. REP. B. DAVIS said there was more than a normal chance that he or the five or six other doctors practicing a similar type of alternative medicine might be brought up before the same medical board on which he served. She asked whether he might be more vulnerable than other doctors. DR. ROWEN said that was not true; he had only a couple of complaints filed against him in ten years. One of those, which was tossed out, was from a patient who did not want to pay her bill. Another was due to his nurse's error, in which case he was exonerated. Two other complaints came from medical doctors who did not like what he did, he said. He described a case in which he diagnosed a bowel obstruction in a female patient from Fairbanks, but the two Anchorage gastro-enterologists he asked to treat the patient said they were too busy to do so. The patient went to the Providence Hospital emergency room, where Dr. Merchant saw her and said he would take care of it, but could not get a surgeon to come to the hospital to treat her. The patient languished in the emergency room for hours and Dr. Merchant acknowledged to the patient's daughter that doctors were refusing to treat the patient because she had been seeing Dr. Rowen. As a result of the lack of treatment at the hospital, the woman developed a gangrenous bowel which had to be removed and which led to general bad health for the woman, Dr. Rowen said. REP. B. DAVIS asked why he did not attend to his own patient. DR. ROWEN answered that the woman needed surgery and the matter was out of his hands. TAPE 93-26, SIDE A Number 000 DR. ROWEN said he wanted to see the politics of medicine change to consider more the needs of patients. REP. TOOHEY said she was an emergency room nurse who has worked with Dr. Merchant and said that if Dr. Merchant felt it was an emergency he would have taken action and would not have let the patient become gangrenous. DR. ROWEN answered that the woman was admitted to the hospital at the emergency room, but did not see an appropriate specialist. Dr. Merchant was the emergency room physician and did a good job, Dr. Rowen said. SEN. RIEGER asked Dr. Rowen to leave the two books he had introduced into the record with the committee for committee members to peruse at their will. (The two books were, Encyclopedia of Natural Medicine by Michael T. Murray, N.D., and Joseph E. Pizzorno, N.D., from Prima Publishing, Rocklin, CA; and Nutritional Influences on Illness by Melvyn R. Werbach, M.D., from Third Line Press, Inc., Tarzana, CA. The two articles were "EDTA Chelation Therapy in Chronic Degenerative Disease" by Effrain Olszewer and James P. Carter in Medical Hypotheses, 1988; and "Ultraviolet Blood Irradiation Therapy" by George Miley, M.D., in the Archives of Physical Therapy, Sept. 1942. The articles, and the title pages of the books, are on file in the committee room.) SEN. RIEGER referred to the statutes concerning the State Medical Board, to which Rep. Vezey had earlier referred, and said they were contained in AS 08.64.200, paragraph one, concerning physician applicants and medical school graduation requirements. Sen. Rieger announced that the House Health, Education and Social Services Committee would continue to hear public testimony on Dr. Rowen's appointment, starting at 3:30 p.m. on the same day, March 1, 1993, in Room 104 (106) of the Capitol Building. Sen. Rieger then ADJOURNED the joint meeting at 3:05 p.m.