SENATE LABOR AND COMMERCE COMMITTEE April 3, 1997 1:35 P.M. MEMBERS PRESENT Senator Loren Leman, Chairman Senator Jerry Mackie, Vice Chairman Senator Tim Kelly MEMBERS ABSENT Senator Mike Miller Senator Lyman Hoffman COMMITTEE CALENDAR Confirmation Hearing: Real state Commission Ruth Blackwell - Juneau Board of Nursing Josephine Malemute - Fairbanks Board of Examiners in Optometry William D. Faulkner - Anchorage Aharon Sternberg - Anchorage Certified Direct Entry Midwives Kay Kanne - Juneau Pam Weaver - Chugiak Mark Richey - Anchorage SENATE BILL NO. 92 "An Act relating to veterinarians; extending the termination date of the Board of Veterinary Examiners; and providing for an effective date." - MOVED CSSB 92(L&C) OUT OF COMMITTEE SENATE BILL NO. 90 "An Act relating to dental licensing; extending the termination date of the Board of Dental Examiners; and providing for an effective date." - MOVED CSSB 90(L&C) OUT OF COMMITTEE SENATE BILL NO. 104 "An Act relating to regulation and examination of insurers and insurance agents; relating to kinds of insurance; relating to payment of insurance taxes and to required insurance reserves; relating to insurance policies; relating to regulation of capital, surplus, and investments by insurers; relating to hospital and medical service corporations; and providing for an effective date." - MOVED CSSB 104(L&C) OUT OF COMMITTEE PREVIOUS SENATE COMMITTEE ACTION SB 92 - See Labor and Commerce Committee minutes dated 3/6/97 and 3/13/97. SB 90 - See Labor and Commerce Committee minutes dated 3/18/97. SB 104 - See Labor and Commerce Committee minutes dated 3/25/97. WITNESS REGISTER Ms. Annette Kreitzer, Staff Senate Labor and Commerce Committee State Capitol Bldg. Juneau, AK 99801-1182 POSITION STATEMENT: Staff to sponsor of SB 92. Dr. Burton Miller 2600 Denali St, Ste 500 Anchorage, AK 99503 POSITION STATEMENT: Supported SB 90. Mr. Charlie Brown Consumer Dental Choice Project Washington, D.C. POSITION STATEMENT: Supported SB 90. Ms. Martha Reinbold, Director Alaska Dental Society 3305 Arctic Blvd. Anchorage, AK 99503 POSITION STATEMENT: Commented on SB 90. Mr. Scott Crowther P.O. Box 110854 Anchorage, AK 99511-0854 POSITION STATEMENT: Supported SB 90. Ms. Marianne Burke, Director Division of Insurance Department of Commerce and Economic Development P.O. Box 110805 Juneau, AK 998811-0805 POSITION STATEMENT: Supported CSSB 104(L&C). ACTION NARRATIVE TAPE 97-15, SIDE A Number 001 CHAIRMAN LEMAN called the Senate Labor and Commerce Committee meeting to order at 1:35 p.m. and said they would begin with the confirmation hearings. He said the nominee for the Real Estate Commission, Ruth Blackwell, was not able to be with them today and asked Ms. Josephine Malemute, Board of Nursing, to give them some brief highlights and her reasons for wanting to serve on the Board. MS. JOSEPHINE MALEMUTE said she is currently working as the Clinical Health Director of Nursing and she is interested in advocating not only for the Fairbanks region, but Interior Alaska. She serves on a lot of boards and committees within the Fairbanks area already and has learned a lot being on the Board of Nursing which is a very good board to work with. CHAIRMAN LEMAN asked her if there were any issues she was aware of that needed to be addressed legislatively. MS. MALEMUTE said the biggest thing they deal with now is unlicensed persons working, especially in the long-term care facilities. CHAIRMAN LEMAN thanked her for serving and said the committee would forward her name to the full Senate. MR. AHARON STERNBERG, Board of Examiners in Optometry, said he was born in Israel in 1946 and came to this country in 1967, after the six-day war. He reviewed his resume for the committee. He said he is familiar with optometry, icthamology and opticianry and has a good relationship with professionals in all three fields. He thought HB 195 contained some controversial issues and thought he could contribute more than someone who is not familiar with adult professionals. CHAIRMAN LEMAN thanked him for his willingness to serve. DR. WILLIAM FAULKNER , Board of Examiners of Optometry, briefly reviewed his resume. He noted that Dr. Sternberg is in a big multi-disciplinary practice and he has his perspectives and he, personally, could offer the perspective of a solo practitioner in addressing the Board's concerns. CHAIRMAN LEMAN asked if there were any issues that would be significant to the legislature. DR. FAULKNER replied that they are updating the optometry law (HB 195) which is good. He said he was interested in providing a good quality of service to his patients and continuity of care at a reasonable price. MR. MARK RICHEY, M.D., Certified Direct Entry Midwives, reviewed his resume. CHAIRMAN LEMAN thanked him for his willingness to serve. Number 300 MS. PAM WEAVER, Certified Direct Entry Midwives, reviewed her resume for the committee. CHAIRMAN LEMAN thanked her for her willingness to serve. MS. KAYE KANNE reviewed her midwifery background. She said she would like to continue to serve on the Board as she has in the past. CHAIRMAN LEMAN asked her if the Board was working as well as they had planned when they did the legislation. She said it is and she thought it would be really good to have Mark Richey on the Board. SENATOR MACKIE asked if she worked by herself. She answered that she had a partner in the beginning, but has been by herself for quite a few years now. She was just joined by a nurse midwife. She said she delivers an average of three babies per month. CHAIRMAN LEMAN thanked her for her willingness to serve. SENATOR MACKIE moved to submit for confirmation consideration: Ruth Blackwell, Real Estate Commission; Josephine Malemute, Board of Nursing; Dr. Bill Faulkner and Aharon Sternberg, Board of Examiners in Optometry; Kay Kanne, Pam Weaver, and Mark Richey, Direct Entry Midwives. There were no objections and it was so ordered. SB 92 BOARD OF VETERINARY EXAMINERS; LICENSE  CHAIRMAN LEMAN announced SB 92 to be up for consideration. MS. ANNETTE KREITZER, Staff to Labor and Commerce Committee, explained there was a new CS before them labeled LS0595B. She said there was some concern that veterinarians hadn't been consulted, so she has spoken with eight or nine veterinarians. She said the committee had been concerned that veterinarians graduate from an accredited veterinary school and that is the case in the CS. She said the CS also changes the State exam to make it specific to Alaska issues of veterinary practice and not all of the veterinarians agree or disagree with that. The feeling from the Division is if you're going to graduate from an accredited school, take the National Board Exam, pass the clinical competency test, and take the State exam it should be focused on issues that are pertinent to the State of Alaska. The bill also adds pay required fees. MS. KREITZER said under licensing by credentials that section 3 is conforming to sections 1 and 2. SENATOR MACKIE moved to adopt the CS to SB 92. There were no objections and it was so ordered. SENATOR KELLY asked if the State test was a new requirement now. MS. KREITZER replied that it's not new; some of the questions on it, however, would be and were going to be specific to Alaska issues. SENATOR KELLY asked how people were supposed to know about Alaska issues without living here for a long time. MS. KREITZER said that would be a question for Dr. Brasler, Anchorage Veterinary Association. She has been advised that this is the practice in Colorado and other states. CHAIRMAN LEMAN commented that in the practice of engineering and architecture people at least have to take an arctic engineering class and pass that or write a paper on the topic. So people from out of State have some training in cold weather. SENATOR MACKIE said he would like to see an example of what a specific Alaska issue is. MS. KREITZER replied that some veterinarians suggested rabies, some of the things that happen along the Iditarod Trail, and cold weather situations specific to Alaska animals. Their point is that veterinarians who are treating animals in Alaska should have the training to deal with them whether they are getting licensed for the first time or coming in under credentialling. SENATOR MACKIE said he wants the bill they pass to give the opportunity for those who are qualified and trained and for us to have a conducive atmosphere to invite people to come and practice here. MS. KREITZER explained that some veterinarians think the required State test is redundant to the other tests given and there is concern with the purpose of the State test. Of the nine veterinarians she spoke with they all agreed that it is supposed to test veterinarians to practice within this State. Number 424 SENATOR KELLY said his concern was that Alaska veterinarians would not necessarily want or encourage competition from outside applicants and might make the test difficult to pass. SENATOR MACKIE said he didn't like specific Alaska language and asked how it is currently. MS. KREITZER said that she tried to follow the committee's wishes and spoke with several veterinarians and could not get consensus on this issue. There is disagreement about whether the State test is redundant. Number 449 DR. JOHN BASLER, Anchorage Veterinarian Association, said he is not representing the Anchorage Veterinarians per se. He is president of the Alaska State Veterinary Medical Association and on behalf of their executive board, this is a new enough issue that they have not had a board meeting to discuss it. He has polled about 2/3 of the board and their feeling is that they don't have any major objections to the current version. They, however, request the right to comment further after a meeting of the board. MR. BASLER said the main area of concern was the first graduate section and Alaska specific issues. He added that there is a separate Alaska State Board exam that is given twice yearly which veterinarians have to pass in order to practice here. Putting Alaska issues in would cover some specific disease processes within the State, some of which would be pertinent for outside veterinarians. The easiest one might be rabies in which case there are a number of different factors in different areas of the country, including Alaska, and that would be important for a veterinarian to know wherever they are coming from. He didn't know what the passage rate for the State test was here, but in California there is a 30% failure rate. SENATOR MACKIE asked what he thought of in section 3 after "has passed the written examination of the State" inserting "Board, and has been provided orientation..." on specific issues of veterinary practice. MR. BASLER responded that orientation is already provided. The concern is with people coming up being knowledgeable about issues here. SENATOR MACKIE explained his concern is the potential to make the test so stringent that it would be close to impossible to pass it. MR. BASLER said he thought the main reason for passage of this bill was not to address this issue, but to make it easier for licensing by credentials. CHAIRMAN LEMAN noted that people with driver's licenses from other states have to pass an exam to get a license in Alaska. SENATOR MACKIE moved to pass CSSB 92(L&C) from committee with individual recommendations. There were no objections and it was so ordered. SB 90 DENTISTS: LICENSING & EXTEND EXAMINING BD  CHAIRMAN LEMAN announced SB 90 to be up for consideration and said in a previous meeting there was discussion about reducing the number of dentists from six to five and the grounds for discipline. The committee adopted an amendment deleting sections 2 and 5, leaving the Board at six dentists. Another amendment that was offered was taken out of the physician statutes regarding unconventional experimental practices. The core of the issue was mercury amalgam fillings and other restorative materials. SENATOR KELLY moved to bring amendment, Lauterback 4/3/97 A.2 version, before the committee for discussion. CHAIRMAN LEMAN explained this was similar to language adopted in at least one other state. DR. BURT MILLER said that life is a learning process and this is reflected in the issue of using mercury/amalgam as a dental filling material. It consists of approximately 50% mercury which is more toxic than lead, cadmium, or arsenic. The EPA states that the maximum safety limit for mercury vapors is 10 micrograms per day and mercury forms a vapor at 10 degrees fahrenheit. They have been documented between one and 29 micrograms per day. He read a long list of doctors who disagreed with the American Dental Association's conclusion on the safety of mercury amalgam fillings. TAPE 97-15, SIDE B Number 580 DR. MILLER said that the latest news and magazine polls indicate that 50% of the American public are skewing toward alternative medicine - outside of the dental and medical establishment. An informed group of people in Colorado and their state Attorney General demonstrated to the Colorado Board of Dental Examiners that the American Dental Association (ADA) was not the expert counsel on amalgam that the board assumed it to be. The American Dental Association is a trade association that has never conducted any primary research into the safety of mercury amalgam and the ADA had either withheld or distorted vital information. He concluded saying that he supported SB 90, especially sections 6 and 7. Number 573 MR. CHARLIE BROWN, former Attorney General of West Virginia, said there are many kinds of dentistry; some want to use just gold, some want to use amalgam, and some want to use composite fillings. He said this bill doesn't take sides on the mercury debate. It allows the consumers, competition, and dentists to make that decision. It doesn't affect their battle against fraud which can happen with any kind of dentist. He urged them to take this out of the social debate and keep it in the scientific debate letting consumers decide what they want to do with their lives. MS. MARTHA REINBOLD, Director, Alaska Dental Society, said that she is an administrator and represents what the profession of dentistry feels to the ADA. She said they are concerned with proposed amendment, section 5(b), because of what the ADA Code of Ethics says, "The removal of amalgam restoration from the non-allergic patient for the alleged purpose of removing toxic substances from the body when such treatment is performed solely at the recommendation or suggestion of the dentist is improper and unethical. A dentist who represents a dental treatment recommended or performed by the dentist has the capacity to cure or alleviate diseases, infections, or other conditions, when such representations are not based upon accepted scientific knowledge or research, is acting unethically." MS. REINBOLD said the amendment was confusing as written. She suggested clarifying the use of "remove" or "place," "recommended the removal" or "recommended placement." She asked that wording be used that would comply with the Code of Ethics. MR. SCOTT CROWTHER, Palmer civil engineer, said he is an amalgam victim and he works with a consumer's dental choice project to promote a level playing field between mercury free dentists and other dentists in our State. He noted that he had a lot of science with him on the issue and there are two disturbing things about the use of mercury amalgam for fillings. One is that the mercury that leaks out of amalgam crosses into the placenta and into the tissue of a developing fetus which results in birth defects. He said that Germany has commenced its phase-out of using amalgam for fillings based on a conclusive study on this. MR. CROWTHER said that an on-going study at the University of Kentucky has documented the fact that mercury leaves the amalgam and goes into brain tissue and once it does this, it damages the tubuli, our memory cells - damage that is identical to what you find in Alzheimer's disease. A correlation has been found between the number of amalgams and length of mercury exposure to the amount of mercury in the brains of 100 autopsied Alzheimer's victims. Regarding the code of ethics and advocating the removal of amalgam, he said, SB 90 would allow acknowledgement that these things are happening and allow the issue to go back into the professional arena. SENATOR MACKIE moved to adopt amendment #3 to SB 90. There were no objections and it was so ordered. SENATOR MACKIE moved to pass the CSSB 90(L&C) from committee with individual recommendations and the accompanying $0 fiscal note. There were no objections and it was so ordered.  SB 104 OMNIBUS INSURANCE REFORM CHAIRMAN LEMAN announced SB 104 to be up for consideration. SENATOR KELLY moved to adopt CSSB 104(L&C). There were no objections and it was so ordered. Number 440 MS. MARIANNE BURKE, Director, Division of Insurance, said after the last meeting on this issue they received a fax from the Health Insurance Association of America, which represents 65% of the insurance writers in the country. They offered some minor wordsmithing and technical amendments which she absolutely agrees with. MS. KREITZER noted that all of those changes had been incorporated into the CS. SENATOR MACKIE moved to pass CSSB 104(L&C) from committee with individual recommendations with the accompanying fiscal notes. There were no objections and it was so ordered. CHAIRMAN LEMAN adjourned the meeting at 2:41 p.m.