Legislature(2003 - 2004)

05/09/2004 03:35 PM House JUD

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
SB 306 - NATUROPATHIC MEDICINE                                                                                                
[Contains discussion of HB 434.]                                                                                                
Number 0044                                                                                                                     
CHAIR McGUIRE announced that the  committee would consider CS FOR                                                               
SENATE BILL NO. 306(FIN) am, "An  Act relating to the practice of                                                               
naturopathic medicine; and providing for an effective date."                                                                    
CHAIR McGUIRE asked  what the differences are  between the Senate                                                               
and the House versions of the bill.                                                                                             
Number 0249                                                                                                                     
BRIAN  HOVE,  Staff  to  Senator   Ralph  Seekins,  Alaska  State                                                               
Legislature, sponsor,  on behalf  of Senator Seekins,  noted that                                                               
the  committee  has  before  it [CSSB  306(FIN)  am],  which,  he                                                               
opined, has been  greatly improved from the  original version via                                                               
the committee process.  He  relayed that the sponsor has listened                                                               
to and read  extensive testimony on both sides of  the issue.  As                                                               
a  result, [CSSB  306(FIN) am]  now contains  some sideboards  to                                                               
accommodate    naturopaths,   particularly    with   regard    to                                                               
prescription  schedules  IIIA,  IVA,  and VA  drugs.    This  was                                                               
accomplished  by providing  for  a process  whereby a  naturopath                                                               
would collaborate with  a doctor to develop a  formulary and work                                                               
together on  certain issues.   He expressed  the hope  that [CSSB
306(FIN) am]  will satisfy most,  though perhaps not all,  of the                                                               
concerns raised by  the bill, and posited that most  of the bases                                                               
have been covered.                                                                                                              
CHAIR McGUIRE noted  that a sectional analysis  has been provided                                                               
to members.   In response to a question, she  relayed that copies                                                               
of the  original version and  latest version  of HB 434  would be                                                               
provided to members as well.                                                                                                    
MR. HOVE explained  that the sectional analysis  pertains to CSSB
306(FIN) and  so does  not reflect the  amendment adopted  on the                                                               
Senate floor, and  offered his understanding of  what that Senate                                                               
floor amendment  entailed.   He suggested  that this  change will                                                               
ensure that  just one  or two  doctors aren't  collaborating with                                                               
all the naturopaths, since this might not be good public policy.                                                                
MR. HOVE went on to explain  that Section 1 of [CSSB 306(FIN) am]                                                               
changes   "naturopathy"  to   "naturopathic  medicine",   and  is                                                               
basically a housekeeping provision.   He characterized Sections 2                                                               
and 3  as similar,  and said  Section 4  repeals and  reenacts AS                                                               
08.45.030,  which pertains  to the  issuance  of a  license.   He                                                               
noted that the  original law [regarding naturopaths]  is 17 years                                                               
old,  and so  much  of what  [CSSB 306(FIN)  am]  does is  update                                                               
existing   statute  with   what  he   described  as   much-needed                                                               
revisions.  Section  5 speaks to restrictions on  the practice of                                                               
naturopathic medicine, he relayed.                                                                                              
CHAIR McGUIRE  noted that the  sectional analysis  indicates that                                                               
Section 4  removes a  reciprocity provision  previously available                                                               
to  naturopaths licensed  in other  states.   She asked  why [the                                                               
sponsor] would want to do that.                                                                                                 
MR. HOVE said doing so will  give the state more control over who                                                               
it  wishes   to  license  versus  just   allowing  for  automatic                                                               
CHAIR McGUIRE  directed attention  to Section  5 and  offered her                                                               
understanding  that the  language therein  had been  removed from                                                               
some  version of  one of  the  bills though  she couldn't  recall                                                               
which one.                                                                                                                      
MR.  HOVE offered  his belief  that  that language  had not  been                                                               
removed from any  of the Senate versions of the  bill, the latest                                                               
of which is currently before the committee.                                                                                     
CHAIR McGUIRE noted  that Section 5 allows for  the performing of                                                               
minor surgery.                                                                                                                  
MR.  HOVE offered  his understanding  that that  provision covers                                                               
only very minor types of  [surgeries], not anything that would be                                                               
considered invasive surgery.                                                                                                    
CHAIR McGUIRE offered the adage  that "surgery is only major when                                                               
it's on you - it's minor when it's on others."                                                                                  
Number 0890                                                                                                                     
REPRESENTATIVE  GARA asked  about  AS  08.45.120(a)(6), which  is                                                               
referenced in Section 5.                                                                                                        
CHAIR McGUIRE posited  that perhaps it is  referencing a proposed                                                               
new provision  of statute  that can  be found  further on  in the                                                               
bill.   She suggested that  perhaps the naturopaths that  will be                                                               
testifying  could  provide  a  description  of  what  constitutes                                                               
"minor surgery".  She noted  that Section 6 addresses the grounds                                                               
for suspension, revocation, or refusal to issue a license.                                                                      
MR. HOVE said the  important part of the bill is  Section 9 - new                                                               
statutory  language  that   addresses  collaborative  agreements,                                                               
continuing  education,  and a  peer  review  process.   Directing                                                               
attention  to   Section  10,  starting   on  page   5,  regarding                                                               
"Authorized activities; use of titles",  he noted that it says in                                                               
part,  "A person  licensed  under  this chapter  may  ... (4)  if                                                               
authorized  under   regulations  of  the   department,  prescribe                                                               
schedules  IIIA, IVA,  and  VA controlled  substances  ...".   He                                                               
characterized  these controlled  substances as  the heart  of the                                                               
addictive drugs, offered  his belief that [CSSB  306(FIN) am] now                                                               
contains  "something   that  will  be  acceptable   in  terms  of                                                               
arranging   for  these   collaborative  agreements,"   and  again                                                               
mentioned  putting together  a formulary  between the  naturopath                                                               
and the doctor  such that there will be a  pretty good one-on-one                                                               
understanding between them regarding what is allowed.                                                                           
MR.  HOVE said:    "So the  sideboard  we built  in  here is  the                                                               
collaborative  agreements,  ...   specifically  with  respect  to                                                               
developing  that   formulary;  then  it  goes   through  ...  the                                                               
regulatory  process -  so the  sideboards that  are here  will be                                                               
fleshed out  in that process;  and then it  comes down to  how it                                                               
works in practice."   He described the latter as  being a one-on-                                                               
one  situation such  that "individuals  will have  a pretty  good                                                               
idea of who  they're working with, what  they're capabilities are                                                               
and level of experience, and so on and so forth."                                                                               
CHAIR  McGUIRE posited  that much  of the  controversy over  this                                                               
bill probably  centers on the  issue of schedules IIIA,  IVA, and                                                               
VA  controlled  substances  as   described  under  AS  11.71.160,                                                               
11.71.170,  and  11.71.180.   She  noted  that  phenobarbital  is                                                               
included in [schedule  IVA], and asked why a  naturopath would be                                                               
[prescribing/using] such a drug.                                                                                                
MR. HOVE  suggested that the  naturopaths who will  be testifying                                                               
could better address that issue.                                                                                                
CHAIR  McGUIRE,  noting that  the  sponsor  had joined  them  via                                                               
teleconference, mentioned  that the bill seems  somewhat circular                                                               
with regard to the reference to "minor surgery".                                                                                
Number 1267                                                                                                                     
SENATOR  RALPH   SEEKINS,  Alaska  State   Legislature,  sponsor,                                                               
offered  his belief  that "minor  surgery"  would include  simple                                                               
things  like treating  abrasions, removing  a piece  of class  or                                                               
gravel, or sewing a couple  of stitches; "it's nothing invasive."                                                               
He also offered his belief  that naturopaths have had training in                                                               
minor  surgery "before  they could  get there."   With  regard to                                                               
schedules IIIA, IVA,  and VA controlled substances,  he said that                                                               
under the bill,  the naturopath will have to  review a particular                                                               
drug with  the collaborative physician,  and have  an individual,                                                               
written protocol - which they must  both agree on - regarding how                                                               
to  use  that  drug.    Additionally,  before  a  naturopath  may                                                               
prescribe  a schedule  IIIA  controlled  substance, the  protocol                                                               
that's developed and agreed to must be patient specific.                                                                        
SENATOR  SEEKINS said  he feels  that of  any other  state's law,                                                               
[CSSB 306(FIN) am]  contains the best sideboards  that exist with                                                               
regard to  allowing naturopaths  to service  their patients.   He                                                               
predicted that California  and Alaska will be vying  to see which                                                               
state has the best collaborative  agreements.  He, too, suggested                                                               
that the naturopaths  that will be testifying  can better address                                                               
some of the committee's questions.                                                                                              
CHAIR McGUIRE  noted that "minor  surgery" is defined on  page 8,                                                               
lines 18-29:                                                                                                                    
     (6)  "minor surgery"                                                                                                       
          (A)  means the use of                                                                                                 
               (i)  operative, electrical, or other methods                                                                     
     for surgical repair and  care incidental to superficial                                                                    
     lacerations and  abrasions or superficial  lesions, and                                                                    
     the removal  of foreign  bodies located  in superficial                                                                    
     tissues; and                                                                                                               
               (ii)  antiseptics and local anesthetics in                                                                       
     connection with  methods authorized  under (i)  of this                                                                    
          (B)  does not include use of general or spinal                                                                        
     anesthetics,  major   surgery,  surgery  of   the  body                                                                    
     cavities,  or  specialized  surgery,  such  as  plastic                                                                    
     surgery,  surgery   involving  the  eyes,   or  surgery                                                                    
     involving   tendons,   ligaments,  nerves,   or   blood                                                                    
Number 1472                                                                                                                     
SENATOR SEEKINS, in conclusion, said  he introduced SB 306 at the                                                               
request  of the  naturopaths, who  were seeking  to better  serve                                                               
their patients  in a safe  and consistent manner through  the use                                                               
of  pharmaceuticals  and   minor  surgery.    The   goal  of  the                                                               
naturopaths, he surmised,  was to provide the same  high level of                                                               
care as  physicians with regard to  pharmaceutical protocols, and                                                               
the  collaborative agreement  provisions  of  [CSSB 306(FIN)  am]                                                               
should help them achieve that goal.   Noting that a lot of people                                                               
have  done a  lot of  hard  work on  this issue,  he offered  his                                                               
belief that [CSSB 306(FIN) am] is a good bill.                                                                                  
CHAIR McGUIRE,  referring to a  House version of the  bill [which                                                               
failed  to move  out of  the House  Health, Education  and Social                                                               
Services Standing  Committee] - committee substitute  (CS) for HB
434,  Version  23-LS1574\W,  Mischel,  5/4/04  -  noted  that  it                                                               
doesn't contain  reference to  "minor surgery".   She  also noted                                                               
that "the liability is different."                                                                                              
Number 1572                                                                                                                     
REPRESENTATIVE PEGGY  WILSON, Alaska State  Legislature, speaking                                                               
as  chair of  the  House Health,  Education  and Social  Services                                                               
Standing  Committee, remarked,  "The liability  is there  now, it                                                               
wasn't [before].                                                                                                                
CHAIR  McGUIRE clarified  that she  is  speaking about  liability                                                               
with regard to the collaborative agreements.                                                                                    
Number 1601                                                                                                                     
SCOTT LUPER, N.D., Alaska  Association of Naturopathic Physicians                                                               
(AKANP), said  he would be speaking  on behalf SB 306,  and noted                                                               
that he has three main points to make.  He elaborated:                                                                          
     The first  one is  about education,  the second  one is                                                                    
     about safety,  and the third one  is about cooperation.                                                                    
     ...  In  terms  of  education, in  order  to  become  a                                                                    
     naturopathic  physician,  one  needs to  graduate  with                                                                    
     good  grades  from  an  "undergrad  degree,"  then  get                                                                    
     accepted  into naturopathic  medical  school, which  is                                                                    
     not  an easy  thing to  do,  and then  go through  four                                                                    
     years of  naturopathic medical school.   The  first two                                                                    
     [of those  four] years being lecture  and didactic, and                                                                    
     the second  two years  being an emphasis  on outpatient                                                                    
     clinical training:   basically  working with  doctors -                                                                    
     mostly naturopathic  doctors but  also some  "M.D.s and                                                                    
     D.O.s" -  treating patients, working in  their offices,                                                                    
     ... working  in the college clinic,  and [working] some                                                                    
     rotations in hospitals, especially in Arizona.                                                                             
     After that, you need to  pass the national board exams,                                                                    
     which makes sure that you're  safe, and then after that                                                                    
     you  can qualify  for a  license.   Now, the  degree of                                                                    
     education of naturopathic  physicians does exceed other                                                                    
     health  care  providers here  in  Alaska  that do  have                                                                    
     prescription  rights,   including  nurse  practitioners                                                                    
     [N.P.s], and  way exceeds the education  of physician's                                                                    
     assistants  [P.A.s].   And  the  level of  prescription                                                                    
     rights that  we've negotiated ... with  this compromise                                                                    
     bill is actually less than  the nurse practitioners and                                                                    
     [physician's]  assistants,   though  the  collaboration                                                                    
     agreement really is modeled on  that of the physician's                                                                    
     assistants  - since  it's already  in  statute we  just                                                                    
     basically  adopted it  as best  we could.   So  ... the                                                                    
     point I'm making is that we're well trained.                                                                               
Number 1696                                                                                                                     
DR. LUPER continued:                                                                                                            
     The next point  is safety.  And the fact  of the matter                                                                    
     is,  ... this  isn't new  - prescription  rights aren't                                                                    
     new for naturopathic physicians.   Of the ... 14 states                                                                    
     that license  naturopathic physicians, 12 of  them have                                                                    
     some   level   of   prescription  rights.      And   we                                                                    
     investigated  the rate  of  disciplinary actions  taken                                                                    
     against   naturopathic  physicians   with  prescription                                                                    
     rights, and  the fact  of the matter  is, ...  in every                                                                    
     state  that we  got results  back from,  the complaints                                                                    
     and    the   disciplinary    actions   taken    against                                                                    
     naturopathic  physicians was  less than  that of  other                                                                    
     doctors, M.D.s in particular.   For example, in Oregon,                                                                    
     where  the ...  right  for prescriptions  has been  the                                                                    
     longest,  the  rate for  M.D.s  is  about [.5]  percent                                                                    
     [and]  the rate  for naturopathic  physicians is  about                                                                    
     [.33]  percent.   In  Arizona,  where the  prescription                                                                    
     rights  are the  broadest,  the rate  against M.D.s  is                                                                    
     about  1   percent  and   the  rate   for  naturopathic                                                                    
     physicians  is about  [.5]  percent.   Nationwide,  the                                                                    
     rate   is   about   [.33]  percent   for   naturopathic                                                                    
CHAIR McGUIRE noted, however, that there are probably more                                                                      
physicians practicing than there are [naturopathic physicians].                                                                 
DR.  LUPER  pointed  out,  though,  that  the  statistics  he  is                                                               
relaying  involve "rate."   In  other words,  if there  are 1,000                                                               
physicians and  one looked at 100  of them, it would  be the same                                                               
as having 100 naturopathic physicians and looking at 10 of them.                                                                
REPRESENTATIVE  GRUENBERG surmised,  though, that  the difference                                                               
in  percentages   between  the   two  groups  could   be  because                                                               
physicians are probably performing  more difficult and more risky                                                               
DR. LUPER  acknowledged that point.   He mentioned,  though, that                                                               
he  is merely  attempting to  illustrate  that there  is a  track                                                               
record  of  naturopathic  physicians  safely  using  prescription                                                               
REPRESENTATIVE  GARA said:   "I  take it  there's a  statute that                                                               
comes up  with a formulary  system with a  physician collaborator                                                               
for physician's assistants."                                                                                                    
Number 1787                                                                                                                     
DR.  LUPER  said "No,  that's  not  correct."   The  prescription                                                               
authority  for physician's  assistants  is broader  that what  is                                                               
being  proposed  via the  bill  for  naturopathic physicians,  he                                                               
REPRESENTATIVE  GARA  surmised, then,  that  if  "we're going  to                                                               
provide prescription  authority, what we're  going to want  to do                                                               
is  allow a  naturopath  to administer  [a] prescription  without                                                               
getting approval every single time."                                                                                            
DR. LUPER concurred.                                                                                                            
REPRESENTATIVE  GARA  asked  whether physician's  assistants  can                                                               
prescribe  drugs without  approval  for  that prescription  every                                                               
single time.                                                                                                                    
DR. LUPER  said they  can.   In fact,  they can  practice without                                                               
having a  M.D. in their clinic,  and many do, often  because they                                                               
are  in communities  that don't  have M.D.s.   Also,  physician's                                                               
assistants don't have  to clear a plan of treatment  with an M.D.                                                               
on a case-by-case  basis before treating a patient.   He remarked                                                               
that the  intention of the  [proposed] law is to  have oversight,                                                               
to have M.D.s oversee protocols.                                                                                                
DR. LUPER went on to say:                                                                                                       
     The way  we see this  working is, when the  bill passes                                                                    
     and becomes law,  we'll go out and find  M.D.s that can                                                                    
     supervise us, and we'll create  a list of drugs that we                                                                    
     want  to use  in  our particular  practice.   Now,  our                                                                    
     practices  are  not  identical.     Some  of  us  [who]                                                                    
     emphasize pain  control, for example, may  have certain                                                                    
     medications that  they want  to use.   Most of  us just                                                                    
     emphasize  ...  family  medicine, and  there's  certain                                                                    
     things that  we want to use.   We'll take this  list to                                                                    
     our  M.D. ...  collaborator,  and  we'll discuss  these                                                                    
     medications with  them and get their  approval, to say,                                                                    
     "Yes,  these  are  appropriate  ...  to  use  in  these                                                                    
     situations," so that there is  a high degree of safety,                                                                    
     [a]  high degree  of  oversight -  more  than [in]  any                                                                    
     other  state   in  the  United  States   that  licenses                                                                    
     naturopathic physicians.                                                                                                   
     And when we create these  protocols, ... my hope ... is                                                                    
     that we'll  create relationships  with these  M.D.s, so                                                                    
     that  not only  will we  learn from  them, but  it's my                                                                    
     conjecture  that  they're going  to  learn  from us  as                                                                    
     well.  ...  In  the   treatment  of  hypertension  [for                                                                    
     example] I've  had some success;  I think I'll  be able                                                                    
     to teach them a  thing or two.  And I  think it'll be a                                                                    
     great  advantage  for the  general  public  to have  us                                                                    
     working  together hand  in hand.   In  fact, what  this                                                                    
     bill  does  is  it   really  forces  that  cooperation.                                                                    
     That's  how I  sold [the  concept  of the  bill] to  my                                                                    
     colleagues, and they bought it.                                                                                            
Number 1921                                                                                                                     
CHAIR  McGUIRE  asked  how  a pharmacist  would  know  whether  a                                                               
particular naturopathic  physician has a  collaborative agreement                                                               
with a physician  or whether a naturopathic  physician is staying                                                               
within the bounds of a collaborative agreement.                                                                                 
DR. LUPER  explained that the  naturopathic physicians  will send                                                               
their pharmacists the list of  the medications they have approval                                                               
for.   In  that  way,  a relationship  will  develop between  the                                                               
naturopathic  physician and  the pharmacist,  and the  pharmacist                                                               
will come to know what  the naturopathic physician can and cannot                                                               
CHAIR McGUIRE, noting  that Alaska is a big  state, asked whether                                                               
Dr.  Luper is  saying that  naturopathic physicians  will provide                                                               
every pharmacy in the state  with a copy of his/her collaborative                                                               
agreement.   Or  would it  be part  of a  collaborative agreement                                                               
that a naturopathic physician can only use certain pharmacies?                                                                  
DR. LUPER replied, "Only certain  pharmacies."  For example, if a                                                               
patient from  Barrow came to  see him  with the end  result being                                                               
that he  wanted to  prescribe a  particular medication,  he would                                                               
send/fax a  copy of his  collaborative agreement to  a pharmacist                                                               
in Barrow.   This sort  of thing  would happen on  a case-by-case                                                               
basis.  For  the most part, though, with regard  to his practice,                                                               
there are a  few pharmacists that he already  knows and respects,                                                               
and so he would be working with those pharmacists, he relayed.                                                                  
CHAIR McGUIRE  told Dr. Luper that  she is not worried  about how                                                               
he  will conduct  himself;  rather, she  is  concerned with  what                                                               
effects the bill will have on  the population at large.  She said                                                               
she wants something  in place that will  minimize the possibility                                                               
that  someone might  die  as a  result  of allowing  naturopathic                                                               
physician to prescribe medication.                                                                                              
Number 2088                                                                                                                     
DR.  LUPER, in  response to  questions, offered  his belief  that                                                               
physician's  assistants have  prescription  rights for  schedules                                                               
IIA-VA controlled substances as well  as "legend" drugs, and that                                                               
M.D.s do  provide some  oversight, though  not on  a case-by-case                                                               
basis.    He  noted  that   nurse  practitioners  have  the  same                                                               
prescription  rights  as  physician's  assistants,  but  are  not                                                               
subject to  any supervision  from a  doctor; they  are completely                                                               
DR. LUPER concluded:                                                                                                            
     I  think   I  did  make   my  third  point,   which  is                                                                    
     cooperation; I think I spoke  to that in answering your                                                                    
     questions.  ...  Just to  summarize,  ...  I think  the                                                                    
     education  is very  good  for naturopathic  physicians,                                                                    
     ... that  we are well  educated.   We do go  to school.                                                                    
     In fact,  a point I  forgot to mention  is pharmacology                                                                    
     specifically.   The  level of  [classroom] pharmacology                                                                    
     that  we get  is comparable  to that  of M.D.s  ... and                                                                    
     D.O.s.   ...   The   safety  record   of   naturopathic                                                                    
     physicians   with  prescription   rights,  and   that's                                                                    
     unsupervised  prescription  rights,  ...  is  safe,  is                                                                    
     good.   And finally, ...  this bill creates  a vehicle,                                                                    
     or  a   discipline  if   you  will,   for  naturopathic                                                                    
     physicians and  allopathic physicians or M.D.s  to work                                                                    
     together for the betterment of Alaskans.                                                                                   
CHAIR McGUIRE  directed attention to  page 2, lines  10-11, which                                                               
says in part, "is a  graduate of an approved naturopathic medical                                                               
college or program".   She asked what "approved"  in this context                                                               
DR. LUPER replied:                                                                                                              
     That  is spelled  out later  on in  the bill.  ... What                                                                    
     that approval  is, [is  it] comes  from the  Council on                                                                    
     Naturopathic  Medical   Education  [CNME];   that's  an                                                                    
     accrediting body  that's ...  empowered by  the federal                                                                    
     government,  and every  naturopathic  college in  North                                                                    
     America has  accreditation, or  at least  candidacy for                                                                    
     accreditation,  from  the  CNME.    Now,  most  of  the                                                                    
     colleges   also    have   accreditation    from   local                                                                    
     accrediting   bodies.       For    example,   Northwest                                                                    
     Accrediting  Agency  accredits its  Northwest  schools,                                                                    
     "central" for Arizona schools, and  so on and so forth.                                                                    
     That's  the list  of  schools;  it's basically  schools                                                                    
     recognized by the federal government.                                                                                      
Number 2291                                                                                                                     
CHAIR  McGUIRE, mentioning  a  recent  scandal involving  masters                                                               
degrees in  teaching that were  available on the  Internet, asked                                                               
whether the CNME  regularly polices the entrance  and approval of                                                               
DR. LUPER replied:                                                                                                              
     I can  speak to that  from personal experience.   I was                                                                    
     chairman  of diagnostics  at the  Southwest College  of                                                                    
     Naturopathic Medicine,  and ... one  of my jobs  was to                                                                    
     have us  go through the  self-study for the CNME.   And                                                                    
     it was  very rigorous, extremely  rigorous.  We  had to                                                                    
     look  at  every aspect  of  operations,  and it  was  a                                                                    
     years-long  process to  get accreditation.   We  worked                                                                    
     very  hard and  we  were very  proud  when we  received                                                                    
     Now,   there   are    naturopathic   colleges,   quote,                                                                    
     "colleges," or schools  that do generate correspondence                                                                    
     degrees; those do  exist in the United States.   But in                                                                    
     states that license  naturopathic physicians, you can't                                                                    
     practice as a naturopathic  physician or a naturopathic                                                                    
     doctor with  one of those  degrees because  they're not                                                                    
     accredited  by  the  CNME.     In  fact,  there's  some                                                                    
     misconception  about this,  that  the  passage of  this                                                                    
     bill will allow  uneducated pseudo-naturopaths to [have                                                                    
     prescription  rights,  but  that's  not  true.]    [The                                                                    
     previously bracketed  portion was not on  tape, but was                                                                    
         taken from the Gavel to Gavel recording on the                                                                         
TAPE 04-82, SIDE B                                                                                                            
Number 2346                                                                                                                     
DR. LUPER continued:                                                                                                            
     And in  fact, it's  no more true  than someone  who got                                                                    
     their  M.D.  degree from  the  Internet  being able  to                                                                    
     practice  allopathic  medicine  in this  state.    That                                                                    
     can't happen; that's against the  law, and likewise for                                                                    
     the naturopathic physician.                                                                                                
CHAIR McGUIRE asked Dr. Luper whether  he would be amenable to an                                                               
amendment  that  specifies  that  in  order  to  be  licensed,  a                                                               
naturopath  must graduate  from  a  naturopathic medical  college                                                               
certified by the CNME.                                                                                                          
DR. LUPER  said he  would not  object to such  an amendment.   He                                                               
mentioned, however, that the name  "naturopath" isn't a protected                                                               
name,  so anybody  with any  kind of  education can  say, "I'm  a                                                               
naturopath,"  and hang  up a  shingle.   So one  of the  possible                                                               
benefits of [CSSB 306(FIN) am] is  that it will protect that name                                                               
because it says  that one must have gone through  a certain level                                                               
of education in order to call  oneself a naturopath.  In response                                                               
to  further   questions,  he   offered  his   understanding  that                                                               
currently,  there are  five naturopathic  schools that  have CNME                                                               
accreditation   and   one  that   has   a   candidacy  for   CNME                                                               
accreditation.  He indicated that the  intent of the bill is that                                                               
only   graduates  of   CNME   accredited   schools  should   have                                                               
prescription rights as proposed in the bill.                                                                                    
DR.  LUPER   opined  that  naturopathic  schools   that  are  not                                                               
accredited  do not  offer the  same level  of education  as those                                                               
that are  accredited.  He  noted, for example, that  the "Clayton                                                               
School  of  Natural  Healing"   has  a  nine-month-long  program,                                                               
completion of  which results in  a certificate being  issued that                                                               
says a person  is a naturopath.  "Those are  the folks that would                                                               
not be  licensable here  in Alaska,"  he added.   In  response to                                                               
further  questions,  he  reiterated his  comments  regarding  the                                                               
amount  of  education required  to  graduate  from an  accredited                                                               
naturopathic  school,  specifically that  a  person  must have  a                                                               
four-year  degree  with good  grades  before  being permitted  to                                                               
enroll in an accredited naturopathic degree program.                                                                            
Number 2199                                                                                                                     
KAYCIE ROSEN, N.D., said she fully supports Dr. Luper's                                                                         
comments.  She went on to say:                                                                                                  
     The main  point that I want  to make today is  that our                                                                    
     intention   with   this   bill  and   as   naturopathic                                                                    
     physicians  is  to  [be] absolutely  committed  to  the                                                                    
     safest,  most   comprehensive  primary  care   for  our                                                                    
     patients.   And so  by creating  this bill,  what we're                                                                    
     really hoping  for is just  to increase our  ability to                                                                    
     be as safe  and as effective as possible,  to make sure                                                                    
     that  our patients,  when  they come  in,  are able  to                                                                    
     receive exactly what they need  at that time within the                                                                    
     context  of  ambulatory outpatient  care.    And so  by                                                                    
     doing this,  our patients  aren't necessarily  going to                                                                    
     receive different  care in the  sense of whether  it is                                                                    
     appropriate  at the  time  to receive  some  sort of  a                                                                    
     prescription  medication; it's  a  question of  whether                                                                    
     they will  be able  to do it  within ...  adequate cost                                                                    
     and within an adequate time period.                                                                                        
[Chair McGuire turned the gavel over to Representative Samuels.]                                                                
     And so  [if] my  patients ... come  in [and]  need, for                                                                    
     [example],  an  antimicrobial,   an  antibiotic,  blood                                                                    
     pressure  regulating  medication,   ...  blood  glucose                                                                    
     regulating medication, ... or  hormones - which are the                                                                    
     things  that we  would  most likely  [be] dealing  with                                                                    
     here in  terms of  what we'd like  to be  prescribing -                                                                    
     we're saving  our patients the money  [they'd spend] to                                                                    
     go see  another provider and  also the time:   ... [it]                                                                    
     is very,  very challenging  to get  patients in  to see                                                                    
     ... other  family practitioners,  ... endocrinologists,                                                                    
     et  cetera.   And so  I just  want to  really underline                                                                    
     that my  commitment and our commitment  as a profession                                                                    
     is to  safe, quality, comprehensive care,  and that ...                                                                    
     having  this  collaboration  as  part  of  the  medical                                                                    
     community is absolutely our intention.                                                                                     
REPRESENTATIVE  OGG  -  noting  that   over  the  course  of  the                                                               
legislative  session,   the  committee   has  heard   much  about                                                               
malpractice insurance  costs and the alleged  diminishing numbers                                                               
of doctors that  can provide care in Alaska -  asked how the bill                                                               
will help that situation and whether  it will help lower the cost                                                               
of medicine in Alaska.                                                                                                          
Number 2064                                                                                                                     
DR. ROSEN  relayed her  belief that  it would  do the  later, and                                                               
offered  an  example wherein  a  patient,  after consulting  many                                                               
providers,  came  to  her  and she,  through  a  basic  "workup,"                                                               
determined that  the patient had very  high blood sugar -  in the                                                               
high-200s -  which is  a potentially dangerous  high number.   As                                                               
naturopathic doctors, she remarked, they  are familiar with a lot                                                               
of therapies that are really good  at helping to bring down blood                                                               
sugar  levels.     The  patient,  however,  was  at   a  place  -                                                               
physically,  financially, and  emotionally  - where  it was  very                                                               
difficult for  him to be regulating  his diet and to  be taking a                                                               
lot of different types of supplements.   When he called to get an                                                               
appointment with  an endocrinologist, the patient  found he would                                                               
have to wait six weeks.                                                                                                         
DR.  ROSEN  indicated  that  had   she  been  able  to  prescribe                                                               
glucophage to regulate his blood  sugar while she and her patient                                                               
worked  out other  aspects of  a  treatment plan,  it would  have                                                               
saved the  patient a lot  of money because  he was left  with the                                                               
choice  of  going  to  either  a walk-in  family  clinic  or  the                                                               
emergency room in  order to get that medication.   This situation                                                               
was not efficient,  either for the patient or for  the people who                                                               
saw him; the patient spent a lot  of time and money out of pocket                                                               
that  he  wouldn't  have  had  to spend  had  she  been  able  to                                                               
prescribe the medication.   This sort of thing  happens all time,                                                               
she   remarked.     As  another   example,  if   a  patient   has                                                               
hypothyroidism,  under the  bill a  naturopath would  be able  to                                                               
give  the  person  thyroid supplementation  without  sending  the                                                               
patient  on to  someone  else and  thereby  engendering an  extra                                                               
doctor  bill and  an  extra  wait while  being  in a  potentially                                                               
dangerous situation.                                                                                                            
DR. ROSEN,  in response to  questions, relayed that she  has been                                                               
in practice  for less than a  year, and that on  average, she has                                                               
to refer people out for  prescription medication one to two times                                                               
per week - usually for some type of antibiotic.                                                                                 
[Representative Samuels returned the gavel to Chair McGuire.]                                                                   
REPRESENTATIVE  WILSON asked  for a  description of  the surgical                                                               
training naturopathic physicians receive.                                                                                       
Number 1918                                                                                                                     
DR. LUPER replied:                                                                                                              
     We have two courses in  minor surgery, ... and in those                                                                    
     courses  we learn  the various  techniques involved  in                                                                    
     minor surgery.   We learn  sterile technique,  we learn                                                                    
     to  do  anesthesia  appropriately -  with  epinephrine,                                                                    
     without epinephrine -  so on and so  forth, those kinds                                                                    
     of things.   And then at the end of  those two courses,                                                                    
     we  go  into the  clinic  with  a list  of  check-offs,                                                                    
     things  that  we  need  to:    we  need  to  sew  up  a                                                                    
     laceration,  we  need to  remove  a  mole, we  need  to                                                                    
     remove  a  sebaceous cyst,  ...  we  need to  lance  an                                                                    
     infection -  a boil,  ... abscess,  and those  kinds of                                                                    
     There's check-offs - and several  of them - and what we                                                                    
     do is  we look hard  for those  things as they  come in                                                                    
     the door,  and enthusiastically jump on  the people who                                                                    
     have those  and practice with  them; of course,  it's a                                                                    
     teaching clinic.  ... We  practice those  things; then,                                                                    
     at the end of that process,  we take a test. ... One of                                                                    
     the  tests  in the  national  board  exam is  on  minor                                                                    
     surgery.   And if  you can pass  the courses  [and] you                                                                    
     can do  the procedure successfully -  under supervision                                                                    
     - and  then finally pass  the ... national  board exam,                                                                    
     then you  get the right  to do minor surgery  in states                                                                    
     that allow you to do minor surgery.                                                                                        
REPRESENTATIVE WILSON asked how many procedures must be done, at                                                                
a minimum, for each item on the check-off list.                                                                                 
DR. LUPER replied:                                                                                                              
     I  can't answer  ... for  all the  schools, I  only can                                                                    
     answer it for the one school  that I went through.  And                                                                    
     I  do  want to  say,  too,  that  not all  the  schools                                                                    
     actually practice minor surgery;  some of those schools                                                                    
     are located  in states that don't  allow minor surgery.                                                                    
     So  [with  regard to]  those  states  that don't  allow                                                                    
     minor  surgery, ...  the  students  that graduate  from                                                                    
     [the  schools in]  those states  would not  be able  to                                                                    
     perform minor  surgery here  in Alaska  without getting                                                                    
     additional  training.   Now, that's  the kind  of stuff                                                                    
     that  goes into  regulations and  not into  [statutory]                                                                    
     law, and that'll be addressed in those regulations.                                                                        
Number 1832                                                                                                                     
     [In  speaking]  for myself,  though,  what  I ended  up                                                                    
     having to  do [was] three sebaceous  cysts, one lipoma,                                                                    
     any number of  lacerations - I couldn't  count how many                                                                    
     lacerations, ten, maybe  - and then ten  moles as well.                                                                    
     Boy, I was scrambling for  those moles; I traded moles,                                                                    
     I've lost  moles, myself, trading  back and  forth with                                                                    
     people - ... we had to  work hard to get that number of                                                                    
     them.    But  at  the  end of  that  I  certainly  felt                                                                    
     competent in  doing minor surgery.   In fact,  it turns                                                                    
     out that I had some skill at  it - I was pretty good at                                                                    
     it -  and went on  to write questions for  the national                                                                    
     board exam. ...                                                                                                            
CHAIR McGUIRE said  she wants to see  naturopathic physicians and                                                               
allopathic physicians  working together,  and noted that  this is                                                               
already happening to some degree,  both in Alaska and nationally.                                                               
A concern,  however, is how  the surgical provisions of  the bill                                                               
will  interplay  with  various  licensing  requirements  as  they                                                               
pertain to allopathic physicians.                                                                                               
DR.  LUPER   indicated  that  that   aspect  has  not   yet  been                                                               
researched.  He added:                                                                                                          
     I'm not  overambitious with minor surgery;  ... if it's                                                                    
     simple and  straightforward, I'm going to  do it, [but]                                                                    
     if it is at all complicated  - and I can speak, really,                                                                    
     for my whole  profession - we're going to  refer to the                                                                    
     people who  do it best,  as we  do now. ...  Stuff that                                                                    
     we're not qualified [to do],  or not experienced enough                                                                    
     to be  able to  treat, ... we're  very quick  to refer.                                                                    
     That's  ... one  of  the major  tenets of  naturopathic                                                                    
     medicine, is  ... to first  do no harm; ...  that's the                                                                    
     last  thing I  want  to  do, is  send  somebody with  a                                                                    
     botched minor  surgery to the  emergency room.   Heaven                                                                    
     forbid!  So  I'll [be] very quick to refer  those.  And                                                                    
     Dr.  Rosen,  we  had  this  discussion  yesterday,  she                                                                    
     agrees - the same thing.                                                                                                   
REPRESENTATIVE WILSON asked about  the training that naturopathic                                                               
physicians receive with regard to internal medicine.                                                                            
Number 1641                                                                                                                     
DR. LUPER  relayed that naturopathic  physicians take  courses in                                                               
anatomy,  physiology,  biochemistry,  histology,  embryology  and                                                               
many other courses.  They learn  a lot of vocabulary and concepts                                                               
about how  the human body  works, and  pathology - how  things go                                                               
wrong.   "Basically,  we learn  the  same things  that M.D.s  and                                                               
D.O.s learn at  the same degree of intensity ...  for those first                                                               
two  years," he  added.   He  emphasized that  students learn  to                                                               
recognize   illness  in   a  class   called  "clinical   physical                                                               
diagnosis," which  enables a naturopathic physician  to interview                                                               
a patient,  get past  medical history  - family  history, habits,                                                               
review of systems  - do a physical exam, and  run appropriate lab                                                               
tests to come up with a  diagnosis.  He remarked that this aspect                                                               
[of training] is quite strong in naturopathic medicine.                                                                         
DR. LUPER explained that after  learning these various aspects of                                                               
medicine, naturopathic  physicians must  pass a  "clinic entrance                                                               
exam"  in  order to  be  able  to  work  in a  clinical  setting;                                                               
naturopathic  physicians can't  get into  the clinic  unless they                                                               
can  show that  they have  a basic  level of  skill at  doing the                                                               
interview, doing  the physical exam, identifying  the appropriate                                                               
lab tests, and then coming up with the correct diagnosis.                                                                       
CHAIR  McGUIRE surmised,  then,  that this  applies  to all  CNME                                                               
accredited schools.                                                                                                             
REPRESENTATIVE  WILSON asked  whether the  four years  at a  CNME                                                               
accredited  college  would  qualify  a  person  for  [allopathic]                                                               
medical school.                                                                                                                 
DR. LUPER replied:                                                                                                              
     No,  it would  not  because the  medical schools  don't                                                                    
     recognize the  education.  Likewise, we  wanted to take                                                                    
     the  national  medical  boards  and  we  were  told  we                                                                    
     couldn't.   That's  why we  came up  with the  national                                                                    
     naturopathic  medical boards,  is because  we were  not                                                                    
     allowed to  take the national  medical boards.   I wish                                                                    
     we could.  I think it would answer a lot of questions.                                                                     
Number 1477                                                                                                                     
DR. LUPER, in  response to another question,  reiterated that the                                                               
course  work  naturopathic physicians  take  doesn't  count.   He                                                               
     The education  is just  thrown out  wholesale.   If you                                                                    
     want  to become  an M.D.,  you have  to start  from the                                                                    
     beginning.    There's  no  reciprocity  at  all  to  my                                                                    
     knowledge.  ... The  real  difference  between the  ...                                                                    
     three  professions [N.D.,  M.D.,  D.O.] ...  is in  the                                                                    
     second two years.  In  the second two years, what we're                                                                    
     taught are  natural methods of treating  illness; we're                                                                    
     taught  how to  use  herbs,  nutrients, diet,  physical                                                                    
     therapy.     We're  also  taught   how  to   use  drugs                                                                    
     appropriately  in  certain  situations, but  given  the                                                                    
     choice  between  using  a  drug  and  using  a  natural                                                                    
     substance and having the  natural substance work, we'll                                                                    
     go for ... [the natural substance] first.                                                                                  
     It's  in  our  nature  in terms  of  our  hierarchy  of                                                                    
     therapeutics to use something  that will restore normal                                                                    
     function in somebody  as best we can.   And there [are]                                                                    
     differences;  ...  clearly   there's  a  difference  in                                                                    
     philosophy, there's a difference  in approach.  There's                                                                    
     certain  ways  of  thinking about  illness  that  we're                                                                    
     imbibed with as a  culture that's different from M.D.s,                                                                    
     and it  should be that  way - there's some  people that                                                                    
     resonate more  with natural  medicine and  there's some                                                                    
     people that  resonate more or  get better  results with                                                                    
     allopathic  medicine.    And  part of  our  job  is  to                                                                    
     recognize  [that] and  to refer  our patients  to where                                                                    
     they're going to get their [best] care.                                                                                    
DR. LUPER, in response to a  comment, remarked that there is much                                                               
more  in   common  between  N.D.s   and  M.D.s  than   there  are                                                               
CHAIR McGUIRE  relayed that she thinks  naturopathic medicine has                                                               
a big role  to play, and that she has  two childhood friends that                                                               
are N.D.s.   She  said that according  to her  understanding, the                                                               
mission of a  naturopathic physician is to try  to treat patients                                                               
holistically,  to  try  to look  at  alternatives  to  chemicals,                                                               
drugs, and  invasive methods of  treatment.  Many times  when one                                                               
goes  to  an  allopathic  physician, she  ventured,  dietary  and                                                               
nutritional  aspects  are  overlooked.   One  of  the  issues  to                                                               
contemplate is  where do  the two  different philosophies/methods                                                               
appropriately  cross   and  where  do  they   appropriately  stay                                                               
separate.   She said she is  trying to understand why  they would                                                               
want to  move towards  granting prescriptive  chemical authority,                                                               
minor  surgery, and  other types  of things  that are  associated                                                               
with  allopathic  medicine,  to  naturopathic  physicians.    Why                                                               
shouldn't  the   focus  of  naturopathic  physicians   remain  on                                                               
naturopathic methods?  Where is this push coming from?                                                                          
Number 1270                                                                                                                     
DR.  LUPER  said the  push  is  coming  from  his patients.    So                                                               
although  naturopathic  physicians  are  trained  to  look  at  a                                                               
patient  from   a  naturopathic  perspective,  from   a  holistic                                                               
perspective, sometimes  the patient  just needs antibiotics.   He                                                               
offered an example of a patient  with a kidney infection who came                                                               
to  him  while he  was  practicing  in  Arizona; in  addition  to                                                               
discussing holistic ways of keeping  one's kidneys healthy he was                                                               
able to  write prescription for  that condition, and  the patient                                                               
improved.   But  practicing in  Alaska, if  faced with  a similar                                                               
case, he  would have to  refer the  patient elsewhere.   The same                                                               
would occur if  he saw a patient who needed  thyroid medication -                                                               
while practicing in  Alaska, he would have to  refer that patient                                                               
elsewhere.   Although the number  of cases  may not be  great, he                                                               
relayed, there  are just enough that  he feels he's got  one hand                                                               
tied behind his back; "I took  the classes, I passed the national                                                               
board exam, and I still can't ... [treat the patient].                                                                          
CHAIR  McGUIRE, mentioning  a concern  that someone  might suffer                                                               
serious  consequences  as a  result  of  an  N.D. not  getting  a                                                               
diagnosis right and prescribing  the wrong medication, asked what                                                               
the  harm is  in having  to refer  a patient  to someone  else if                                                               
holistic measures are not sufficient.                                                                                           
DR. ROSEN  explained that a naturopathic  physician's training is                                                               
to  provide  ambulatory family  care;  therefore,  N.D.s will  be                                                               
using the  same diagnostic  skills in  determining whether  it is                                                               
appropriate to  refer a patient  elsewhere that any  other family                                                               
doctor -  whether an  M.D. or  a D.O.  - would  use.   The bottom                                                               
line, she  said, is that  if a  procedure is not  appropriate for                                                               
outpatient care, naturopathic physicians  won't be performing it.                                                               
In response  to further questions,  Dr. Rosen echoed  Dr. Luper's                                                               
comments regarding  surgical training and what  might be required                                                               
[via  statute  and regulations]  to  ensure  that a  naturopathic                                                               
physician  has  the  appropriate  training,  and  mentioned  that                                                               
students graduating from CNME accredited  schools are required to                                                               
have   had  2,000-plus   hours  of   clinical  experience   under                                                               
supervising  physicians, as  well as  other experience  in either                                                               
hospitals or similar clinical situations.                                                                                       
Number 0875                                                                                                                     
DR. LUPER added:                                                                                                                
     What's  happening across  the country  is [that]  M.D.s                                                                    
     and N.D.s are working together  more and more, that the                                                                    
     profession   is  maturing,   and  that   we're  getting                                                                    
     friends, frankly,  colleagues that we're  working with.                                                                    
     And in  Arizona, the students  now do  [an observatory]                                                                    
     rotation  through  Banner  Health emergency  rooms,  so                                                                    
     that they get to see ...  a wider variety of health ...                                                                    
     conditions.  And  as time goes on, it's my  hope and my                                                                    
     ... [belief]  that it's  going to  happen more  - we're                                                                    
     simply going to  see more of this  cooperation, more of                                                                    
     this working together.                                                                                                     
REPRESENTATIVE GRUENBERG, noting  that he is a  fan of continuing                                                               
education, asked  why the continuing  education provision  of the                                                               
bill doesn't take effect until January 1, 2007.                                                                                 
DR.  LUPER   said  it  might  be   because  continuing  education                                                               
requirements are going to be  "reported for two-year blocks."  In                                                               
response to another question, he  indicated that he would support                                                               
changing  the effective  date  of that  provision  to January  1,                                                               
2006.     He  noted  that   currently,  there  is   no  statutory                                                               
requirement,  at all,  for continuing  education of  naturopathic                                                               
Number 0700                                                                                                                     
ALEX MALTER,  M.D., President,  Alaska State  Medical Association                                                               
(ASMA), remarked  that according to allopathic  teachings, kidney                                                               
infections,  as was  offered  as  an example  by  Dr. Luper,  are                                                               
classified as complicated,  and it is during  the five-plus years                                                               
of  clinical  education  that M.D.s  experience  as  interns  and                                                               
residents  that  they  learn that  kidney  infections  are  never                                                               
considered  simple.    He  then   paraphrased  from  his  written                                                               
testimony, which read in part [original punctuation provided]:                                                                  
     The Alaska State  Medical Association (ASMA) represents                                                                    
     physicians statewide  and is primarily works  to ensure                                                                    
     that Alaskans  receive high  quality healthcare.   ASMA                                                                    
     urges  the  committee  to  not support  SB  306.    The                                                                  
     legislation would  not enhance  patient care  nor would                                                                    
     it improve access to care.                                                                                                 
     Training  for naturopaths  is less  rigorous than  that                                                                    
     for  medical  doctors,  in both  length  and  depth  of                                                                    
     study.  Its emphasis on  natural healing does not allow                                                                    
     students sufficient  time to  fully learn the  in depth                                                                    
     pathology, physiology and  pharmacology needed to treat                                                                    
     most  medical  conditions.   A  list  complied  by  the                                                                    
     American  Association  of  Naturopaths  (Attachment  1)                                                                    
     shows  the different  treatment  modalities studied  by                                                                    
     naturopaths.  Such a broad  curriculum cannot allow the                                                                    
     time   needed  to   master  the   appropriate  use   of                                                                    
     prescription drugs.                                                                                                        
     We  are  not convinced  that  the  first two  years  of                                                                    
     naturopath and medical  schools are the same.   But for                                                                    
     any  courses that  actually did  cover material  in the                                                                    
     same detail,  medical students might still  be expected                                                                    
     to master  the content  better than naturopaths.   This                                                                    
     is  because  students  are  only  admitted  to  medical                                                                    
     school   if    they've   excelled   in    sciences   as                                                                    
     undergraduates  and   then  passed   rigorous  entrance                                                                    
     By comparison,  we are not  aware of  similar admission                                                                    
     tests  for  naturopath  schools  and  some  don't  even                                                                    
     require a  college degree for  enrollment.   (While the                                                                    
     naturopath  doctors have  argued  this  isn't true  for                                                                    
     programs  accredited  for  the Alaskan  licensure,  the                                                                    
     HHES  committee  heard  testimony  two days  ago  of  a                                                                    
     Bastyr student without a  prior college degree enrolled                                                                    
     in a ND program.)                                                                                                          
REPRESENTATIVE GARA interjected  to point out that  one either is                                                               
or isn't  required to  complete four  years of  college education                                                               
before entering  a naturopathic program at  an accredited school,                                                               
and so simply  hearing testimony that someone  heard from someone                                                               
else  that  someone  got  into   a  naturopathic  program  at  an                                                               
accredited school without first  completing four years of college                                                               
education isn't helpful.                                                                                                        
Number 0387                                                                                                                     
DON  LEHMAN, M.D.,  acknowledged  that  he was  the  one who  had                                                               
provided  the   House  Health,  Education  and   Social  Services                                                               
Standing Committee  with the  aforementioned testimony,  and that                                                               
it pertained to  his nephew who, he relayed, was  accepted in the                                                               
naturopathic   program  as   a  first-year   student  at   Bastyr                                                               
University even though he didn't have a four year degree.                                                                       
REPRESENTATIVE GRUENBERG suggested that  they do some research to                                                               
find out whether  Bastyr University offers a  special program for                                                               
exceptional  students, one  that  might allow  a  few persons  to                                                               
start in the naturopathic program  while still shy of a four-year                                                               
degree.   He also suggested that  they could amend the  bill such                                                               
that  it would  require a  four-year  degree in  addition to  the                                                               
educational requirements already listed in the bill.                                                                            
Number 0189                                                                                                                     
DAVID M.  HEAD, M.D., Chair,  Alaska State Medical  Board (ASMB),                                                               
predicted  that if  Alaska becomes  one  of the  few states  that                                                               
grants  prescriptive  rights to  naturopaths,  it  will open  the                                                               
floodgates  for  an  onslaught  of  naturopathic  physicians  and                                                               
providers all over  the country that will be looking  for a place                                                               
to widen their scope of work  far beyond their level of training.                                                               
He went on to say:                                                                                                              
     I have  absolutely nothing against naturopaths;  I have                                                                    
     consulted them  myself regarding  nutritional subjects,                                                                    
     regarding my own health, and  I think, when it comes to                                                                    
     their  own   scope  of   work,  that   naturopaths  can                                                                    
     definitely add  something to the healthcare  and to the                                                                    
     management of patients.   And it's also  not [an] issue                                                                    
     of a  turf battle.   As a  provider in Nome,  Alaska, I                                                                    
     would  welcome the  help  from  any qualified  provider                                                                    
     that I could  get.  But, in my opinion  and the opinion                                                                    
     of  the [ASMB],  naturopaths are  not qualified  ... to                                                                    
     provide  the type  of  primary care  when  it comes  to                                                                    
     prescribing  medication and  doing  the  type of  minor                                                                    
     surgery that is described here.                                                                                            
     Neither  their  training   nor  their  philosophy,  the                                                                    
     philosophy  of their  training, meets  the standard  of                                                                    
     care that ... the Alaska  public has come to expect and                                                                    
     ...  deserve.   I'd like  to  have the  members of  the                                                                    
     committee  ...  ask  themselves if  they  want  someone                                                                    
     who's just  received [pharmacological] training  from a                                                                    
     book  or  from a  [CNME]  course  changing their  heart                                                                    
     medications  or  their   hypertensive  medications,  or                                                                    
     suturing up their  son's face [the] next  time he comes                                                                    
     to the  [emergency room after having  some misfortunate                                                                    
     accident.]   [The previously bracketed portion  was not                                                                    
     on  tape,  but  was  taken  from  the  Gavel  to  Gavel                                                                    
     recording on the Internet.]                                                                                                
TAPE 04-83, SIDE A                                                                                                            
Number 0001                                                                                                                     
DR. HEAD,  referring to Dr. Luper's  example of a patient  with a                                                               
kidney  infection,   offered  his  opinion  that   there  are  no                                                               
uncomplicated cases from the viewpoint  of the patient; "very few                                                               
patients don't consider  it an emergency when it  is taking place                                                               
on their body."   He went on to say, "There  are many things that                                                               
a,  quote, 'uncomplicated  kidney infection'  could actually  be,                                                               
and its  medicine, unfortunately,  is not  black and  white, it's                                                               
not well  tested on  national board exams,  and that's  where the                                                               
fear comes  that this may  be an area  that the public  of Alaska                                                               
should not be  exposed to."  He relayed that  the ASMB feels that                                                               
it would  be irresponsible and  unconscionable to pass  the bill,                                                               
that doing  so would create  a serious  threat to the  health and                                                               
wellbeing of  Alaskans; the  ASMB strongly  recommends a  vote of                                                               
REPRESENTATIVE  OGG   asked  whether   the  ASMB  has   passed  a                                                               
resolution outlining its opinion of the bill.                                                                                   
DR. HEAD said  the ASMB did not pass a  resolution, though it did                                                               
send a letter to the governor relaying its opinion of the bill.                                                                 
REPRESENTATIVE  GRUENBERG, referring  to Dr.  Head's hypothetical                                                               
example of a  child coming in with a laceration  on his/her face,                                                               
offered his  belief that  the bill  specifies that  minor surgery                                                               
can  include  treating  superficial   lacerations  but  does  not                                                               
include performing  specialized surgery such as  plastic surgery.                                                               
He asked how one would tell  whether a laceration fell within the                                                               
realm of needing plastic surgery.                                                                                               
DR. HEAD  said that such  a determination  would be hard  to make                                                               
and would be  dependant upon the eye of the  beholder and his/her                                                               
experience with similar  lacerations.  So much of what  is in the                                                               
bill is  open to  interpretation, he remarked,  that he  feels it                                                               
would be premature to pass it.   He suggested that the bill needs                                                               
to have more work done on it.                                                                                                   
Number 0321                                                                                                                     
CHAIR McGUIRE noted that members'  packets now include the ASMB's                                                               
letter to the governor.  Addressing Dr. Head, she said:                                                                         
     What  do you  feel  is the  appropriate  way, over  the                                                                    
     interim, ...  to have these  discussions?  Do  you feel                                                                    
     like there  should be a task  force?  Do you  feel like                                                                    
     you ought to select some  folks from the [ASMB] and the                                                                    
     naturopaths  ought  to  select some  folks  from  their                                                                    
     board to  begin these  dialogs?   Because I  think what                                                                    
     you have seen this session  is a wakeup call that there                                                                    
     [are]  folks  across  the  state  of  Alaska  that  see                                                                    
     naturopathic  physicians,  that  have a  concern  about                                                                    
     this bill passing.                                                                                                         
     And  we are  just mere  policy makers  [and] there  are                                                                    
     arguments on  both sides.   But one thing that  I think                                                                    
     has become  clear is  that there does  need to  be some                                                                    
     communication  between the  M.D.s  and  the N.D.s  with                                                                    
     respect  to these  protocols,  ...  the differences  in                                                                    
     defining serious  or ... superficial  laceration versus                                                                    
     a   no-superficial   [laceration],  how   could   these                                                                    
     collaborative agreements be worked out,  and so on.  Do                                                                    
     you have any recommendation or  ideas that you would be                                                                    
     willing to make?                                                                                                           
DR. HEAD replied:                                                                                                               
     The   [ASMB]   is   always  open   to   any   type   of                                                                    
     communication.   We've  had a  similar  issue going  on                                                                    
     with  the  Board  of Pharmacy  recently,  and  we  have                                                                    
     actually met with the Board  of Pharmacy, we've invited                                                                    
     them  to   our  meetings,   and  ...  we've   sent  [a]                                                                    
     representative  to their  meetings.   And, like  I said                                                                    
     during  my statement,  I  definitely think  naturopaths                                                                    
     have a  place in  the medical care  of the  patients of                                                                    
     Alaska, and  I would  be more than  happy to  meet with                                                                    
     them or  to have members  of the [ASMB] meet  with them                                                                    
     and work the  details out, work something  out that was                                                                    
     agreeable to  us and  to them  if at  all possible.   I                                                                    
     think  [the] more  communication  that goes  on in  the                                                                    
     health  field,  the  better  off   we  are,  because  I                                                                    
     definitely   think  that   there   is   a  place   [for                                                                    
     naturopathic medicine].   I just don't  think that this                                                                    
     bill necessarily addresses it.                                                                                             
Number 0457                                                                                                                     
CHAIR  McGUIRE said  she wants  Dr.  Head's ideas  about the  two                                                               
groups working together  in writing as soon  as possible, perhaps                                                               
by tomorrow,  including his thoughts  about whether  there should                                                               
be  a  governmental  vehicle  to   highlight  the  issues.    She                                                               
mentioned that she  would be asking the same  of the naturopathic                                                               
physicians who've  come to today's  meeting.  She  indicated that                                                               
what she would like  to see in writing are:   "what would be your                                                               
expectations, what  would be  the things that  you would  hope to                                                               
get out  of such a working  relationship, and whether or  not you                                                               
believe it takes  us to force that issue."   It's really easy for                                                               
both sides  to say, "Well, our  doors are open," but  then no one                                                               
makes  an effort  to knock  on the  door and  so nothing  is ever                                                               
accomplished, she remarked.                                                                                                     
DR.  HEAD  said  he  could  not   commit  the  ASMB  to  such  an                                                               
enterprise,  though   he  knows  the   ASMB  would  be   open  to                                                               
communication.     He  added  that  although   he  could  provide                                                               
suggestions in  writing, it  wouldn't be  by tomorrow  because he                                                               
would have to consult with the rest of the ASMB first.                                                                          
REPRESENTATIVE GRUENBERG,  acknowledging that there  are probably                                                               
those who  feel that  the bill  could still  use some  more work,                                                               
suggested  that  with  only  two  days left  before  the  end  of                                                               
session,  that  it  might  be  better to  work  on  a  compromise                                                               
solution  over  the interim  in  order  to allow  for  thoughtful                                                               
legislative  drafting.     For   example,  perhaps   including  a                                                               
provision in  the bill to form  an interim committee, made  up of                                                               
representatives from  the interested  professions, that  with the                                                               
assistance  and  guidance  of the  legislature,  would  take  the                                                               
language in  the bill  as a  starting point and  fine tune  it so                                                               
that all  interested parties  are satisfied,  and report  back to                                                               
the  legislature  early  in  the  upcoming  legislative  session,                                                               
perhaps by  February 1, 2005.   Such an endeavor might  result in                                                               
the interested  parties arriving at a  consensus.  He went  on to                                                               
     You people are used  to solving problems, problems that                                                                    
     save people's  lives; surely  you ought  to be  able to                                                                    
     solve this  problem with some  help from  your friends.                                                                    
     And we in the legislature  are used to solving problems                                                                    
     too.  And with a little  bit of time, what do you folks                                                                    
     think?  Would that be worth doing?                                                                                         
DR. MALTER relayed  that the ASMA made a  similar suggestion when                                                               
     testifying in the House Health, Education and Social                                                                       
     Services Standing Committee.  He said he committed the ASMA                                                                
     to work on this [legislation] over the interim.                                                                            
Number 0775                                                                                                                     
CHAIR McGUIRE  characterized the current  version of the  bill as                                                               
creating a  profound change in state  policy and law.   She noted                                                               
that  although 14  other states  are doing  something similar  to                                                               
what the  bill proposes, the  details all  vary.  She  also noted                                                               
that  the latest  version  of HB  434, Version  W,  failed to  be                                                               
reported  from the  House Health,  Education and  Social Services                                                               
Standing Committee.  On the  issue of [perhaps forming an interim                                                               
working group], she said, "I don't  want this to be promises that                                                               
never come  through and ...  some way  of pushing away  the issue                                                               
and  never coming  back  to it  for the  folks  that oppose  [the                                                               
bill],  because this  is a  serious  issue that's  going to  keep                                                               
coming up ... until we address it."                                                                                             
REPRESENTATIVE WILSON added:                                                                                                    
     I  don't want  the naturopaths  to think  that this  is                                                                    
     just something  that we're brushing  aside and  then we                                                                    
     can let  go [of it],  because ... we do  want something                                                                    
     to happen.  And I put  that charge to the M.D.s because                                                                    
     we do want  to see some honest effort put  forth to try                                                                    
     to  ... make  some progress  here, ...  and we're  very                                                                    
     serious about this.                                                                                                        
REPRESENTATIVE GRUENBERG suggested that an interim working group                                                                
could meet under the auspices of both committees jointly.                                                                       
REPRESENTATIVE GARA offered:                                                                                                    
     I do  have one reservation  about this  whole approach.                                                                    
     ... If we  think that the two professions  are going to                                                                    
     get together and  come up with something  that they can                                                                    
     agree  upon,  we  have  to   recognize  they  take  two                                                                    
     completely  different  approaches  to the  practice  of                                                                    
     medicine. ... Naturopaths  are naturopaths because they                                                                    
     believe in  that kind of  health care; M.D.s  are M.D.s                                                                    
     because  they  believe in  that  kind  of health  care.                                                                    
     There's  a  certain  portion of  their  ethic  that  is                                                                    
     inconsistent, that  causes them to join  the profession                                                                    
     that they  join. ... It  might work out very  well that                                                                    
     they can come up with  a very good piece of legislation                                                                    
     that  they all  agree  upon, but  that  shouldn't be  a                                                                    
     requirement.  Ultimately, ... in  many of the pieces of                                                                    
     legislation  we work  upon, there  are interest  groups                                                                    
     that have  completely different views  on them,  and we                                                                    
     can't  expect  that everybody  can  always  come to  an                                                                    
     agreement that everybody is happy with.                                                                                    
Number 1017                                                                                                                     
     So, ... the  task force idea is good,  but ultimately I                                                                    
     don't  think we  should  assume that  ... both  parties                                                                    
     will  agree to  the best  piece of  policy.   One party                                                                    
     might and one party might  not, so we have to recognize                                                                    
     that.  And I  hope we can come up with  a good piece of                                                                    
     legislation.  If  we think that it's good,  or the task                                                                    
     force thinks it's good, even  if one party doesn't ...,                                                                    
     that's ultimately  our job  when interest  groups can't                                                                    
     agree with each other.                                                                                                     
REPRESENTATIVE GRUENBERG concurred, adding that via a task force                                                                
approach, the legislature can't make people agree - it can only                                                                 
help by providing  a little mediation.  "We're here  to help, and                                                               
if you  are at a total  impasse, ... we'll make  the decision and                                                               
maybe neither one  of you will be happy, but  at least let's take                                                               
it as far as it can go," he added.                                                                                              
CHAIR McGUIRE  mentioned that the  committee must recess  for the                                                               
purpose of allowing  members to attend a caucus  meeting and then                                                               
a  House floor  session.   She  asked the  interested parties  to                                                               
consider  the  committee's  thoughts regarding  an  interim  task                                                               
force  and present  something  in writing,  if  possible, to  the                                                               
committee as  soon as possible.   She said  that as chair  of the                                                               
House  Judiciary Standing  Committee,  she would  support a  bill                                                               
that will  direct a  task force  to form and  work on  the issues                                                               
raised, perhaps  with legislators present; the  membership of the                                                               
task  force could  be  made  up of  members  of the  legislature,                                                               
members  of the  allopathic  medical profession,  members of  the                                                               
naturopathic medical  profession, members of  the pharmacological                                                               
profession,  and members  of  any  group as  yet  unknown to  the                                                               
committee with  an interest in  the legislation.  She  noted that                                                               
members  have  heard  concerns  from  pharmacists  regarding  the                                                               
potential liability  that could result  from passage of  the bill                                                               
in  its  current  form.    She reiterated  that  she  would  like                                                               
suggestions from  the interested parties in  writing, and relayed                                                               
that [the committee] would try  to synthesize something that will                                                               
give all parties some direction over the interim.                                                                               
DR. MALTER surmised,  then, that the bill would  become a vehicle                                                               
creating  an interim  task force  that would  work on  the issues                                                               
CHAIR  McGUIRE concurred,  and indicated  that aspects  listed in                                                               
both the House  and Senate versions of the bill  would be used as                                                               
a starting point for negotiations.                                                                                              
[SB 306 was held over.]                                                                                                         

Document Name Date/Time Subjects