Legislature(2015 - 2016)BARNES 124

02/13/2015 03:15 PM House LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved HB 26 Out of Committee
Heard & Held
         HB 26-EXTEND CERT. DIRECT-ENTRY MIDWIVES BOARD                                                                     
4:11:44 PM                                                                                                                    
CHAIR OLSON  announced that the final  order of business  would be                                                              
HOUSE BILL NO. 26,  "An Act extending the termination  date of the                                                              
Board of  Certified Direct-Entry  Midwives;  and providing  for an                                                              
effective date."                                                                                                                
4:11:59 PM                                                                                                                    
LAURA  STIDOLPH, Staff,  Representative Kurt  Olson, Alaska  State                                                              
Legislature,  on behalf of  the prime sponsor,  stated that  HB 26                                                              
would extend  the sunset date for  the Board of  Certified Direct-                                                              
Entry Midwives  to June  30, 2017.   The  Division of  Legislative                                                              
Audit  conducts   audits   to  determine   if  state  boards   and                                                              
commissions should  be reestablished.   The division  reviewed the                                                              
activities  of the  Board of  Certified  Direct-Entry Midwives  to                                                              
determine if there  is a demonstrated public need  for the board's                                                              
continued  existence  and whether  it  has  been operating  in  an                                                              
effective  manner.  She  directed  attention  to  a  copy  of  the                                                              
legislative audit  in members' packets.  The  auditors recommended                                                              
that the board be extended two years until June 30, 2017.                                                                       
MS.  STIDOLPH   explained  that   auditors  found  the   Board  of                                                              
Certified  Direct-Entry  Midwives has  been  serving the  public's                                                              
interest   by   effectively   licensing   certified   direct-entry                                                              
midwives (CDM)  and apprentices.   In addition, it was  found that                                                              
the board  continues to  improve the  profession by modifying  and                                                              
adopting  midwifery regulations  to conform  to current  standards                                                              
of care.                                                                                                                        
MS. STIDOLPH highlighted  that the auditors had  four findings and                                                              
recommendations, including  the Department of  Commerce, Community                                                              
&   Economic  Development   (DCCED)   should  immediately   pursue                                                              
disciplinary  sanctions  for CDM  cases when  warranted;  increase                                                              
licensing fees  to eliminate the  board's operating  deficit; that                                                              
the   board  should   communicate   certificate  requirements   to                                                              
continuing  education  providers  to  facilitate  compliance  with                                                              
centralized licensing  regulations; and  the board should  approve                                                              
apprentice  permit applications  in accordance  with statute.   In                                                              
response  to a  question, she  reiterated  the chair  of Board  of                                                              
Certified Direct-Entry Midwives (CDM) is Cheryl Corrick.                                                                        
4:15:15 PM                                                                                                                    
REPRESENTATIVE  JOSEPHSON referred to  page 10  of the audit.   He                                                              
expressed  concern  about the  failure  of the  certified  direct-                                                              
entry midwives  (CDM) respondents  to sign  consent orders  (CAs).                                                              
He  asked  whether   the  committee  should  be   concerned  about                                                              
anything in  terms of the nature  of the reason the  CDMs wouldn't                                                              
sign.    He said  he  was  concerned  about  this given  that  the                                                              
legislature  removed the statute  and gave  the board the  liberty                                                              
to create its own regulations.                                                                                                  
KRIS  CURTIS,  Legislative Auditor,  Legislative  Audit  Division,                                                              
Legislative  Agencies  and  Offices, answered  that  the  division                                                              
doesn't see  any correlation or cause  and effect related  to last                                                              
legislature's  Senate Bill  136, which moved  the requirement  for                                                              
what the profession  could do from statute to  regulations to give                                                              
the board  more flexibility.   At the end  of an investigation  if                                                              
any   problems   are   found   and    sanctions   are   necessary,                                                              
investigators  draft consent  agreements and  ask the  respondents                                                              
to voluntarily  agree to the sanctions.   If that does  not occur,                                                              
the  investigators  can use  standard  procedures  to elevate  the                                                              
matter to the  commissioner, file an accusation,  and move forward                                                              
with civil licensing  action through the Office  of Administrative                                                              
Hearings (OAH).   However, it is  not uncommon for  respondents to                                                              
refuse to sign consent agreements, she said.                                                                                    
4:17:45 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON  suggested that he felt  less secure when                                                              
the process  changed.  He read  page 10, paragraph 2,  as follows,                                                              
"By not  pursing licensing  action, the  respondents were  allowed                                                              
to  continue practicing,  and the  public's safety  was placed  at                                                              
risk."    He  went on  to  say  that  this  referred  to 4  of  52                                                              
providers, but  he wanted to be  sure a pattern  wasn't developing                                                              
that the legislature should be concerned about.                                                                                 
MS.  CURTIS answered  that the  audit period  covered four  years.                                                              
There  were  28  complaints  filed   and  investigated,  with  all                                                              
addressed timely except  for these four cases.   She reported that                                                              
the  four investigations  involved  two people  and  investigators                                                              
concluded the  disciplinary sanctions  should occur, but  were not                                                              
pursued timely.   She explained  that two  of the four  cases were                                                              
forwarded   to  the  Department   of  Law's   Office  of   Special                                                              
Prosecutions  and Appeals  (OSPA)  for criminal  action.   At  the                                                              
time of  the audit  the cases  had been  at OSPA  for over  a year                                                              
without  action.    OSPA  regarded   these  cases  as  the  lowest                                                              
priority  due   to  the   cases  being   classified  as   class  B                                                              
misdemeanors.   She  stated  that due  to  turnover, the  auditors                                                              
were not  able to determine why  the investigators did  not pursue                                                              
a civil  licensing action,  which at a  minimum, should  have been                                                              
pursued concurrently  with  criminal action  to ensure the  public                                                              
safety  is protected.   Auditors  characterized this  as a  fairly                                                              
serious deficiency  which is why  the audit only recommend  a two-                                                              
year extension.   She said it is unusual for the  auditors to give                                                              
such a  short extension,  but auditors felt  it was important  for                                                              
the  division  to  follow  up  on   this  matter  to  ensure  that                                                              
corrective action has been taken.                                                                                               
4:20:17 PM                                                                                                                    
REPRESENTATIVE  COLVER   assumed  these  cases  were   not  simple                                                              
licensing  actions, but  were due  to cases driven  by mothers  or                                                              
families who  experienced problems  with the  midwifes.   He asked                                                              
for  further   clarification  on   the  cases  without   breaching                                                              
anything that is confidential.                                                                                                  
MS. CURTIS  answered  that one or  two of  the consent  agreements                                                              
asked  for  voluntary license  revocation,  which  would  indicate                                                              
severe  problems  were encountered.    She recalled  that  another                                                              
consent  agreement  asked for  continuing  education,  which is  a                                                              
common  outcome for  an investigation.   She  declined to  provide                                                              
any details about the cases.                                                                                                    
4:21:38 PM                                                                                                                    
REPRESENTATIVE   COLVER  related   his  understanding   that  some                                                              
direct-entry  midwives practice  at a birthing  center and  others                                                              
assist  with home  births.   He said  that  he and  his wife  used                                                              
midwives with  the birth of both  of his children, and  the births                                                              
went  very well.   In  their experience,  the  midwives were  very                                                              
professional.   He asked  whether the  mother or child  endangered                                                              
by  the procedures  or care  since, at  some point,  he has  found                                                              
that midwives  are very clear to  determine when the  mother needs                                                              
to go  to a  hospital.   He thought  it would  be helpful for  the                                                              
committee to have a better understanding of what happened.                                                                      
MS.  CURTIS responded  that  the  audit does  not  comment on  the                                                              
profession  as   a  whole,  but  does  comment   on  investigative                                                              
practices,  which  are in  place  to  protect  the public  and  to                                                              
ensure  quality of  care.   She  said  that the  allegations  were                                                              
pretty  serious  and  the  auditors   found  the  lack  of  timely                                                              
disciplinary sanctions  as fairly significant.   In response  to a                                                              
question,  she   reiterated  that  there  were  four   cases  that                                                              
involved two people.                                                                                                            
4:23:30 PM                                                                                                                    
REPRESENTATIVE  KITO referred to  page 10 of  the audit  and read,                                                              
"A year  after the  cases were  forwarded to  OSPA, no  action had                                                              
been taken."   He asked whether it was the  board's responsibility                                                              
or of OSPA.                                                                                                                     
MS.  CURTIS  stated  that  board   members  were  asking  for  and                                                              
receiving  updates  on  the investigations.    Thus,  there  isn't                                                              
anything in  the auditor recommendations  on the board  not taking                                                              
appropriate  action.    She  stated that  the  board  must  recuse                                                              
themselves   since  the   board  must   weigh  in   later  as   an                                                              
adjudicative  entity.    Therefore  the  board  typically  is  not                                                              
furnished  details.   The board  was  advised that  the cases  had                                                              
been  referred  to the  Department  of  Law.   She  described  the                                                              
typical process  is that cases are  referred to the  Department of                                                              
Law for review  of sufficiency of evidence prior  to an accusation                                                              
being filed for  civil licensing action.  However,  the cases were                                                              
at OSPA, in an effort to pursue a criminal case.                                                                                
4:25:05 PM                                                                                                                    
REPRESENTATIVE  TILTON referred  to page 10,  to recommendation  2                                                              
in the audit.   She related her understanding that  this board has                                                              
a small number of  people who pay a large licensing  fee, but face                                                              
a deficit.   She  acknowledged that  she personally used  midwives                                                              
when she  gave birth  to her  children, so  her questions  are not                                                              
about care,  but relate to the  fiscal impact.   Recommendation 2,                                                              
which  read,  "DCBPL,  in  consultation  with  the  board,  should                                                              
increase  licensing  fees  to  eliminate   the  board's  operating                                                              
deficit."  She asked whether there is a plan for that action.                                                                   
MS. CURTIS  answered that the  license fees for  certified direct-                                                              
entry midwives  have been  a continual problem.   In  2006, during                                                              
the sunset  review, the licensing  fees were over $2,000  and they                                                              
paid the highest  fees of any occupation.  Thus this  issue is not                                                              
new to  the occupation.   She directed attention  to the  table on                                                              
page 15 that lists  license fees.  She stated that  in fiscal year                                                              
[FY]  10, the  initial  certification  fee was  $500.   Fees  were                                                              
increased in  FY 11 and  again in FY 13,  at which time  fees were                                                              
$1,450.   However, the  fees were not  sufficient enough  to cover                                                              
increased  costs, which  were associated  with regulation  changes                                                              
and  investigative  costs.    As  of March  2014,  the  number  of                                                              
licensees  was 35,  plus 13  apprentices.   Thus  to shoulder  the                                                              
cost  for  such a  small  group  of licensees  results  in  higher                                                              
license fees.  In  terms of the future plan, the  department would                                                              
need to address how it plans to reduce the deficit.                                                                             
4:27:15 PM                                                                                                                    
CHAIR  OLSON  stated   that  the  Legislative  Budget   and  Audit                                                              
Committee (LB&A)  started a  year ago to  grapple with  the issue.                                                              
He  recalled one  board  had $150,000  in  legal  costs and  other                                                              
boards have  large numbers of licensees  to spread out  the costs.                                                              
He explained  the difficulty  in establishing  standards that  can                                                              
be applied to all  of the boards.  He said the  LB&A committee and                                                              
the division spent the interim working on these issues.                                                                         
4:28:24 PM                                                                                                                    
REPRESENTATIVE   TILTON  expressed   thanks  for   the  work   the                                                              
Legislative Budget  & Audit (LB&A)  and the division have  done on                                                              
this matter.                                                                                                                    
4:28:31 PM                                                                                                                    
REPRESENTATIVE  HUGHES asked  for the typical  extension time  for                                                              
MS.  CURTIS   answered  that  the   statutes  provide   a  maximum                                                              
extension of eight years.                                                                                                       
4:28:57 PM                                                                                                                    
REPRESENTATIVE   HUGHES  related   her   understanding  that   the                                                              
auditors  questioned  why the  board  didn't pursue  civil  action                                                              
simultaneously  with the referral  of cases to  OSPA and  that the                                                              
board wasn't criticized because OSPA didn't take action.                                                                        
MS. CURTIS said  she expected to see civil licensing  action to be                                                              
taken to  be sure  a negligent or  incompetent practitioner  isn't                                                              
allowed to practice.                                                                                                            
REPRESENTATIVE  HUGHES  asked  for further  clarification  on  who                                                              
would initiate the civil action.                                                                                                
MS. CURTIS  answered that  it would be  filed by the  commissioner                                                              
in conjunction  with the  board.  The  respondents are  allowed to                                                              
file   a  response   to  the   accusation,  and   the  Office   of                                                              
Administrative  Hearings  (OAH)  has  120 days  to  conduct  their                                                              
hearings after which the board has time to make a decision.                                                                     
4:30:17 PM                                                                                                                    
CHAIR OLSON remarked  that two years is short extension  time.  He                                                              
recalled that  the Alaska Bar  Association was extended  for three                                                              
years in a row.                                                                                                                 
MS. CURTIS replied that she did not specifically recall.                                                                        
4:31:06 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON  referred to  the repeal of  AS 08.65.140                                                              
since  he was  unsure  of  what fills  that  gap.   He  asked  for                                                              
further clarification  on part of  the statutes that at  a minimum                                                              
the  regulations  must  require that  the  certified  direct-entry                                                              
midwife  not  knowingly deliver  a  woman  with certain  types  of                                                              
health  conditions, prior  history or  complications as  specified                                                              
by the board.   He suggested that the language was  ambiguous.  He                                                              
asked for  clarification that  safeguards are  in place  before he                                                              
could vote  to extend  the board.   He said  he was curious  about                                                              
the  status of  the  regulations.   He  asked  for an  explanation                                                              
since the legislature deferred to the board to make the rules.                                                                  
SARA  CHAMBERS,   Acting  Director,   Division  of   Corporations,                                                              
Business,  and  Professional Licensing,  Department  of  Commerce,                                                              
Community,  &  Economic  Development (DCCED),  answered  that  the                                                              
board  has  been  conscientious   in  working  to  adopt  its  new                                                              
regulations.   The department has  been working with the  board to                                                              
minimize  the  window   between  the  statutory   repeal  and  the                                                              
effective  date  of  new  regulations.   The  Board  of  Certified                                                              
Direct-Entry  Midwives (CDM)  met  over the  past two  days.   She                                                              
related her  understanding that the  board planned to  continue to                                                              
work  on regulations  and  if they  adopted  the regulations,  the                                                              
division  would  expedite  the  public  comment  within  the  next                                                              
month.  She  said Ms. Corrick  could provide more details  but the                                                              
board and division are very aware of the concern.                                                                               
4:34:12 PM                                                                                                                    
CHAIR   OLSON   pointed   out   that    Representative   Josephson                                                              
participated this  summer during the Legislative  Budget and Audit                                                              
Committee hearings on the board issues.                                                                                         
4:34:51 PM                                                                                                                    
REPRESENTATIVE   JOSEPHSON   asked  about   the   status  of   the                                                              
regulations.    He  further  asked what  part  of  the  prohibited                                                              
statutes that  was particularly unfair  that the board  wanted the                                                              
authority over regulations for prohibited actions.                                                                              
CHERYL CORRICK,  Chair, Board  of Certified Direct-Entry  Midwives                                                              
(CDM), Department  of Commerce,  Community & Economic  Development                                                              
(DCCED), replied  she serves as one  of two midwifes on  the board                                                              
that also includes  a certified nurse midwife and  a physician who                                                              
practices in obstetrics/gynecology.   She said the  board felt the                                                              
prohibitions were  somewhat out of  date, particularly  since they                                                              
had not been  addressed in over 20  years.  She reported  that the                                                              
board  just  finished  its regulations  project  today  that  will                                                              
further guide midwives.   Up until that point, the  board has made                                                              
it  clear to  practitioners  through board  actions  that the  old                                                              
regulations still apply until the new ones were promulgated.                                                                    
4:36:28 PM                                                                                                                    
MS. CORRICK  recalled one  in terms  of prohibitions for  treating                                                              
with women  with gestational  diabetes.   The new regulation  will                                                              
allow  midwives, in  consultation with  a physician,  to manage  a                                                              
woman  as  long   as  she  can  be  managed   without  medication,                                                              
basically through  diet and  exercise, and  can deliver  the baby.                                                              
Midwives can  now co-manage the  patients with the  physician, but                                                              
the physician will deliver the baby.                                                                                            
REPRESENTATIVE  JOSEPHSON  related that  she  has provided  enough                                                              
information that gives him comfort and he appreciated her time.                                                                 
4:38:35 PM                                                                                                                    
CHAIR OLSON,  after first  determining no  one wished to  testify,                                                              
closed public testimony on HB 26.                                                                                               
4:38:49 PM                                                                                                                    
REPRESENTATIVE  COLVER  deferred to  the  Chair,  but he  wondered                                                              
whether  it  might be  possible  to  extend  the board  for  three                                                              
years.  He expressed  a concern that the legislature  will have to                                                              
revisit this again.                                                                                                             
CHAIR OLSON deferred  to the legislative auditor  on the extension                                                              
time and  said he completely  trusts her  judgment.  He  could not                                                              
think of  any time that  he disagree  with the auditor's  judgment                                                              
on extension times.                                                                                                             
4:40:42 PM                                                                                                                    
REPRESENTATIVE  HUGHES  commented  that  she  personally  has  had                                                              
wonderful  experiences with  midwifes  and was  grateful that  the                                                              
state has very  competent midwives who provide  wonderful services                                                              
to families.   She  viewed the  two-year extension  for the  board                                                              
was more a  reflection on the division  and not the midwives  as a                                                              
profession.    She  commended  the midwives  who  provide  a  very                                                              
wholesome and wonderful experience delivering babies.                                                                           
CHAIR OLSON commented  that most of the boards  the committee will                                                              
review  request  a   four  to  eight  year  extension,   but  this                                                              
represents  an  exception.   He  acknowledged  the  importance  of                                                              
protecting Alaskans.                                                                                                            
4:42:11 PM                                                                                                                    
REPRESENTATIVE  COLVER  echoed  earlier  comments  that  midwifery                                                              
provides a valuable  service that allow families  to make choices.                                                              
He  emphasized  the  importance   of  allowing  families  to  make                                                              
choices, especially  since this  is their  baby and their  family.                                                              
He offered  his belief that it  is important in medical  care that                                                              
government  does not mandate  women must  to go  to a hospital  to                                                              
have  her baby.   He  stressed  that it  is  up to  the family  to                                                              
decide what  works for  them.   He imagined  that using  a midwife                                                              
also has  an economic role  since women  can have their  babies at                                                              
home, which  is especially important  for the uninsured.   He said                                                              
that  it is  important  to help  families.   He  hoped that  there                                                              
won't be  any complications  that will  cause an expensive  birth,                                                              
but again,  it offers a  means to deliver  health care  without an                                                              
expensive trip  to the hospital.   He offered that this  bill will                                                              
accomplish a  number of goals and  objectives in our society.   He                                                              
said he  is very  supportive of  the profession  and he  hoped the                                                              
punitive issues would soon be resolved.                                                                                         
4:43:55 PM                                                                                                                    
CHAIR OLSON remarked  that boards are comprised  of volunteers and                                                              
most of the  time things go well.   The only time  the legislature                                                              
hears  about  it  is  when  something  goes  wrong  and  in  those                                                              
instances  often the  whole profession  is blamed.   He  commended                                                              
the volunteers  who serve  on boards, stating  his "hat  goes off"                                                              
to them.                                                                                                                        
4:44:44 PM                                                                                                                    
REPRESENTATIVE  HUGHES moved  to  report HB  26  out of  committee                                                              
with  individual  recommendations   and  the  accompanying  fiscal                                                              
note.   There  being no  objection, HB  26 was  reported from  the                                                              
House Labor and Commerce Standing Committee.                                                                                    

Document Name Date/Time Subjects
HB49 ver H.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Sponsor Statement.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Sectional Analysis.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Fiscal Note-DCCED-CBPL-02-06-15.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Supporting Document-2015 Legal FAQS-B Lab.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Supporting Document-2015 Sampling of Benefit Corporations.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Supporting Document-2015 States with Benefit Corporations.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Supporting Document-Letter ASFT 2-2-2015.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB49 Supporting Document-Letter Diane E. Hughes 2-4-2014.pdf HL&C 2/13/2015 3:15:00 PM
HB 49
HB26 ver A.pdf HL&C 2/13/2015 3:15:00 PM
HB 26
HB26 Sponsor Statement.pdf HL&C 2/13/2015 3:15:00 PM
HB 26
HB26 Fiscal Note-DCCED-CBPL-02-06-15.pdf HL&C 2/13/2015 3:15:00 PM
HB 26
HB26 Supporting Documents-Legislative Audit 6-30-2014.pdf HL&C 2/13/2015 3:15:00 PM
HB 26
HB49 Draft Proposed Amendment H.1.pdf HL&C 2/13/2015 3:15:00 PM
HB 49