Legislature(2003 - 2004)
04/27/2004 09:02 AM Senate FIN
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE BILL NO. 306 "An Act relating to the practice of naturopathic medicine; and providing for an effective date." This was the third hearing for this bill in the Senate Finance Committee. Co-Chair Wilken explained that this legislation would update current law pertaining to the practice of naturopathic medicine and would allow naturopaths to conduct minor surgery and prescribe controlled substantive medication. He noted that the bill's sponsor, Senator Ralph Seekins, has developed a new committee substitute. Co-Chair Green moved to adopt Version 23-LS1572\S as the working document. Co-Chair Wilken objected for explanation. BRIAN HOVE, Staff to Senator Ralph Seekins, the bill's sponsor, apologized to the Committee for the fact that Senator Seekins, who has conducted most of the work on the committee substitute, has been delayed and could not testify on its behalf until later in the meeting. Co-Chair Wilken ordered the bill SET ASIDE in order to allow time for the bill's sponsor to arrive. [NOTE: The bill was re-addressed later in the meeting.] SENATE BILL NO. 306 "An Act relating to the practice of naturopathic medicine; and providing for an effective date." [NOTE: This bill was heard earlier in the meeting.] Co-Chair Wilken stated that this bill would change Statutes pertaining to naturopathic medicine. He noted that a committee substitute, Version 23-LS1572\S, has been presented for discussion. SENATOR RALPH SEEKINS, the bill's sponsor, explained that changes in the Version "S" committee substitute include: eliminating the temporary license language in the bill which would, in effect, require a naturopath to be fully licensed in the State before they could begin practicing; clarifying the authorized activities that could be conducted by a naturopath; and, providing that the naturopath has registered with the Federal Drug Enforcement Administration (FDEA), has successfully completed pharmacology training at an approved naturopathic college, and "has entered into a collaborative agreement" with a person or persons licensed to practice medicine under applicable Alaska Statutes, they could prescribe controlled substance medication. He stated that provisions allowing minor surgery have not been altered nor were any provisions altered that would allow a person to conduct any other diagnostic testing beyond what they are currently licensed to do. Explanatory prescription drug language has also been incorporated. Senator Seekins stated that Statute language and the details required of the collaborative naturopath/physician agreement are referenced in Section 10, Sec. 08.45.125 on page six, beginning on line 19 of the bill and continue through line 21, page seven. He read Section 10 to the Committee. Senator Seekins stated that Section 10 addresses physicians' concerns regarding the prescribing of drugs and patient care. Senator Bunde asked the particulars of minor surgery that could be performed by a naturopath. Senator Seekins expressed that language in Section 10, Sec. 08.45 120, subsection (6), page six, lines one through three, addresses minor surgery. He described minor surgery as treatment of such things as abrasions, and that the naturopath must have undergone training in their educational process and provide proof of such to the Division of Occupational Licensing, Department of Community and Economic Development. Therefore, he commented that the Division would be responsible for determining what level of surgery could be performed. Senator Bunde responded that a medical board might be required to review a naturopath's qualification level. He asked whether a naturopath would be able to administer sutures. Senator Seekins stated that a naturopath would be able to perform minor surgery limited to one or two sutures. SCOTT LUPER, Doctor, testified via teleconference from an offnet site in Fairbanks and informed the Committee that the State would allow Naturopathic physicians (NP) to practice provided they graduate from a naturopathic college and pass a national Board examination that tests their ability to perform minor surgery. Senator Bunde acknowledged; however, opined that because naturopaths are not required to participate in an intern program such as that required of medical physicians, their medical training does not equate to that required of medical doctors. Senator Bunde asked whether the collaborative agreement that would be required between a naturopath and a medical doctor is a one-to- one arrangement or whether, for example a retired medical doctor might participate in such an agreement with a dozen or more naturopaths. Senator Seekins stated that the bill's language specifies that a collaborating doctor must be an actively practicing, State licensed doctor. Senator Olson understood therefore that a physician could have a collaborative agreement with more than one naturopath. Senator Seekins affirmed. Co-Chair Green asked whether a fiscal note would be required to address language in Section 9, subsection (c) on page four, line 26 that states that, while the three-member naturopathic peer review committee would serve without compensation, they would be "entitled to travel and per diem expenses authorized for boards and commissions." Co-Chair Wilken asked whether this is new language. Senator Seekins understood that this is existing language. Senator Olson expressed that both subsections (b)(2) and the entirety of subsection (c) in Section 9, on page four, were new language. Senator Seekins concurred that this might be correct. The original intent of the bill was to be revenue neutral. However, the Department suggested that an amendment be entertained to delete language in subsection (c), page four, line 28, that specifies that the three-member naturopathic peer review committee should meet quarterly as the Department has determined that, considering the low number of complaints, meeting quarterly would not be required at this point in time. The Commissioner of the Department feels that the cost of the Board would be minimal as their meetings could be conducted via teleconference. Co-Chair Wilken, understanding that the majority of Section 9 is new language, asked what the Section would do. Senator Olson asked for clarification which language the Department would like to have amended. Senator Seekins clarified that the Department suggests that the word "quarterly" be removed from subsection "c" so that the language would read "The committee shall meet to review complaints filed with the division under this chapter." rather than the current language "The committee shall meet quarterly to review complaints filed with the division under this chapter." This change, he stated, would alleviate the need for a fiscal note as the three-member naturopathic peer review committee could conduct meetings via teleconference. Co-Chair Wilken suggested that language on lines 26 through line 28 of that Section should also be eliminated as it pertains to the travel and per diem expense authorization. He stated that, over time, were more meetings required, this language could be revisited. Senator Seekins suggested that language on line 26 that specifies that they would serve on the committee without compensation should remain in the bill. However, he agreed that the travel and per diem language could be eliminated. The language on lines 26 through 29 reads as follows. …The committee members serve without compensation for their work on the committee but are entitled to the travel and per diem expenses authorized for boards and commissioners Under AS 39.20.180. The committee shall meet quarterly to review complaints filed with the division under this chapter… Co-Chair Green moved to adopt Version "S" as the working document. There being no objection, the Version "S" committee substitute was ADOPTED as the working document. Senator Seekins stated that subsection "c" was modified in Version "S" at the request of the Director of the Division of Licensing. Amendment # 2: This amendment deletes the following language in Section 9, subsection (c) beginning on line 27 and continuing through line 28. … but are entitled to the travel and per diem expenses authorized for boards and commissioners Under AS 39.20.180. In addition, the amendment deletes the word "quarterly" following the word "meet" in Section 9, subsection (c) on line 28. The amended language reads as follows. The committee shall meet to review complaints filed with the division under this chapter. Co-Chair Wilken moved to adopt Amendment #2. Co-Chair Green asked whether this language is atypical to other committee language. Senator Seekins affirmed that this language is applicable to most committee language. Senator Olson concurred. Co-Chair Wilken voiced concern that, were this language retained, a fiscal note would be required. Senator Seekins voiced acceptance to the removal of the language as proposed in the amendment. The adoption of this bill would be welcome to the naturopath community and this language would be acceptable were it to further the bill's progress. Senator Olson voiced concern that a telephonic meeting, rather than a face-to-face meeting, might not be the appropriate manner in which to best serve the naturopathic defendant were a complaint filed. He would desire a face-to-face meeting in order to observe "the body language" of both the defendant and the witnesses. Co-Chair Wilken noted that forthcoming amendment #3 might address Senator Olson's concerns. Co-Chair Wilken stated that the adoption of Amendment #2 would allow this bill to move forward without requiring a fiscal note to be developed. There being no objection, Amendment #2 was ADOPTED. Conceptual Amendment #3: This conceptual amendment would allow the bill's drafter to insert language in the bill that would address Committee concerns regarding allowing the peer review group to meet via two-way conference or teleconference. Co-Chair Green moved to adopt Conceptual Amendment #3. Co-Chair Green stated that the desire of this amendment would be to allow the Committee to best operate utilizing teleconferencing technology assisted with transmittal of information via facsimile. Senator Olson continued to voice concern that a face-to-face meeting would be more desired. Senator Seekins interjected that this amendment concerns a peer review committee and that the naturopath defendant could, as detailed in Section 9, subsection (c), page five, lines two and three, either accept the recommendations of the peer committee or request a hearing before the division, which he stated, "would be a more formal procedure at that time." Doctor Luper recalled that Rick Urion, the Director of the Division of Occupational Licensing, had communicated that were a complaint filed, he would contact the peer committee members and "discuss the merits of the complaint"… and were the complaint to have merits, the Division would investigate it and conduct a hearing, via the Departments established method. SFC 04 # 97, Side B 06:25 PM Doctor Luper continued therefore, that the participation of the naturopathic physician peer committee would be to assist "in weeding out the various complaints." Senator Olson asked how disciplinary action regarding a naturopathic license would occur. Doctor Luper stated that the Division of "Occupational Licensing would be the final arbitrator on that." He stated that the role of the peer committee would be advisory in regards to the substance of the complaint. There being no objection, Conceptual Amendment #3 was ADOPTED. Senator Bunde voiced discomfort with the possibility that one doctor could have a collaborative agreement with more than one naturopath. He asked how a doctor's oversight of a physician's assistant (PA) is conducted. Senator Seekins responded that he researched collaborative agreements on a national basis. PA collaborative agreements have "substantially less" requirements than the one proposed in this bill for Naturopaths. He also noted that no oversight agreements are required for Nurse Practitioners, "who have unlimited prescriptive authority and have no supervision and have about the same amount of pharmacology training as naturopaths do." The intent of the collaborative agreement in this bill is that a naturopath would develop an agreement with a physician whom he or she is comfortable communicating with. While no limitation language was found during his national review, this bill would require a physician review protocol to be specified, as he allowed that there might be a physician who might not be too attentive. While he would not object to a reasonable limit being imposed, he believed that a physician would choose to be near where the naturopath is practicing. Co-Chair Wilken, commenting that Senator Bunde has "raised a good issue," asked whether the sponsor would desire the bill held in Committee in order to further address the issue or whether he would desire to address the issue after the bill transmits from the Senate to the House of Representatives. Continued halting of the bill, this late in the Legislative session, might negate its passage. Senator Bunde understood that delaying the bill could undermine its progress; therefore, he stated that he would further research the issue and might offer an amendment during its Senate floor hearing. Senator Seekins voiced willingness to work with Senator Bunde in this regard. Co-Chair Wilken noted that, as an alternative to a Senate floor amendment, a statement of concern could accompany the bill to the House. The resulting action would require Senate concurrence. Senator Bunde stated that a level of confidence in the other body would be required in that instance. Senator Olson asked regarding language in Section 10, page five, line 25, regarding pharmacology training. The federal Food and Drug Administration (FDA), rather than the DEA, has the most authority over non-scheduled drugs. Senator Seekins responded that non-scheduled/prescription drugs are addressed in the collaborative agreement, in that each drug that might be prescribed must have an established protocol in the collaborative agreement. Senator Olson understood, therefore, that both FDA and DEA drug requirements are addressed under the collaborative agreement. Senator Seekins affirmed. He noted that Section 10, subsection (4), on line 21 on page five is applicable to controlled substances and that prescriptive "or legend" drugs are addressed in Section 10, subsection (8) on page six, line eight. Co-Chair Green moved to report the bill, as amended, from Committee with individual recommendations and accompanying fiscal notes. There being no objection, CS SB 306(FIN) was REPORTED from Committee with zero fiscal note, dated April 28, 2004 from the Department of Community and Economic Development.