Legislature(2003 - 2004)

04/27/2004 09:02 AM Senate FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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                                                            
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                                                            
Co-Chair  Green moved to  adopt Version 23-LS1572\S  as the  working                                                            
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                                                            
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                                                            
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                                                            
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                                                            
Senator Seekins  stated that  the bill's  language specifies  that a                                                            
collaborating doctor must  be an actively practicing, State licensed                                                            
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                                                            
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                                                            
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                                                            
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                                                            
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                                                            
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.                                                                               

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