Legislature(2015 - 2016)SENATE FINANCE 532

04/15/2015 01:30 PM Senate FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 26 Presentation: Overview FY17 Operating Budget TELECONFERENCED
Heard & Held
Heard & Held
Scheduled but Not Heard
<Pending Referral>
Heard & Held
Bills Previously Heard/Scheduled:
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<Pending Referral>
HOUSE BILL NO. 26                                                                                                             
     "An Act extending the termination date of the Board of                                                                     
     Certified Direct-Entry Midwives; and providing for an                                                                      
     effective date."                                                                                                           
1:57:20 PM                                                                                                                    
LAURA STIDOLPH, STAFF,  REPRESENTATIVE KURT OLSON, discussed                                                                    
HB  26, which  would  extend the  termination  date for  the                                                                    
Board of  Certified Direct-Entry Midwives to  June 30, 2017.                                                                    
She shared that each year  the Division of Legislative Audit                                                                    
reviewed state  boards and commissions to  determine whether                                                                    
they should be  reestablished per AS 24.44.  The division of                                                                    
Legislative  Audit reviewed  the  activity of  the board  in                                                                    
order to  determine whether there was  a demonstrated public                                                                    
need for the board's continued  existence and whether it had                                                                    
been operating in  an effective manner. She  relayed that it                                                                    
was the opinion  of the division that the  board be extended                                                                    
two  years  to  June  30,  2017.  She  stated  that  in  the                                                                    
auditor's  opinion  the  board   was  serving  the  public's                                                                    
interest  by  effectively licensing  certified  direct-entry                                                                    
midwives  and apprentices.  She furthered  that it  had been                                                                    
found that the board continued  to improve the profession by                                                                    
modifying and  adopting midwifery regulations to  conform to                                                                    
current standards  of care. She  spoke to the  four findings                                                                    
and recommendations  from the  audit, including;  having the                                                                    
department pursue  disciplinary cases,  increasing licensing                                                                    
fees to  eliminate the boards operating  deficit, having the                                                                    
board  communicate  certificate requirements  to  continuing                                                                    
education  providers and  approving apprentice  applications                                                                    
in accordance  with statutes. She  concluded that  the Board                                                                    
of Certified Direct-Entry Midwives  served an important role                                                                    
in  protecting  the  wellbeing of  Alaskans  by  identifying                                                                    
individuals who  were willing  to pursue  technical training                                                                    
and  meet specified  technical qualifications  necessary for                                                                    
licenses  as midwives;  the continuation  of  the board  was                                                                    
important to  the health  and safety  of Alaska's  women and                                                                    
2:00:00 PM                                                                                                                    
Senator Olson  asked why the  board was only  being extended                                                                    
for two years.                                                                                                                  
Ms. Stidolph related  that a number of issues  brought up in                                                                    
the audit  had led  to the  recommendation of  the shortened                                                                    
2:00:33 PM                                                                                                                    
Senator Dunleavy understood that the  board was doing a good                                                                    
job in spite of the issues raised in the audit.                                                                                 
Ms. Stidolph replied that the  responsibility for the issues                                                                    
highlighted  by  the  audit  was   found  to  lie  with  the                                                                    
Department of Commerce,  community and Economic Development.                                                                    
She  assured the  committee that  the  department had  taken                                                                    
action on the issues.                                                                                                           
2:01:08 PM                                                                                                                    
Co-Chair MacKinnon  directed the committee's attention  to a                                                                    
report from Legislative Budget and Audit (copy on file).                                                                        
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE   AUDIT,  testified   that   the  division   had                                                                    
performed and audit of the board and recommended a short                                                                        
extension. She spoke to the four recommendations:                                                                               
     Recommendation No. 1                                                                                                     
     The  Department of  Commerce,  Community, and  Economic                                                                  
     Development's   (DCCED)    commissioner   should   take                                                                  
     immediate action  to pursue disciplinary  sanctions for                                                                  
     certified  direct-entry   midwives  (CDM)   cases  when                                                                  
     Disciplinary  sanctions were  not actively  pursued for                                                                    
     four  CDM-related investigations  which were  completed                                                                    
     during the audit  period. The investigations, involving                                                                    
     two people, supported  disciplinary sanctions including                                                                    
     probation   with  continuing   education  and   license                                                                    
     However,   Division  of   Corporations,  Business   and                                                                    
     Professional Licensing (DCBPL)  investigative staff did                                                                    
     not actively  pursue disciplinary sanctions  to protect                                                                    
     the public's safety.                                                                                                       
     In all four CDM cases,  the respondents refused to sign                                                                    
     a  CA. Rather  than file  an accusation  and pursue  an                                                                    
     administrative hearing, DCBPL  staff followed alternate                                                                    
     procedures.  Two of  the four  cases were  forwarded to                                                                    
     the Department of Law's  Office of Special Prosecutions                                                                    
     and Appeals  (OSPA) without  a sufficiency  of evidence                                                                    
     review  by  an  AAG.  A   year  after  the  cases  were                                                                    
     forwarded to OSPA, no action  had been taken. According                                                                    
     to OSPA,  the cases represent their  lowest priority as                                                                    
     the  related  offenses  were  categorized  as  Class  B                                                                    
     misdemeanors. The  other two  cases were held  by DCBPL                                                                    
     investigators  with the  understanding  that the  cases                                                                    
     would be  forwarded to OSPA  once the other  cases were                                                                    
     addressed.  Due to  staff turnover,  it is  unclear why                                                                    
     DCBPL staff did not pursue  a civil licensing action as                                                                    
     required  by   standard  operating  procedures.   At  a                                                                    
     minimum,   licensing    action   should    be   pursued                                                                    
     concurrently  to ensure  the public  is protected  from                                                                    
     incompetent,  negligent,  or unlicensed  practitioners.                                                                    
     By not pursuing licensing  action, the respondents were                                                                    
     allowed  to  continue   practicing,  and  the  public's                                                                    
     safety was placed at risk.                                                                                                 
2:04:08 PM                                                                                                                    
Ms. Curtis discussed the three remaining recommendations:                                                                       
     Recommendation No. 2                                                                                                     
     DCBPL, in consultation with  the board, should increase                                                                  
     licensing  fees  to  eliminate  the  board's  operating                                                                  
     As  of  March 31,  2014,  the  board had  an  operating                                                                    
     deficit of $115,261.                                                                                                       
     Recommendation No. 3                                                                                                     
     The board  should communicate  certificate requirements                                                                  
     to   continuing  education   providers  to   facilitate                                                                  
    compliance with centralized licensing regulations.                                                                        
     Recommendation No. 4                                                                                                     
     The    board   should    approve   apprentice    permit                                                                  
     applications in accordance with statutes.                                                                                
     For two of two  apprentice applications tested, permits                                                                    
     were  inappropriately   issued  by   DCBPL's  licensing                                                                    
     examiner rather than by the board.                                                                                         
Senator  Bishop asked  whether the  word "apprentice"  was a                                                                    
term of  art, and  was the  occupation of  midwife federally                                                                    
recognized by the United States Department of Labor.                                                                            
Ms. Curtis deferred the question to the department.                                                                             
2:04:48 PM                                                                                                                    
Co-Chair MacKinnon welcomed Co-Chair Kelly to the table.                                                                        
2:05:14 PM                                                                                                                    
SARA CHAMBERS,  ADMINISTRATIVE OPERATIONS  MANAGER, DIVISION                                                                    
OF  CORPORATIONS,   BUSINESS  AND   PROFESSIONAL  LICENSING,                                                                    
DEPARTMENT OF COMMERCE,  COMMUNITY AND ECONOMIC DEVELOPMENT,                                                                    
related  that  she was  unsure  whether  "apprentice" was  a                                                                    
federally  recognized term;  however, the  term was  created                                                                    
through  the board  statutes  and  regulations to  recognize                                                                    
someone who  had yet to  fully meet the  technical standards                                                                    
to  become  a midwife,  but  was  in  training to  meet  the                                                                    
2:05:49 PM                                                                                                                    
Senator Bishop requested further clarification.                                                                                 
2:06:04 PM                                                                                                                    
Co-Chair  MacKinnon   asked  for  the  name   of  the  board                                                                    
Ms.  Chambers related  that the  board president's  name was                                                                    
Cheryl   Corrick;   Deborah   Schneider  was   the   board's                                                                    
representative for the hearing.                                                                                                 
Co-Chair  MacKinnon  asked how  long  Ms.  Corrick had  been                                                                    
serving as board president.                                                                                                     
Ms. Chambers replied two to three years.                                                                                        
2:06:41 PM                                                                                                                    
Co-Chair  MacKinnon   wondered  why  the  board   should  be                                                                    
extended given the mismanagement highlighted in the audit.                                                                      
Ms. Chambers  stated that the  concerns that were  raised in                                                                    
the audit were being addressed.  She shared that the primary                                                                    
concern,  the investigative  procedures, had  been addressed                                                                    
by the  department. She explained that  different management                                                                    
strategies had been implemented,  as well as quality control                                                                    
elements that  served all  licensing programs.  She deferred                                                                    
to the board to speak to the topic of public service.                                                                           
2:08:23 PM                                                                                                                    
Co-Chair  MacKinnon asked  whether the  recommendations were                                                                    
Ms.  Curtis  stated  that  the deficit  and  the  fees  were                                                                    
reoccurring  issues.  She  noted  that the  2006  audit  had                                                                    
identified  that the  board's  fee was  the  highest of  any                                                                    
board, over  $2000. She  said that it  had been  a continual                                                                    
struggle, with  the small number  of licensees, to  bear the                                                                    
cost  of investigations  and regulatory  projects. She  said                                                                    
that the  issue of investigative  staff was isolated  to one                                                                    
instance, the  department routinely  went into  the division                                                                    
and scrutinized  their investigative function;  a systematic                                                                    
problem  had   not  been  identified,  the   problem  seemed                                                                    
specific to this particular board.                                                                                              
2:09:23 PM                                                                                                                    
Co-Chair MacKinnon asked if the  deficit the board faced was                                                                    
due to investigations.                                                                                                          
Ms. Curtis  replied that the  audit had determined  that the                                                                    
deficit  was based  on investigative  and regulatory  costs.                                                                    
She  furthered  that  the board  had  recently  undergone  a                                                                    
regulatory  project and  thought that  some of  the incurred                                                                    
costs were due to the project.                                                                                                  
Ms.  Chambers  reiterated  that   it  was  difficult  for  a                                                                    
licensing group  of less  than 50  licensees to  sustain the                                                                    
statutory  requirement  for  all  of their  expenses  to  be                                                                    
covered by revenues. She furthered  that the board currently                                                                    
had the  highest licensing fee  of any other  program, which                                                                    
would continue to  be raised on a regular basis  in order to                                                                    
overcome  the  deficit.  She   expressed  concern  that  the                                                                    
organization was "top  heavy" due to the nature  of the work                                                                    
and fees.                                                                                                                       
2:11:26 PM                                                                                                                    
Senator Hoffman asked if there  were any midwives in Western                                                                    
Ms. Chambers  responded that  she would  follow up  with the                                                                    
information at a later date.                                                                                                    
2:11:44 PM                                                                                                                    
Senator Dunleavy  asked what would occur  if the legislation                                                                    
did not pass.                                                                                                                   
Ms.  Curtis responded  that the  licensing  function of  the                                                                    
board would revert back to the department.                                                                                      
Ms. Chambers reiterated that there  was a one year period in                                                                    
which  the board  transition  responsibilities  over to  the                                                                    
department. She shared that the  department had 43 licensing                                                                    
programs, only 21 with boards.                                                                                                  
2:13:10 PM                                                                                                                    
Co-Chair MacKinnon pointed out that  over the last two years                                                                    
work  had  been  done  to understand  why  certain  licensee                                                                    
groups in the state had deficit balances.                                                                                       
2:14:16 PM                                                                                                                    
Co-Chair  MacKinnon asked  whether the  board was  acting on                                                                    
first recommendation of the audit.                                                                                              
DEBORAH   SCHNEIDER,  CERTIFIED   DIRECT   ENTRY  BOARD   OF                                                                    
MIDWIVES,  WASILLA (via  teleconference),  replied yes.  She                                                                    
said  that  the  recommendations   in  the  audit  had  been                                                                    
addressed  by  the  board.  [The quality  of  the  audio  is                                                                    
failing. This testimony is nearly impossible to decipher.]                                                                      
2:18:03 PM                                                                                                                    
AT EASE                                                                                                                         
2:19:45 PM                                                                                                                    
Co-Chair MacKinnon repeated her question.                                                                                       
Ms.  Schneider  stated  that  the   board  had  worked  with                                                                    
investigators  to  address  the  issues in  the  audit.  She                                                                    
stressed  that  the  board  was  working  within  its  legal                                                                    
authority in the investigation issue.                                                                                           
Co-Chair  MacKinnon reminded  Ms. Schneider  that the  legal                                                                    
authority of the board was outlined in state statute.                                                                           
Co-Chair MacKinnon asked how the  board was communicating to                                                                    
its  providers the  certificate requirements  for continuing                                                                    
Ms. Schneider  specified that a  letter detailing  the state                                                                    
requirements  had  been  drafted  and sent  to  the  Midwife                                                                    
Association  of  Alaska.  She   said  that  license  renewal                                                                    
certificates  were  being  reviewed  to  assure  that  state                                                                    
requirements  were being  met, and  that agencies  that were                                                                    
providing  continuing  education   were  notified  of  those                                                                    
specific requirements.                                                                                                          
2:22:29 PM                                                                                                                    
Co-Chair MacKinnon  asked whether the board  understood that                                                                    
they  were responsible  for approving  apprenticeship permit                                                                    
applications in accordance with state statutes.                                                                                 
Ms. Schneider  explained that  the board  was aware  and had                                                                    
directed that  the apprentice permits come  before the board                                                                    
for approval.                                                                                                                   
2:23:11 PM                                                                                                                    
Co-Chair MacKinnon wondered why  the board' authorization in                                                                    
state statute should be extended.                                                                                               
Ms.  Schneider explained  that the  board  worked to  ensure                                                                    
that midwives practiced under  the most current regulations.                                                                    
She stated  that midwifery was  a growing practice  and that                                                                    
well  written  regulations  and experienced  oversight  were                                                                    
important.  She shared  that  Alaska was  one  of the  first                                                                    
states  to have  licensure of  direct-entry midwives,  which                                                                    
had been a  blueprint for many other  states when developing                                                                    
their own guidelines.                                                                                                           
2:24:55 PM                                                                                                                    
Senator Bishop asked how many  midwives and apprentices were                                                                    
currently licensed in the state.                                                                                                
Ms. Schneider replied that there  were 34 licensed midwives.                                                                    
She said she was unsure on the number of apprentices.                                                                           
2:25:38 PM                                                                                                                    
Co-Chair MacKinnon OPENED public testimony.                                                                                     
2:26:07 PM                                                                                                                    
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
2:26:13 PM                                                                                                                    
Senator  Olson  assumed  that the  licensing  fee  was  paid                                                                    
Ms. Chambers replied yes.                                                                                                       
Senator  Olson  asked  if investigators  were  shared  among                                                                    
other boards and departments.                                                                                                   
Ms. Chambers said that the  department adhered to a positive                                                                    
time  keeping practice  to  assure  that investigators  were                                                                    
being used that  had the highest skillset  in the healthcare                                                                    
community,  while  spreading  resources across  the  various                                                                    
competing,  and ever-changing,  needs of  the division.  She                                                                    
stated that  the investigator was  not a  full-time position                                                                    
for the board.                                                                                                                  
Senator  Olson expressed  concern  that  the public  welfare                                                                    
could be harmed due to malpractice.                                                                                             
2:28:33 PM                                                                                                                    
HB  26  was   HEARD  and  HELD  in   committee  for  further                                                                    

Document Name Date/Time Subjects
HB26 Sponsor Statement.pdf SFIN 4/15/2015 1:30:00 PM
HB 26
HB26 Supporting Documents-Legislative Audit 6-30-2014.pdf SFIN 4/15/2015 1:30:00 PM
HB 26
HB116 Sponsor Statement.pdf SFIN 4/15/2015 1:30:00 PM
HB 116
HB116 Supporting Document - Legislative Audit 05-30-14.pdf SFIN 4/15/2015 1:30:00 PM
HB 116
HB 176 Legal Opinion re Geo Diff.pdf SFIN 4/15/2015 1:30:00 PM
HB 176
HB 176 Sponsor Statement (2).pdf SFIN 4/15/2015 1:30:00 PM
HB 176
HB178 Sponsor Statement.pdf SFIN 4/15/2015 1:30:00 PM
HB 178
HB178 Supporting Documents-CSHB316(FIN) Sectional Analysis ver R.pdf SFIN 4/15/2015 1:30:00 PM
HB 178
HB 316
HB178 Supporting Documents-HB316 enacted in 2014.PDF SFIN 4/15/2015 1:30:00 PM
HB 178
HB 316