Legislature(2015 - 2016)SENATE FINANCE 532

03/16/2016 09:00 AM Senate FINANCE

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Heard & Held
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Heard & Held
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+ Bills Previously Heard/Scheduled TELECONFERENCED
SENATE BILL NO. 69                                                                                                            
     "An Act relating to the Board of Chiropractic                                                                              
     Examiners and the practice of chiropractic."                                                                               
9:03:04 AM                                                                                                                    
Senator Dunleavy disclosed that  he had a financial interest                                                                    
in a chiropractic office.                                                                                                       
9:03:26 AM                                                                                                                    
SENATOR BILL  STOLTZE, SPONSOR, hoped  to work as  a conduit                                                                    
for better  access to medical services  by increasing access                                                                    
for  high  school  physicals. He  relayed  that  the  Alaska                                                                    
School  Activities Association  had  lamented their  limited                                                                    
access  to physicals  for children,  not only  availability,                                                                    
but also efficiency and affordability.  He said that schools                                                                    
had not  used chiropractors  for physicals due  to ambiguity                                                                    
in  statute. He  believed that  the bill  would provide  the                                                                    
guidance needed in order to expend access to physicals.                                                                         
9:06:57 AM                                                                                                                    
Co-Chair MacKinnon requested a sectional analysis.                                                                              
9:07:00 AM                                                                                                                    
BRANDON BREFCZYNSKI, STAFF,  SENATOR BILL STOLTZE, discussed                                                                    
the sectional analysis (copy on file):                                                                                          
     Section 1:  Amends AS 08.20.055 by  adding new language                                                                  
     that  allows the  board to  adopt  regulations for  the                                                                    
          - Training and scope of practice of chiropractic                                                                      
          interns and chiropractic preceptors;                                                                                  
          -   Designation   of   a   nationally   recognized                                                                    
          certification program for chiropractic clinical                                                                       
          - Performance of patient examinations.                                                                                
     Section  2:  Amends   AS  08.20.100(b)  clarifying  how                                                                  
     chiropractors   can    accept   referrals,   authorizes                                                                    
     chiropractors to  perform school physicals,  and allows                                                                    
     the  employment  of   certified  chiropractic  clinical                                                                    
     assistants,  chiropractic   interns,  and  chiropractic                                                                    
     Section  3:  Amends  AS  08.20.100   by  adding  a  new                                                                  
     subsection (d)  that exempts chiropractic  interns from                                                                    
     this section.                                                                                                              
     Section   4:   Amends   AS  08.20.160   regarding   the                                                                  
     requirements for temporary permits.                                                                                        
     Section 5: Amends AS 08.20  by adding a new section (AS                                                                  
     08.20.168) regarding chiropractic clinical assistants.                                                                     
     Section 6:  Amends 08.20.185 by changing  name of "peer                                                                  
     review committee" to  "utilization review committee" to                                                                    
     better reflect the purpose of  the committee. Also, the                                                                    
     change  is  intended  to  assist  in  determining  what                                                                    
     complaints warrant a referral to investigative staff.                                                                      
     Section 7:  Amends AS  08.20.200 by  updating penalties                                                                  
     for unlicensed practice.                                                                                                   
     Section 8:  Amends AS  08.20.210 by  updating penalties                                                                  
     for fraudulent licenses and certificates.                                                                                  
     Section   9:   Amends   definition   of   "chiropractic                                                                  
     examination" located in AS 08.20.900(7).                                                                                   
     Section  10:   Amends  AS   08.20.900  by   adding  new                                                                  
     definitions  for   "chiropractic  clinical  assistant,"                                                                    
    chiropractic intern," and "chiropractic preceptor."                                                                         
9:10:09 AM                                                                                                                    
Senator Hoffman  looked at Section  2, and  wondered whether                                                                    
the referrals  were for  chiropractic treatment  or physical                                                                    
Mr. Brefczynski deferred the question to Mr. Barrington.                                                                        
9:11:13 AM                                                                                                                    
Senator  Olson asked  whether other  medical providers  were                                                                    
able to sign off on a sports physical.                                                                                          
Senator Stoltze responded that he did not know the answer.                                                                      
9:11:51 AM                                                                                                                    
Co-Chair  MacKinnon noted  that there  were several  experts                                                                    
waiting to testify, as well  as were available to respond to                                                                    
9:12:25 AM                                                                                                                    
Senator  Stoltze noted  that other  practitioners that  were                                                                    
able  to  perform  physicals   under  statute  were  medical                                                                    
doctors,  doctors of  osteopathic  medicine, advanced  nurse                                                                    
practitioners, and physician's assistants.                                                                                      
9:12:52 AM                                                                                                                    
Senator Olson  queried the most  common reason for  a person                                                                    
to fail a sports physical exam.                                                                                                 
Mr.  Brefczynski  responded  that  he  could  not  speak  to                                                                    
disqualifying factors for sport physical exams.                                                                                 
9:13:19 AM                                                                                                                    
Senator Olson  understood that cardiovascular issues  were a                                                                    
main  disqualifying   factor.  He  expressed   concern  that                                                                    
chiropractic  care was  generally  related  to muscular  and                                                                    
skeletal expertise, and not cardiovascular issues.                                                                              
JANEY   HOVENDEN,  DIRECTOR,   CORPORATIONS,  BUSINESS   AND                                                                    
PROFESSIONAL  LICENSING, DEPARTMENT  OF COMMERCE,  COMMUNITY                                                                    
AND ECONOMIC  DEVELOPMENT (DCCED),  testified that  the bill                                                                    
would add  layers to the existing  chiropractic program. She                                                                    
solicited specific questions on the legislation.                                                                                
9:15:24 AM                                                                                                                    
Co-Chair MacKinnon  stated that  medical questions  would be                                                                    
held for the medical professionals.                                                                                             
Co-Chair MacKinnon  wondered whether the  administration was                                                                    
in favor of the legislation.                                                                                                    
Ms.  Hovenden   replied  that  the  Board   of  Chiropractic                                                                    
Examiners had  come out  in support,  but that  the division                                                                    
did not have a position on the bill.                                                                                            
Co-Chair MacKinnon asked whether  the division had any input                                                                    
on the bill.                                                                                                                    
Ms. Hovenden replied that she did not believe so.                                                                               
9:16:00 AM                                                                                                                    
Senator Olson asked whether the bill faced any opposition.                                                                      
Ms.  Hovenden  replied  that  she   was  not  aware  of  any                                                                    
opposition to the legislation.                                                                                                  
9:16:05 AM                                                                                                                    
Senator  Olson probed  whether the  State Medical  Board and                                                                    
Board of Nurse Practitioners supported the bill.                                                                                
Ms. Hovenden  responded that  those groups  had not  taken a                                                                    
position on the legislation.                                                                                                    
9:16:20 AM                                                                                                                    
Vice-Chair Micciche aske Ms. Hovenden  to explain the fiscal                                                                    
note, specifically  the way in which  boards and commissions                                                                    
were of no cost to the state.                                                                                                   
Ms. Hovenden  replied that  the division  received supported                                                                    
services, which  meant that  the licensees  paid for  all of                                                                    
the expenses for their program within the division.                                                                             
9:16:52 AM                                                                                                                    
Co-Chair MacKinnon  understood that  the bill  would require                                                                    
the addition of one, part-time position.                                                                                        
Ms.  Hovenden replied  in the  affirmative, and  stated that                                                                    
there would also be a regulations project.                                                                                      
9:17:31 AM                                                                                                                    
DR.   EDWARD   BARRINGTON,  LEGISLATIVE   CHAIRMAN,   ALASKA                                                                    
CHIROPRACTIC SOCIETY AND BOARD,  testified in support of the                                                                    
legislation. He  said that the proposed  changes outlines in                                                                    
SB 69 were  in the public interest. He  stated that allowing                                                                    
the  Board of  Examiners to  set standards  for chiropractic                                                                    
clinical assistance was essential  so that any employee that                                                                    
had  direct patient  care contact  was  fully qualified.  He                                                                    
relayed that  authorizing and setting standards  for doctors                                                                    
that  were  already  practicing   who  wished  to  host  new                                                                    
graduates,  or  students  who  had   completed  all  of  the                                                                    
requirements but  had not fully  graduated, to  acquire more                                                                    
clinical  experiences.  He  shared that  the  law  currently                                                                    
allowed for chiropractic physicians  to examine children for                                                                    
student physicals  and to  write excuses  to keep  them from                                                                    
participating in  sports activities.  He relayed  that rural                                                                    
districts in the state  currently used chiropractic services                                                                    
for  sports examinations.  He believed  that other  areas of                                                                    
the state did not use  chiropractors in the same way because                                                                    
the law was  not specific enough. He noted  that the statute                                                                    
had not  been addressed since  1988, and that  a utilization                                                                    
review would be a step  toward clarification. He stated that                                                                    
the board  had brought penalties for  fraudulent practice up                                                                    
to par with other disciplines.                                                                                                  
9:21:53 AM                                                                                                                    
Senator Olson wondered how  many chiropractors were licensed                                                                    
in the state.                                                                                                                   
Dr.  Barrington  responded  that there  were  300  currently                                                                    
licensed chiropractors; 265 actively practicing.                                                                                
9:22:05 AM                                                                                                                    
Senator  Olson queried  any type  of licensing  action taken                                                                    
against licensees over the past 3 years.                                                                                        
Dr.  Barrington replied  that no  suspension of  license had                                                                    
been undertaken. He said that  investigations did occur, but                                                                    
that the board  did not hear of those  until a determination                                                                    
had been reached. He relayed  that within the last year, the                                                                    
board had recommended additional  classes for a practitioner                                                                    
that had made an error in chart keeping.                                                                                        
9:23:20 AM                                                                                                                    
Vice-Chair Micciche  queried how the legislation  served the                                                                    
public interest.                                                                                                                
Dr. Barrington replied that public  interest was best served                                                                    
by  the qualifications  of chiropractor  physicians, and  by                                                                    
the  ability   for  parents   to  select   the  practitioner                                                                    
performing  their child's  physical.  He said  that in  many                                                                    
cases  the  availability  of other  practitioners  might  be                                                                    
9:24:31 AM                                                                                                                    
Vice-Chair  Micciche  asked  whether  a  chiropractor  could                                                                    
recommend that  a student  avoid a  sporting activity  for a                                                                    
cardiovascular reason.                                                                                                          
Dr. Barrington  replied in the  affirmative. He  stated that                                                                    
the scope  of chiropractic  practice was limited,  but their                                                                    
diagnostic and examination abilities were unlimited.                                                                            
9:26:16 AM                                                                                                                    
Vice-Chair Micciche understood  that currently chiropractors                                                                    
could  not write  letters  allowing  for participation,  but                                                                    
could write letters recommending non participation.                                                                             
Dr. Barrington replied in the affirmative.                                                                                      
9:26:47 AM                                                                                                                    
Senator Hoffman reiterated his question about referrals.                                                                        
Dr.  Barrington  replied  that  anyone  who  walked  into  a                                                                    
chiropractic office  of their own volition  was considered a                                                                    
self-referred patient.  He thought  that word  "referral" in                                                                    
Section 2  was related  to a  person who  walked in  off the                                                                    
street, or was referred by another practitioner or entity.                                                                      
Co-Chair MacKinnon OPENED public testimony.                                                                                     
9:28:16 AM                                                                                                                    
DR.  JENNIFER JOZWIAK,  MEMBER, ALASKA  CHIROPRACTIC SOCIETY                                                                    
AND BOARD, JUNEAU, spoke in support of the legislation.                                                                         
9:29:13 AM                                                                                                                    
Senator  Olson queried  the  expertise  of chiropractors  as                                                                    
related  to   disqualifying  issues  pertaining   to  sports                                                                    
physicals,  such   as  cardiovascular   disease,  rheumatoid                                                                    
arthritis, or diabetes.                                                                                                         
Dr. Jozwiak  replied that in  her training a  Palmer College                                                                    
of  Chiropractic she  had also  been  a diagnostic  teaching                                                                    
assistant. She shared  that in that training  she was taught                                                                    
to recognize  red flags for  the aforementioned  issues. She                                                                    
asserted  that  patient  history   was  a  major  factor  in                                                                    
diagnosing  medical conditions,  and that  there was  always                                                                    
more than one indicator observed.                                                                                               
9:30:38 AM                                                                                                                    
Senator  Bishop referred  to a  letter  in member's  packets                                                                    
Palmer  College  (copy  on  file). He  pointed  out  to  the                                                                    
committee the  section related  to United  States Department                                                                    
of Transportation physicals:                                                                                                    
     Doctors  of  Chiropractic   are  included  as  eligible                                                                    
     health care providers  to provide physical examinations                                                                    
     by  the  United  States  Department  of  Transportation                                                                    
     (DOT). In  fact, two faculty  clinicians at  the Palmer                                                                    
     Chiropractic Clinics in the  Quad Cities (Davenport and                                                                    
     Bettendorf,  Iowa, and  Moline and  Rock Island,  Ill.)                                                                    
     are  listed on  the National  registry as  certified to                                                                    
     provide DOT "Fit for Duty" physical exams.                                                                                 
     The   DOT  physical   is  a   comprehensive  evaluation                                                                    
     covering  all   systems  of   the  body,   including  a                                                                    
     comprehensive health  history and  review along  with a                                                                    
     urinalysis screening. All  of these examination aspects                                                                    
     are taught  and tested  as part  of Palmer's  Doctor of                                                                    
     Chiropractic  curriculum,  in  both  the  academic  and                                                                    
     clinical portion of the education.                                                                                         
9:31:22 AM                                                                                                                    
Vice-Chair  Micciche recalled  that  sports  exams had  been                                                                    
fairly simple in his experience.                                                                                                
Dr. Jozwiak responded  that she had a copy of  the exam that                                                                    
she could share with the committee.                                                                                             
9:32:32 AM                                                                                                                    
Senator Olson surmised that chiropractors  did not check for                                                                    
inguinal hernias.                                                                                                               
Dr. Jozwiak  stated that  she had patients  lay down  on the                                                                    
table with  their knees  bent while  she palpated  the area.                                                                    
She  explained  that   anything  abnormal  was  investigated                                                                    
Senator Olson  argued that there  was no  direct examination                                                                    
for an inguinal hernia.                                                                                                         
Dr. Jozwiak  responded that a  check would be done  if other                                                                    
red flags were observed.                                                                                                        
9:34:24 AM                                                                                                                    
DEBBIE  RYAN, ALASKA  CHIROPRACTIC  SOCIETY, ANCHORAGE  (via                                                                    
teleconference), noted that  she did not wish  to testify on                                                                    
the record.                                                                                                                     
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
9:34:51 AM                                                                                                                    
AT EASE                                                                                                                         
9:38:27 AM                                                                                                                    
Senator Dunleavy  clarified that  he had  an interest  in an                                                                    
investment company  that had an  interest in  a chiropractic                                                                    
SB  69  was   HEARD  and  HELD  in   committee  for  further                                                                    

Document Name Date/Time Subjects
CSSB 69 (L&C) Letter of Support - Logan University.pdf SFIN 3/16/2016 9:00:00 AM
SB 69
CSSB 69 (L&C) Letter of Support - Dr. Campbell.pdf SFIN 3/16/2016 9:00:00 AM
SB 69
CSSB 69 (L&C) Letter of Support - Palmer College.pdf SFIN 3/16/2016 9:00:00 AM
SB 69
CSSB 69 (L&C) Letter of Support - UWS.pdf SFIN 3/16/2016 9:00:00 AM
SB 69
CSSB 69 (L&C) Sectional Analysis.pdf SFIN 3/16/2016 9:00:00 AM
SB 69
CSSB 69 (L&C) Sponsor Statement.pdf SFIN 3/16/2016 9:00:00 AM
SB 69
SB 124 AK Senior Resource Guide 2016.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 - Sponsor Statement (SFIN).pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 Backup Document - ACoA Fact Sheet.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 Backup Document - ACoA Roster of Members.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 Backup Document - ACoA State Plan FY16-FY19.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 Backup Document - Sunset Review of the Alaska Commission on Aging Report #06-20090-15.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 Letter of Support - DOLWD 2 24 2016.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 Letters of Support (Consolidated - 16) - 2-8-16.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 124 Support Document - Letter of Support from Mat-Su Health Foundation - 3-4-16.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 196 PCE sponsor statement.pdf SFIN 3/16/2016 9:00:00 AM
SB 196
SB 196 sectional.pdf SFIN 3/16/2016 9:00:00 AM
SB 196
SB 124 Resolution of Support - Fairbanks North Star Borough 2-25-16.pdf SFIN 3/16/2016 9:00:00 AM
SB 124
SB 69 Student Health Review-Exam.pdf SFIN 3/16/2016 9:00:00 AM
SB 69
SB 196 PCE Endowment Fund - percentage pf payput with only program costs funded.pdf SFIN 3/16/2016 9:00:00 AM
SB 196
SB 69 CSSB 69 (LC) - Explanation Changes.pdf SFIN 3/16/2016 9:00:00 AM
SB 69