Legislature(2003 - 2004)

02/19/2004 01:35 PM Senate L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                  SB 306-NATUROPATHIC MEDICINE                                                                              
CHAIR CON BUNDE announced SB 306 to be up for consideration.                                                                    
MR.  BRIAN HOVE,  staff to  Senator Seekins,  sponsor of  SB 306,                                                               
said  it updates  current law  relating to  naturopathic medicine                                                               
and,   as   a   result,    Alaskans'   accessibility   to   safe,                                                               
comprehensive,  high-quality health  care  will be  significantly                                                               
     The key elements of this legislation include:                                                                              
     1. Safeguarding Alaskans' use of naturopathic medicine                                                                     
        by  insuring  that  the  highest   quality  of  care                                                                    
        possible    from    licensed,    well-trained    and                                                                    
        professional naturopathic physicians.                                                                                   
     2. Mandating continuing education requirements so that                                                                     
        practitioners are  subject to  a state  and national                                                                    
        examination process.                                                                                                    
      3. Establishment of scope of practice to include the                                                                      
        use of  natural  substances,  homeopathic  medicine,                                                                    
        dietary, nutritional  and  health counseling,  minor                                                                    
        surgery and  all  necessary  diagnostic and  imaging                                                                    
      4. Providing prescriptive writing authority to those                                                                      
        naturopathic physicians earning licenses.                                                                               
      5. Establishment of a qualified trade association of                                                                      
        naturopathic physicians to work with the Division of                                                                    
        Occupational Licensing towards the implementation of                                                                    
        regulations requiring  specific  state  and  federal                                                                    
        examinations and licensure requirements.                                                                                
He explained  that naturopathic physicians go  through four years                                                               
of  undergraduate   pre-professional  training  followed   by  an                                                               
intensive  four-year natural  program  emphasizing both  academic                                                               
and clinical  studies. The practice of  naturopathic medicine was                                                               
first  licensed  in   Alaska  17  years  ago   and  the  proposed                                                               
legislation   updates   the   statute   where   needed.   Similar                                                               
legislation exists in 14 other states.                                                                                          
CHAIR BUNDE said  that complaints about a regular  M.D. get taken                                                               
up  with  the  State  Medical Board  and  asked  if  naturopathic                                                               
physicians follow that same route if a complaint was filed.                                                                     
MR.  HOVE  replied  that  he thought  that  complaints  would  be                                                               
circulated through the Division of Occupational Licensing.                                                                      
CHAIR  BUNDE  asked if  the  Division  of Occupational  Licensing                                                               
would act like the Medical Board.                                                                                               
DR.  SCOTT LUPER,  Fairbanks naturopath,  stated  support for  SB
263. [END OF TAPE]                                                                                                              
TAPE 04-13, SIDE A                                                                                                            
DR. LUPER said  he has had a lot of  experience with naturopathic                                                               
education and has practiced in  Fairbanks for the past 3.5 years.                                                               
The central  issue of SB  306 is whether  naturopathic physicians                                                               
have enough  education to have  prescription rights and  do minor                                                               
surgery.  He referred  the  committee to  a  Journal of  American                                                               
Medical  Association   (JAMA)  article  that   said  naturopathic                                                               
physicians  are   trained  as  primary  care   providers  (family                                                               
     Naturopathic doctors are trained  to take a history, do                                                                    
     physical   exams,  order   the  appropriate   tests  or                                                                    
     diagnostic images  and come up  with a diagnosis  and a                                                                    
     treatment. Naturopathic physicians  are also trained to                                                                    
     refer when  necessary. We're trained  in all  the basic                                                                    
     things that family doctors are  trained to do including                                                                    
     minor     surgery,     including     the     use     of                                                                    
     pharmaceuticals....   Their   [naturopathic]   clinical                                                                    
     education,  which  is   entirely  outpatient-based,  is                                                                    
     designed to prepare them to be primary care providers.                                                                     
Another handout from  Dr. LUPER showed that the  number of course                                                               
hours required  by the three  leading naturopathic and  the three                                                               
leading allopathic  colleges are comparable and  run around 4,000                                                               
hours. Another  article averaged the pharmacological  training of                                                               
126 allopathic,  naturopathic and osteopathic schools  across the                                                               
country and  indicated that they  all provide about 100  hours of                                                               
Instructors  at  the  naturopathic  colleges  are  comparable  in                                                               
training  and experience  to the  instructors  at the  allopathic                                                               
colleges. When  he was in  school, his instructor also  taught at                                                               
the  local   medical  school.   Clerkship  hours,   for  hands-on                                                               
training,  are comparable  for both  naturopathic and  allopathic                                                               
colleges at about 3,000 hours. The  last thing he pointed out was                                                               
a comparison of  the pharmacology catalogues from  the College of                                                               
Naturopathic  Medicine and  Stanford University,  which indicated                                                               
that  they basically  have the  same courses  and cover  the same                                                               
CHAIR  BUNDE   asked  why  naturopaths   would  not   have  their                                                               
disciplinary problems  addressed by the Medical  Board if doctors                                                               
and  naturopaths  have  similar  training and  now  begin  to  do                                                               
similar duties.                                                                                                                 
DR. LUPER  said that is  a good  question and explained  that the                                                               
original intention  was to create a  naturopathic board. However,                                                               
the Legislature  as well as  the governor's office  are reluctant                                                               
to create new bureaucrats. Director,  Rick Urion, of the Division                                                               
of  Occupational  Licensing,  said   that  the  division  already                                                               
functions  in   an  oversight   capacity  for   the  naturopathic                                                               
profession, as  well as  others. "If there  is a  complaint, they                                                               
hear the complaint."                                                                                                            
CHAIR  BUNDE   interrupted  to  say   that  the   division  hears                                                               
complaints from  barbers and hairdressers. "You're  talking about                                                               
medicine.  Why wouldn't  you  want  this to  be  under the  State                                                               
Medical Board?"                                                                                                                 
SENATOR  RALPH  SEEKINS  remembered that  originally  a  separate                                                               
board  was   discussed,  but  the  department   recommended  that                                                               
oversight be  contained within the  administration at  this time.                                                               
"It's  not that  these folks  were trying  to avoid  any kind  of                                                               
oversight of professional practices."                                                                                           
CHAIR BUNDE  said he  wasn't indicating that  at all;  rather let                                                               
doctors be judged by doctors.                                                                                                   
DR. LUPER  agreed and said  that Mr. Urion suggested  creating an                                                               
advisory board.  The complaints  would go  to the  advisory board                                                               
first,  and  it would  let  the  division  know if  a  particular                                                               
complaint is valid.  "It takes the people who would  have been on                                                               
the board  and takes them out  of state government and  puts them                                                               
in the private sector to act as an advisory board."                                                                             
SENATOR HOLLIS FRENCH asked why  naturopaths would not fall under                                                               
the purview of the State Medical Board.                                                                                         
DR. LUPER replied:                                                                                                              
     I think  it's because  the State Medical  Board doesn't                                                                    
     have  the  expertise  and   knowledge  to  know  what's                                                                    
     appropriate in  the practice of  naturopathic medicine.                                                                    
     Naturopathic doctors  will do things which  are outside                                                                    
     the  educational scope  and experience  of M.D.s  - for                                                                    
     example, the use  of herbs or the  use of homeopathics,                                                                    
     the use of physical  therapy modalities, those kinds of                                                                    
SENATOR  FRENCH  asked  if  that   problem  would  be  solved  if                                                               
naturopaths had better representation on the board, itself.                                                                     
DR. LUPER  said the M.D.s  would have to  be asked if  they would                                                               
want naturopaths on  the Medical Board. He  concluded saying that                                                               
his real passion  is for giving quality care to  his patients. He                                                               
spoke about one  of his patients who  needed an anti-hypertensive                                                               
medication right  away and  while Dr. Luper  has the  training to                                                               
write it, he can't legally do that in Alaska.                                                                                   
     In Fairbanks, where I practice,  it's difficult for him                                                                    
     to get  an appointment with another  doctor. It's three                                                                    
     weeks  out. And,  I know  exactly what  he needs.  I've                                                                    
     been trained  in knowing  what he  needs. In  Arizona I                                                                    
     can  write  the  prescription,  because I  have  a  DEA                                                                    
     license  that   allows  you  to   write  prescriptions,                                                                    
     already. But only  in Alaska am I  prevented from doing                                                                    
     what is best and appropriate for my patients.                                                                              
     So what did he do? He  went to another doctor; he spent                                                                    
     the  money. The  doctor  took his  case  and said,  'Oh                                                                    
     yeah, Doctor  Luper is right;  that's exactly  what you                                                                    
     need.' He complained. It's stories  like his that drive                                                                    
     me to  sit across from  you. I don't have  any monetary                                                                    
     gain in  this. I'm  a busy doctor.  I'm seeing  as many                                                                    
     patients as I  can see, but I want to  provide the best                                                                    
     care I  can to my patients.  Right now one of  my hands                                                                    
     is tied behind my back. I  don't use drugs very much, I                                                                    
     don't  need to.  But every  once in  a while,  in cases                                                                    
     like  that,  it's  in  the  best  interests  of  public                                                                    
     health, I think, to do that.                                                                                               
DR. CLYDE  JENSEN, Juneau, said  he is frequently called  upon to                                                               
speak at  hearings comparing educational programs  because of his                                                               
leadership   experiences   at   naturopathic,   osteopathic   and                                                               
allopathic colleges. He  has a doctorate in  pharmacology and has                                                               
been   a  faculty   member  and   chief   executive  officer   at                                                               
osteopathic,  allopathic and  naturopathic  medical schools.  The                                                               
requirements to get into these  medical schools are all the same,                                                               
the basic sciences are taught at  the same level of intensity and                                                               
for the same  number of hours. Clinical  education of naturopaths                                                               
differs  in   some  instances   from  training   for  physicians.                                                               
Naturopaths  receive stronger  training  in  areas of  nutrition,                                                               
botanical  medicine, physical  medicine  (with  the exception  of                                                               
osteopaths),  preventive  medicine  and  referrals.  Medical  and                                                               
allopathic schools  have an  advantage over  naturopathic schools                                                               
in  that  much  of  their   training  takes  place  in  inpatient                                                               
facilities.   Naturopathic   physicians  typically   don't   have                                                               
hospital  privileges.  They  don't  have the  opportunity  to  do                                                               
residencies  or other  types of  post-graduate medical  education                                                               
because  there is  no federal  reimbursement for  those types  of                                                               
programs for naturopathic physicians.                                                                                           
     In  summary,   I  have  learned   naturopathic  medical                                                                    
     students have some areas of  training that are superior                                                                    
     to, and other areas of  training that are not as strong                                                                    
     as, conventional  medicine, but most areas  of training                                                                    
     I've learned were quite comparable.                                                                                        
CHAIR BUNDE thanked him for his comments.                                                                                       
DR. DAN  YOUNG, Eagle  River, said that  Dr. Jensen's  resume' is                                                               
very  unique  and  comprehensive.  Dr.  Young  reviewed  his  own                                                               
credentials, which  were quite extensive,  as well. He  said that                                                               
Alaska is the  only state that does not allow  naturopaths a full                                                               
scope  of  practice.  The  main issues  are  inclusion  of  minor                                                               
surgery  and prescriptive  rights.  He noted  several letters  of                                                               
support  from medical  doctors, nurse  practitioners, physicians'                                                               
assistants and dentists and the  letters keep coming in. The goal                                                               
is  complementary   medicine  so  patients  get   the  best  care                                                               
possible. He wanted  the committee to understand  that some M.D.s                                                               
attend naturopathic medical schools,  under an advanced standing,                                                               
to learn naturopathic therapies.                                                                                                
     We  are  the  foremost  experts in  drug  and  nutrient                                                                    
     interactions.  My  wife [another  naturopathic  doctor]                                                                    
     specifically  who   does  women's  health,   is  really                                                                    
     limited  because  when  she   needs  to  do  conjugated                                                                    
     estrogen for one of her  patients, she cannot write for                                                                    
     that and  that is absolutely  absurd. We are  very well                                                                    
     trained in  these cutting edge therapies  and it serves                                                                    
     Alaskans for us to be able to do this.                                                                                     
DR. YOUNG pointed out that  naturopaths have been licensed for 17                                                               
years  in Alaska  and  have  been regulated  by  the Division  of                                                               
Occupational  Licensing. There  have been  very few  disciplinary                                                               
actions.  And, of  the 601  practicing  naturopaths in  Portland,                                                               
Oregon, two have committed improprieties, a very low percentage.                                                                
     So, we  practice safe medicine,  our patients  like us,                                                                    
     we  have very  low malpractice  rates and  we are  very                                                                    
     good at  what we do. We  are trained to refer  to those                                                                    
     people who  do the  thing that we  don't do,  just like                                                                    
     any primary care would do.                                                                                                 
CHAIR BUNDE thanked  him for his comments and  said the committee                                                               
would  take  this  bill  up  again, but  time  had  run  out.  He                                                               
adjourned the meeting at 3:33 p.m.                                                                                              

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