Legislature(2003 - 2004)
02/19/2004 01:35 PM Senate L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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 enhanced. 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 studies. 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 doctors). 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 instruction. 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 material. 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 things. 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.