Legislature(2009 - 2010)BELTZ 105 (TSBldg)

02/09/2010 02:00 PM LABOR & COMMERCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 247 EXTENDING BOARD OF PHARMACY TELECONFERENCED
Heard & Held
*+ SB 248 EXTEND BD OF MARITAL & FAMILY THERAPY TELECONFERENCED
Heard & Held
*+ SB 117 PRICE OF CIGARETTES TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                                                                                                                                
               SB 247-EXTENDING BOARD OF PHARMACY                                                                           
                                                                                                                                
2:05:54 PM                                                                                                                    
CHAIR PASKVAN announced SB 247 to be up for consideration.                                                                      
                                                                                                                                
JIM COLVER, staff to Senator Olson,  sponsor of SB 247, said this                                                               
bill extends the  Board of Pharmacy that will sunset  on June 30,                                                               
2010. The  fiscal note  of $130,300  is to  pay staff,  board per                                                               
diem  and transportation  for three  board meetings  a year.  The                                                               
Legislative  Budget  and  Audit Division  recently  completed  an                                                               
audit of  the board and  concluded that the termination  date for                                                               
the Board of Pharmacy should be  extended until June 30, 2018. He                                                               
noted that  the termination date  in SB  247 says June  30, 2015,                                                               
and he said  the sponsor wanted the committee to  amend that date                                                               
to align it with the audit recommendation of June 30, 2018.                                                                     
                                                                                                                                
2:08:17 PM                                                                                                                    
MR. COLVER  said the audit  also recommended that  the department                                                               
should   improve  administrative   support  (for   various  small                                                               
accounting and staffing issues)  and the department has responded                                                               
that  it   is  dealing  with   those  issues.   Additionally,  it                                                               
recommended  that the  board  and  staff need  to  work with  the                                                               
Office of the Governor to  improve recruitment of qualified board                                                               
applicants to ensure a full board.                                                                                              
                                                                                                                                
He  said   SB  247  is   supported  by  the   Alaska  Pharmacists                                                               
Association.                                                                                                                    
                                                                                                                                
2:08:49 PM                                                                                                                    
SENATOR THOMAS joined the committee.                                                                                            
                                                                                                                                
2:09:37 PM                                                                                                                    
PAT DAVIDSON, Division of  Legislative Audit, Legislative Affairs                                                               
Agency, Alaska State Legislature, said  she conducted an audit of                                                               
the Board  of Pharmacy and  recommended extending it to  June 30,                                                               
2018, an eight-year extension as  provided by law. The audit also                                                               
found  that   administrative  support   by  the   department  was                                                               
insufficient for  the board to get  its work done; so  this needs                                                               
some correction.  She remarked  that her  audits have  found this                                                               
issue as well as others exist with most of the other boards.                                                                    
                                                                                                                                
Another  issue, Ms.  Davidson said,  is  that the  Office of  the                                                               
Governor did  not make timely  appointments to the  boards. These                                                               
boards  are voluntary  and take  peoples'  time, and  if a  board                                                               
doesn't  have a  full  slate  of members,  that  makes the  other                                                               
members work harder, which, in  turn, decreases their willingness                                                               
to be reappointed and makes it harder to get new members.                                                                       
                                                                                                                                
2:11:17 PM                                                                                                                    
The last  was a technical  issue, she said,  that had to  do with                                                               
collaborative  protocols.   She  explained  that   typically  one                                                               
doesn't go  to a pharmacist to  get an injection, but  in certain                                                               
circumstances a  pharmacist in association with  a physician will                                                               
go through  a collaborative protocol  that allows  the pharmacist                                                               
to  dispense  a  flu  shot,  for  instance.  She  explained  that                                                               
regulations  require  that  an   written  agreement  between  the                                                               
physician and  the pharmacist and it  has to be submitted  to the                                                               
board.  She found  that those  protocols were  for one  length of                                                               
time -  one year, but  the board  allowed that protocol  to exist                                                               
for two  years. She  recommended that the  board limit  itself to                                                               
approving those protocols  for a time limited to  what is reached                                                               
between the pharmacist and the physician.                                                                                       
                                                                                                                                
CHAIR PASKVAN said  he understands that the  two requirements are                                                               
that the doctors review the  decisions made by the pharmacists at                                                               
least once every three months and  that the doctors would get the                                                               
patient  records.  He asked  if  those  protocols were  the  ones                                                               
addressed in the audit.                                                                                                         
                                                                                                                                
MS.  DAVIDSON answered  yes. Regulations  identify those  things,                                                               
but the board wasn't necessarily  following all those regulations                                                               
in approving the protocols.                                                                                                     
                                                                                                                                
CHAIR PASKVAN  asked if some  of the agreements were  written for                                                               
periods of  time longer than the  doctor had committed to  and if                                                               
that would result  in the pharmacist dispensing  flu shots beyond                                                               
the period of time the doctor had agreed to.                                                                                    
                                                                                                                                
MS.  DAVIDSON replied  that she  didn't see  any evidence  of the                                                               
protocols actually  being enforced  beyond the  written agreement                                                               
between the  pharmacist and the physician.  However, in reviewing                                                               
those protocols the  board should make sure  that everything that                                                               
is required by regulation be  written into the protocols and that                                                               
the board limits itself to adopting  it for the timeframe that is                                                               
in the written agreement.                                                                                                       
                                                                                                                                
CHAIR PASKVAN  asked her  to more  fully explain  the cooperative                                                               
practice agreements.                                                                                                            
                                                                                                                                
MS.  DAVIDSON responded  that those  agreements were  required so                                                               
that  the  physician  could  review the  decisions  made  by  the                                                               
pharmacist  at  least once  every  three  months and  so  patient                                                               
records could be provided to  the physician. She found those were                                                               
not always specifically spelled out  in the written agreement. In                                                               
regard  to   the  timeframe,  either  the   practitioner  or  the                                                               
pharmacist  could  be confused  as  to  how  long they  would  be                                                               
allowed; so  to avoid those  sorts of confusion, it  is important                                                               
that  the  board go  through  the  written cooperative  agreement                                                               
process.  And then  limit their  approval  of that  for the  time                                                               
frame indicated in the written agreement.                                                                                       
                                                                                                                                
2:15:58 PM                                                                                                                    
CHAIR PASKVAN asked if a  template is followed for the protocols,                                                               
whether  it's for  flu shots  or  something else,  that is  board                                                               
approved and that regulations could be compared to.                                                                             
                                                                                                                                
MS. DAVIDSON replied there is no template established for those.                                                                
                                                                                                                                
CHAIR PASKVAN asked  if there is any reason they  couldn't have a                                                               
template  to  make  it  easier  to  compare  protocols  with  the                                                               
regulations.                                                                                                                    
                                                                                                                                
MS. DAVIDSON  said because the  written agreements could  cover a                                                               
wide  range  of  what  the   practitioners  and  pharmacists  are                                                               
comfortable  in  delegating,  she   didn't  know  if  creating  a                                                               
template  would necessarily  be  beneficial. Practitioners  would                                                               
probably change things to fit their individual circumstances.                                                                   
                                                                                                                                
2:18:13 PM                                                                                                                    
CHAIR PASKVAN found no questions on recommendation 1.                                                                           
                                                                                                                                
SENATOR MEYER commented  that he had already heard SB  247 in the                                                               
Legislative Budget and  Audit Committee and he  was very familiar                                                               
with it.                                                                                                                        
                                                                                                                                
CHAIR PASKVAN  said recommendation 2 identified  deficiencies and                                                               
the first one  was errors in license statistics; he  asked her to                                                               
more fully explain that.                                                                                                        
                                                                                                                                
MS.  DAVIDSON responded  that an  annual report  is prepared  for                                                               
each  of  the boards  to  give  an  idea  of its  activities.  It                                                               
identifies how many  new licenses were issued,  how many renewals                                                               
there were; some  boards that have license  by credentials versus                                                               
examination will break  those out. They will also  talk about non                                                               
licensing statistics  like investigations and actions  taken as a                                                               
result of investigations,  for instance. She said  that she would                                                               
talk  about  this recommendation  a  lot  because she  has  found                                                               
different  types  of  licensing statistics  errors  in  different                                                               
boards.  This  is  one  of  the things  she  saw  when  verifying                                                               
statistics that were included in annual reports.                                                                                
                                                                                                                                
CHAIR  PASKVAN  said  a  paragraph  on page  8  addressed  a  key                                                               
administrative  staff  member  that   was  both  unqualified  and                                                               
untrained. He asked how a key person could get that position.                                                                   
                                                                                                                                
MS. DAVIDSON deferred that answer to the department.                                                                            
                                                                                                                                
CHAIR PASKVAN asked if this board had more turnover than others.                                                                
                                                                                                                                
MS. DAVIDSON replied  that her experience with  boards in general                                                               
is  that  they have  a  higher  turnover  rate because  they  are                                                               
relatively  entry level  positions and  better opportunities  are                                                               
available elsewhere.                                                                                                            
                                                                                                                                
CHAIR PASKVAN  said language on  page 8 says "may  provide policy                                                               
makers with  misleading information" and  he wanted to  know what                                                               
types of information that would be.                                                                                             
                                                                                                                                
MS.  DAVIDSON explained  that goes  back to  the annual  reports;                                                               
various boards have  issues come up that may rise  to a very high                                                               
level or may  be dealt with at  a board level. As  an example, if                                                               
insufficient pharmacists were a  concern, and if their statistics                                                               
were  understated by  100 or  200 percent,  a situation  would be                                                               
created where  someone who is  relying on that  information would                                                               
come to  a bad  conclusion. Or  if someone  was using  the annual                                                               
reports to  monitor numbers of  physician assistants or  EMTs for                                                               
the   Medical  Board,   for  instance,   or   to  correlate   the                                                               
relationship  between  the  number  of  licensees  and  what  the                                                               
university is doing,  when you have bad statistics,  you will get                                                               
bad policy  information. What she  was trying to express  is that                                                               
these data  get published  and people will  use it.  She asserted                                                               
also, "It comes from a state agency; it should be good data."                                                                   
                                                                                                                                
CHAIR  PASKVAN   asked  if  misleading  information   extends  to                                                               
budgeting  issues and  if turnover  of  key administrative  staff                                                               
members was one of her concerns.                                                                                                
                                                                                                                                
2:24:23 PM                                                                                                                    
MS.  DAVIDSON  replied  that  she  didn't  look  at  staffing  in                                                               
particular;   boards  and   commissions   are  financially   self                                                               
supporting.  Their  conclusion  with  regards  to  the  Board  of                                                               
Pharmacy  is  that it  has  no  financial deficits,  because  the                                                               
licensees themselves pay for those things.                                                                                      
                                                                                                                                
2:25:18 PM                                                                                                                    
CHAIR PASKVAN asked if the fee  that is being assessed isn't high                                                               
enough, would  that indirectly affect  being able to  hire enough                                                               
people to do the work.                                                                                                          
                                                                                                                                
MS. DAVIDSON  replied that she  hadn't looked at  staffing enough                                                               
to make  any recommendations  about it  and maybe  the department                                                               
would want to address it.                                                                                                       
                                                                                                                                
2:25:48 PM                                                                                                                    
CHAIR PASKVAN  found no questions  on recommendation 2 on  page 8                                                               
and  went to  the  last recommendation  on page  9  and said  the                                                               
number of  vacancies that are  identified goes to the  core issue                                                               
of consumer protection and asked if she could add anything.                                                                     
                                                                                                                                
MS.  DAVIDSON  replied that  it  goes  back to  maintaining  good                                                               
membership on  the boards so  that work  can get done.  You don't                                                               
want the  occupational boards to  be so  focused on what  is good                                                               
for  the occupation.  If the  state is  going to  be involved  in                                                               
regulating an occupation, there has to  be a good public need for                                                               
it and  that is where  the public members, particularly,  bring a                                                               
valuable perspective. So  when it's a public  member vacancy, not                                                               
only  does  everybody  else  have  a  bigger  work  load,  but  a                                                               
different point of view is missing from deliberations.                                                                          
                                                                                                                                
CHAIR PASKVAN asked  if she has come across  an "unwillingness or                                                               
uneasiness" with either  the public or professional  members of a                                                               
board   about   sitting  on   it   because   of  APOC   reporting                                                               
requirements.                                                                                                                   
                                                                                                                                
MS.  DAVIDSON answered  that the  members of  the board  that she                                                               
talks to  are already  appointed and they  would already  be over                                                               
that hurdle. But  that might come up from people  who decided not                                                               
to apply to serve  on a board. That might be  a good question for                                                               
the Governor's Office in terms of  what sort of barriers they are                                                               
having in getting board members.                                                                                                
                                                                                                                                
CHAIR PASKVAN asked if she  has come across instances where there                                                               
just  wasn't  an  applicant  for  a board  position  or  where  a                                                               
qualified applicant was just not being appointed.                                                                               
                                                                                                                                
MS.  DAVIDSON replied  that the  audit  just looked  at how  many                                                               
vacancies there were.                                                                                                           
                                                                                                                                
2:29:27 PM                                                                                                                    
SENATOR  MEYER remarked  that one  member resigned  because of  a                                                               
direct financial  interest in the  health care industry.  How big                                                               
of  an issue  is that?  He said  you would  want people  who have                                                               
knowledge of  the pharmaceutical industry  on the board.  He then                                                               
asked how  they determine whether  or not a conflict  of interest                                                               
is too great; is it a subjective call?                                                                                          
                                                                                                                                
MS. DAVIDSON answered that the  generic law for public members is                                                               
that they  can't have  a financial  interest in  that occupation.                                                               
However, this  board in particular  has a requirement  in statute                                                               
that the public  member cannot have direct  financial interest in                                                               
the health care industry.                                                                                                       
                                                                                                                                
SENATOR MEYER asked how direct  financial interest is defined. Is                                                               
owning stock in a hospital a health care interest?                                                                              
                                                                                                                                
MS. DAVIDSON answered  that she didn't know  the specific details                                                               
on this one.  However, what happened to this public  member is he                                                               
passed through  when he was  appointed, but then he  changed jobs                                                               
once he was  a board member and that created  a conflict with the                                                               
statute.  She explained  that during  the audit  they ask  public                                                               
members  to certify  that  they meet  the  requirements and  this                                                               
member was unwilling to do that.                                                                                                
                                                                                                                                
2:31:45 PM                                                                                                                    
JENNIFER    STRICKLER,    Operations   Manager,    Division    of                                                               
Corporations, Business and  Professional Licensing, Department of                                                               
Commerce, Community  and Economic Development (DCCED),  said they                                                               
would probably  hear recommendation  2 repeated for  every sunset                                                               
audit report. She said unfortunately  the division went through a                                                               
couple of  "rough years" with  an administrative officer  who was                                                               
not "very accounting savvy" and  he didn't educate himself. Since                                                               
he moved  on, someone  with an  accounting background  was hired.                                                               
Mistakes were corrected to such a  degree that some of the boards                                                               
are now pleased with the budget reports they are getting.                                                                       
                                                                                                                                
MS. STRICKLER explained that the  Board of Pharmacy, for example,                                                               
gets   direct   support  from   the   licensing   unit,  but   an                                                               
administrative unit  handles all of the  budgetary and accounting                                                               
information. The enforcement unit  does enforcement. The problems                                                               
they  ran   into  were   in  the   administrative  unit   in  the                                                               
Professional  Licensing  area.  She recalled  that  Ms.  Davidson                                                               
mentioned the  entry level licensing  examiners are range  13 and                                                               
while they  had tried to  get them reclassed higher,  they hadn't                                                               
been successful. That  is not where the issues  lie, however; she                                                               
said  it  was   with  the  group  that   provides  the  licensing                                                               
statistics  to the  administrative group.  The problem  came with                                                               
the  former administrative  officer  she had  just mentioned  who                                                               
didn't  educate  himself  about   their  accounting  system.  For                                                               
several years, although the writing  on the wall, this person was                                                               
her peer and he was allowed to stay.  She said it is a shame that                                                               
this problem  had to  get such  a level before  he moved  on. The                                                               
report said that "known procedures  were in place" and they were,                                                               
but they  had been  "thrown out" by  this individual,  which made                                                               
the problem worse.   She has taken great strides  to recreate the                                                               
procedures and to correct a lot of the mistakes.                                                                                
                                                                                                                                
CHAIR PASKVAN  asked if some of  the high turnover was  a product                                                               
of the unqualified and untrained person.                                                                                        
                                                                                                                                
MS. STRICKLER answered yes; she  said there was great turnover in                                                               
the  administrative  and licensing  staff;  but  turnover in  the                                                               
licensing areas  of all  of the  programs is  because of  the pay                                                               
level of that job class.                                                                                                        
                                                                                                                                
CHAIR PASKVAN asked  if the fees being  charged the professionals                                                               
are  sufficient  for  members  of  the  board  to  operate  in  a                                                               
responsible manner.                                                                                                             
                                                                                                                                
MS. STRICKLER answered yes; in fact,  the fees will be lowered by                                                               
$100 across all categories that pay more than $200.                                                                             
                                                                                                                                
2:36:45 PM                                                                                                                    
CHAIR PASKVAN asked  how the fee can be lowered  and services can                                                               
still  be   adequately  provided  -  focusing   on  the  consumer                                                               
protection aspect.                                                                                                              
                                                                                                                                
MS. STRICKLER replied that because  of posting errors in the cost                                                               
accounting  system (direct  and indirect  costs of  expenditures)                                                               
caused by the former employee she  went back and compared that to                                                               
what  is  in the  state's  accounting  system.  She found  a  big                                                               
disparity; so everything was corrected  and now matches the state                                                               
accounting   system  to   date.  Fortunately,   this  board   had                                                               
accumulated a surplus which allows the fee to be lowered now.                                                                   
                                                                                                                                
CHAIR PASKVAN found no questions regarding recommendation 2.                                                                    
                                                                                                                                
2:37:54 PM                                                                                                                    
SENATOR THOMAS asked if this area is in good shape now.                                                                         
                                                                                                                                
MS. STRICKLER replied "yes."                                                                                                    
                                                                                                                                
2:38:21 PM                                                                                                                    
CHAIR  PASKVAN  went to  the  issue  of policy  makers  receiving                                                               
misleading information  and he  wanted to know  if he  was asking                                                               
the right question.                                                                                                             
                                                                                                                                
MS. STRICKLER  responded that  any information  he sees  from the                                                               
boards  to  date  will  be   accurate.  The  possible  misleading                                                               
information would  be incorrect  licensing statistics -  not from                                                               
the licensing staff that had  accurate information - but from the                                                               
financial  person  it  was  submitted to  in  the  division  that                                                               
prepares the annual reports.                                                                                                    
                                                                                                                                
2:39:48 PM                                                                                                                    
CHAIR PASKVAN found no further  questions on SB 247 and concluded                                                               
public testimony  for the  day. So  SB 247  was held  for further                                                               
work.                                                                                                                           

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