Sunset review of the Board of Homeopathic Medical Examiners

              Arizona House of Representatives
House Majority Research
MEMORANDUM
Kristine StoddardW
Assistant Legislative Research Analyst
(602) 926-5299
To: JOINT LEGISLATIVE AUDIT COMMITTEE
1700 W. Washington
Phoenix, AZ 85007-2848
FAX (602) 417-3140
cc: Representative Rick Murphy, Chair
Senator Jim Waring, Vice-Chair
Re: Sunset Review of the Board of Homeopathic Medical Examiners
Date: December 2, 2005
Attached is the fin~ report ofthe sunset review ofthe Board ofHomeopathic Medical Examiners,
which was conducted by the Senate Health and House ofRepresentatives Health Committee of
Reference.
This report has been distributed to the following individuals and agencies:
Governor ofthe State ofArizona
The Honorable Janet Napolitano
President ofthe Senate
Senator Ken Bennett
Senate Members
Senator Jim Waring, Vice-Chair
Senator Carolyn Allen
Senator Marsha Arzberger
Senator Robert Cannell
Senator Barbara Leff
Board of Homeopathic Medical Examiners
Department of Library, Archives & Public Records
Auditor General
Senate Republican Staff
Senate Research Staff
Senate Democratic Staff
Speaker ofthe House ofRepresentatives
Representative Jim Weiers
House Members
Representative Rick Murphy, Chair
Representative David Bradley
Representative Laura Knaperek
Representative Linda Lopez
Representative Doug Quelland
House Majority Staff
House Research Staff
House Democratic Staff
Senate Health and House ofRepresentatives Health
Committee ofReference Report
Board ofHomeopathic Medical Examiners
Date: December 2, 2005
To: Joint Legislative Audit Committee
Representative Rick Murphy, Chair
Senator Jim Waring, Vice-Chair
Background
Pursuant to Arizona Revised Statutes (ARS) §41-2953, the Joint Legislative Audit
Committee (JLAC) assigned the sunset review of the Board of Homeopathic Medical
Examiners (Board) to the Senate Health and House of Representatives Health Committee
of Reference.
The Board was established by the Legislature in 1980. Its mission is to protect the health,
safety and welfare of Arizona citizens by examining, licensing and regulating
homeopathic physicians. According to ARS §32-2904, the Board is responsible for
issuing licenses, conducting all examinations for license applications, holding hearings,
and regulating the conduct of those licensed by the Board. The Board also reviews and
registers homeopathic medical assistants. The Board is authorized to adopt rules, accredit
educational institutions in Arizona which grant the degree of doctor of medicine in
homeopathy, hire staff, and adopt rules to establish competency or professional review
standards for any minor surgical procedure.
Committee ofReference Sunset Review Procedures
The Committee of Reference held one public meeting on November 8, 2005 to review the
Board's responses to the sunset factors as required by ARS §41-2954, subsections D and
F, and to hear public testimony.
Committee ofReference Recommendations
The Committee of Reference recommends that the Board continue for two years and
requested the Auditor General conduct a special audit of the Board.
Attachments:
1. Sunset report requirements pursuant to ARS §41-2954, subsections D and F.
2. Meeting notice.
3. Minutes of the Committee of Reference meeting.
Arizona House of Representatives
House Majority Research
MEMORANDUM
Kristine Stoddard ~
Assistant Legislative Research Analyst
(602) 926-5299
1700 W. Washington
Phoenix, AZ 85007-2848
FAX (602) 417-3140
To: Members of the House and Senate Health Committees of Reference
Re: Sunset Review of the Board of Homeopathic Medical Examiners
Date: October 26, 2005
The Arizona Board ofHomeopathic Medical Examiners (Board) is scheduled to sunset July 1,2006.
The following is a brief description ofthe history and duties ofthe Board, as well as the Board's
response to the sunset questionnaire. A public meeting is scheduled for November 8, 2005 to allow
you to ask questions ofthe Board, take public testimony, and make a [mal recommendation on the
Board's continuation. Ifyou have any questions or need further assistance, please feel free to contact
me.
BOARD mSTORY AND MISSION
The Board was established by the Legislature in 1980. Its mission is to protect the health, safety
and welfare of Arizona citizens by examining, licensing and regulating homeopathic physicians.
According to Arizona Revised Statues (ARS) §32-2901, homeopathy is defined as "a system of
medicine that employs homeopathic medication in accordance with the principle that a substance
that produces symptoms in a healthy person can cure those symptoms in an ill person." Further,
homeopathic medication is defined as "a substance of animal, vegetable or mineral origin that is
./
prepared according to homeopathic pharmacology and that is given usually in a homeopathic
microdosage." Kinesiology, chelation therapy, orthomolecular therapy and nutritional therapies
are all examples of acceptable standards ofpractice within the homeopathic community.
October 26, 2005
ORGANIZATION AND DUTIES
The Board consists of the following six members: four licensed homeopathic physicians and two
public members. Board members serve staggered three year terms. Board members cannot
serve more than three consecutive terms. According to ARS §32-2904, the Board is responsible
for issuing licenses, conducting all examinations for license applications, holding hearings, and
regulating the conduct of those licensed by the Board. The Board reviews and registers
homeopathic medical assistants. The Board is authorized to adopt rules, accredit educational
institutions in Arizona which grant the degree of doctor of medicine in-homeopathy, hire staff,
and adopt rules to establish competency or professional review standards for any minor surgical
procedure.
According to the Board, individuals applying for licensure undergo a lengthy application process
that includes the verification of medical educational credentials, verification of the active status
of MD and/or DO licenses in Arizona or any other state or territory of the United States, and
reviews the 300 hours of post graduate education an applicant must complete in homeopathic
modalities. The Board does not require that their licensees maintain both an allopathic (or
osteopathic) medical license in addition to the homeopathic license.
The Board stated in its sunset response that it has improved its complaint processing times from
an average of 140 days in FY 2004 to an average of 69.3 days in FY 2005. In FY 2004, the
Board reviewed 10 complaints and in FY 2005 the Board reviewed 22. The Board also stated
that over the past two years the number of complaints involving dual-licensed physicians
(licensed by both the Board of Homeopathic Medical Examiners and the Arizona Medical
Board) physicians has increased. The Board believes that the new procedures instituted by the
Arizona Medical Board have resulted in a more efficient process that allows both boards to
review complaints involving dual-licensees.
2
October 26, 2005
FISCAL ISSUES
Pursuant to ARS §32-2906, the Board is required to deposit ten per cent of all monies collected
into the State General Fund and the remaining ninety per cent into the Board of Homeopathic
Medical Examiners' Fund. In Fiscal Year 2005, the Board had one full-time employee (FTE)
and a budget of$77,300.
LEGISLATIVE ISSUES
The Board is requesting legislation to repeal ARS §32-2914(A)(l4), which requires the Board to
establish a fee of no greater than $50 for triennial registration of supervision of a homeopathic
medical assistant. The Board believes that the fee is "counterproductive to the intent of
registering homeopathic medical assistants, penalizes the supervisor and is difficult to enforce."
The Board is also requesting that the definition of unprofessional conduct, stipulated by ARS
§32-2933, be amended in order to "align" the language to that of the Arizona Medical Board and
Arizona Board of Osteopathic Medicine.
ADDITIONAL BACKGROUND
Staff contacted individuals and agencies that work with the Board to discuss their working
relationships with the Board.
Lisa E. Platt from the Arizona Homeopathic and Integrative Medical Association CAHIMA)
stated that the AHIMA feels that the Board serves the public and its high standards protect the
public by licensing doctors who have a higher level of education, are knowledgeable and well
known in" their fields. Ms. Platt also stated that the AHIMA licensees support the Board's
decisions.
According to Ms. Platt, the AHIMA has a good working relationship with the Board and believes
that the Board's existence has "enabled Arizona to become a leader and the nation's center of
Holistic Medicine." The AHIMA supports a 10-year renewal of the Board and believes that the
Board sees that highly qualified licensed physicians provide patient care.
3
x
Charles Schwengel, DO, MD(H)
President
Annemarie Welch MD, MD(H)
Vice-President
Don Farris
Secretary-Treasurer
ARIZONA STATE BOARD OF HOMEOPATIDC MEDICAL E-XA-M-I-NE-R-S ------ 1400 West Washington, Suite 230, Phoenix, Arizona
85007
(602) 542-8154 phone· (602) 542-3093 fax
email bhme@mindspring.com
Janet Napolitano
Governor
August 30, 2005
Rick Murphy
State Representative
Chair, Health Committee ofReference
Arizona House ofRepresentative
1700 West Washington, Suite H
Phoenix, Arizona 85007-2844
RE: Sunset Review Response to Joint Legislative Audit Committee:
Dear Representative Murphy:
The Board ofHomeopathic Medical Examiners hereby submits its responses to the June 30, 2005
letter submitted regarding the Joint Legislative Audit Committee pending sunset review ofthe
Board.
1. The objective and purpose in establishing the agency.
The Board was established in 1981 to examine and license physicians (either M.D. or D.O.) that
practice homeopathic medicine. The Board also reviews and registers homeopathic medical
assistants and is statutorily approved to accredit education institutions in the state that grant the
degree of doctor ofmedicine in homeopathy. The Board issues dispensing permits. The Board
regulates the conduct of licensees by investigating complaints. The Board may discipline
physicians that are found to have violated laws related to professional conduct as described in
A.R.S.32-2933.
2. The effectiveness with which the agency has met its objective and purpose and the
efficiency with which it has operated.
The Board operates efficiently at the current level oflicensees and number of complaints
received. One 30-hour per week employee serves as executive director and is charged with
preparing physician and medical assistant applications for Board review, gathering information
on complaints for submission to the Board for disposition, effectively responding to state
requirements related to auditing, administrative time-lines, information technology requirements,
inventory and other miscellaneous and extraneous reports, as well as budgeting, rulemaking, and
responding to consumer inquiries.
The Board has met its objective and purpose to license physicians that practice homeopathic
medicine. Applicants undergo a lengthy application process that verifies the medical educational
credentials ofapplicants, verifies active status ofMD and/or DO licenses in this state, any other
Arizona Board ofHomeopathic Medical Examiners
Sunset Review Response
state, or territory ofthe United States, and reviews the 300 hours of post graduate education an
applicant must complete in modalities defined in A.R.S. §32-290l(22) as the ''practice of
homeopathic medicine n.
The Board believes they have met their objective to respond effectively to consumer complaints,
provide information to the public on the status of licensees, and direct consumers to appropriate
sources if they seekfurther information or education about homeopathic practices.
3. The extent to which the agency has operated within the public interest.
The Board operated within the public interest in several ways that include updating the Board's
web site to provide access to a list oflicensees, on-line application forms, links to statutes and
rules and posting of board minutes and agendas.
While being aware that complaint reviews can be quite time-consuming and involve referrals to
the Superior Court which can impact the overall timeframe given to the resolution of complaints,
the Board has improved its complaint processing times from an average of 140 days in Fiscal
Year 2004 to and average of 69.3 days in Fiscal Year 2005. In addition, the number of
complaints has increased because of a greater awareness by the Arizona Medical Board that their
licensees are dual licensed by the Board of Homeopathic Medical Examiners. Referrals from the
Arizona Medical Board and the Osteopathic Medical Board have resulted in more complaint
reviews but more effective time frames. As an example in Fiscal Year 2004 the Board reviewed
10 complaints. In Fiscal Year 2005 the number of complaints received jumped to 22.
The Board has met its published time frames with regard to processing license and registration
applications.
4. The extent to which rules adopted by the agency are consistent with legislative
mandate.
Adopted rules are consistent with legislative mandate. The Board has revised A.A. C. Chapter 38,
Article 1 andArticle 2 within the last two years in response to recommendations published in its
Five Year Rules Review. The Board is currently revisingA.A.C. Chapter 38, Article 3.
5. The extent to which the agency has encouraged input from the public before
adopting its rules and the extent to which it has informed the public as to its actions and
their expected impact on the public.
As indicated in number 4 above, the Board has revised A.A. C. Chapter 38, Article 1 andArticle
2. Before adopting the rules, the Board mailed copies ofthe proposed rules to all licensees,
associations, and other state agencies that would be considered stakeholders. Notices were
published according the Arizona Administrative Procedures Act and public hearings were held in
Phoenix, with advance notice provided to all licensees and professional associations well in
advance ofpublication ofthe Notice ofFinal Rulemaking. The Board believes it has provided
adequate and legal notice to all interested and affected parties prior to adoption ofrules.
The expected impact ofthe rules has been discussed in published economic impact statements.
No negative comments were received by the Board in either recent rulemaking.
6. The extent to which the agency has been able to investigate and resolve complaints
that are within its jurisdiction.
The Board has been able to investigate complaints within its jurisdiction. Overall, the number of
complaints increased in the last fiscal year, but the overall time frame to resolve them has
improved from an average of 140 days in 2004 to an average of 69.3 days in 2005. The
- - 2 --
Arizona Board of Homeopathic Medical Examiners
Sunset Review Response
percentage of complaints resolved within 120 days has increased from 40% in 2004 to 77% in
2005.
The number of complaints involving dual-licensed (licensed by both the Board of Homeopathic
Medical Examiners and the Arizona Medical Board) physicians increased over the last two years.
The Arizona Medical Board instituted procedures that resulted in a more efficient process that
allowed both boards to review complaints involving dual-licensees within the parameters of
A.R.S. §32-2907. We continue to work with Arizona Medical Board staff to resolve any issues
that hamper either board's ability to complete their investigation, including complaints involving
primarily homeopathic treatments that fall clearly within the jurisdiction ofthe Board of
Homeopathic Medical Examiners.
The Board strives to educate the complainant about the complaint process and address their
concerns first and foremost. The Board's website includes information regarding the complaint
process and explanatory information is sent to complainants and physicians regarding the
complaint process in the first written communication acknowledging that a complaint has been
received.
7. The extent to which the Attorney General or any other applicable agency ofstate
government has the authority to prosecute actions under the enabling legislation.
Judicial review of suspension or revocation of a license is available as provided in Title 12,
Chapter 7, Article 6. The Board may seek injunctive relief through the attorney general or the
county attorney may apply to the superior court ofMaricopa County for an injunction restraining
individuals from violating the statutes governing the Board.
8. The extent to which the agency has addressed deficiencies in its enabling statutes
that prevent it from fulfilling its mandate.
and
9. The extent to which changes are necessary in the laws of the agency to adequately
comply with these factors.
The Board fulfills its mandate. A.R.S. §32-2914 (A)(14) should be repealed. The fee is counter­productive
to the intent ofregistering homeopathic medical assistants, penalizes the supervisor,
and is difficult to enforce.
A.R.S. §32-2933 regarding unprofessional conduct should be reviewed to determine what
language should be included to align the statute to language found within the professional
conduct statutes ofthe Arizona Medical Board and the Arizona Board of Osteopathic Medicine.
Historically, all three boards have similar professional conduct statutes.
10. The extent to which the termination of the agency would significantly harm the
public, health, safety or welfare.
The Board serves as a valuable liaison to citizens of the state seeking information regarding
homeopathic care. Without the Board's regulatory and enforcement activities that provide
oversight the public could be subject to unprofessional or deceptive practices. Individuals seek
alternative medical care either as a complement to their allopathic care or as their sole care based
on years of frustrating experience in the more traditional approach to medical care. As consumers
become more educated in seeking medical care, alternative care including homeopathy remains a
viable option. Many of the calls that come to the Board check the validity of practitioner's
credentials. The consumer seeks the consistency and professionalism that a regulatory
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Arizona Board ofHomeopathic Medical Examiners
Sunset Review Response
mechanism brings to a profession while at the same time seeking to have ready access to
homeopathic care.
11. The extent to which the level of regulation exercised by the agency is appropriate
and whether less or more stringent levels of regulation would be appropriate.
The level ofregulation is appropriate for the community the legislation was intended to oversee.
Gauged by the number of complaints referred to the Board for review there does not appear to be
a perception in the public's eyes that the Board is lax in their oversight of the licensed physicians.
Staff interactions with individuals seeking to find a homeopathic practitioner indicate that a
majority ofthe consumers ofthis type of health care are educated and very well versed in
describing the type of care they seek and are aware of efforts they may be called to make with
regard to lifestyle and diet modifications.
Ofcontinuing challenge to the Board concerns the unlicensed, but well trained homeopathic lay
practitioner. Often these practitioners will seek to comply with Arizona's laws (A.R.S. 32­2931(
A) and (B» concerning the practice ofhomeopathy and will serve as homeopathic medical
assistants under the direct supervision of a licensed homeopathic physician. They provide a
valuable and competent adjunct therapeutic service within the practices of the licensed
homeopathic physicians.
However, the other side ofthe landscape is that there are homeopathically trained lay
practitioners that work outside the regulatory framework of physician supervision and the
potential exists for harm to Arizona citizens. In the last ten year sunset cycle two lay practitioners
created a dangerous outcome for Arizona citizens. One citizen died and the other citizen's health
was severely compromised and medical costs associated with rehabilitation to a healthful state
remains a state funding issue under AHCCCS. The Board remains dedicated to the protection of
the health, safety, and welfare of the citizens ofArizona. Consumer education is an important
board priority. There are many reasons citizens may seek unlicensed healthcare practitioners
including lack ofmoney, a disease state that makes ones ability to logically consider the adverse
consequence of a particular therapy, the need to feel protected by a cult-like, all knowing
"spiritual" figure, and the feeling that the traditional medical establishment is not to be trusted.
The Board would urge the legislature to consider an additional layer of regulation directed at the
homeopathic lay practitioner.
12. The extent to which the agency has used private contractors in the performance of
its duties and how effective use of private contractors could be accomplished.
Due to budgetary considerations the Board has not utilized private contractors to a large extent.
CUlTently, the Board utilizes an outside contractor to update and install program enhancements to
its website. Again, budgetary restraints have kept the Board from installing more than a select
targeted enhancement to its website each fiscal year.
The executive director provides rulemaking support to the Board and works closely with the
Governors Regulatory Review Council to meet statutory and administrative requirements.
The Board could effectively utilize private contractors in the areas of website enhancement, rule
writing, and the preparation of medical investigative reports. However, without adequate funds
from a larger license base an increased utilization of private contractors is not anticipated.
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Arizona Board of Homeopathic Medical Examiners
Sunset Review Response
Additional questions
1. An identification ofthe problem or the needs that the agency is intended to address.
The Board is charged with licensing homeopathic physicians. The applicants must have an active
M.D. or D.O. license at the time of initial licensure. Because ofthe unique nature of a
homeopathic, rather than allopathic or osteopathic approach to addressing patient's health needs,
the Board provides a licensing framework for physicians who practice homeopathy and other
modalities defined inA.R.S. §32-2901(22) as the practice ofhomeopathic medicine. In addition,
patients that seek a homeopathic approach to the management oftheir health conditions rely on
the Board to enforce standards of practice that may not be compatible with standards of practice
within the allopathic medical community; but that, nonetheless, provide relief for many patients.
Examples of standards of practice acceptable in the scope ofpractice within the homeopathic
community include kinesiology, chelation therapy (for other than the removal ofheavy metals),
orthomolecular therapy (ie. IV's that provide the optimum concentration of substances normally
present in the human body such as vitamins, minerals, amino acids and enzymes), or nutritional
therapies.
In the interest ofproviding alternative therapies to sometimes chronically sick patients, dual
licensed physicians (licensed by the Homeopathic Board of Examiners and either the Arizona
Medical Board or the Osteopathic Board ofMedical Examiners) are sometimes faced with
providing their patient a requested therapy that may be considered "experimental" within the
standard of care ofthe allopathic community but acceptable within the standard of care in the
homeopathic community. The Homeopathic Board ofMedical Examiners ultimately provides
choice and protection to the health, safety, and welfare of consumers that seek alternative care. In
addition, the Board provides an educational framework and enforcement model for its licensees
that offer a particular modality and a defmed standard ofpractice to the consumers that seek out
homeopathic medicine or one ofthe other modalities that make up the practice ofhomeopathic
medicine in Arizona. .
2. A statement, to the extent practicable, in quantitative and qualitative terms, of the
objectives of such agency and its anticipated accomplishments.
The Board remains dedicated to enhancing its web presence to promote greater access to
information regarding licensees, complaints, and practice locations. The current website does not
list physician addresses or complaint information. Unanticipated costs associated with increased
health insurance costs absorbed by the Board and joint office costs will draw down the Board's
2006 appropriation and bar further website enhancements. In July, 2005, new rules were
approved that will raise additional revenue, the bulk ofwhich will be realized in spring, 2006. A
primary objective ofthe Board is to complete website enhancements as indicated above.
Hand in hand with the website enhancements will be the completion of a catalogue of closed
complaints. It is the intention ofthe Board to make the current year and five previous years
available on-line. By making the information readily available to the public, staff time will be
freed up for other duties and consumers will have an objective history of a physician's
disciplinary record.
The second primary objective is to convert the Lotus Approach database to Access. The current
database, developed in 1997 is difficult to program and the Lotus software version is not
supported by Windows XP which necessitates maintaining the database on an aging computer
with a Windows 98 operating system. The conversion ofthe database to Access would free up
staff time currently utilized by the need to 'jerry-rig' the Lotus Approach database to provide
reporting capabilities not conceptualized in the original programming effort.
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Arizona Board of Homeopathic Medical Examiners
Sunset Review Response
3. An identification of any other agencies having similar, conflicting or duplicate objectives,
and an explanation of the manner in which the agency avoids duplication or conflict with
other such agencies.
The Arizona Medical Board and the Osteopathic Board of Medical Examiners licenses allopathic
and osteopathic physicians within Arizona. Although the licensing qualification ofthe physician
seeking licensure under the Board of Homeopathic Medical Examiners is similar in that each of
the Boards require graduation from an accredited medical or osteopathic medical college, or
completion of a Fifth Pathway Program, the Board also requires additional post-graduate
education in modalities that make up the practice of homeopathic medicine in Arizona. These
include acupuncture, nutrition, homeopathy, orthomolecular medicine, neuromuscular integration,
minor surgery, pharmaceutical medicine, and chelation therapy. The Board's rules provide
standards that applicants must meet to practice as a homeopathic physician and create choice for
the Arizona consumer seeking treatment outside the allopathic or osteopathic medical paradigm.
The standards provide a regulatory framework by which the Board regulates the physicians
seeking to practice certain alternative methods. Additional rules provide definitions ofwhat
constitutes experimental medicine and gives guidance to the Board as they investigate
complaints.
Naturopathic physicians also practice homeopathic medicine in Arizona. However, the
educational criteria for naturopathic physicians differs from the educational criteria required of
the homeopathic physician. In addition, the emphasis on the application of herbal remedies
differs from the practice ofhomeopathic medicine defmed in A.R.S. §32-2901(22).
A.R.S. §32-2907 provides guidance in those instances where a complaint is filed against a
physician dual-licensed by either ofthe traditional medical boards and the Homeopathic Medical
Examiners.
4. An assessment of the consequences of eliminating the agency or of consolidating it with
another agency.
The elimination of the Board would result in some of the licensed homeopathic physicians
loosing their ability to provide healthcare services in Arizona. The Board does not require that
their licensees maintain both an allopathic (or osteopathic) medical license in addition to the
homeopathic license. While many of the Board's licensees hold a traditional license in another
state it does not follow that they hold an Arizona M.D. or D.O. The elimination ofthe Board
would result in fewer physicians practicing medicine within Arizona.
The ability of consumers to seek alternative medical care would also suffer were the Board to be
eliminated. While physicians licensed by the Arizona Medical Board and the Osteopathic Board
of Medical Examiners may consider practicing one of the alternative modalities in Arizona, to do
so can have serious consequences under the standard of practice act ofthe traditional boards. The
fear ofretribution by the traditional board effectively bars experimentation or even the provision
of something as essentially helpful as nutritional counseling to assist patients in making healthful
lifestyle changes. Consumers demand and expect choice in their medical care.
It is unlikely that a consolidation would address what has historically been an uneasy relationship
between the Arizona Medical Board and the Board of Osteopathic Medical Examiners. Although
current procedures in place at the Arizona Medical Board herald a respectful consideration ofthe
practices recognized by the laws governing the Homeopathic Medical Board, it is unlikely that
the traditional boards would expand their scope of practice to accommodate homeopathic
modalities.
--6--
Arizona Board ofHomeopathic Medical Examiners
Sunset Review Response
Request for annual report
Please note, the Board does not publish an annual report. A copy ofthe Strategic Plan is enclosed
and will address many ofthe questions you may have regarding the number of current licensees,
the number of applications acted upon and complaint data.
If you have further questions do not hesitate to contact me.
Sincerely,
Christine Springer
Executive Director
Enclosures
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Interim agendas can be obtained via the Internet at http://www.azleg.state.az.usllnterimCommittees.asp
ARIZONA STATE LEGISLATURE
INTERIM MEETING NOTICE
OPEN TO THE PUBLIC
SENATE HEALTH AND HOUSE OF REPRESENTATIVES HEALTH
COMMITTEE OF REFERENCE FOR THE:
SUNSET OF THE HEALTH FACILITIES AUTHORITY
SUNSET OF THE MEDICAL RADIOLOGIC TECHNOLOGY BOARD OF EXAMINERS
SUNSET OF THE NURSING CARE INSTITUTION ADMINISTRATION AND ASSISTED LIVING
SUNSET OF THE BOARD OF HOMEOPATHIC MEDICAL EXAMINERS
SUNRISE REQUEST OF THE ARIZONA ASSOCIATION FOR HOME CARE
SUNRISE REQUEST OF THE ARIZONA MIDWIFERY INSTITUTE
SUNRISE REQUEST OF THE ARIZONA ALLIANCE OF SURGICAL SPECIALISTS
Date:
Time:
Place:
Tuesday, November 8,2005
9:00 a.m.
House Hearing Room 1
AGENDA
1. Call to Order - Opening Remarks
2. Health Facilities Authority
• Presentation by the Health Facilities Authority
• Public Testimony
• Discussion and Recommendations by Committee of Reference
3. Medical Radiologic Technology Board of Examiners
• Presentation by the Medical Radiologic Technology Board of Examiners
• Public Testimony
• Discussion and Recommendations by Committee of Reference
4. Nursing Care Institution Administration and Assisted Living Facility Managers Board
• Presentation by the Nursing Care Institution Administration and Assisted Living
Facility Managers Board
• Public Testimony
• Discussion and Recommendations by Committee of Reference
5. Board of Homeopathic Medical Examiners
• Presentation by the Board of Homeopathic Medical Examiners
• Public Testimony
• Discussion and Recommendations by Committee of Reference
6. Arizona Alliance of Surgical Specialists
• Presentation by the Arizona Alliance of Surgical Specialists
• Public Testimony
• Discussion and Recommendations by Committee of Reference
7. Arizona Association for Home Care
• Presentation by the Arizona Association for Home Care
• Public Testimony
• Discussion and Recommendations by Committee of Reference
8. Arizona Midwifery Institute
• Presentation by the Arizona Midwifery Institute
• Public Testimony
• Discussion and Recommendations by Committee of Reference
9. Adjourn
Members:
Senator Jim Waring, Co-Chair
Senator Carolyn Allen
Senator Marsha Arzberger
Senator Robert Cannell
Senator Barbara Leff
10/31/05
jmb
Representative Rick Murphy, Co-Chair
Representative David Bradley
Representative Laura Knaperek
Representative Linda Lopez
Representative Doug Quelland
People with disabilities may request reasonable accommodations such as interpreters,
alternative formats, or assistance with physical accessibility. If you require accommodations,
please contact the Chief Clerk's Office at (602) 926-3032, TOO (602) 926-3241.
ARIZONA STATE LEGISLATURE
SENATE HEALTH AND HOUSE OF REPRESENTATIVES HEALTH COMMITTEE OF
REFERENCE FOR THE:
SUNSET OF THE HEALTH FACILITIES AUTHORITY
SUNSET OF THE MEDICAL RADIOLOGIC TECHNOLOGY BOARD OF EXAMINERS
SUNSET OF THE NURSING CARE INSTITUTION ADMINISTRATION AND
.ASSISTED LIVING
SUNSET OF THE BOARD OF HOMEOPATHIC MEDICAL EXAMINERS
SUNRISE REQUEST OF THE ARIZONA ASSOCIATION FOR HOME CARE
SUNRISE REQUEST OF THE ARIZONA MIDWIFERY INSTITUTE
SUNRISE REQUEST OF THE ARIZONA ALLIANCE OF SURGICAL SPECIALISTS
Minutes of the Meeting
Tuesday, November 8,2005
9:00 a.m., House Hearing Room 1
Members Present:
Senator Jim Waring, Co-Chair
Senator Carolyn Allen
Senator Marsha Arzberger
Senator Robert Cannell
Senator Barbara Leff .
Members Absent:
Representative David Bradley
Staff:
Beth Kohler, Senate Health Research Analyst
Elizabeth Baskett, House Health Research Analyst
Representative Rick Murphy, Co-Chair
Representative Laura Knaperek
Representative Linda Lopez
Representative Doug Quelland
Co-chairman Murphy called the meeting to order at 9:12 a.m. and attendance was
noted. .
Presentation by the Health Facilities Authority
Blaine Bandi, Executive Director, Health Facilities Authority (HFA), stated that his
organization was established in 1977 to issue bonds exempt from income tax on the
Authorities interest which enables them to get lower interest rates. He explained that the
Authority would then loan their proceeds to health care facilities at lower rates than the
healthcare facilities would receive from banks. Mr. Bandi remarked that the Authority
provided low cost loans for rural and underserved healthcare facilities.
He stated that rural communities that have benefited from the program included:
• Flagstaff
• Kingman
• Prescott
• Wickenburg
• Douglas
• Springerville
• Page
• Bisbee
• Camp Verde
• Fort Mojave
• Peach Springs
• Sacaton
• Elfrida
• Morenci
• Ajo
• St. Michaels
Mr. Bandi remarked that the Health Facilities Authority was not a regulatory agency and
that it existed solely to improve the health care for the residents of Arizona through the
financing of critical health care projects. He remarked that failure to continue the
Authority would deprive the State's health care providers of a needed source of tax
exempt financing. He respectfully requested the Committee of Reference recommend
the Arizona Health Facilities Authority be continued for ten years.
In response to Senator Cannell's question about the possibility of a hospital not paying
their loan back, Mr. Bandi told the Committee that since the inception of the HFA in
1977, this had only occurred once. He remarked that payments by that hospital were
still being made to HFA. Mr. Sandi added that the residents of the State have no legal
obligation to back up those bonds because they were issued solely on the credit of the
institution.
Representative Knaperek asked Mr. Bandi to list the seven directors for HFA and he did
so as follows:
1. Bruce Gulledge, health care underwriter who does financing for health
care institutions across the country.
2. Donald Shropshire, former hospital administrator; Tucson Medical
Center.
3. Jennifer Ryan, community health center director from Southern Arizona.
4. Rufus Glasper, Chancellor of the Maricopa County Community College
District.
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5. William Emerson, City Attorney for the City of Peoria.
6. Susan Straussner, Community Health Nurse from Parnell County.
7. Steven Russo, Sond Attorney based in Tucson.
In response to Representative Knaperek's question about funding, Mr. Sandi told the
Committee that the HFA's annual budget was approximately $300,000 per year and that
revenues to the Authority were generated through bond financing activities. He stated
that when the HFA approved bonds, applicants are paying one basis point, which is .01
of one percent of total financing. He remarked that additionally applicants paid 7.5 basis
points which was equal to .075 percent. Mr. Sandi told the Committee that the HFA
brought in between $300,000 to one million dollars per year, a five year cycle with one
million dollars every fifth year. He added that the extra money was used for loans to
other healthcare facilities in underserved parts of the State. Mr. Sandi told the
Committee that the credit rate was predicated on a number of things, the most
prominent being the credit worthiness of the applicant and also on the term and purpose
of theJoan. He remarked that he had seen the interest rates in the range of about four
percent up to about seven percent.
Representative Knaperek asked the amount of savings in interest rates there was for
people who used the HFA services. Mr. Sandi responded that historically, the industry
used a figure of 15 percent savings going to tax exempt financing versus taxable
financing. He stated that today, when interest rates are lower, that 15 percent figure
would be closer to 10 or 11 percent.
In response to Representative Quelland, Mr. Sandi stated that the title holder on any
property in which the HFA loaned money is going to be that non-profit corporation. He
remarked that the HFA had liens on record for every loan they do. Mr. Sandi explained
that the bond financing has specific guidelines and rules the HFA must follow in the
event of a default.
In response to Senator Leff, Mr. Sandi told the Committee that HFA hired a lobbyist
solely from lack of experience with legislative scenarios. and to help the organization
navigate through the process.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend to continue the Health
Facilities Authority Board for ten years. By voice vote, the motion
CARRIED.
Presentation by the Medical Radiologic Technology Board of Examiners
Aubrey Godwin, Director, Radiation Regulatory Agency, told the Committee that the
Medical Radiologic Technology Board of Examiners (MRTBE) was created in 1977 by
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legislation due to the large number of unqualified technicians in the State. He stated that
the role of MRTBE was to make sure that technicians or people applying ionizing
radiation to a human being had been properly trained. He remarked that the type of
technologist observed by MRTBE were X-ray, therapy, nuclear medicine and
mammography technologists. Mr. Godwin pointed out that nuclear medicine technology
had been added recently to MRTBE's certification program. He stated that MRTBE
presently had approximately 9,000 certificate holders, some of whom hold dual
certification. Mr. Godwin pointed out that most of the MRTBE cases dealing with
disciplinary matters were related to failure to pay dues or questionable certifications
since their last sunset review.
In response to Senator Allen, Mr. Godwin explained that drug treatment was made
available through MRTBE for certified technicians who may need it and failure to
successfully complete these proceedings would result in termination of certification.
In response to Senator Cannell, Mr. Godwin said that most of the drug related issues
with technicians took place in larger institutions such as hospitals as opposed to private
physician offices. He stated that if the institution where a troubled technician worked
had a drug treatment program, MRTBE would direct the technician to utilize that
program and if not, the technician would attend an independent drug program paid for
by the technician.
In response to Senator Arzberger, Mr. Godwin remarked that due to the different State
requirements for technician certification, out of town applicants must be certified in
Arizona before working in this State.
In response to Representative Knaperek, Mr. Godwin told the Committee that there
were both nationally certified and non-nationally certified radiological technician schools
in Arizona. He stated that the vacancy on MRTBE had been available for less than one
year.
In response to Representative Murphy, Mr. Godwin told the Committee that he looked
forward to finding a citizen to fill the vacancy on the MRTBE.
In response to Representative Knaperek, Mr. Godwin remarked that due to the shortage
of technicians in the State, Arizona has experienced an influx of out of State
technicians.
In response to Senator Allen, John Gray, Program Manager, MRTBE, informed the
Committee that a high school graduate could enter into the field of radiological
technology either through community college or privately funded programs. He added
that private school training took two years or less.
In response to Senator Leff, Mr. Godwin stated that there was a continuing education
requirement in place for the field of radiological technology due to changing technology.
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Public Testimony
Jerry High, Arizona State Society of Radiologic Technologists, told the Committee
that out of concern for public safety, he was glad that certification was required before
becoming a technician.
In response to Senator Leff, Mr. Hyde said that passing the "Registry," a test sponsored
by the American Association of Radiologic Technology (AART) was very difficult, yet
allowed him to be nationally certified.
In response to Senator Leff, Mr. Godwin told the Committee that radiologic
technologists were certified professionals, not licensed professionals.
Stephen Sapareto, Director of Medical Physics, Banner Good Samaritan Hospital,
stated that he was the boss of the technologists at his facility and expressed the
importance of technologists to be certified. He pointed out that another group certified
by MRTBE were radiologic therapists, who administered ongoing care such as
chemotherapy, and that it was especially important for these therapists to be certified.
Iniresponse to Senator Leff, Mr. Safereto explained that radiologic technologists and
therapists had a chief technologist or therapist supervising them, followed by a chain of
command that ultimately led to a physician at his facility.
Jeff Siupik, Director of Radiation Services, MRTBE toid ~he Committee that being a
director of technologists, he is concerned about the shortage of technologists in the
State due to strict standards by the MRTBE on non-local technologist operating
machinery in a crisis situation.
Senator Leff opined that two weeks, the time it takes for MRTBE to certify a non-local
technician, was not a long period of time.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend to continue' the Medical
Radiologic Technology Board of Examiners for ten years. The motion
CARRIED by voice vote~
Presentation by the Board of Examiners of Nursing Care Institution
Administrators and Assisted Living Facility Managers
Allen Imig, Executive Director, Board of Examiners of Nursing Care Institution
Administrators and Assisted Living Facility Managers (BENCIAIALFM), informed
the Committee that the Board was created in 1975 to protect the public's health and
welfare by regulating and licensing nursing care institution administrators. He stated that
in 1990, the board statutes were amended to add the responsibility of certifying and
regulating adult home care managers and renamed in 1998 to Assisted Living Facility
Managers. The mission of the Board was to protect the health, welfare and safety of its
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citizens, to seek and institute the use of services of nursing care institution
administrators and assisted living facility managers. Mr. Imig said that the Board's
procedures helped ensure quality and competency standards were met by
administrators and managers. In addition, the Board approves continuing education
courses to make sure quality and useful education is being taught. He explained that
since June of 2005, the Board had undergone an "extreme makeover" with virtually all
new members being appointed. This reduced the back log of uninvestigated complaints
significantly. Mr. Imig told the Committee that the Board had reduced their staff from five
to three, leaving an executive director, investigator and a licensing coordinator. He
encouraged the Committee to continue the BENCIAIALFM.
In response to Senator Allen, Mr. Imig said that the Board consisted of five managers,
two public members and the remaining members were administrators.
Senator Allen opined that home care nursing staff deserved better pay.
In response to Senator Waring, Mr. Imig stated that the changes made to the Board has
helped, but not solved its financial problems.
In response to Senator Arzberger, Mr. Imig said that his Board investigated complaints
from citizens regarding private care nurses and administrators as well as complaints
filed by the Department of Health Services.
In response to Senator Waring, Mr. Imig told the Committee that the Board's website
contained information regarding decisions on disciplinary action.
In response to Senator Allen, Mr. Imig explained that out of the last renewal period for
managers, 2,000 of 2,500-2,600 renewal notices sent were renewed, causing 578
expired notices to be sent by the Board.
In response to Senator Leff, Mr. Imig opined that his Board received between 60 and 70
complaints a year, mainly not health care related but administrative related.
In response to Senator Waring, Mr. Imig stated that with the current staff, the Board
should catch up on its back log of complaints by January 2006.
In response to Representative Quelland, Mr. Imig remarked that the Board was actively
seeking replacements for the three vacancies on the Board.
Senator Leff suggested that the Committee send a letter to the Governor encouraging
her to appoint the three positions.
In response to Representative Quelland, Mr. Imig opined that he would like to see a five
year continuation be given to the Board.
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Representative Knaperek remarked that time elected to the Board would reflect
concerns with term limits and not reflect faith in Mr. Imig.
Public Testimony
Robert Frechettee, President, Arizona Health Care Association (AHCA), told the
Committee that on behalf of his Board, he would like to offer support in the continuation
of the BENCIAIALFM. He opined that the efforts implemented by the new staff showed
that the Board was very serious about suggestions and concerns brought forth by the
Legislature.
In response to Senator Waring, Mr. Bruschette stated that the AHCA was seen as the
organization that represented the for profit facilities, containing some non-profit facilities
and representing assisted living communities and independent full service communities.
He said that Assisted liVing Federation represents assisted living centers in homes and
the Arizona Association of Homes for the Aging represents a number of facilities seen
as non-profit businesses.
In rE;sponse to Senator Cannell, Mr. Bruschette opined that if fee increases were
nece'!Ssary to fund the continuation of the Board, that it would be supported by AHCA.
Senator Leff stated that if the Committee made a five year recommendation at this
meeting and the audit comes out in December and is changed, the legislation coming
out in January does not have to be the same as the recommendation.
Representative Knaperek told the Committee that Mr. Imig had a good work history as a
Director in other fields.
In response to Representative Knaperek, Beth Kohler, Senate Health Research Analyst,
stated that the first audit of the Board would take place approximately six months after
nomination adding an 18 month follow up audit, only if the requirements and
recommendations made by the report were not met.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend that the Board of
Examiners of Nursing Care Institution Administrators and Assisted
Living Facility Managers be continued for two years. The motion
FAILED.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend that the Board of
Examiners Nursing Care Institution Administrators and Assisted
Living Facility Managers be continued for five years pending the
findings of the Auditor General's report due in December of 2005.
The motion CARRIED.
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Presentation by the Board of Homeopathic Medical Examiners
Chris Springer, Executive Director, Homeopathic Board, told the Committee that
she had worked for the Board of Homeopathic Medical Examiners (BHME) since 1999.
She complimented appointments made to the Board by all of the Governors on both the
Democrat and Republican side. She opined that the laws governing the licensing of
homeopathic physicians set forth by the State had been upheld. Ms. Springer stated
that a potential audit could be helpful in improving procedures and welcomed the
process of an impartial audit. She said that the Board currently has 117 licensed
homeopathic physicians.
Senator Leff opined that it was nice to hear Ms. Springer suggest an audit of the Board
and noted that BHME had gone approximately 20 years without an audit.
Senator Allen opined that she would like to see an audit of the BHME as well. She
added that in no way did legislation intend to do away with the homeopathic form of
medicine. .
In response to Representative Lopez, Ms. Springer stated that a licensed homeopathic
physician could only continue to practice in one state after receiving disciplinary action
in another state for less than one year, due to the Board's annual. renewal application
required of all homeopathic physicians, which would discover the violation in the other
state. .
In response to Representative Murphy, Ms. Springer said that there was the possibility
of a physician being dishonest about any past disciplinary action, however, there is a
standard penalty in place for such an event.
In response to Senator Waring, Ms. Springer told the Committee that there was not an
easily accessible data base of criminal background checks for physicians and added
that the fee to search names on the federal data base was $3.75 per name.
Senator Leff opined that being dishonest on an application should have strong
consequences for any physician when dealing with the subject matter of past
disciplinary action.
Dr. Charles Schwengel, President of the Homeopathic Medical Licensing Board,
told the Committee that being dishonest on an application was the most egregious of
unprofessional conduct that could happen.
In response to Representative Knaperek, Ms. Springer stated that a physician lying on
the application was discovered once and a letter of concern was issued.
Representative Knaperek opined that there should be a certain amount of consideration
afforded to the applicant on whether the incident was an issue of forgetfulness or
deliberate intent.
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In response to Senator Cannell, Ms. Springer stated that setting aside funds to check
each individual physician's background would be a step in the right direction.
Senator Allen remarked that the concerns stated today could be addressed in the
forthcoming audit.
In response to Representative Quelland, Ms. Springer told the Committee that some
traditional doctors became homeopathic physicians, and then dropped their traditional
medical license.
In response to Representative Quelland's comments on a medical doctor dropping their
license to pursue homeopathy due to decreased chances of medical malpractice
occuring, Dr. Schwengel remarked that he could not comment on the personal reasons
a physician might do this.
In response to Representative Murphy, Ms. Springer stated that the percentage of
homeopathic physicians who were previously licensed as medical doctors was very low.
Representative Murphy told the Committee that some physicians may choose to not
carry medical malpractice insurance to avoid becoming a target for medical malpractice.
Senator Cannell opined that there was a fear with physicians of becoming a target for
medical malpractice by carrying medical malpractice insurance.
In response to SenatorWaring, Ms. Springer stated that BHME kept records indefinitely
of reported complaints against homeopathic physicians. She told the Committee that in
her opinion, the BHME should only keep records for up to five years similar to other
medical boards.
In response to Senator Waring, Ms. Springer remarked that she felt it necessary to keep
records of complaints for longer than five years, only if they were substantiated.
In response to Senator Allen suggesting that more public members should be on the
BHME, Ms. Springer said that additional public members on the Board would be a good
idea.
Public Testimony
Dr. Kathleen Fry, dually licensed by the Arizona Medical Board and Arizona
Homeopathic Medical Board, told the Committee that she had gathered a large
amount of important information pertaining to the BHME that she would like to share
with the Legislature and the Office of the Auditor General. She stated that she had been
committed to the practice of homeopathic and alternative medicine for twenty years in
Scottsdale, Arizona. She remarked that it was not her intent to keep patients from
receiving homeopathic care. Dr. Fry opined that the BHME had been grossly negligent
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in its spiritual, moral and judicial responsibilities to protect the public from unscrupulous
physicians by licensing felons, failing to adequately discipline physicians who had
harmed patients, failing to adequately file complaints against other board members and
by giving licenses to physicians who could not pass a basic oral examination of
homeopathy. She stated that when she was recruited to the BHME in 1994, she was
informed by the Board that her dues were necessary to keep the Board in existence and
to allow her to continue to practice homeopathic medicine. Dr. Fry remarked that the
dues for the Association were $1000 per year in addition to the $500 per year licensing
fee and the $150 dispensing fee. She explained that if a homeopathic physician in
Arizona lost their M.D. license in another state, they could still practice homeopathy
here in Arizona which gives that physician the power to write prescriptions for all
classes of drugs, conduct minor surgery in their office, perform acupuncture and various
other medical techniques. In conclusion, Dr. Fry told the Committee that the
homeopathic license gives the physician a much broader range of modalities that they
can use with much less scrutiny and training.
In response to Senator Waring, Dr. Fry stated that in theory, physicians who had marks
on their records in other states should be rehabilitated in that state before being allowed
a license in Arizona, but that had not always been the case.
In response to Representative Knaperek, Dr. Fry remarked that transcripts from board
meetings that she had obtained from Ms. Springer, were public record. .
In response to Senator Left, Dr. Fry explained that a device called a sputnik originated
in Russia and is swallowed by a patient and designed to kill parasites by radiation. She
told the committee that a physician sold the device to a patient in Florida over the
phone, and that upon taking this device orally, the patient developed a bowel
obstruction resulting in the removal of several feet of her intestine. She added that the
said physician, being one of the originators of the BHME, only received a letter of
concern and an apology by the Board for placing that letter in the physicians file.
In response to Senator Waring, Dr. Springer told the Committee that she disagreed with
Ms. Fry's perception of the Board.
Dr. Todd Rowe, Homeopathic and Integrative Medical Physician, Desert Institute
of Classical Homeopathy, dually licensed, told the Committee that he had been
practicing homeopathic medicine for over twenty years. He urged the Committee to
continue the BHME. He remarked that after attending several meetings over the years
of the BHME, he had found most of what Dr. Fry said to be untrue.
In response to Senator Cannell, Dr. Rowe stated that the number of out-of-state
homeopathic physicians licensed in Arizona was very small. He explained that Arizona
was one of only three states who had homeopathy boards and that this was another
reason for an increase in out-of-state applicants in this State.
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In response to Senator Leff, Dr. Rowe said that his homeopathy school had a 1,000
hour program for homeopathy, with plans on expanding that program to 4,000 hours
within the next few years.
In response to Senator Leff, Dr. Rowe stated that the qualifications for a license for
homeopathy consisted of either 40 hours of class of homeopathy, in addition to 300
hours of alternative medicine, or 90 hours of class for homeopathy. He opined that this
met the minimum requirements to become a homeopathic physician and commented on
the fact that some applicants were already licensed medical doctors.
Lee Bakunin, practicing attorney in Arizona for 36 years, representing self, told the
committee that he had spent the last eleven years of his life studying homeopathy. He
explained that after the required 90 hours, there was no continuing education required
to continue practicing homeopathy. Mr. Bakunin said that the Auditor General may
come across the problem of incomplete records of past BHME meetings.
In response to Representative Quelland, Mr. Bakunin said that he currently had studied
about 2,000 hours of homeopathy.
Gladys Conroy, patient of homeopathy, representing self stated that homeopathy
had saved her life. She told the Committee that standard medication caused her great
danger.
Clifford Heinrich, practicing family physician for alternative medicines, opined that
no alternative medical board should be able to have jurisdiction over the spiritual
practice of homeopathy. He added that he had obtained over 1,200 hours of
homeopathy. Dr. Heinrich told the Committee that he had a petition with 200 signatures
recogniz:ing homeopathy as a spiritual practice. He stated that he had an additional
petition to request the Legislature audit the BHME for "reasons previously addressed in
the meeting."
In response to Senator Allen, Dr. Heinrich opined that· homeopathy was being
misrepresented by the BHME from its original spiritual foundation, causing the public to
believe they were receiving homeopathic care when in fact, they were not.
In response to Representative Knaperek question about the spiritual aspect of
homeopathy, Dr. Heinrich explained that a nonmaterial substance was one that had
been diluted to a point where the original property is no longer there, leaving only the
essence of that object.
In response to Representative Murphy, Dr. Heinrich told the Committee that he wanted
the separation between homeopathy and alternative medicines distinguished by the
State.
Amanya Jacobs, Director of Evolution of Self/Soul School Homeopathy, remarked
that she was deeply committed to making homeopathy available to all citizens in the
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State. She said that the Board regulated activities that it deemed homeopathy which
were totally unrelated to that area of medicine. Ms. Jacobs stated that she was in favor
of an audit of the BHME.
Linda Heming, Arizona Homeopathic and Integrative Medical Association, told the
committee that western medicine could not help her and homeopathy saved her life.
Senator Leff remarked that the open meeting law stated that recordings and minutes
must be kept by the open body and must be accurate and open for inspection three
days after the meeting, with no language about whether or not they could be destroyed
at any time period.
Russell Olinsky, patient of homeopathy, spoke in favor of the BHME.
Cynthia MacLuskie, patient of homeopathy, told the Committee that all homeopathy
medicines were not available at health food stores and that prescriptions were the only
way to obtain some of these medicines.
Lisa Platt, Arizona Homeopathic and Integrative Medical Association, speaking on
behalf of the BHME, remarked that BHME was not recruiting felons. She stated that a
number of patients had told her how homeopathy had saved their lives.
Senator Allen moved that the Senate Health and House Health
Committee of Reference recommend that the Board of Homeopathic
Medical Examiners continue for two years, adding the request for an
audit addressing the concerns covered in today's committee.
Representative Quelland explained his vote. He said that although he did not have an
educational background in homeopathy, the homeopathic physicians had a certain
amount of disagreement and confusion among themselves. He reminded the
Committee that this was just a recommendation and that someone was going to create
a bill and that bill would be voted on, making today's vote not a guarantee that the
Board will continue, and he voted "aye."
Senator Cannell explained his vote. He said that although he advocated homeopathy
and the continuation of the Board, that the BHME had suffered a "major black eye"
today. He opined that the director and the president of the boards had not changed their
attitudes and that they should consider their Board a precious commodity by not diluting
their group of good physicians with out of state applicants with questionable credentials
and he voted "aye."
Senator Leff explained her vote. She requested the Auditor General to do both a
financial and performance audit. She remarked that the people who came forward today
against the Board should feel free to do so without retaliation and she voted "aye."
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Senator Waring explained his vote. He said that he was very frustrated with the Board,
and that he would be the first to vote "no" on a bill in the following session if changes
weren't made, but since today's vote was merely a recommendation, he would vote
"aye."
Representative Murphy explained his vote. He said that he shared many of the
concerns voiced by the Committee members today and looked forward to hearing what
the Auditor General had to say and he voted "aye."
The motion CARRIED by a roll call vote of 9-0-1 (Attachment 1).
Representative Murphy RECESSED the meeting at 1:35 p.m. to the sound of the gavel.
Representative Murphy RECONVENED the meeting at 2:30 p.m.
Presentation by the Arizona Midwifery Institute
Marinah Valenzuela Farrell, President of the Arizona Midwifery Institute (AMI),
subrpitted handouts (Attachment A) and (Attachment B) to the Committee. She told the
Committee that as midwives, their main concern was for safe outcomes of mothers and
babies. She remarked that midwives chose home birth because they believe that birth is
a natural and safe event in the life of a woman. Ms. Farrell explained that in the 1970's,
midwifery became licensed in the State, yet because of medical liability issues,
midwives had experienced difficulty in consults with physicians and access to items to
assist in home birth. . .
In response to Senator Allen, Ms. Farrell stated that midwife licensing exams were very
tough and that she had received specialized intravenous training in New Mexico through
the local hospital.
In response to Senator Cannell, Ms. Farrell told the Committee that licensing of
midwives was dependent upon number of hours of experience in child birth delivery with
that applicant. She stated that there were also schools available to midwives that
involved intense clinical training. Ms. Farrell said that a surveyor in the Department of
Special Licensure administered a national exam to applicants in which upon passing,
the applicant must then go through an oral board and upon passing this, must complete
a practical exam which is overseen by the surveyor and other midwives. She told the
Committee that midwives were trained in resuscitating babies.
In response to Senator Leff, Ms. Farrell stated that the midwives were requesting that a
physician not be required to sign off on supplies.
Representative Lopez opined that her own personal experience of giving birth to her last
two children at home from midwives was a wonderful experience.
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Representative Quelland informed the Committee that Arizona had 53 licensed
midwives with 22 of them located in Maricopa County and that there were 343 midwife
births in the home in 2004 in the State.
In response to Representative Quelland, Ms. Farrell remarked that none of the 343
reported midwife births reported in 2004 resulted in any problems. She stated that
although medical malpractice and liability insurance was available to midwives, the
majority refused it due to its cost in proportion to their pay. She told the Committee that
the Arizona Health Care Cost Containment System (AHCCCS) discontinued the
payment for midwife delivery two years ago due to midwives not carrying medical
malpractice and liability insurance which could possibly put AHCCCS at risk for such
claims.
Senator Leff stated that midwives dealt mostly with low-risk births and that she would
like to see the issue of AHCCCS discontinuing payment for midwife births examined.
Senator Cannell opined that the Committee should hear from AHCCCS because they
obviously found midwifery funds a financial risk for some legitimate reason.
Ms. Farrell told the Committee that mothers who chose home births mainly did so, not
for financial reasons, but because of belief that the hospital environment was just one
intervention leading to another.
Public Testimony
Rory Hays, Arizona Nurses Association, said that the items asked for by the AMI
were appropriate, if accompanied by more training. She stated that she opposed
expanding prescription privileges for anything requiring a Drug Enforcement Agency
number.
In response to Representative Ouelland, Ms. Hays said that certification would be
appropriate for midwives.
Ms. Farrell stated that the only thing midwives were requesting was the power to obtain
items already in their reach through a physician, without that physician's pre-approval
and that the laws were already in place on limitations for uses with these items.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend that the Legislature
expand the scope of practice for Arizona's licensed midwives by
allowing procurement, possession, and administration of various
medical devices and medications which will be named in the bill. The
motion was CARRIED by voice vote.
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Senator Allen opined that midwifery was a choice to be made by the citizen and she
hoped that fatalities did not occur due to the choice of using such a method.
Presentation by the Arizona Association for Home Care
Suzanne Gilstrap, representing the patients for the Arizona Association for Home
Care (AAHC), stated that AAHC was founded in 1983 with a mission to advance quality
home care as an integral component of the health care delivery system. She told the
Committee that she believed in continuing education for home care providers. She
remarked that AAHC had discussed having a joint workshop with the Physical Therapy
Association (PTA) but never actually initiated these workshops. Ms. Gilstrap requested
that the Committee grant an expansion to allow physical therapy assistants to work
under general supervision of a physical therapist as opposed to direct supervision. She
told the Committee that the AAHC respectfully requested the joint Committee
recommend that physical therapy assistants be allowed to practice in the home health
care setting and only in that setting under the following conditions:
• The supervising physical therapist shall be solely responsible for
evaluating the patient and determining a plan of care.
• The supervising physical therapist shall be available at all times via
telecommunication while the physical therapist assistant is providing
treatment interventions.
• The supervising physical therapist supervises no more than two physical
therapy assistants. .
• The supervising physical therapist shall see the patient and revise the plan
of care no less than every 21 days.
• The supervising physical therapist not assign responsibilities to the
physical therapy assistants that in any way allow them to provide
evaluation services for procedures.
• Continuing education requirements should be added to the statute as well.
• The physical therapist would be the one responsible for final evaluation
and discharge of the patient.
In response to Senator Arzberger, Ms. Gilstrap said that proposing a mileage limit would
be a good idea in reference to a physical therapist along with the constant
telecommunication contact. She stated that it was not unusual to recommend that the
practice of home care be extended to other areas outside of the home such as
hospitals.
SENATE HEALTH AND HOUSE HEALTH COMMITIEE
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Tuesday, November 8, 2005
Page 15
In response to Senator Leff, Ms. Gilstrap remarked that the AAHC was not intending to
mandate what physical therapists do, but to enable legislation that would allow them to
choose.
In response to Representative Murphy, Ms. Gilstrap stated that home care therapist
assistants were well schooled for their job no matter what setting, with the exception of
no clinical experience required of the physical therapist.
In response to Senator Waring, Ms. Gilstrap remarked that in all fields of medicine,
health care providers were experiencing an inability to serve patients.
Representative Lopez opined that an outside organization should not be directing
physical therapists on how to conduct their practice.
In response to Senator Allen, Ms. Gilstrap told the Committee that currently more than
45 states allow general supervision in the home health care setting and that the only
two states that do not allow it are Pennsylvania and Arizona.
Public Testimony
Karen Jeselun, President of the Ariz.ona AssQciation for Home Care, stated that
even if there were no home care physical therapist available at the time, a patient could.
still be released from the hospital even though they required home care to continue
recovery. Ms. Jeselun compared the relationship between a physical therapist and a
physical therapist assistant to that of a registered nurse and a licensed practical nurse.
She told the Committee that all of their home care providers go through an interview
process, a mandatory criminal background check and participate in orientation often
with preceptors.
In response to Representative Knaperek, Ms. Jeselun stated that Medicare currently
paid home health agencies on an episode basis, meaning for every 60 days of time that
patient is in the care of a home health provider, the home care provider gets a lump
sum. She opined that she was hoping to serve more patients with no increase in cost.
Susie Stevens, representing the Arizona Physical Therapy Association (AZPTA),
informed the Committee that the definitions of general supervision and direct
supervision needed to be reviewed. She stated that she was there in opposition to the
sunrise request.
Heidi Herbst Paakkonen, Executive Director of the Arizona Board of Physical
Therapy (ABPT), told the Committee that the ABPT regulates about 3,200 physical
therapists and 434 physical therapist assistants. She said that due to lack of detailed
information at this time, she would encourage the Board to oppose the Sunrise
Application of the AAHC.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8, 2005
Page 16
In response to Representative Knaperek, Ms. Paakkonen remarked that there were
exactly 3,268 licensed in the State but not all of them worked in Arizona. She told the
Committee that approximately 2,800 physical therapists listed Arizona addresses. She
stated that there were 434 physical therapy assistants and that approximately 396
reside in Arizona and that it was ABPT's estimate that 350 of them were currently
working in the field of physical therapy.
In response to Representative Quelland, Ms. Paakkonen stated that the ABPT was
required by statute to have three physical therapists and two public members, but no
physical therapist assistants.
In response to Senator Leff, Ms. Paakkonen told the Committee that the ABPT does
and has disciplined physical therapist assistants.
Bob Direnfeld, President of the Arizona Physical Therapy Association (AZPTA),
remarked that his organization was the only one in the State representing physical
therapists. He told the Committee that his association opposed the idea of general
supervision. Mr. Direnfeld said that patients were getting discharged from the hospital
too early in most cases compared to years ago, which cause a greater need for these
home. care physicians. He remarked that a therapist was ultimately responsible for
anything the physical therapy assistant does which puts the physical therapist's license
on the line.
In response to Representative Murphy, Mr. Direnfeld opined that passing legislation
supporting general care could potentially decrease an even larger amount of physical
therapists.
In response to Senator Cannell, Mr. Direnfeld stated that he was not sure that there was
a shortage in home health care providers. He also remarked that setting a parameter or
definition of a home care patient, would cut down on the patient load.
Representative Knaperek opined that physical therapist assistants should have more of
a vote on the Board.
Peter Zawicki, in favor of the sunrise recommendation, told the Committee that
physical therapists and physical therapist assistants were trained at community colleges
and technical schools across the country. He opined that it was critical that there be
communication between the physical therapist and the physical therapist assistant in all
patient care.
In response to Senator Cannell, Mr. Zawicki stated that physical therapist assistants
were under direct supervision during the education process.
In response to Representative Murphy, Mr. Zawicki remarked that to be able to perform
in public health care, it would be helpful if a physical therapist assistant had a certain
amount or certain type of training.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8, 2005
Page 17
Senator Leff opined that home health patients are the most vulnerable patients and she
felt uncomfortable "experimenting" with the care of those patients.
Kerry Halcomb, Physical Therapy on Wheels, representing AAHC, opined that he
did not believe that a physical therapist could adequately supervise a physical therapist
assistant.
Gayle Haas, physical therapist, representing AAHC, remarked that a physical
therapist and a physical therapist assistant can work together for years and develop a
relationship which allowed for better understanding and communication skills with one
another.
Deborah Bornmann, physical therapist, stated that she did not feel represented by
her own board. She opined that it was great for an outside organization to try to help
physical therapists.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend that the Legislature
expand the· scope of practice for licensed physical therapist
assistants by allowing home health visits under the general
. supervision of licensed physical therapists. The motion was
CARRIED by voice vote.
Senator Waring stated that although he was unhappy with what he had heard
today, he hoped discussions were started to improve the situation.
Representative Knaperek remarked that she hoped they could work out their
differences for the benefit of the State.
Senator Arzberger opined that changes do need to be made and issues need to
be addressed. .
Representative Murphy stated that hopefully, this would get people back into
discussions.
There being no further business, the meeting was adjourned at 5:12 p.m.
Respectfully submitted,
Jeff Turner
Committee Secretary
(Tapes and attachments on file in the Secretary of the Senate's Office/Resource Center, Room 115.)
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
OF REFERENCE
Tuesday, November 8,2005
Page 18
Senate Health and House of Representatives Health Committee
of Reference
ARIZONA STATE LEGISLATURE
FORTY-FIFTH LEGISLATURE - ROLL CALL VOTE
Recommendation: 'Tt+Ar 'll-tG "13o!JB-p () F \±OM£O?fr1}t1
MBDIC/xL Gth'V\! tlGl2-S CQNllNlIE Fo<t- -nun"'l@i-S W1Tlt
f\ «€QVESl 'fOQ. fVJ f\1JPIT BY THE AvD,T"O(L GC]'J8?-/rt i
Rep. Bradley
Rep. Lopez
Rep. Quelland
Senator Allen
Senator Arzberger
Senator Cannell
Senator Left
Senator Waring, CoChair
Rep. Murphy, CoChair
Committee Secretary jf1Pf:"' =r0 fSNbJ'2-- Date \ I-O<g ~dOO<)
Attachment-.L
November 8, 2005