Senate Health & Social Services, 4/30/26, 3:30pm

This hearing of the Senate Health and Social Services Committee will now come to order. Today is Thursday, April 30th, and the time is 3:32. We are in Butchovitz Room 205. Members present: Senator Myers, Senator Clayman, Senator Tobin, Vice Chair Giesel, myself, Chair Dunbar. Let the record reflect we have a quorum to conduct business.

Before we begin, I would like to thank Mary Gwen Kawakami, the Senate Health and Social Services Recording Secretary, and Kyla Tupou from from the Juneau LIO for staffing the committee today. We have 2 items on our agenda today. First, we have a— actually, we'll probably do this in reverse order. We have a confirmation hearing for an appointee to the State Medical Board, Mr. Michael McNamara, and then we have our 4th hearing on SB 281, Health Care Compacts Rural Health Programs. I believe that Mr. McNamara is currently testifying before the House.

Let me double-check. He's not online. So we are going to take up the second item first. SB 281. Available online for questions, we have Lisa Pierrenton, the Director of the Division of Statewide Services, Department of Public Safety, Brian Webb, the State EMS Training Coordinator, and in the room we have Ms. Sylvan Robb, the Director of Division of Corporations and Business and Professional Licensing.

We do have an S version. So, Ms. Harbison, will you please come forward. First, we'll start with a motion, and then we will discuss the changes in the committee substitute. So, Madam Vice Chair, can I have a motion? Mr. Chairman, what I have is version H, as in Hilo.

Did I— I do not have an S. Did I say S? I apologize. Yes, I have. Okay.

Oh, I think maybe I said CS, but yes, let's just move version H. All right, Mr. Chairman, I move the committee substitute for Senate Bill 281, version 34LS1488/H, before the committee as our working document.

I will object for purposes of discussion. Ms. Harbison, will you please go over the summary of changes?

Thank you, Chair Dunbar and members of the Senate Health and Social Services Committee. For the record, Ariel Harbison, staff to Senator Dunbar. Uh, the changes are as follows: Sections 2, 4, 6, 7, 8, 9, 10, 25, 27, 33, 37, and 38.

8 Adds genetic counselors to a list of healthcare professionals licensed by the Department of Commerce, Community, and Economic Development. There is an Appendix A that has a longer sectional for the genetic counseling licensure. Next, sections 1, 3, 5, 24, 26, 28, 30, 34, 39, and 40 adds respiratory care practitioners to a list of healthcare professionals licensed by the Department of Commerce, Community, and Economic Development. Appendix B has the in-depth sectional for those sections. Section 35, AS4429 subsection C, was added to read that members appointed by the governor shall be based on interest in public affairs, good judgment, knowledge, and ability in the field of action of the council, shall provide diversity of interest of points of view and should be considered without consideration of political affiliation, and they should collectively represent each judicial district.

Last section I'm going to go over is Section 36, which repeals the Rural Health Transformation Program on December 31, 2031. [Speaker:CHAIR] Very good. I said, does it— okay, never mind. Um, are there any questions on these changes?

Okay, uh, seeing none, I will remove my objection. Is there further objection to adopting the CS, Committee Substitute? Okay, seeing none, the Committee Substitute is adopted and Let's see here. Now we can discuss this version. Um, let's see here.

I set an amendment deadline for 5 PM yesterday. We received, uh, well, we should— one amendment. So, uh, Senator Giesel, do you have an amendment to move? I do, Mr. Chairman. I move Amendment Number H.1.

H.1. And I will object for purposes of discussion. Could you describe the amendment, please? Sure, Mr. Chairman. It adds electronic format to page 15, line 29.

It reads, the applicant shall submit an applicant's fingerprints to the Board in an electronic format approved by the Department of Public Safety. It appears again on page 63, line 31, related to the psychologist compact and also criminal justice information, I think. The reason for this, Mr. Chairman, is it is so archaic that we do all of this by paper. It's hard to— I mean, you've got to carry this piece of paper around to different places. There's error possibilities, and electronic format is available.

In many places. Now, I actually have an amendment to this amendment, Mr. Chairman. I know you have fun managing this. Yeah, no worries. So that's my explanation for this, and I'll make the amendment to the amendment after you deal with this, I think.

I'm not sure when. I think you make the amendment to the amendment now. Okay. We object, and then we would pass the amendment as amended. The amendment to the amendment is, um, off after the words electronic format on both lines 7 Line 11, the words "where available" be inserted between electronic format and approved by the department.

So electronic format, where available, approved by the department. Okay, I'm not going to object to that change. Does anyone else want to object to the amendment to the amendment? Okay, so we now have the amendment before us as amended. Did you make— object to the amendment to the amendment?

Yeah, I did have a question on the Yup. And so we're back to the main amendment. Senator Myers, you have a question? Yeah, just for clarity's sake, does this amendment apply to just the compacts that we have, or is this to licensing in general? This applies just to the compacts, the sections of which it appears in.

Okay. All right. Cool. Very good. We do have someone online from the Department of Public Safety, um, Ms. Lisa Purinton.

Ms. Purinton, do you have any comments on this amendment?

Uh, thank you. Uh, Chair Dunbar, can you hear me? We can hear you. Thank you, sir. For the record, Lisa Purinton with the Department of Public Safety.

I'm the division director here for the Division of State Life Services. Thank you for the question. The Department does not anticipate an impact from this change because we can currently accept electronic fingerprints from the board or from other government agencies. Our understanding is this would be for the applicants to submit their fingerprints electronically to the board specifically, and then they would submit those fingerprints to us. At the Department of Public Safety.

Okay. Does anyone else have any other questions on this? I suppose then, Ms. Robb, do you have any comments on this? May I? Yes.

Thank you, Mr. Chair. For the record, Sylvan Robb, Director of the Division of Corporations, Business and Professional Licensing. Thank you for the opportunity to speak to this amendment, and we do appreciate the amendment to the amendment because our understanding is that there are many places where a person can't obtain electronic fingerprints. At this time, I think with the "where available"— and we do have Ms. Burrington online— but DPS can only accept fingerprints from other government agencies.

And so right now we would need individuals to come in to be fingerprinted, and CBPL only has offices in Anchorage and Juneau. And so that would— we anticipate it may slow down licensing as well as causing costs for applicants until such time as DPS is able to take electronic fingerprints from third-party vendors. What would it take for them to do so? Let's say there's a tribal entity, for example, you know, as the largest, most sophisticated organization in, let's say, YKHC or something like that. They can't take— I guess my question is, what would it take to allow them to do that?

I guess that's a question for you, Ms. Pierrenton. What kind of change would it take to allow you to take things from other agencies And also, I guess, the DMV is a government agency. Municipal governments are government agencies. Could someone not get fingerprinted at those kind of places?

Thank you, Chair Gensler. Again, for the record, Lisa Parenton with the Department of Public Safety, Division of Statewide Services. I'm verifying you can hear me. Yes. Okay.

I'm sorry. Thank you for the question. To kind of explain the process, the, the process we have for accepting fingerprints electronically, we take them from the government entity. The government entity is the one that is requesting the criminal history background check. So the process, for example, that we have currently in place with the Department of Health, they collect their applicant fingerprint cards from a variety of sources.

And then their— through their background check unit, they submit all of those fingerprints to us electronically, because we are no— they're the licensing employing agency, and so those authorizations and the statutory authority are included on those fingerprints. And they— that information is submitted to the department electronically. We process it electronically, send it off to the FBI, pull the results from the FBI, and pull the results from the state system. And then we send the results electronically back to that government agency because they receive the results. They're the ones authorized to receive the information, and they make their licensing or employment decisions based on that.

So we would never— we would not have a return mechanism to a private vendor to get that information. So that's one issue just on a general workflow process. The other issue is a security matter because we would need to make sure that we are securing that connection to a private vendor because they're taking fingerprints for a variety of purposes that have nothing to do with licensing or employment sometimes. And so we would want to make sure that we are not getting information sent to us that we're not authorized to process, or that we've seen instances in the past where a person had applied for a job at a certain place that required fingerprints, and they went in to get fingerprints at a private vendor here in Anchorage, and that private vendor, through an agreement with that particular employer, would bring the fingerprints, hand-carry them down to the Department of Public Safety, and we were processing them and then sending the results to that employer, and they were getting very confused because they were getting results for people that they did not employ, It was just people that had applied with them, that they hadn't moved further in the selection process. So they were receiving criminal history information, but they.

Weren't entitled to receive. So there's a variety of issues of why we're trying to make sure that we have this requirement that's coming in from a government entity. Okay. Do you have any follow-up? Well, my question would be, how do other states do this?

I mean, are we the only backwoods state State. Yeah, I guess practically speaking, why are we still using physical fingerprints as opposed to electronic fingerprints everywhere except you said Anchorage and Juneau? It's the only place we have the capability to do that, is that correct? Uh, Mr. Chair, those are the only places we have offices at this time.

We accept paper fingerprint cards. And, you know, just to speak to Senator Giesel's point, um, you know, we agree that paper fingerprints with people sticking their, their fingers in ink, um, is— doesn't feel like 2026. And we've had discussions with the Department of Public Safety about how we can move forward with this. As I think was testified to at an earlier hearing, they are in the process of moving to a new database for their, their information and that they're getting that stabilized. And in those conversations, it has been, you know, that we can sort of pick up this conversation once they off of their mainframe system that was out of date and try to find a way to move forward with this.

But there are the challenges that Director Perrington just outlined. Okay. I am going to remove my objection to the amendment. Is there further objection to the amendment? No objection, just a comment.

Okay. All right. So—. Mr. Chairman, I hate to interrupt here, but This sounds like we still are not going to be able to do this. And yeah, I mean, this has been an issue for— let's see, I served on the Board of Nursing starting in 2002, and here we are.

Let's see, this is what, 24 years later, and we still have these barriers. Mr. Chairman, I'm withdrawing the amendment. Okay. All right. Very good.

Still a worthwhile discussion. I will say for my part, I get fingerprinted with some regularity by the Army, and of course it is electronic. It has been decades since I had to use ink. Yes, Senator Klain. I am not sure who this is directed to, maybe Ms. Pierrenton.

My impression is that There's a number of places where public safety and the courts do have electronic fingerprinting in-state. So a lot of fingerprinting in-state is done in the courthouse, probably by public safety electronically, but DCCED only has 2 of them. Have I got that right? And I may be wrong. This is the question.

Oh, through the chair to Senator Clayman, we only have 2 offices. We do not have the ability to take electronic fingerprints from individuals at this time. So do you do ink fingerprints at the offices, or they go someplace else and get it fingerprinted and hand you the cards? Through the Chair to Senator Clayman, people bring in completed fingerprint cards. I have learned from Ms. Perrington that there is real skill involved in taking sufficient fingerprints that will be able to be accepted by the FBI.

And I guess this is for Ms. Perrington. Public Safety or the courts have electronic fingerprinting options here in state?

Uh, thank you. Uh, again, for the record, Lisa Carrington with the Department of Public Safety. Uh, through the chair to Senator Clayman, yes, we have, uh, they're called Live Scan devices that will capture electronic fingerprints. We have them across the state, uh, in all of the Department of Corrections facilities A lot of the contract jails have them. The— we are working on installing them at several of the Judicial Services offices across the state.

We have them here at headquarters. The— we do capture electronic fingerprints. As mentioned, Department of Health has them. And so they capture the fingerprints electronically, and most fingerprints are captured in electronic format, and then printed out into a hard card. So we don't see a lot of the ink tool fingerprints, but we do get those still as well.

But a lot of them are taken— the images are captured electronically, printed, and then brought into our office to process. And then we work with the clients, and as Director Robb alluded to, what we would like to do is work with all of our clients that we currently process fingerprints for and to work on what is the requirements for setting up those live scan fingerprint capturing devices at their offices so that we can at least process that portion of the fingerprints and those results to all do this electronically instead of doing a lot of processing this information through the mail as it's currently being done. Very good. Thank you. Okay.

I think that's enough fingerprint talk. Thank you all for that discussion. So we're back to the main bill. Is there further discussion on the underlying bill?

Okay. Well, Madam Vice Chair, can I have a motion? Mr. Chairman, I believe Senator Clayman has the motion. Very good. Senator Clayman, may I have a motion?

Thank you, Mr. Chair. I move Senate Bill 281, version 34-LS1488/h, as in Homer, as amended from committee with individual recommendations and attached fiscal note. Legislative-legal has the authority to make any necessary conforming changes. Are there any objections?

Yes, I object, Mr. Chairman. Would you like to speak to your objection, Senator? Sure, Mr. Chairman. These compacts, I fundamentally— it's not anyone specific, it's the whole concept of these compacts. I believe that it significantly erodes state sovereignty.

And so I fundamentally disagree with the whole concept. So I object to the moving of the bill, Mr. Chairman. Very good. Madam Clerk, would you please call the roll? Senator Diesel?

No. Senator Myers? Yes. Senator Tobin? No.

Senator Clayman? Yes. Senator Dendle? Yes.

With a vote of 3 yeas and 2 nays, SB 281, Version H passes from committee. If members would please stay after to sign the paperwork. Okay, now we are going to see if we have our person here. They are not online. Are they physically in the building?

Okay, we're going to take a brief at ease.

Back on the record. The time is 3:54, and next up we're going to hear— double check here— Mr. Michael McNamara. Dr. McNamara is an appointee to the State Medical Board. Um, Dr. McNamara, please state your name for the record and begin your testimony.

Yes, Mr. Chairman.

Mike McNamara. I was appointed approximately 5 months ago by Governor Dunleavy to the State Medical Board. I'm an orthopedic surgeon. I trained in Tacoma, Washington for college. I went to medical school at the University of Washington.

And then did an orthopedic residency training, 5 years in Texas, which I followed with a hand, elbow, shoulder, and microvascular training in San Antonio before coming to Alaska. I came to Elmendorf Air Force Base. I owed 6 years to the Air Force for my education back in 1994, a little while ago, and my family and I fell in love with Alaska and chose to stay. We've been here for 27 years now. I'm close to retiring, probably in the next month.

I've worked as a president or executive director of Alaska Surgery Center for approximately over 20, maybe 22 years, and spearheaded a lot of projects, including a new Alaska Surgery Center building that we built 5 years ago, and I was a key person on that. I've always wanted to be on the medical— State Medical Board and just didn't have time. Now I have time to do that.

Very good. Thank you, Dr. McNamara. And so I'll ask you the same question I asked a lot of folks that are being appointed to boards and commissions. What do you see as the primary issues that are likely to come before the board, or you see the primary challenges coming before the board in the coming years?

Well, I'm just getting a taste of that now. You know, I've seen, obviously, a big part of the job on the board is vetting new docs coming to town, whether they wanna be here or are they runaways or PAs. That are the same, and then docs and PAs that have made some bad decisions and choices. We see a lot of that. But I see that whether there's going to be compacts with other states for providers of different levels, whether that's appropriate for us, there's, to try to figure out how to properly bring more access and care to our remote, especially our remote villages, and communities, I see that as a real issue.

I trained at the University of Washington, did the WHAMI program that brought me to Alaska. That's how I ended up up here. And I spent time in Nome and Kotzebue, and it's, there's a need. I always assume that because we have we did the WHAMI program, we would go out to the communities and when we came back up here, I was not, I didn't pursue primary care, so it didn't make sense as an orthopedic surgeon to go out to the communities directly. But I did help with Native hospital care a lot when I first came up here.

And I would occasionally go out to the villages doing that. So there's a need. I think it's coming up with how to, get primary care to go out to the communities or how to make it easier for those that want to live out there. I don't know, scholarships. I don't know what it would take.

Other questions? Senator Tobin. Thank you, Mr. Chairman. Mr. McMurphy, I just have a few process questions. I see here on your CV that you're located in Anchorage, and I'm just curious how many of the other members that you serve with are located in an urban center, or do you have any members on the State Medical Board that you serve with that are located outside of kind of Anchorage, Fairbanks, or Mat-Su, or Kenai?

Oh, the other board members, through the chair? Yes. Is that the question? I know that we just added a PA out of Wrangell, so that's further away from the hub. And the rest are really from, you know, Matsu and Anchorage right now.

I think there's a need, and I think it would be a great idea if we can find a provider or representative that represented the more remote areas. We could learn a lot from somebody like that. I think that's— there's a need for that. Follow-up? Thank you, Mr. Chairman, and thank you, Mr. McNamara.

Actually, I believe that The physician assistant currently resides in Delaware. They're not actually located in Wrangell. I do want to make a note of your comment. Alaska statute 08.64.010 says the creation membership of the state medical board should ensure that the 5 physicians licensed in the state are residing in as many separate geographic areas of the state as possible. So in our state statutes, we do request and demand and require our state medical board to encompass, perspectives from a geographic region, which unfortunately it, it does not at this point in time.

Uh, I do wanna follow up another question I have for you, sir. Uh, I'm curious about your clinical experience in the fields of endocrinology and reproductive medicine, uh, and particularly your, uh, interest or belief in affirming or potentially challenging na— national standards of care.

So through the chair, could you repeat the second half of that question? Yes, sir. I'm curious of your experience in the fields of endocrinology and reproductive medicine and your experience in affirming or potentially overriding national standards of care in those particular fields.

Boy, that is a— that's a very good question. Through the chair, that's a very good question. I don't have a lot of— I have no experience in endocrinology background. You know, I've certainly taken care of many people that have— they're on different treatments, and that is an area that I don't have a strong opinion on or experience on. Right now.

Follow-up? Thank you, uh, thank you, Mr. Chairman. And I do just want to note, uh, sir, that you did sign on to a letter that challenges national standards of care in those particular areas, uh, and challenging parental rights in terms of what care that they should provide to their children in terms of gender-affirming evidence and medically necessary care. So it's, it's concerning to me that you indicate you don't have experience, and yet you're you're willing to sign on to legislation or potentially sign a letter of support ending parental rights. But that's just a point to make.

I'm curious about your experience with the state's privacy clause and interested to hear your perspective on how that balances within your responsibilities on the State Medical Board. Yes, through the Chair, to answer that, I better understand what you're asking now. Under Underage gender reassignment question. I have, uh, you know, as I said, I've only been on the board about 5 months. That topic was brought up only one time really during the time that I have been serving, at least while I've been on the board or present for the board, and it was when a vote was taken.

And it's really my— I know that that's been looked at a lot by the board, I know that there's been numerous presentations to it. I know that they take into account, the board in general takes into account the Department of Law, the Attorney General's opinions, the government, or, you know, our governor's opinion, as well as public input in making these decisions. Really, for me, when I signed on to that, you know, it was just the short amount of information and education that I had at the time to assume that the board board was making this decision and I was supporting what the board was choosing to do. Definitely an area that I need to understand more. Dr. McNamara, if you could, could you please turn off your video but leave your audio on because it's causing some choppiness.

Sometimes the bandwidth issues. If you turn off your camera but leave your mic on, then we can hear you. But hopefully you don't. Okay, are you still there, Dr. McNamara? I am still there, Mr.

Chair. Very good. Now we can hear you, and there was a little bit of choppiness before. So I'm curious about that. Are those kind of letters typical for the medical board?

Do you take those kind of political stances very often?

No, uh, in the time I've been there, the need for major political stances has been very minimal. It's really been, uh, more time spent reviewing charts, uh, for doctors and providers that have been in trouble and had malpractice suits that are issues and other violations of regulations. There's certainly a lot more of that, and there's plenty of it. We're pretty overwhelmed with work right now.

So I'm sort of curious, why do you feel the board felt any need to weigh in on gender-affirming care?

Well, that wouldn't be something I could answer, being new to the board and finding something new. I'm assuming that's a question that got asked as an opinion of the board to weigh in on that, and I would assume it's been put through the Department of Law and Attorney General, the governor, all that as well. So I, I can't answer that because of my inexperience on the board at this point.

Other questions? Uh, Senator Giesel. Well, thanks, and I don't know if this is a question so much, Dr. McNamara, but perhaps more, uh, comment. I have served two terms on the Board of Nursing. You made the comment that the board takes into account our governor's opinion.

This is a quasi-adjudicatory board. You have the authority to take a property right— that's a license— from a clinician, and those aren't political decisions. Those are— the reason that physicians are put on the State Medical Board is because you have expertise as a clinician and you are adjudicating clinician practices. And so my comment is to weigh out the appropriateness of a political opinion from an elected official who incidentally appointed you It's not a good picture. So just some advice in the future.

And I know you're new on the board, and it takes about a year to actually get your feet under you when you're serving on one of these professional boards. Thank you, Mr. Chairman. Thank you, Senator Diesel.

I want to revisit the question that Senator Tobin asked and make it a little bit more explicit about the privacy clause. Again, I think it's unusual to the state Medical Board weighed in on gender-affirming care. I agree that's not your general purview, but I'm worried that it will become more common if this is now what the boards are going to be doing. And we do have a privacy clause in the Alaska Constitution. And do you see any way in which, uh, the State Medical Board could, uh, define, um, say abortion as not an ethical medical practice and then and thus circumvent the privacy clause?

Gosh, I'm so, uh, not aware and don't understand well this issue. So, and that, that question is, I really can't answer it at this point. I have too much to learn about that. I don't know what generated the question that then brought it to the board. I would assume it came from, from representative or a legislator to the board.

So if that's not the case, then I don't even know how it got generated. Very good. Well, I, I think your testimony today is in line with what I would like to see from the medical board, which is to continue to do that quasi-judicial role that I think you would, that I think is why it's there. And hopefully we can keep you doing that core competency. So thank you, Dr. McNamara.

Are there any other questions from, we've got Senator Clayman. Dr. McNamara, I had a question because I see one of your references is Dr. Stephen Tower. And I know he's had a, He's had a lot of research and experience, I think, in terms of replacement joints and the materials turned out to not be, not work well and cause reactions in the person that the artificial joint was put in. Do you know much about the experience and knowledge he's gained over the years about those issues?

Yes, through the chair. Excellent question. Steve Tower has really been ahead of most orthopedic surgeons, I think, in the country in understanding the metallosis, or the, you know, metals tend to give off, like an iron, give off some of their own metals into the surrounding area, and metals and metal on metal joints. Most joints are metal on plastic, like a total knee or typical, typical shoulder or hip. And for a while, people were putting in metal on metal joints, and they create a metallosis where they elute this, this metallic substance ions out, oxidization out into the body, and people get pretty sick from it.

Dr. Tower is one of the early ones to see it. And, and I think experience it. And so he was really a specialist in town on understanding it. I think he's just retiring here now, or just did, and so that'll be a great loss to the community for that. But I think many of us in the community have learned from him to pay more attention to that, be willing to recognize that there are a lot of neurologic symptoms, joint symptoms, And many people, you have to get those joints out to get rid of all those symptoms and put a proper, more standard joint in.

So it's a real, real issue. Yeah. So the, the reason I was curious about that is that my general sense is that when Dr. Towers started raising those questions, to raise those questions, he's, he's at some level, he and others were really challenging some of the standard views about how artificial joints were working, challenging some of the major manufacturers who were providing these for surgeons to put in folks. And so he was really, in the early stages, very much an outlier in terms of kind of the mainstream of medical thought in this way.

And so my question in light of your role on the medical board, how would you take the, how would you take your role on the medical board when you have a physician who may be somewhat outspoken about what has been a fairly standard treatment and people are having problems with that treatment, how would you go about approaching those kinds of issues on the medical board if you both have what has been pretty routine practice and now people say, are saying, maybe that doesn't work so well anymore, maybe we should rethink this? [Speaker:DR. MCGRAW] Well, historically, the medical field, that has been a problem. I mean, since, you know, from, Socrates. I mean, really, it's always been a problem where someone with something new is figuring out that something that has been accepted for many, many years is wrong or harmful, and it is very hard for a system to accept that.

I hope that I have always been one in my practice to not jump on bandwagons too quick and just because the patients want it or because the advertise, you know, the companies advertise so well that they really feel like that's what they have to have. It makes sense to listen to those outliers, as you mentioned, or call them, that start to find something that isn't normal. That is very common in medicine and I think it'll continue, but on the medical board we gotta watch for that and pay attention to what the real problem is and what may be real. We're not going to be the scientists and we're not going to do the testing, but we can at least be supportive of rather than penalizing if it makes sense. Thank you.

Thank you. I don't see any further questions at this time. We will open public testimony.

Public testimony will be limited to 2 minutes. Is there anyone in the room wishing to testify on this nominee?

Not seeing any. Anyone online? I don't see anyone. No one online. I'm going to close public testimony.

Thank you, Dr. McNamara, for, for being with us today.

You're very welcome, through the chair. Very good.

All right. That brings us to the end of our agenda today. The next meeting of the Senate Health and Social Services Committee we held on Tuesday, May 5th. During that time we have 2 additional appointees to the State Medical Board and we also have bills previously heard if we choose to take one up. So thank you everyone for productive hearing.

Remember to stay afterwards so we can sign the documents. It is 4:14, and this meeting is adjourned.