House Health & Social Services, 5/5/26, 3:15pm

This meeting of the House Health and Social Services Committee will come to order. It is 3:22 PM Tuesday, May 5th, 2026, in Davis 106. Members present are Representative Schwanke, Representative Gray, and myself, Representative Mena Chair. Let the record reflect that we have a quorum to conduct business. Please take this time to silence your cell phones for the duration of the meeting.

Staffing the committee today, we have Andrew Gianotti, our Health and Social Services Recording Secretary, Kyla Tupou, our LIO moderator, and Katie Giorgio, my committee aide. If you need anything during the meeting, please don't hesitate to get her attention. We have today the confirmation hearings of two appointments to the State Medical Board. First, we have Dr. Robert Scala. Dr. Scala, please introduce yourself for the record and tell us about your interest and qualifications for serving on the State Medical Board.

[FOREIGN LANGUAGE] Oh, I'm sorry. I didn't think I would be directed. Thank you, Chair, and thank you, members of the committee. I'm Dr. Robert Skell.

I'm a board-certified family medicine physician practicing in Eagle River since about 2002 when I returned to Alaska. I earned my DO from Chicago College of Osteopathic Medicine, and I completed my internship and residency at Doctors Hospital in Columbus, Ohio. I served as a family physician in the U.S. Army at Reynolds Army Community Hospital before taking a year to practice in a small underserved community in rural Ohio, after which I decided to come back home to Alaska. I've spent the last 20 years in private practice here.

I've focused on diabetes and lipid disorders in addition to family medicine, and our clinic was the first in Alaska to receive a National Committee for Quality Assurance recognition for excellence in diabetes care and a superior rating. I also established in 2005 Alaska's first dedicated outpatient diabetes and cholesterol clinic. I've lectured extensively across the western United States on these topics for major pharmaceutical companies and at Alaska Native Medical Center and for the FAA on diabetes management for commercial pilots and motor carriers. I'm honored the governor appointed me and gave me an opportunity to serve because I've seen firsthand these challenges of trying to deliver high-quality care in Alaska, and I've seen the Medical Board's role in licensing competent providers and reviewing complaints fairly and setting a standard that helps us to protect patients and support access, especially in rural and remote areas. And I'm ready to bring my clinical experience and commitment to evidence-based medicine to this work.

Thank you, Dr. Scala. Do we have any questions from the committee? Representative Gray. Thank you, Chair Mena. Through the chair to Dr. Scala, I reviewed your resume.

You look very well qualified to do this. I think my question is about your publications in television, and you have an upcoming AI-assisted application, Your Saint Revealed. Can you explain what that is? Yeah, my, uh, my wife decided to join the Catholic Church, and one of the problems that she came up with in January was, how does one pick a patron saint? And I said, well, there's 1.422 billion Catholics in the world.

You should probably ask one of them how you would pick a patron saint. And then it came to my mind that if there's 12,000 patron saints and if nobody has a clearly defined mechanism for, for actually choosing one, can we use AI to try and match up keywords in a series of 20 questions, deep and probing questions about one's life and about where one wants to go spiritually, with attributes of a patron saint for whom we have about 1,800 biographies? And so it's basically a a very sophisticated matching program to allow people to create alignment with things that seem most appropriate or more appropriate than picking things at random. That's very interesting. Follow-up?

Follow-up! What patron saint was your wife matched with?

She was matched with Saint Marguerite d'Youville. A French-Canadian patron saint of nurses and helping those less fortunate, which I think suits my wife, who's also a nurse, quite well. Thank you so much. No further questions, Madam Chair. Thank you, Representative Gray.

Uh, I'll ask a quick question, uh, Dr. Scala. When were you appointed to the State Medical Board? About 5 minutes ago. Actually, last week. Thank you for the clarification.

Have you been able to have the opportunity to either attend a meeting of the State Medical Board or watch any of their previous meetings or follow either the minutes or the work of the State Medical Board? I've actually just done some work on my own to look at their past minutes, and I've already been given links to look at next Friday's medical— Alaska State Medical Board meeting. So I've already reviewed the cases that are in front of the board. I completed training at my onboard training at lunch, and then I have some more training tomorrow at lunch as well. Oh, wonderful.

We are in the middle of your training. Um, what has been your interest in joining the State Medical Board?

Well, the first one is my concern that if the State Medical Board doesn't have enough people who are willing to step up and serve, that we're going to lose the ability to form a quorum. And, you know, Alaska is kind of unique in that 98% of our state is underserved. And if we don't have a streamlined process for licensure to qualify people to serve the public, well, then neither the public nor the medical community is well served. And I'm at the stage in my career where I have an opportunity to try and give back to the state that's given me so much of an opportunity to practice. That's great to hear.

And, you know, since you've been on the other side of, you know, practicing in the state for a few decades, what concerns or ideas that you have about the licensing process in Alaska and how we can help improve that?

Well, I'm not sure you're going to do a lot to improve it beyond what it has already. I, I mean, I was very impressed with talking with your investigators today that it looks like we have a very good opportunity to review every case for application or every disciplinary case very thoroughly and fairly, and we can we get a really great report from the investigative committees, committees relying on facts and evidence and input, and it allows us an opportunity to do both the medical licensure to protect the public and license qualified physicians and PAs and adopt reasonable standards and regulations. And then, you know, we also have a good opportunity with the State Medical Board to investigate and discipline when standards aren't met. So so that we balance patient safety as well as provider shortages in a vast geography of Alaska. It's not always easy, but I'm very pleased so far.

Wonderful. I also have a question just related to the State Medical Board. They've been in the news over the past year for taking stances and passing certain resolutions that have caused a little bit of controversy. I'm just wondering if you had any perspective.

Or any opinions or comments on the State Medical Board's actions in the news over the past year?

Well, I'm not sure if this is an advantage or disadvantage, but I actually haven't had a TV in the house for over a dozen years, so I've actually been at somewhat distance if there's been a controversy for the board itself addressing issues within the medical community. I guess I'm not familiar with how the Medical Board has exposed its members to public scrutiny.

I have another question then just related to, you know, there's some of these different issues where that— those are the ones where I usually hear of a lot of public testimony from the public, and so I'm just curious about your role as a physician and being on the State Medical Board. How do you balance between listening from providers, from doing your research, from integrating feedback from the public, and also working with the administration and other colleagues to make the right decisions on healthcare for our state?

I think on the healthcare side, it's to make sure that we're actually adhering to the board's core mission, protecting public and licensing qualified candidates. And to make sure that the legislative aspects of medicine are left to legislators.

And I guess that, you know, I mean, public opinion is going to be particularly important. We serve the public at one level or another, all of us do, or we don't have a job.

For sure. Same here.

Do we have questions from the committee? I want to see if Rep. Schwanke, if you might have any.

Madam Chair. Representative Schonke. I wanted to ask about high and low density lipids, but it's probably the wrong— Go ahead. Why not? I'm fascinated.

We're going to have to have more conversations about cholesterol, Dr. Scala. I'm very fascinated by the concept of different medical perspectives on it. I'm sort of curious what your experience is with rural Alaskan healthcare. You hit on it a little bit there, you kind of indicated, you know, we have vast geography and we do have a lot of situations around the state of Alaska where we have very limited healthcare opportunities and we have some clinics, some beautiful new clinics that have been built in some of our rural villages, but they're not staffed full-time and we have traveling nurses. And, um, could you describe your, your knowledge of that system?

And, and do you have any, um, knowledge of instances, I guess, uh, where there might have been unprofessional medical care? Or just what do you foresee coming to the, the board on that front?

Well, I think that the medical community has a lot of responsibilities to try and provide better access. I mean, I would tell you or relate just today on my schedule of patients, I've already seen one patient who drove 6 hours to come and see me. And my concern when people are driving more than 30 minutes to see their physician is not necessarily the fact that I can provide superior care to someone else in my, in my profession, but my disappointment that we're, we're not able to provide what people need all the time. And so they're forced to drive 6 hours to provide somebody who has an expertise in diabetes and lipid therapy. And I think that there's— and I think the military has been very instrumental in this idea of promoting that Maybe we need to rethink the manner in which we deliver our care, whether that's through telemedicine that allows us to bridge these distances, or maybe it's through mid-level providers, PAs and nurse practitioners, who can provide a fairly high standard of medical practice for most of the stuff that comes through their door, and having the backup, whether that's through video conferencing or a regional or dedicated physician staff, to allow them better decision-making.

And maybe it's going to include the use of AI as more than something that's a novelty for writing a saint-choosing program for someone's wife. Because as it gets better and better, I think the difficulty in predicting its utility is that most of our minds are, are oriented towards linear progressions or improvements, and AI is going to offer us exponential increases And as that takeoff point goes up, it will provide us an opportunity to leverage that intelligence squared. So I think that this is a great— it's just all opportunity and upside to me. Follow-up? No, I really appreciate that, and I think it kind of dovetails really nicely with the fact that we have the Rural Health Transformation Program coming up, and we've got some providers in some of our rural areas that are kind of chomping at the bit to see when awards are going to be distributed, and I received information from the Department of Health that they're looking at mid-May to trying to try to get some of those awards moving.

And it seems like, it seems like the telehealth model and the distance delivery model or some combination of technology and potentially AI or, you know, VTC, whatnot, it seems like that's really the best solution because we have such sparsely populated areas across large geographic areas, so there's just not the customer base really to, to put a lipid specialist in every community. However, we have probably one of the highest rates of diabetes throughout the country in Alaska, and specifically in rural Alaska, so I suspect that your expertise is going to be very helpful in, um, in moving forward with professional perspective on the board. So I really appreciate you being here and being willing to step up and put your name in the hat because volunteer service in the state of Alaska doesn't seem to be as robust as it used to be. So thank you. Much appreciated.

Representative Gray. Thank you, Chair Mena. So, Dr. Scala, reviewing your resume, you've been a guest lecturer for a lot of pharmaceutical companies. Just a little bit about my experience as a PA. Working at the Alaska VA was a refreshing change because we didn't have pharmaceutical reps coming in and marketing their drugs directly to us.

It wasn't allowed. It was against the law. Having worked in private practice before going to work for the VA, there was— I mean, we had a lot of pharmaceutical reps coming in.

You know, I can't help but look back and say that the pharmaceutical reps who brought the best lunches and gave the best swag and was everybody's favorite rep, that people were prescribing more of her medicines. And I guess, Can you talk a little bit about the influence of the pharmaceutical industry in medicine today? And from my perspective, it's not in the best interest of patients to have the pharmaceutical industry telling us which medicines we should give. Sometimes the more expensive option is not the best option. Just speak a little bit to that.

Yeah, I think that that was— there was a concept called share of voice back in the early 2000s where there was literally an onslaught of pharmaceutical reps through one's office. And even if they only wanted 3 or 4 minutes of your time, by the time you hit the 10th or 11th or 12th one, your day has been significantly interrupted by that share of voice. And I think that the difference that I would say in what we have modern— in modern repping is that what they can say and how they can say it has contracted immensely. So they really can't do the same things that they used to be able to do back in the early or late 1990s and early 2000s. So that's been significantly curtailed.

The limit problem, as I see it, is that the conceptual models for how we think of disease and then how we treat disease are, are going to be informed by technologies driven in part by research in the pharmaceutical industry. And if we start to eliminate the ability to exchange ideas, whether that's with the pharmaceutical industry or each other, well, then we limit flows of information, and it's difficult for us to update the model of practice if we don't have that free exchange of information. And I mean, I would, I would say an analogy could be made for any person in sales, whether that was somebody in the pharmaceutical industry, in lobbying for any particular position on an issue, that we all have to be wary of the influence of.

Of that marketing. Follow-up. Follow-up. Thank you. I guess just to go back to my experience at the VA, we did not have any pharmaceutical reps there.

I believe that we did learn about new medications. And we did, you know, obviously the VA has its own formulary. So, you know, we were prescribing a lot of, you know, we were, we prescribed generic medications. We do not prescribe name brand medications. Generally.

And we do not prescribe the newest name brand medications except under very specific circumstances. I'm not sure that we really had a limit in the flow of information.

And I, I hear what you're saying. But I was working at Prime Primary Care in 2012, 2013, 2014. That was a period where I felt like every man in any direction was getting topical testosterone, and it was— so when I'm talking about pharmaceutical reps, I am talking about it was the topical testosterone pharmaceutical reps who were bombarding the office. They were competing on the types of lunches they were giving. They were coming all the time, and there was one particular a topical testosterone called Testim that had a scent that no one liked, but somehow our office was prescribing more of this topical testosterone than the others, and I know it was because the doctors really liked that rep.

So I'm just saying my own personal experience that even with the new sort of, curtailment for what pharmaceutical companies can do to influence medical providers. There's still influence there, and it sometimes doesn't make sense. I don't disagree with you.

Yeah, I guess I would say my role was more in speaking about disease state management. I actually started speaking back in 2004 when you had to make your own slides, and and then create an entire slideshow based upon a disease state model of understanding. So my role was more limited to describing the state of the art in blood pressure, cholesterol, or diabetes management. And that was my role within the speaking environment. Follow-up.

Follow-up. Thank you. That makes me feel much better. I will just say that I did attend a, a Synthroid dinner once where a doctor in your shoes who was just supposed to be talking about hypothyroidism was asked point blank if he would recommend brand name Synthroid and said no, much to the chagrin of the Synthroid reps who were paying for this very expensive dinner. So I'm hoping that you're in the same shoes as that doctor and was just teaching about the disease and not promoting a particular brand name medication.

Perfect.

Representative Schonke. Uh, yeah, thank you, Dr. Skala. Just kind of a couple follow-up questions. Um, what do you see kind of as your primary role here? I see that you're a DO, so that's kind of different.

Um, more of a public protection or kind of a physician advocacy perspective. Is it indeed? Well, I guess I would advocate for policies that recruit and retain excellent providers and don't compromise safety. I think we have to keep the patient at the center, or like I said before, none of us— I wouldn't have a job if I didn't serve my patients as my primary role. And at the same time, I think we need to have team-based care that has an opportunity to serve those patients at the center.

So, I guess, you know, maybe appropriate expansion of scope so that patients are being served, making sure that we have good training and experience and evidence for the patients that— or, excuse me, for the providers that we're licensing. I guess it would be a balance between both of them so that both the medical community and the patients have a fair and transparent effort to serve both of them. I appreciate that. Thank you. Great.

Um, any other questions from the committee? Um, one last question, Dr. Skala. You mentioned you haven't owned a TV in a few years, and I'm also looking at your publication slash television. Tell me more about HGTV Buying Alaska, September 2015, Bob the Deckhand.

Yeah, one of my patients is a six-pack charter captain out of Whittier, Alaska, and she called me to come help her run her boat because she didn't have any deckhands. Her season hadn't quite started, and she was shooting an episode of Buying Alaska and needed somebody to act as her deckhand for this TV show. So I took a day and a half off of work to to break in some new powerheads on her engines and then set out some pots for her. And then the next morning we met a crew of 6 people from this television show, and reality TV was less exciting and less real than I thought it was supposed to be. But I got to act as the deckhand.

Lovely. A lot of diversity in your resume. Well, seeing no other questions or comments from the committee, I want to thank you, Dr. Scala, for spending some time with us in the House Health and Social Services Committee and for calling in to our committee today and serving on the State Medical Board. And we will now let you go. I believe you have another hearing to attend to.

We will now transition to our second confirmation hearing today on the appointment of Hannah Milkey to the State Medical Medical Board. Ms. Milkey, please introduce yourself for the record. Tell us about your interest and qualifications for serving on the State Medical Board.

Hello, thank you so much for having me. My name is Hannah Milkey. I'm a lifelong Alaskan. I'm interested in serving on the State Medical Board because I see it as a great opportunity for public service. I know how important public health and safety is in our state, and I I am excited for the opportunity to learn more and do what I can to serve Alaskans through this position.

I would believe I would offer a unique perspective on the board as a young female Alaskan who cares about bettering our great state.

Wonderful. Thank you, Miss Milkey. Uh, do we have any questions from the committee? Uh, I, I'll start. To start, Ms. Melky, uh, it's always great to see young women stepping up to serve and volunteer and serve our great state.

I'm wondering about what particular interests that you have specifically in the State Medical Board and any healthcare experience or interest that you have with your background. Uh, yeah. Yeah. Thank you for your question. Um, one of the requirements to be a public member is that I'm not affiliated with the medical industry.

So I won't receive any financial benefits or anything related to the medical industry. So I'm just interested and excited to be a public member who can offer non-biased opinions based off of what the law says and what benefits Alaskans the most.

Wonderful. And just to clarify, when were you appointed to the State Medical Board? I was appointed one week ago. Wonderful. Same time as Dr. Scholar.

And what— could you tell me more about your interest in healthcare in Alaska and what you would like to bring or what you're curious about as you serve on the State Medical Board?

Yeah, healthcare is so important to Alaska. Um, as one of the main functions and focuses of the board is individual licensing matters, and so I see that as just a great opportunity to help serve the board. Um, as you know, the board approves doctors' licenses and such, and so I see this as a way that we can benefit Alaskans directly by having a full board to make this process a little smoother and quicker and better for Alaskans.

Great. Um, I, I guess I have another question. Um, I know that you're currently the only woman, I believe, that's serving on the State Medical Board, and I've definitely been in many rooms and different areas where I am the only woman on the State Medical Board. So thanks for sticking up for us. Uh, I— being in that position, what perspective do you hope to provide to help advocate for, especially since there are a lot of different medical issues, primary care issues that do impact women in our state.

Yeah, um, that is true. I am the only woman on the board. Um, I am excited to just see what that unique perspective brings to the table. Um, I am new, so I'm still getting up to speed on the current board issues and such, but I look forward to, as issues coming up, just reviewing all sides and making decisions based off of, you know, the information gathered, the law, what.

Best for Alaskans. And then, as you mentioned, yeah, being the only woman on the board, just making sure that Alaskans are equally represented as well is very important to me. Great. I'll see if we have questions from the committee. Representative Gray and then Representative Schwanke.

Thank you, Chair Mina. Through the chair to Miss Mielke, um, it says that you've been working as, um, the managing the reception desk for the governor from October 24th to the present. Do you work in Anchorage Yes, that's correct. I work in the Anchorage office. Thank you.

And, and I guess my follow-up question, I, I think it's probably what struck a lot of us. We— I, I see that you graduated from high school in 2025, um, and I guess, like, can you just talk a little bit about your future plans? Um, do you, you know, are you planning to go to university, or what, what's your plans for the near future? [Speaker:KAYLA] Yeah, of course. My current plan for the near future is just seeing what else I can do to help Alaskans.

Yeah, I did recently graduate high school, but I do think that while an education is very important, and I am open to the option of going to college in the future if I need to, I think that what also is very important is just having the ability to learn and grow and view all sides and make decisions based off of the information gathered. And so I just look forward to working with the rest of the board members and just seeing what I can learn to help serve others. Thank you. Representative Schwanke. Thank you, Madam Chair.

Thank you, Miss Milkey, for being interested in stepping up. I, I have some concerns that your youth is, um, going to leave you with a few gaps in trying to address some of the more serious issues that come in front of the board. I have a question for you. What role would you say that rehabilitation or probation play versus suspension or revocation of a license? When it comes to a concern with an incompetent physician?

Sorry, could you please repeat the last part of the question again? Yeah, so you're, you're going to be dealing with concerns for licensed medical providers, and I'm curious what role that you think that rehabilitation versus rehabilitation or probation versus having a license suspended or revoked in the case of an incompetent physician?

Okay, thank you so much for your question. Yeah, like I said, I was appointed to the board one week ago, so I haven't had time to review all of the information for our upcoming board meeting. But the way the board meetings do work is the doctor appointees are assigned different cases, and So as a public member, my role would be to review all of the information and vote on— based off of the information given. And so I think that is the benefit of being a public member, is that I do not have affiliation with the medical industry. And so I see this as more of an advantage being a younger female board member.

I see it as an advantage offering a unique perspective to board. So when it does come time for me to review the board information, I know you said about, you know, taking licenses away or rehabilitation and all that you mentioned. I'm just looking forward to reviewing all the facts and then making decisions based off of that. Thank you. Wonderful.

Uh, I have a question, just going back talking about healthcare. Ms. Melke, what do you see as the top healthcare issues that are facing Alaska?

Uh, thank you so much. Are you referring to top healthcare issues for Alaska as a whole or top healthcare issues that the board may be facing? Uh, that is facing Alaska as a whole.

Hmm. I am new to the board, so I'm not familiar with all of the issues that the board has. Uh, one issue that I have heard other board members talk about, or I have heard talked about, is just making sure that healthcare is accessible to all of Alaska. I know that we are in a very unique state in that we do have just over 700,000 people in our state, but we are the biggest state out there. I do think it is very important that everyone has equal access to healthcare.

I know that isn't always possible, but it is something I believe as Alaskans we should be striving to make sure that everyone has access to healthcare.

For sure. Thank you.

Any other questions from the committee?

All right, seeing none, thank you, Miss Milkey, for putting your name forward and for calling into the committee today and for serving on on the State Medical Board. I will now open public testimony on the appointments of Dr. Scala and Ms. Mielke. First off, is there anyone in the room who wishes to testify? Seeing none, is there anyone online who wishes to testify? Seeing no more individuals wishing to testify, I'm going to go ahead and close public testimony.

Do we have any further discussion on our appointments to the State Medical Board? Seeing none, in accordance with AS 39-580, the Health and Social Services Committee held a hearing on Dr. Robert Scala and Hannah Milkey, appointee to the State Medical Board. A signature on this report does not reflect an intent by any of the members to vote for or against the confirmation of the individuals during any further sessions. I ask that— that members sign the committee report after we adjourn. The time is 3:57 PM, and this hearing of the House Health and Social Services Committee is now adjourned.