Senate Committee on Health and Human Services (01/28/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	01/28/2009	ATTENDANCE

Time:	09:35 AM to 11:37 AM	Carroll M.	X
		Lundberg	*
Place:	SCR 356	Mitchell	*
		Morse	*
This Meeting was called to order by		Newell	X
	Senator Boyd	Schultheis	X
		Tochtrop	X
This Report was prepared by		Boyd	X
	Elizabeth Burger
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Sunset Review of the Bd. of Chiropractic Examiners Sunset Rev. of Bd. of Nursing Home Administrators		- -

09:36 AM -- Sunset Review of the Bd. of Chiropractic Examiners

Bruce Harrelson, Department of Regulatory Agencies (DORA), reviewed the DORA sunset review of the Board of Chiropractic Examiners (Attachment A). He discussed the practice of chiropractic and the regulation of the practice by DORA. He reviewed the recommendations of the DORA sunset review, which include:

Recommendation 1: continuing the Board of Chiropractic Examiners until July 1, 2020;
Recommendation 2: increasing the malpractice insurance requirements for chiropractors to $300,000 per claim and $1 million per year;
Recommendation 3: specifying that failure to respond to a board-generated complaint letter is grounds for discipline;
Recommendation 4: modifying the scope of practice for chiropractors, and removing a statutory prohibition against chiropractors performing colonic irrigation;
Recommendation 5: deleting an obsolete provision relating to board member terms;
Recommendation 6: conforming the definition of "acupuncture" to an existing definition; and
Recommendation 7: limiting the Board of Chiropractic Examiner's fining authority to a range set in statute.

He stated that there have been discussions related to provisions of the bill that modify the definition of acupuncture and stated there may be an amendment to address these concerns. A draft bill containing the DORA recommendations was distributed to the committee (Attachment B), as well as amendment L.001 (Attachment C).

09:47 AM -- Leo Boyle, Colorado Veterinary Medical Association and Acupuncture Association of Colorado, testified regarding amendment L.001 (Attachment C), stating that the amendment represents a compromise between both groups he represents and the Colorado Chiropractic Association. Mr. Boyle discussed the requirements for individuals who practice acupuncture. He stated that there is a difference in requirements for chiropractors who practice acupuncture and acupuncturists who practice oriental medicine, but that the definition contained in the bill does not make a distinction. He stated that the amendment will remove that definition in favor of the definition which currently is contained in the chiropractic act which does make the appropriate distinction between the different types of acupuncture. Mr. Boyle noted that the amendment also contains language related to the use of chiropractic techniques on animals.

09:51 AM -- Dr. Jed Rogers, Colorado Veterinary Medical Association, stated that there are chiropractors practicing on animals, and that there are not enough veterinarians to meet the demand. He stated that the Veterinary Medical Association would like to collaborate with chiropractors to ensure that the demand is met in an appropriate manner. He testified in support of amendment L.001, stating the amendment was a result of collaboration between chiropractors and veterinarians. He noted that currently when nonveterinarians engage in the treatment of animals, they are breaking the law. He stated that the two associations worked together to create education, scope of practice, and disciplinary requirements for chiropractors to treat animals, which are specified in amendment L.001. Dr. Rogers responded to questions from Senator Schultheis regarding certain practices that were not included in the definition of animal chiropractic. He responded to additional questions from Senator Tochtrop regarding whether the practice of animal chiropractic was limited to horses and dogs, stating that it is limited because the animal chiropractic training currently available is only for horses and dogs.

09:59 AM -- Ralph Johnson, Colorado Veterinary Medical Association, offered to respond to committee questions.

09:59 AM -- Leo Boyle, responded to questions from Senator Newell regarding the required number of training hours for acupuncturists. Senator Newell and Mr. Boyle discussed the definition of acupuncture contained in the amendment. Senator Boyd clarified that the amendment returns the definition of acupuncture to the one that currently exists in the statutes governing chiropractors. Senator Lundberg asked for clarification regarding the list of exclusions from the list of animal chiropractic, and how the amendment interacts with the veterinary practice act. Dr. Rogers responded to questions from Senator Mitchell regarding whether consumers will face more barriers seeking chiropractic care for their animals as a result of the amendment. A letter was distributed to the committee (Attachment D).

10:12 AM -- Terry Snyder, Colorado Chiropractic Association, testified that the Colorado Chiropractic Association is satisfied with the compromise represented in L.001.

10:16 AM -- Dr. Ben Vernon, Colorado Medical Association, testified regarding the portion of the bill that the removes statutory language specifying that chiropractic does not include colonic irrigation. A copy of his testimony was distributed to the committee (Attachment E). Senator Mitchell and Dr. Vernon discussed medical problems associated with colonic irrigation. Senator Carroll suggested that some of the existing statutory language regarding colonic irrigation be restored in the draft bill.

10:25 AM -- Mr. Harrelson returned to the table to address Senator Carroll's suggested amendment to the draft bill, stating that the suggestion was a reasonable compromise. He stated that he didn't know of any problems with chiropractors practicing colonic irrigation, and that the practice of colonic irrigation is unregulated. He responded to questions from Senator Schultheis regarding amendment L.001 and whether or not the language of the amendment would allow for insurance coverage of chiropractic care for animals. Mr. Harrelson stated that DORA had just received the amendment and couldn't comment on that issue at this time.

10:31 AM

Tom Morris, Office of Legislative Legal Services, discussed an amendment to L.001 (Attachment C). He stated that the amendment inadvertently applied the requirement that a chiropractor receive veterinary medical clearance prior to performing animal chiropractic to only chiropractors who have not registered pursuant to the bill. He stated that the intent was that the requirement for veterinary medical clearance apply to both registered and unregistered chiropractors. He walked the committee through the amendment.


BILL:	Sunset Review of the Bd. of Chiropractic Examiners
TIME:	10:32:59 AM
MOVED:	Tochtrop
MOTION:	Amend prepared amendment L.001 (Attachment C), page 4, line 19, to clarify that both registered and unregistered chiropractors must receive veterinary medical clearance to perform animal chiropractic. The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	Sunset Review of the Bd. of Chiropractic Examiners
TIME:	10:35:35 AM
MOVED:	Tochtrop
MOTION:	Adopt prepared amendment L.001 (Attachment C), as amended. The motion passed on a 6-2 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 6 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

10:38 AM

Senator Carroll moved to restore the language of the bill that provides that treating a patient by colonic irrigation is grounds for discipline of a chiropractor. Tom Morris, Office of Legislative Legal Services, returned to the table to clarify Senator Carroll's motion.


BILL:	Sunset Review of the Bd. of Chiropractic Examiners
TIME:	10:37:36 AM
MOVED:	Carroll M.
MOTION:	Amend the draft bill, pages 4 and 5, strike section 6 of the bill. The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

10:41 AM

Tom Morris, Office of Legislative Legal Services, responded to committee questions regarding an amendment to clarify the levels of fines that may be assessed by the Board of Chiropractic Examiners.


BILL:	Sunset Review of the Bd. of Chiropractic Examiners
TIME:	10:42:07 AM
MOVED:	Boyd
MOTION:	Amend the draft bill, page 6, lines 9 through 22, allowing the drafter to draft language to set floor of $1,000 and a ceiling of $5,000 for fines assessed by the Board of Chiropractic Examiners, with a graduated schedule for subsequent violations, specified in statute, with the specific fine levels to be determined by DORA. The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	Sunset Review of the Bd. of Chiropractic Examiners
TIME:	10:46:29 AM
MOVED:	Boyd
MOTION:	Introduce the draft bill (Attachment B), as amended. The motion passed on a 7-1 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 7 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS

10:47 AM

Senator Boyd noted that she will be the prime sponsor of the bill. Senator Tochtrop and Senator Newell were added as cosponsors. Senator Lundberg asked to change his vote on the bill. Senator Boyd noted that a motion to reconsider was necessary. Senator Lundberg stated that wasn't necessary, and his vote could stand as originally recorded.


BILL:	Sunset Review of the Bd. of Chiropractic Examiners
TIME:	10:47:53 AM
MOVED:	Mitchell
MOTION:	Having voted on the prevailing side, Senator Mitchell moved to reconsider the previous vote to recommend that the draft bill be introduced, as amended. The motion was withdrawn.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Withdrawn

10:50 AM -- Sunset Rev. of Bd. of Nursing Home Administrators

Bruce Harrelson, DORA, reviewed recommendations contained in the DORA Sunset Review of the Board of Examiners of Nursing Home Administrators (Attachment F). A draft bill containing the recommendations of the sunset review was distributed to the committee (Attachment G). DORA's recommendations with regard to the board are to:

Recommendation 1: continue the Board of Nursing Home Administrators through July 1, 2018;
Recommendation 2: reduce the size of the board from 8 to 5 members;
Recommendation 3: eliminate the requirement that participants in administrator-in-training program submit bimonthly progress reports, and allow the board, by rule, to determine the frequency of the progress reports;
Recommendation 4: eliminate a bachelor's degree in business administration from the list of degrees that an applicant for a nursing home administrator license can hold in order to avoid participation in the administrator-in-training program as a prerequisite to licensure;

Recommendation 5: eliminate the ability of an applicant for licensure as a nursing home administrator to avoid participation in the administrator-in-training program as a prerequisite to licensure by demonstrating that the applicant has had two years of supervision in a nursing home or hospital;
Recommendation 6: repeal the requirement that the board submit an annual report to the governor;
Recommendation 7: allow the board to impose fines pursuant to rule when a licensee commits an act constituting grounds for discipline; and
Recommendation 8: correct technical errors in the statutory provisions governing the board.

Mr. Harrelson responded to questions from Senator Tochtrop regarding whether the draft bill's language is intended to mirror language contained in other licensing practice acts. Senator Carroll asked for clarification of recommendations number 3 and 6. Mr. Harrelson stated that DORA doesn't feel strongly about recommendation 6, but that the reporting requirement has been eliminated for other licensing boards. He responded to questions from Senator Carroll about recommendation number 3, stating it was his belief that allowing the board to dictate the timing of the reports would strengthen the reporting requirement. He responded to questions from Senator Tochtrop recommendation number 6. Senator Tochtrop noted that there is a lot of public information available about specific licensees, and that if the reports aren't required for other regulatory boards, they shouldn't be required for the Board of Nursing Home Administrators. Senator Tochtrop discussed recommendation number 3, and stated that it should be the purview of the board as to the timing of submission of the progress reports.

11:04 AM

Senator Lundberg asked for clarification of recommendation number 7, which allows the boards to issue fines for disciplinary actions. Mr. Harrelson responded, stating that there are times when surrender or revocation of a license is not appropriate, and that there are incidents that are administrative in nature where assessment of a fine may be more appropriate. He stated that fines are another tool for regulators to use, and gave an example of a situation in which assessment of a fine may be appropriate. The committee discussed the provision allowing the board to assess fines.

11:18 AM -- Susan Miller, Department of Regulatory Agencies, testified regarding recommendation number 7, stating that fining is an appropriate tool in certain circumstances and that sometimes there is a need for disciplinary tools outside of those that currently exist. She clarified the range for penalties specified in the bill. She responded to comments from Senator Carroll regarding various reporting requirements in the bill. Ms. Miller responded to comments from Senator Carroll regarding recommendation 6, stating that even though the reporting requirement would be removed, the data would still be available to the public. Senator Lundberg asked for clarification of Ms. Miller's comments related to recommendation number 7. Ms. Miller responded, stating that the fines would be discretionary. She stated that adding fining as an option for the board will allow the board to determine the appropriate disciplinary action to fit the circumstances of the offense.


BILL:	Sunset Rev. of Bd. of Nursing Home Administrators
TIME:	11:32:40 AM
MOVED:	Lundberg
MOTION:	Strike sections 8 and 9 of the draft bill (Attachment G) . The motion failed on a 4-4 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	No

Not Final YES: 4 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: TIE


BILL:	Sunset Rev. of Bd. of Nursing Home Administrators
TIME:	11:35:36 AM
MOVED:	Boyd
MOTION:	Introduce the draft bill (Attachment G) as drafted. The motion passed on a 8-0 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

11:36 AM

Senator Boyd announced that Senator Tochtrop would be the prime sponsor of the bill. Senator Boyd reviewed the committee's schedule for upcoming meetings and the committee recessed.