Alaska Legislature: House Health & Social Services - April 30, 2026 3:15pm

This meeting of the House Health and Social Services Committee will come to order. It is 3:22 PM Thursday, April 30, 2026, in Davis 106. Members present are Representatives Ruffridge, Mears, Prox, Fields, 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, Chloe Miller, our LAO moderator, and Katie Giorgio, my committee aide. If you need anything during the meeting, please don't hesitate to get her attention. Our only item on the agenda today, we have a confirmation hearing on the appointment of Dr. Michael McNamara to the State Medical Medical Board. Dr. McNamara, please introduce yourself for the record and tell us about your interest and qualifications for serving on the State Medical Board. Uh, yes, Madam Chair, thank you for having me and taking the time to be here.

I was appointed by Governor Dunleavy to the board about 5 months ago now, so have been doing some work in that time frame. I'm an orthopedic surgeon that trained in Tacoma, Washington. Went to medical school at the University of Washington. Did a residency training in San Antonio, Texas in orthopedics. And then did a hand, elbow, shoulder, and microvascular training in San Antonio as well.

I— some of my schooling was paid for by the Air Force. So my time in Alaska was paying back time to the Air Force. I came up for 6 years. To Elmendorf Air Force Base, and really it was at that time that we, my family and I, developed a love for Alaska, and we stayed. While in Alaska, I've served about 25 years as president and executive director for the Alaska Surgery Center of Anchorage and spearheaded many projects, including a state-of-the-art surgery center that was built 5 years ago, and I was the representative surgeon involved in that as well.

I've always wanted to be on the Medical Board, but just been too busy. I'm probably going to retire this next month and, and I feel like I have the time now to devote to the State Medical Board. So I look forward to trying to help continue to improve and vet docs coming to Alaska as well as, you know, reach out to the communities and small— smaller communities in Alaska with physicians, PAs. And what we've done most in the last 5 months is look at different docs and PAs that have, you know, gotten in trouble and we're just trying to see whether we can keep them going or work with trying to figure out how to how to move forward. So I do expect excellence in medicine.

Having been here almost 30 years, I've watched Alaska go from really 30 years ago, I frequently heard patients say they were going out of state to get care or second opinion, and in that 30 years, that has totally flipped. I've seen improvement in every realm of medicine. There's very few things I think really ever need to go out of Alaska anymore, and patients, I think, reflect that too. So, it'd be nice to be a part of that continued direction.

Thank you, Dr. McNamara, for talking about your qualifications. Do we have any questions from the committee? Representative Mears. Thank you. Through the chair to Dr. Mangumara, your comment just about folks seeking care outside of Alaska hit me a little bit because I've got a staff member that's just heading up from Juneau to Anchorage for a specialty appointment.

And it kind of strikes me that, you know, the representation on the medical board very much is in, you know, that south-central area where if folks need to go to a specialist that's within driving distance, but the reality in a lot of Alaska is that any kind of specialized care is not immediately available to you. So could you share with us a little bit of your experience maybe with patients that are coming in from out of town or your thoughts on that part of our medical system that we are spread out?

Well, that is an excellent question. Through the chair, excuse me. I've just watched medicine markedly improve in the sense that, you know, in orthopedics, when I first came up here, almost all children's orthopedics had to go to Seattle or go south. And in that timeframe, you know, we have excellent orthopedic providers doing kids' care now. And even though our state is so big, that they do have to travel, I agree, and sometimes the travel to Seattle is just as fast as coming to Anchorage for some, but they don't have to leave the state and we really have excellent providers.

I think there's certain cancers that still get sent out once in a while, there's certain very complex heart things that get sent out, but we really have done a wonderful job of excelling with training, bringing new people up here. I wish we could bring more. I think there's a great need for more physicians up here, more specialty trained in almost all areas, and certainly getting people out to the communities, out to the villages. There's— I see a weakness there for sure. Did that answer your question through the chair?

Follow-up? Thank you, Dr. McMurray, through the chair. I was more getting at expertise and experience on the board? Oh yes. That, you know, like, are we missing a rural experience voice on there, or do you think, like, do you have enough experience with working with patients from outside of Anchorage that you feel that you can help supply some of that perspective?

I think it's an excellent idea to have somebody from the village somebody outside that has more exposure to educate us. I have traveled quite a bit out to the villages, and I was a UW student, and we actually came up and did rotations where we went out to the villages to care for patients, and it's very rural. We are very rural when you get out there, and to have someone that's out there that could potentially be on the board would be, would be great. There are doctors out there, and I'm not sure why they haven't applied, but I think it would be a great idea to bring someone on that is part of that community.

Representative Brooks.

Yes, thank you. Through the chair, thank you for stepping forward We need more people who are willing to do that, I guess. But what I was really interested in is your view on scope of practice and other licensed medical professionals being allowed to expand their scope of practice.

Good question. I'm not sure— through the chair, I'm not sure that I fully understand the question, probably because I had— that hasn't been brought up heavily on the board as of yet while I've been on. And, you know, as an orthopedic surgeon, I don't— I'm not exposed to that, that question. I work a lot with PAs. I have used PAs for really 30-plus years, and.

And understand how valuable they are. But I know even most PAs work directly with a physician, and that's hard to do out in the valleys or out in the villages.

So can you ask your question, sir, through the chair in a different way or something I'm not picking up? Sure, I suppose so. It seems that we have a shortage of Family practice and general practitioners, I guess, and other— like, for instance, there's a bill to get respiratory therapists licensed, and naturopaths are trying to expand their scope of practice, and another third bill pharmacists trying to get licensed to work with physicians and get more prescription authority. Just trying to figure out—. We are—.

I, I guess especially am trying to figure out how to get more providers available in the general care as opposed to specialists. We seem to be really short on general providers of one persuasion or another. And then it comes down to the board usually weighs in on whether they should be allowed to do that. So do you think that the balance between quality of care and availability of care, what should we be focusing on? [Speaker:DR. KELLY] Well, one, I— through the chair, to answer your question, I think I think one follows the other.

As you increase availability of care providers, you're gonna increase care quality and access. So the answer is, you know, creative ways that you can potentially license people or increase their credentials to help care if that's what it takes in Alaska. We are totally different than the rest of the United States.

Because I think drawing people that want to go out and live in a community, I think is a lot more difficult, especially spouses. We find it just in Anchorage. I've watched numerous physicians come to Anchorage where their provider, where their spouses choose not to want to stay up here. And as you go further out away from the hub, that's even more difficult. So I think looking for creative ways to provide more care makes total sense.

Okay, thank you. Representative Fields. Uh, thank you, through the chair. Yeah, my friend Mike Prox and I have different views about whether naturopaths should be allowed to diagnose and prescribe. I think that's very reckless for naturopaths are out there saying they can treat cancer with vitamin C. But I want to ask you a different version of the question about primary care.

So we do have a shortage of primary care physicians. We haven't— we don't have adequate funding in the Higher Education Investment Fund to sufficiently support WHAMI. The Higher Education Investment Fund has been our vehicle to support WHAMI funding where we've had constraint— constrained undesignated general fund or UGF money. So I was curious if the goal is to get more primary care physicians, and I would like to get more primary care physicians up here, is that something that you've thought about? And are there opportunities that you see on the State Medical Board to pursue that goal?

Through the chair, that's a great question. I trained at the University of Washington, as I told you, and My exposure to Alaska was through the WWAMI program. I came up and did rotations up here, and that's really what exposed me and made me feel like I wanted to go to Alaska. The WWAMI program, as it was presented to us when we were at the University of Washington, was specifically designed to try and expose medical students from Alaska, Idaho, Montana, and to these more rural areas so that they can encourage more primary care people to go those directions. It would be interesting, I don't know the numbers, but it would be interesting to see what percentage of WHMI do go out to the villages or go out to more rural areas and see if the WHMI system is working.

It's certainly working in the sense that it's bringing more providers, primary care, up to Alaska. I know numerous WAMI students that were from Washington or Oregon or Montana, different states that have settled here and made this their home. I don't know how many are out in the villages or more remote places. So that would be interesting to see. Follow-up?

Through the chair, I've heard that there are limited clinical internship positions outside of Anchorage, and that is one of the constraints for training physicians. Um, may also be a constraint for training nurses. And I guess I would commend to you that the medical board do some research on that and consider thinking about how can, how can we as a legislature and a state more broadly support availability of training either for MDs and/or RNs. It is, it is a cost for a hospital to make those training opportunities available. I think we should support hospitals that do that in as geographically broad a manner as possible.

And I think that would be a good thing for the State Medical Board to look at, because some of us wonder, well, gee whiz, how could we support more primary care physicians being here? But I don't feel like I've got a great idea of the 1, 2, 3, or 5 things that I should be doing in the legislature to achieve that goal.

Yeah, and through the chair, to answer that too, I've— the thought has crossed my mind, why not offer some type of scholarships to students that do rotations up here if they will choose to go to Nome, or they would choose to go to Kotzebue, or they choose to go to Shishmaref for 2-year period of time after their training. Everybody's in deep debt these days. Education is very expensive. If we had some system and maybe even have the government help sponsor it or the communities in addition help sponsor it, it may save them an awful lot of money from having to have people come to town.

But I was exposed to Kotzebue and Nome in my rotations. I don't know if they still do that. Okay, well, thank you.

Other questions from the committee? Um, I, I have a quick question that actually builds off of Representative Cox's question about scope of practice because we do have multiple bills in the legislature about this, um, including, um, another one was that wasn't mentioned was related to physician assistants. Um, what do you think about, um, the role of the state medical board in terms of commenting on the scope of practice for other professions, uh, under other state boards?

Well, I think— through the chair, I think that no matter who does it, it's going to have to be some board that has regulatory and oversight to vet different specialties.

I definitely, you know, I've heard numerous things about different medical providers that are not trained as providers wanting to become providers and the theory that if they did, they would go out in the communities and there would be more access. I'm not so sure it'll work that way, but maybe there's a role to try and look at specific cases. Say Shishmaref has this great need for primary care person and it's a physical therapist or it's a, you know, whatever specialty that person is, even if it's a PA and there's, there's no one to do a collaborative agreement with them, but they really want to go to Shishmaref, have the board, whatever entity is regulating them, look at their setting, be sure they've had, you know, 4 to 6 years of a collaborative agreement with some physicians so they've been trained well and that they're trained to do what they're gonna do when they go out there, but give them permission to do it without necessarily, you know, the two collaborative requirement. Maybe one collaborative requirement or maybe none, if that's what it takes to get somebody out there. I think being creative with that makes sense.

Should we do it all the way across the board? I'm not so sure. I need to learn a lot more about the repercussions of that, but— And the question of whether it's the medical board that should be doing that, I think whatever board covers these different paraprofessionals or professionals need to have input into it.

Thank you for your perspective and also just that openness in trying to figure out what are creative solutions to make sure that we can increase primary care access without, you know, being cognizant of patient safety. I know that last year the State Medical Board, they passed a letter regarding opposition to legislation, my legislation related to pharmacists, but just generally.

The, you know, there are, it's an interesting conversation when we're talking about scope of practice and I'm wondering what your position is on that letter which is related particularly to prescription of mifepristone which pharmacists cannot do and how the board can improve on talking with other professional boards regarding these issues.

Yeah, I'm, I am behind the conversation on that since I'm newer to the board and that didn't come up in the time that I've been on the board. So that is a newer topic for me. Interesting thought, but I think it's worth trying to understand it better. And I think what you're saying is there's, there was a A legislation discussed possibly giving treating abilities to pharmacists, is that? Yes.

Okay. Yeah, I honestly, you know, I've used pharmacists my whole career and I just don't know their education. I know they're brilliant, they're very bright people. Pharmacists are incredibly bright. The ones I know are like could have done anything they wanted to do in medicine.

So it's not an intelligence thing, but the question is, is training to be a provider the same or similar or enough? And yeah, there certainly needs to be oversight in that, especially if something like that is pursued. So I don't have a full answer for you on that one. That's one I'm learning on. Thank you.

Thank you for the answer. Representative Gray. Um, thank you, uh, Dr. McNamara, for being here. Um, I wanted to ask a couple of questions, and I'll just start by, by letting you know that I, I am a physician assistant. My father was an orthopedic surgeon, um, and I definitely, when he was alive, asked my question— my dad lots of questions about orthopedics.

Uh, he and I did not agree on everything though, I'll just say. I wanted to ask about your State Medical Board meeting of Thursday, March 19th, when, um, there was a decision for— you voted yes to sign on to a letter in support of HB 342, physician liability, sex reassignment procedures for minors. Again, just offering a little bit of context. So prior to running for the legislature, I, I worked at the Alaska VA. I did work in gender-affirming care at the VA for, uh, transgender veterans.

And, um, and in Alaska, it's a very small group of folks who do any of that type of medicine. So I'm just— my problem with the bill is that we do not do sex reassignment procedures for minors in Alaska as a rule. There's very limited amount of, uh, it would be medication-only treatment for a minor. It would be very limited in scope and very conservative in terms of any of that. It would be really a decision made between parents, the physician who's the expert in the field, and, and, and the child, and it's very rarely done.

So I'm curious if you could just talk about why you felt that was a good— that's something that really needs to be addressed by the medical board.

Oh, that's a good one. I, again, being so— I hate to keep falling back to that I'm new on the board and I'm new on these topics, but that's the reality. And this is like underage gender reassignment question is very, very new to me. And what I think, what I'm seeing that the board does is it takes It takes input from the Department of Law, from the Attorney General, from the Governor, and then whatever has been put in from the legislature as the representatives, and then makes a decision based on that. And this had been discussed and talked about considerably, I think, before I came on.

So it made sense to me that I sign on to that decision. Decision that was made at the time based on what information I had. Certainly, I do think that, that not fully understanding it, I do feel that the medical board is in part supposed to represent the care of others. We especially want to represent the care of young people. And I definitely have learned with time parents aren't always right and parents make bad decisions for their own kids often, more than they should maybe.

So I think that the medical board, you know, it's appropriate that this be looked at by them.

I was going to say that I have a son who's a PA as well, so I definitely love the PA business. You all do a great job in what you do. So it— through the chair, does that answer your question, uh, Mr. Gray? Follow-up? I will follow up.

So I appreciate that thinking that parents often make really bad decisions. Like I said, I would go to my dad for orthopedic advice. I really wouldn't go to him for other advice. Um, you know, I, I was— I, I came out as gay in high school. He did send me to psychiatric care for sort of conversion therapy.

Obviously, that's a very bad decision that a parent made. And so I appreciate you wanting to protect children from bad decisions of their parents. I would just advise that before you vote yes on creating a standard of liability, you should speak to physicians who are actually working in this area. You should speak to, you know, teenagers who might be asking for this care. You should speak to their parents, maybe advise those parents that they're making terrible choices, maybe approach it that way if that's how you believe.

But I just think voting yes to support something without speaking to the folks who actually work in that field is probably— it makes me question, like, I just don't understand. If I have a question about orthopedics, I ask an orthopedic surgeon. If I have a question about endocrine issues, I would go to an endocrinologist. If I had a question about an unusual cardiac condition, I would ask a cardiologist. I wouldn't sign a letter saying that there was medical malpractice for things that physicians were doing in Alaska without talking to those physicians and asking why they're doing it.

Yes, through the chair, I understand your point, and maybe the best thing would have been for me to recuse myself from that vote even, but with that understanding until I further learn more about it. But being new on the board, I really— you have to put some trust in the rest of the board members and the work that's already been done as well. I think that's where I stood on that.

Thank you, Dr. McNamara. I think I'll ask another question related to Representative Gray's line of questioning. Last year, the State Medical Board did pass a number of different controversial resolutions and letters related to gender-affirming care, related to abortion. And so in this whole discussion about the role of the State Medical Board and you having been serving on the board for the past 5 months, I'm always thinking about what is going to be the next contentious issue that might be a statement from the State Medical Board. What do you think about the controversial actions that the board has taken over the past year and how the board can better improve to really focus on how to improve medical care and primary care to Alaskans rather than delving into a lot of these contentious issues.

Through the chair, I'm not I'm not sure I fully understand that.

Does the board— doesn't choose, as far as I can tell, to do these contentious issues. I think they come to them. I haven't been there for most of them, including abortion. And but I do recognize that, you know, I was appointed by Governor Denley, we really be a voice for Alaskans, small town cities, to deal with the physicians and the PA need in our state and to be sure that we vet them properly, but also to look at some of these contentious issues as they are brought up and brought to us and to continue to add Attorney General input, Governor input, Department of Law input, and I think all those come together to come up with an opinion. And at least that's what I'm learning right now.

I could be wrong, but that's, that's what I feel about that. Does that answer your question through the chair? It does partially, and I appreciate the consideration of a lot of different.

Stakeholder input, including from the governor's office as well as the Attorney General's office. But what about the ability to listen from the public and from other medical providers? And I guess I am reiterating Representative Gray's question, but can the board listen to voices from the public and other professions in a lot of these contentious issues to really look at all sides and perspectives of on, on, of these topics?

Oh, well, I haven't mentioned it through the chair. I haven't mentioned that, you know, each of the board meetings is totally open to the public, as far as I know, and I see that there are often public members that do speak up, and I would, you know, I don't think there's any of us that don't listen to the public member and input on any issue that we talk about. So, and would encourage, you know, there to be more of that.

Thank you.

Are there any other further questions or comments from the committee?

All right, seeing none, I just want to thank you again, Dr. McNamara, for your service to the State Medical Board and for sharing your experience and for coming forth to the Health and Social Services Committee today. I will now open public testimony on the appointment of Dr. McNamara. 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.

Is there any further discussion from the committee? Seeing none, in accordance with AS 39-580, the Health and Social Services Committee held a hearing on Dr. Michael McNamara, 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 individual during any further sessions. I ask that members sign the committee report after we adjourn. The next meeting of the House Health and Social Services Committee will be Tuesday, May 7th, at 3:15 PM here in Davis 106.

The time is 3:52 PM, and this hearing of the House Health and Social Services Committee is now adjourned.