Legislature(2005 - 2006)CAPITOL 106
04/12/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB231 | |
| HB161 | |
| HB204 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 29 | TELECONFERENCED | |
| + | HB 231 | TELECONFERENCED | |
| *+ | HB 112 | TELECONFERENCED | |
| + | HB 161 | TELECONFERENCED | |
| *+ | HB 204 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 12, 2005
3:10 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Vic Kohring
Representative Lesil McGuire
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 231
"An Act relating to the definition of 'municipality' for
purposes of human services community matching grants."
- MOVED CSHB 231(CRA) OUT OF COMMITTEE
HOUSE BILL NO. 161
"An Act relating to reemployment of and benefits for retired
teachers and public employees and to teachers or employees who
participated in retirement incentive programs and are
subsequently reemployed as a commissioner; repealing secs. 5, 7,
and 9, ch. 58, SLA 2001; providing for an effective date by
amending the delayed effective date for secs. 3, 5, 9, and 12,
ch. 57, SLA 2001, and repealing sec. 13, ch. 58, SLA 2001, which
is the delayed effective date for secs. 5, 7, and 9, ch. 58, SLA
2001; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 204
"An Act relating to the prescription and use of pharmaceutical
agents, including controlled substances, by optometrists."
- HEARD AND HELD
HOUSE BILL NO. 29
"An Act relating to health care insurance and to the
Comprehensive Health Insurance Association; and providing for an
effective date."
- SCHEDULED BUT NOT HEARD
HOUSE BILL NO. 112
"An Act relating to child protection, including forensic
interviews and transportation of children; and providing for an
effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 231
SHORT TITLE: HUMAN SERVICES GRANT ELIGIBILITY
SPONSOR(S): REPRESENTATIVE(S) WILSON
03/23/05 (H) READ THE FIRST TIME - REFERRALS
03/23/05 (H) CRA, HES, FIN
04/07/05 (H) CRA AT 8:00 AM CAPITOL 124
04/07/05 (H) Moved CSHB 231(CRA) Out of Committee
04/07/05 (H) MINUTE(CRA)
04/08/05 (H) CRA RPT CS(CRA) NT 3DP 2NR
04/08/05 (H) DP: CISSNA, KOTT, LEDOUX;
04/08/05 (H) NR: SALMON, OLSON
04/12/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 161
SHORT TITLE: REEMPLOYMENT OF RETIREES
SPONSOR(S): REPRESENTATIVE(S) ELKINS
02/18/05 (H) READ THE FIRST TIME - REFERRALS
02/18/05 (H) EDU, HES, STA
04/05/05 (H) EDU AT 11:00 AM CAPITOL 106
04/05/05 (H) Moved CSHB 161(EDU) Out of Committee
04/05/05 (H) MINUTE(EDU)
04/06/05 (H) EDU RPT CS(EDU) 1DP 5NR 1AM
04/06/05 (H) DP: THOMAS;
04/06/05 (H) NR: GARA, SALMON, GATTO, LYNN, NEUMAN;
04/06/05 (H) AM: WILSON
04/07/05 (H) EDU AT 11:00 AM CAPITOL 106
04/07/05 (H) -- Meeting Canceled --
04/12/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 204
SHORT TITLE: OPTOMETRISTS' USE OF PHARMACEUTICALS
SPONSOR(S): REPRESENTATIVE(S) THOMAS
03/04/05 (H) READ THE FIRST TIME - REFERRALS
03/04/05 (H) HES, L&C
04/12/05 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
ROSEMARY HAGEVIG, Member
Board of Directors
Southeast Conference
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 231.
JANET CLARKE, Assistant Commissioner
Central Office
Finance and Management Services
Department of Health & Social Services
Juneau, Alaska
POSITION STATEMENT: During the hearing on HB 231, explained the
fiscal note prepared by the department.
HEATHER WHEELER, Deputy Director
Municipality of Anchorage
Department of Health and Human Services (DHHS)
Anchorage, Alaska
POSITION STATEMENT: Her testimony regarding HB 231 was read by
Molly Cullom.
JIM VANHORN, Staff
to Representative Jim Elkins
Juneau, Alaska
POSITION STATEMENT: Introduced new information relevant to HB
161 on behalf of Representative Elkins, sponsor.
MIKE TIBBLES, Deputy Commissioner
Office of the Commissioner
Department of Administration
Juneau, Alaska
POSITION STATEMENT: Testified on behalf of the department
during the hearing on HB 161.
LEO JOHN KERIN
Fairbanks, Alaska
POSITION STATEMENT: Testified during the hearing on HB 161.
ROBERT McHATTIE
Fairbanks, Alaska
POSITION STATEMENT: Testified during the hearing on HB 161.
LARRY WIGET, Director
Government Relations
Anchorage School District
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 161.
BRUCE JOHNSON
Alaska Association of School Boards (AASB)
Juneau, Alaska
POSITION STATEMENT: Testified that the association is in
support of the rehire provision of HB 161.
CHRIS S. CHRISTENSEN, Deputy Administrative Director
Administrative Staff
Office of the Administrative Director
Alaska Court System
Anchorage, Alaska
POSITION STATEMENT: Testified to express his appreciation of HB
161.
REPRESENTATIVE BILL THOMAS
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 204, as sponsor.
CARL ROSEN, M.D., President
Alaska Eye Physicians and Surgeons
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 204.
DONALD J. CINOTTI, M.D.
Jersey City, New Jersey
POSITION STATEMENT: Testified in opposition to HB 204.
BOYD WALKER, O.D.
Homer, Alaska
POSITION STATEMENT: Testified in support of HB 204.
GRIFF STEINER, M.D.
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 204.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:10:54 PM.
Representatives Seaton, Gardner, Cissna, and Wilson were present
at the call to order. Representatives Kohring, McGuire and
Anderson arrived as the meeting was in progress.
HB 231-HUMAN SERVICES GRANT ELIGIBILITY
CHAIR WILSON announced that the first order of business was
HOUSE BILL NO. 231, "An Act relating to the definition of
'municipality' for purposes of human services community matching
grants." [Before the committee was the committee substitute
(CS) for HB 231(CRA), Version 24-LS0791\G.]
CHAIR WILSON turned the gavel over to Vice Chair Seaton.
3:12:45 PM
CHAIR WILSON introduced HB 231, as sponsor. She described the
proposed legislation as "a human services matching grant
program." Currently, the only communities that receive
[matching grants] are Anchorage, Fairbanks, and - most recently
- the Matanuska-Susitna (Mat-Su) Valley. Those communities
qualify because they meet a population requirement. The
original bill version would expand the definition of a qualified
municipality to include a consortium of municipalities located
in the same geographic area, with a population that exceeds
50,000; however, an amendment was adopted in the last committee
of referral to change that number to 35,000.
CHAIR WILSON said in order to qualify for the grants, a
municipality must: provide 30 percent of the funding, comply
with the grant application process, and establish a citizens'
advisory group to help establish the priorities in the area "and
to see who gets the grants." The proposed legislation would
allow Southeast Alaska to qualify for the grants "if they were
under the umbrella of someone else." She added, "We're looking
at Southeast Conference to be our umbrella." She said that
organization presently works closely with the communities of
Southeast Alaska. She listed [organizations that are currently
providing services in Southeast Alaska]: Center for Community,
United Way, Alaska Health Fair, Inc., Southeast Alaska Food
Bank, Catholic Community Services, [Aiding Women in Abuse and
Rape Emergencies (AWARE Inc.)], Alaska Legal Services, and
Southeast Senior Services.
CHAIR WILSON stated, "I really think this is a fairness issue."
She noted that there was a shift in the legislature this year
when it set a precedent by opening up the availability of grants
for utilities that were private and previously could not get
grants.
3:16:50 PM
CHAIR WILSON, in response to a question from Representative
Gardner, said she is not aware of anyone who is opposed to the
bill.
VICE CHAIR SEATON asked Chair Wilson if her intention was to
have the latest bill version adopted by the committee.
3:17:47 PM
CHAIR WILSON said she would rather work with the original bill
than with the committee substitute [currently before the
committee, produced by the House Community and Regional Affairs
Standing Committee]. She expressed that there may be some
reluctance by the communities already receiving the grants to
allow other communities to participate at a lower minimum
requirement; they would rather see communities pull together in
order to "get more bang for the buck." She said she would leave
it up to the committee to decide; however, she predicted the
chances of the bill succeeding would be better if it were in its
original form. In response to a question from Chair Seaton, she
confirmed that the only difference between the original bill and
the version from the House Community and Regional Affairs
Standing Committee is the population requirement.
3:19:01 PM
REPRESENTATIVE CISSNA revealed that, as a member of the House
Community and Regional Affairs Standing Committee, she had
participated in the discussion regarding the population
requirement of HB 231. She said a committee member from the
northern part of Alaska had stated concern that it would be
difficult enough for communities in that region to band together
to meet the requirement of 35,000, let alone 50,000.
CHAIR WILSON responded, "That's left up in the air in the bill,
so that if communities want to pull together to do this, they
can." She said geographic area is not defined in the bill. She
indicated that the intent of the bill is to provide the
opportunity for communities to succeed in getting grants if they
choose to do so.
CHAIR WILSON [indisc.]
VICE CHAIR SEATON, in response to Chair Wilson, suggested that
the intent of the committee now was [to continue to use the
House Community and Regional Affairs Standing Committee's bill
version already before the committee].
3:22:06 PM
ROSEMARY HAGEVIG, Member, Board of Directors, Southeast
Conference, testified on behalf of Southeast Conference. She
told the committee that she is also the executive director of a
regional social services organization that could potentially
benefit from the bill. She stated that many regional social
services providers in Southeast Alaska support HB 231. She
reported that the last U.S. Census data shows that the total
population in Southeast Alaska is just over 70,000; therefore,
the region would qualify. She said the social services
infrastructure in the region is having an increasingly difficult
time coming up with specific grant amounts in the various
budgets. The proposed legislation would provide an opportunity
to infuse an additional level of resources into the community.
She stated, "Certainly, from my own personal experience and what
I know to be in place already, we more than would be able to
meet the required 30 percent match."
MS. HAGEVIG said there was some discussion in the last committee
of referral regarding the fiscal note. She said, "In our
conversations with the department, they shed some light on why
that truly would be a zero fiscal note, even thought they did
provide some scenarios about eventual costs." She offered
further details. She stated, "The other thing that we would
like to make very clear is that we are not interested in seeing
anything happen that would not hold harmless our neighbors to
the north. Certainly what is going on in Anchorage, Fairbanks,
and now in MatSu is of critical importance; we just would like
to share in the opportunity to be able to participate in the
same kind of a program."
MS. HAGEVIG concluded by noting that there are a number of
organizations under the United Way umbrella in Southeast Alaska
that provide region-wide services, and between the Southeast
Conference Board and the United Way Board, there would have no
difficulty at all in putting together the required kind of
fiscal oversight that would be necessary.
3:25:54 PM
JANET CLARKE, Assistant Commissioner, Central Office, Finance
and Management Services, Department of Health & Social Services,
explained the fiscal note prepared by the department. She said
the zero fiscal was prepared for Version G. She stated,
"Because the program is based on prorata proportion of
population, it does not in and of itself require an increase of
appropriations." For example, she illustrated that if the
appropriation is $1 million, no matter what number of grantees
or municipalities qualify, the amount would be prorated.
Second, Ms. Clarke noted that if the bill were to pass, it would
not affect the municipalities who have already applied for the
program by October 1, 2004 and would have profound impact on
fiscal year (FY) 07. She explained, "The legislation requires
that municipalities apply before October 1 of the preceding
fiscal year, so for FY 06, the grantees who would qualify would
be Anchorage, Fairbanks, and MatSu."
MS. CLARKE reviewed the two scenarios provided by the
department, which are both based upon "the change to 35,000."
The first scenario assumes that regional consortiums would form
for all regions of the state and that there would be no
additional money for the program appropriated by the
legislature. She added, "If that were to occur, then Anchorage,
MatSu, and Fairbanks would see significant reductions in their
shares of the appropriated funds, and other communities would
see a corresponding increase." The second scenario, which is
illustrated on page 4 of the fiscal note, uses the same
assumptions in the first scenario, but there would also be an
assumption that the legislature would appropriate additional
funds to hold all communities harmless and still provide grants
"for all the other communities." The hold-harmless portion of
the second scenario would cost an additional $613,483.
VICE CHAIR SEATON asked, "Why is it that only these certain-size
population areas are given those grants and they are not
extended to other areas that may have the same kind of programs
and be able to come up with a local match?"
3:29:46 PM
MS. CLARKE responded by offering a synopsis of the history of
the program. She said the program was put into statute in 1992.
Prior to that, there were block grants provided to Anchorage and
Fairbanks, which began in the early 80s when money was abundant.
She said, "The idea at the time was that Fairbanks and Anchorage
were disproportionately affected by social services programs,
because they were such large hub communities; people came to
those communities for services, and the view was that the state
ought to offset some of those costs that the local communities
were absorbing." At the same time there was a lot more money
available for designated grants for other communities throughout
the state. Ms. Clarke said that that money does not exist
anymore in her department, and she offered her understanding
that it doesn't exist in any other department either. The
statute was written in 1992 so that Anchorage and Fairbanks
would qualify. Now, because of its population increase, the
Matanuska Susitna Borough qualifies for the grants, which has
changed the dynamics of the funding for the program.
MS. CLARKE, in response to a question from Vice Chair Seaton,
said she thinks there were some other designated grants to other
local communities that are no longer designated in the budget.
She stated that there was more opportunity for other local
municipalities to get social services funding.
CHAIR WILSON interpreted Ms. Clarke to have said that "everybody
was getting some kind of extra help - as funds - in all the
areas, but slowly, as the money tightened up, they discontinued
the help in the smaller areas, but Anchorage and Fairbanks
continued with theirs."
MS. CLARKE responded that that's correct. She offered her
understanding that, at one point, the social services block
grants were up to $4 million and have been "ratcheted back to
the level they are now." She added, "Certainly the block grants
themselves have been reduced, as well."
3:33:30 PM
HEATHER WHEELER, Deputy Director, Municipality of Anchorage,
Department of Health and Human Services (DHHS), had her
testimony read by Molly Cullom, Grant Administrator, DHHS, as
follows:
The Anchorage Department of Health and Human Services
supports HB 231 and the effort to expand human service
matching grant programs to benefit more Alaska
communities. However, with that expansion, we would
hope the legislature would ensure sufficient funding
to hold current recipients harmless. Passing this
legislation with sufficient funding will allow more
communities to provide the essential safety net
services to prevent or alleviate serious physical or
mental hardship in this state, while not diminishing
services in current recipient communities. Through
grants to local nonprofit agencies, the human services
matching grant supports the basic services that are
critical to our state's most vulnerable citizens:
children, abuse victims, those in temporary crisis or
homelessness, and senior citizens.
... Human service grant funding was originally made
available to larger Alaska communities in the 1980s in
an effort to offset the disproportionate demand coming
from people all over the state. The municipality
continues to serve the state as a hub community,
drawing and attracting people for services around the
state to Anchorage. Because Anchorage serves so many
people from outside its borders, it is in this state's
best overall interest for the legislature not to
decrease funding for Anchorage in order to make room
for more communities.
Currently, 65 percent of Anchorage's human service
matching grant funding goes for food and shelter
programs. These services are associated with people
on the move, people in crisis, and people in
transition to and from rural communities. The
municipality of Anchorage believes in being a
responsible citizen of the State of Alaska and, as
such, has never closed its doors to people from
outside of Anchorage who seek services. Because of
this, if more communities become eligible for human
service dollars, we ask that sufficient funding be
provided to sustain current services.
VICE CHAIR SEATON said the committee would probably be "looking
at that support"; however, that would happen a year, or so, in
the future, "because we're not talking about our current
budget."
3:37:12 PM
CHAIR WILSON stated her intentions for the bill were not to make
things worse for any other area in the state. She asked Ms.
Clarke if she would submit an increased budget to the governor
if, for example, she were to get two new applications by October
1.
MS. CLARKE responded, "We would certainly prepare the request to
the governor so that he would be aware of what the implications
would be if that was not funded." She added that that
information would be made available to the legislature, as well.
VICE CHAIR SEATON conveyed to Ms. Wheeler through Ms. Cullom
that if all the grants are going through the main communities
and are not provided to the outlying communities, that tends to
bring the people who need services to the hub communities. He
said he thinks the purpose of the bill is "to allow some
distribution so that we can keep people in the communities where
they reside."
VICE CHAIR SEATON closed public testimony.
REPRESENTATIVE GARDNER moved to report CSHB 231(CRA) out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 231(CRA) was
reported from the House Health, Education and Social Services
Standing Committee.
[Vice Chair Seaton handed the gavel back to Chair Wilson.]
HB 161-REEMPLOYMENT OF RETIREES
CHAIR WILSON announced that the next order of business was HOUSE
BILL NO. 161, "An Act relating to reemployment of and benefits
for retired teachers and public employees and to teachers or
employees who participated in retirement incentive programs and
are subsequently reemployed as a commissioner; repealing secs.
5, 7, and 9, ch. 58, SLA 2001; providing for an effective date
by amending the delayed effective date for secs. 3, 5, 9, and
12, ch. 57, SLA 2001, and repealing sec. 13, ch. 58, SLA 2001,
which is the delayed effective date for secs. 5, 7, and 9, ch.
58, SLA 2001; and providing for an effective date."
3:40:41 PM
JIM VANHORN, Staff to Representative Jim Elkins, introduced new
information relevant to HB 161 on behalf of Representative
Elkins, sponsor. He reviewed that the legislation would allow
the rehiring of certain public employees' retirement system
(PERS) and teachers' retirement system (TRS) members who retired
with a normal retirement. These rehired employees can continue
to receive normal retirement and benefits if they waive further
participation in the retirement systems. During their period of
reemployment, he said, no contributions to PERS and TRS are
required from the employee or the employer. The proposed
legislation would sunset July 1, 2009.
MR. VANHORN directed attention to an Alaska Legislative Report
entitled, "Results of the Retiree Return Program," produced by
the Division of Retirement and Benefits and dated February 2005.
The report shows that, as of November 30, 2004, there were a
total of 211 retirees rehired under PERS and 124 retirees
rehired under TRS, for a total of 335 employees, statewide. He
said that equates to one-tenth of 1 percent of all PERS and TRS
participants. He turned to a paragraph on page 4 of the report,
which read as follows [original punctuation provided]:
On September 14, 2004 the Division of Retirement and
Benefits received an Attorney General Opinion
regarding the employment status of returned retirees
as of the sunset date of the legislation. The opinion
states that once the reemployment amendments to the
PERS and TRS statutes sunset on July 1, 2005,
reemployed retirees can no longer receive retirement
benefits while employed by a PERS or TRS employer. If
they continue employment with a PERS or TRS employer,
they must begin making contributions to the retirement
systems and have their retirement benefits stopped.
MR. VANHORN said the attorney general opinion came as a complete
surprise to many. He stated, "The general opinion was that
after the initial period, the legislature would review the
program to see whether or not it was successful, and decide if
it should be continued. Life decisions were made based on this
opinion; now they slam shut in their faces." Mr. Vanhorn noted
that the original legislation was a component of a workforce
development initiative of the state, and a number of employers
undertook to address workforce shortages that were already being
experienced.
MR. VANHORN directed attention to an article entitled, "State
Worker Shortage Looms," from a February 2005 issue of state news
[included in the committee packet]. The article shows that many
states are currently facing the effects of an approaching
retirement implosion that follows Baby Boomers into their golden
years. Mr. Vanhorn paraphrased some highlights of the article,
including: A 2002 study showed that 30 percent of many states'
workforces would be retirement eligible by 2006; and compounding
an approaching shortage of workers, a [Nelson A. Rockefeller
Institute of Government] study confirms that nationally, 50
percent of government jobs are in occupations requiring
specialized training, education, or job skills, compared to just
29 percent in the private sector. Mr. Vanhorn stated that it's
obvious the workforce shortage will not go away, but will only
intensify with time.
MR. VANHORN said that during a hearing on the bill, the House
Special Committee on Education adopted a committee substitute
for HB 161 that clearly states that the legislature understands
that the rehire of retirees is a valuable tool for school
districts and public employers to manage workforce shortages.
The committee substitute also finds that human resource managers
must plan to meet their future workforce needs, without reliance
on retired workers.
MR. VANHORN directed attention to the pie charts on pages 13 and
24 of the previously noted report. He said the charts show that
the majority of retirees that have been rehired were retired
over 24 months before coming back to work, and the percentage of
rehires has slowly decreased since 2002. Mr. mentioned the zero
fiscal note in the committee packet. He concluded, "The current
legislation has provided human resource managers an excellent
tool to retain workers for hard-to-fill positions, and we urge
... passage of this extension."
3:46:19 PM
REPRESENTATIVE MCGUIRE stated, "I am embarrassed that I was in
the legislature at the time that this bill passed. ... This
bill was intended for very narrow circumstances: [For] small
communities in Alaska where there was a teacher shortage, where
kids were being left behind ... because there weren't adequate
teachers there." Representative McGuire said there were also
statements made about the need for public health workers in some
communities where there was a shortage. She said, "I signed off
on those very narrow circumstances, with the agreement and
understanding that this program would sunset and that we would
take a look at how it had been used ...." She said the time has
come to review the program. Representative McGuire reported
that there is a staggering amount of information regarding the
abuse of the program by the current and preceding
administrations. She offered an example of the abuse. She
stated, "I don't even think we will begin to see the full
effects of what's happened over the last five years for decades
to come."
REPRESENTATIVE MCGUIRE said she cannot, in good conscience,
support the extension and she thinks the program should sunset.
She said she has heard concern that the state may be sued for
ending the program. Conversely, she stated that she has
personally studied the waiver that the rehired employees signed
and "there is no possible way that a state employee could have
reasonably relied upon anything other than the waiver that they
signed, which clearly stated that this sunset would occur in
July." She said some people would argue that the personnel
board has made "other statements," but she said many times
statements are made that end up not being true. She offered an
example.
3:51:30 PM
REPRESENTATIVE SEATON said there has been a misunderstanding
that those on the program would have to quit their jobs when the
program sunsets. He stated for the record that those people can
continue their employment; they would just be put back into the
retirement system.
MR. VANHORN confirmed that is true. He noted that TRS has
stringent "sideboards," while PERS does not. He agreed that
there probably have been abuses to the program; however, he
pointed out that the [United Fishermen of Alaska] are strongly
behind the bill, because, without it, 30 or more fish biologist
will be lost. He offered further details. Mr. Vanhorn noted
that [HB 161] is a companion bill to a Senate bill.
3:54:00 PM
REPRESENTATIVE CISSNA said it has been reported that PERS and
TRS are in trouble. She stated, "It seems sort of inconsistent
to at one time be talking about how to fix that program ... at
the same time that we're talking about ... continuing with
something that would only make it harder for the program to
exist, because it's the continual paying in to that program that
gives it the strength that allows it to continue, I would
assume."
MR. VANHORN reminded Representative Cissna that the bill carries
with it a zero fiscal note. He added, "The total cost ... is
$106.53." In response to a follow-up comment from
Representative Cissna, Mr. Vanhorn indicated that the fiscal
note reflects the impact on the retirement systems. He offered
further details.
3:55:50 PM
REPRESENTATIVE SEATON, in response to a request from Chair
Wilson, offered some background information on PERS and TRS as
it relates to the proposed bill. He said if [the State of
Alaska] was "collecting under the normal cost rate all of the
money that would be necessary for a person's retirement," the
amount of employees makes no difference. However, he explained,
there is a $15 billion past service cost liability. He
continued as follows:
So, what has happened in the past use of this bill is
that the employers are not paying in on ... the past
service cost. ... The contribution rate is escalating
at 5 percent a year, so, in just a few years, we're
going to be paying, like, 44 percent for the teachers
for the past service cost. ... I haven't looked at
the new CS on this bill as to whether this bill is now
going to make the employers use their entire wage
base, including these "waivered" employees. ... If
they make that contribution for the waivered employees
- in other words if they would be paying into the
system - then it wouldn't have the effect. If it is
as it has been currently, there is a detrimental
effect, because they're not paying in on the past
service cost.
MR. VANHORN referred to language in CSHB 161(EDU), which was on
page 2, lines 12-14, and read as follows:
(c) It is the intent of the legislature that
employers that benefit from the provisions of the
retiree reemployment provisions pay any increase in
unfunded liability that results to the retirement
systems.
MR. VANHORN directed attention to page 11 of the previously
mentioned report, which shows a less than 1 percent impact on
the [retirement] system. He offered further details.
REPRESENTATIVE SEATON moved to adopt [the committee substitute
(CS) for 161(EDU), Version 24-LS0645\G, Craver, 4/5/05], as a
work draft. There being no objection, Version G was before the
committee.
3:59:58 PM
MIKE TIBBLES, Deputy Commissioner, Office of the Commissioner,
Department of Administration, regarding the cost to the system,
said one concern that has arisen is about bringing an individual
back that would receive a benefit without paying into the
system. He augmented Representative Seaton's previous
explanation as follows:
When we hire an individual, we are paying a blended
rate: a normal cost rate and a past service rate.
The normal cost rate is the amount of the retirement
benefit that that individual received after putting in
a number of years of service - either 30 years, or 25
years, or reaching retirement eligibility by age. But
the benefit that they receive is based on the amount
that they and the employer have been paying over their
lifetime for their career. So, for example, if they
worked 30 years, ... their pension benefit is based on
the amount that's paid, so there's no additional cost
to the system for that individual coming back, because
that individual's not accruing any additional
benefits.
... Since we have this unfunded liability, the cost
isn't associated with an individual; however, it's
associated with the system - it's $5 billion-worth.
When we take out an individual from the system ...,
their salary-base is used to allocate out a cost for
past service rate. Then there becomes a higher rate
among the other members.
MR. TIBBLES, regarding the impact of the program, said an
actuary calculated a separate threshold for PERS and TRS and
reported that "at 100 participants of a 242 waiver, there is a
$106,000 impact to the system." In PERS, there are 211
employees, so "the impact doesn't trigger until 500 employees."
He explained, "So, we have a long way to go on the PERS system
before they can actually put a dollar amount to the impact." He
continued as follows:
So, what the ... committee substitute that you have in
front of you does, is it requires all employers - when
they bring an individual back - to pay that past
service rate at the point that they can put the dollar
amount to it - when it no longer becomes negligible.
... The net effect is: When an employer brings
somebody back on a 242 waiver, they're going to save
the normal cost rate; it's going to be a savings to
their system. The State of Alaska saved a million
dollars.
MR. TIBBLES said although it's certainly not the reason for the
program, the State of Alaska has saved a million dollars because
of it. He concluded, "Going forward under ... the committee
substitute you have in front of you, we would be required to
pay: TRS would be an increase of .01 percent, and at 500
participants on PERS would be .02 percent."
MR. TIBBLES, in response to a question from Chair Wilson, noted
that the language regarding a requirement for a contribution by
employers for the past service cost is found "in Section 3 for
TRS and Section 4 for PERS." He explained that the way the
system is currently set up, the director of the Division of
Retirement & Benefits monitors the number of participants and,
at the point that he/she has been told by the actuary that there
is an impact, then "costs will go out to all the employers." He
said he would support a change to automatically charge the past
service rate equal to every other employee; thereby, even when
the cost is negligible, some amount could still be collected
into the system.
4:07:16 PM
CHAIR WILSON said she thinks the state has a responsibility to
be "covering what we need to cover."
4:07:55 PM
REPRESENTATIVE GARDNER directed attention to language on page 2
[of Version G, beginning on line 4], which read as follows:
In extending the termination date of the reemployment
provisions, it is the intent of the legislature to
allow school districts and public employers to
continue to use this management tool, while developing
plans that address the knowledge, skills, and
abilities that need to be transferred or developed to
assure the work can be accomplished when the
reemployment provisions terminate.
REPRESENTATIVE GARDNER asked if that language was in the
original "waiver legislation."
MR. TIBBLES answered that he doesn't know.
4:09:13 PM
REPRESENTATIVE GARDNER clarified that she wanted to know if the
original plan was a temporary one, with the intent that the
employers have a contingency plan for "the end of the waiver
program."
REPRESENTATIVE MCGUIRE stated her understanding of the original
legislation was designed as a temporary crisis management tool,
which is why there was a sunset clause.
4:11:03 PM
MR. TIBBLES said the original sunset clause was added to the
original House Bill 242 in the House Finance Committee after
discussion regarding the impact to entry-level positions and how
the people in those positions would be able to move up in career
progression. He said that amendment was the basis of the
decision of the Department of Law last year that said that the
individuals currently enrolled in a 242 waiver will, as of July
1, [2005], stop receiving the pension benefits.
4:12:09 PM
REPRESENTATIVE MCGUIRE opined that without the sunset clause,
the bill would not have passed. She said there was concern at
the time [House Bill 242] was on the floor regarding whether
there may be other options, such as recruitment and retraining,
rather than "giving people paychecks after they retire."
REPRESENTATIVE SEATON said the purpose of the previously
mentioned language in the bill was to analyze what the effect of
the program was on upward mobility of people within the system,
and he noted that letters had been received indicating that [the
waiver program] has been a severe detriment to people attempting
to have upward mobility. He asked, "Where is that addressed in
the [previously mentioned] report?
4:14:14 PM
MR. TIBBLES responded that there was language in House Bill 242
that required a report to the legislature; however, it only
applied to the TRS system. The report provided to the committee
complies with the requirement that was submitted in the original
legislation. He stated that the administration has additional
concerns regarding how the program has been implemented
differently in each department. He stated, "I would like to
walk through the administrative order that the governor signed
on March 8, that implements the sideboards and talks about what
we're going to require the departments to do ... and the
workforce planning that needs to take place before they can
bring an individual back on 242."
4:14:54 PM
LEO JOHN KERIN, at the request of the chair and in the interest
of time, offered an abbreviated version of his written
testimony, which he said he would send to the committee. He
said he taught in a rural school district and strongly supports
any measures taken to support excellence in education in rural
Alaska, but is not convinced that "the rehire bill is the way to
do that." He said he would send alternative suggestions to the
committee by facsimile. Mr. Kerin stated his strong opposition
to the extension of the rehire bill for PERS employees for the
following reason: "While there ... may be a shortage of
qualified teachers willing to work in rural Alaska, there is no
shortage of qualified applicants willing to work in town with
the state government bureaucracy, court system, university
system, or municipal government." He continued as follows:
If there was a problem finding qualified applicants,
as was recently the case for [the Department of
Transportation & Public Facilities (DOT&PF)] technical
engineers, the Department of Administration would
adjust their ... internal alignment of salaries for
the job class to attract more applicants. If there is
a real short-term shortage of experienced personnel
for a specific job, ... there is and always has been a
contracting procedure to gain the needed expertise.
MR. KERIN said there has been significant abuse by the program.
He indicated that the administration acknowledged that abuse
when it brought forth a corrective administrative order;
however, he said that order is like closing a barn door after
the horses are out. He mentioned a "flood of recently retired
and rehired employees, many of whom never bothered their desks
during the 30-day waiting period." He asked, "If there is such
a brain-drain for retiring baby boomers, why was the program
only offered to a select few higher-level administrators instead
of all retirement-age employees?"
MR. KERIN said early retirement legislation has not been around
for very long. He said now provisions have been made to let
commissioners come back from early retirement, without having to
make restitution to PERS as is required in the retirement
incentive program bills. He said there has been much discussion
regarding the potential for lawsuits from people who believe
that the information given to them from the Division of
Retirement & Benefits meant that they would be "grandfathered in
for life." He said, "I would worry more about all the people
who ... retired early asserting that they should be given the
same opportunity as all the other double-dippers in the same
job."
MR. KERIN stated his belief that no realistic evaluation has
been made regarding "the cost of PERS of inducing Tier I
employees to retire on time, thereby affecting the retirement
program's actuarials." He offered further details. He
suggested that more testimony against [HB 161] is not heard from
"the rank and file employees," because it's only their bosses
who are being given "this platinum parachute." He added,
"There's a real fear of retaliation."
MR. KERIN said that though the bill is well intentioned, the
sunset needs to take place. He asked that at the very least,
the administration make the positions of those in PERS who have
already been rehired be subject to reexamination "pursuant to
the safeguards of the recent administrative order." He said,
"If it can be shown that a true shortage exists for the job in
question, the person should be allowed to retain their job while
restitution is made to ... PERS ..., as would take place if the
person had taken an early retirement. Any other course of
action results in all members of PERS shouldering the cost of
these people's 60 percent bonus." Mr. Kerin opined that the
legislature also needs to be forthright about the transfer of
general fund operating costs that have already been transferred
to PERS/TRS as a result of existing rehire legislation.
4:21:56 PM
ROBERT McHATTIE, testifying on behalf of himself, told the
committee that he is a retired PERS member, formerly employed by
DOT&PF. He thanked Representative McGuire for her previous
comments, which he said mirror his own. He said House Bill 242
originally addressed hard-to-hire teaching positions, especially
in the Bush. He posited that the rehiring of retired teachers
has generally been more justified and carefully handled compared
to the mostly supervisory and "important person" rehires done in
PERS. He offered an example of the careful handling in TRS.
MR. McHATTIE, regarding PERS, said he thinks it's self-interest
that makes those who are going to be or have been rehired and
those who represent agencies that do the rehiring support the
proposed legislation. He said he personally knows lower-level
staff members in several different agencies who are against
these hiring practices but are afraid to give negative testimony
for fear of reprisals from management or senior workers who have
been rehired or intend to return. Mr. McHattie said obviously
it is the lower-level staffers' paychecks that will be
diminished when the legislature jacks up the PERS contributions,
without collecting it from those who have been rehired. He
clarified, "[Those formerly retired employees who are rehired]
collect two fat paychecks while paying nothing into PERS, and
the coworkers ... know that's going on." He concluded:
It has been argued that individuals are so
knowledgeable and experienced, that they or others on
the staff cannot be replaced. While I am sure that
long-term employees all consider themselves to be
irreplaceable - I know I did while I was working -
that argument just doesn't wash. Administrators have
always had the responsibility of making sure that
staff positions can be covered in case of illness,
vacations, death, or somebody just quitting.
Considering that vacations for long-term employees can
extend most of a month, I assume that various
organizations don't fall apart during that time.
Every employee is replaceable by necessity, except in
cases where poor management or favoritism, or
something like that, exists.
4:26:33 PM
LARRY WIGET, Director, Government Relations, Anchorage School
District, testified in support of the legislative intent of HB
161 to rehire retired employees when there is an actual shortage
of applicants for the vacant position, and urged the legislature
to extend the sunset date for the legislation with the caveat
that similar restrictions currently placed on the rehire of TRS
employees - AS 14.21.35 - be adopted for PERS employees, as
well. He stated concern that the pre-selection and hiring of
retirees to fill the job they have just vacated, without regard
as to whether or not there is a qualified applicant pool from
which to draw, eliminates the career ladder in state employment
for other employees who are qualified and may apply and, unlike
the rehire, would be contributing to the state retirement
system.
4:28:09 PM
BRUCE JOHNSON, Alaska Association of School Boards (AASB), said
that association's membership resolved itself behind the
extension of the rehire provision at its annual conference in
November. He said, "We believe this is a valuable tool for
school districts to have. I think it's been used sparingly,
when necessary, and we still - even with this provision - have
positions that are unfilled at the beginning of every school
year, well into the semester, in some cases." He offered an
example. He said a lot of money has been invested in teachers
who have reached retirement eligibility age, but may still have
a couple years left to teach, perhaps after going away for a
while. They can come back, work for a couple of years, and
"fill some vital needs." He said most districts would just as
soon bring in a young teacher to employment and guarantee that
he/she will be there for a long time, but the reality is that
it's just not possible in some of the areas with an acute
shortage of teachers.
4:30:38 PM
CHRIS S. CHRISTENSEN, Deputy Administrative Director,
Administrative Staff, Office of the Administrative Director,
Alaska Court System, stated that the retiree return program has
been very helpful to the court system, and he said that system
is hopeful that the program will be extended by the legislature.
Mr. Christianson reported that the court system has
approximately 650 nonjudicial employees at 32 locations around
the state. Currently, there are only about 10 people
participating in the program. Though that doesn't sound like
many, he said, those positions are critical to the operation of
the court system. He stated that to a much greater extent than
the executive branch, the court system has a number of unique,
one-person job classes. One example, he said, is the state law
librarian. He said it is crucial that these job positions
remain filled by knowledgeable persons. He said it is difficult
to recruit internally for such positions, because more than half
of the court system's employees are clerical employees who
cannot be promoted to these specific jobs.
MR. CHRISTIANSON stated that for certain jobs in the court
system there have been no qualified applicants and there have
been times when supervisors [who have retired] have had to be
rehired. He explained that the turnover rate in the lower-level
positions is about 50 percent within the first five years of
employment. In some rural locations, the turnover is twice as
bad. He said this is primarily because of low pay.
MR. CHRISTIANSON said that the court system has, for more than
the last decade, been running a mandatory 30-day hiring freeze
for all positions; the only person allowed to waive the freeze
is the administrative director. He said this action is
financially responsible; however, because of the practice, when
jobs turn over there are vacancies that last for 30 days. He
said the freeze is a double-edged sword: it requires that the
supervisors be more experienced in order to keep the case load
moving during times when there are job vacancies, but the
turnover means that fewer people get the years of experience
they need to become supervisors. He continued: "The retiree
return program has enabled the court system to continue to
function in an efficient manner because of our ability to hire
back experienced and knowledgeable employees in the one-person
job classes and in the rare supervisory positions where we
simply cannot fill the job. Without it, we would be struggling
to fill certain key positions."
MR. CHRISTIANSON noted that the court system participated in the
retirement incentive program (RIP) several years ago. He
emphasized how damaging the RIP was; the court system lost the
core of its long-term, experienced supervisors. Mr.
Christianson stated, "To some extent, this program has helped us
make up for that a little bit. And that's one of the reasons we
are appreciative of this."
CHAIR WILSON closed public testimony.
4:35:12 PM
CHAIR WILSON said there are problems to be worked out, but there
also is "an obvious need." She mentioned future work on the
bill.
4:36:49 PM
REPRESENTATIVE ANDERSON said he has heard concerns expressed
from Alaska State Troopers and is glad the bill will be held so
that they will have a chance to offer their comments.
CHAIR WILSON announced that [HB 161 was heard and held].
HB 204-OPTOMETRISTS' USE OF PHARMACEUTICALS
CHAIR WILSON announced that the last order of business was HOUSE
BILL NO. 204, "An Act relating to the prescription and use of
pharmaceutical agents, including controlled substances, by
optometrists."
4:38:45 PM
REPRESENTATIVE BILL THOMAS, Alaska State Legislature, as sponsor
of HB 204, said that he represents 28 communities, which
together have one optometrist and no ophthalmologists. He said
the bill is critical for the needs of those communities. He
said it is important to note that the unemployment rate in those
communities ranges from 35 to 85 percent. The chance of many of
the citizens in these communities having insurance is "nil."
REPRESENTATIVE THOMAS stated that HB 204 would change statutes
to allow optometrists to administer oral pharmaceuticals to
provide better and more complete eye care to Alaskans.
Currently, he noted, optometrists are limited in the treatment
of eye disease that is seen on a routine basis and would benefit
from oral medication, including acute allergic reactions, ocular
herpes, ocular herpes zoster, and chronic lid diseases.
Currently 100 optometrists in 17 locations serve the state,
spanning from Barrow to Juneau. There are 26 eye care
specialists in 6 locations that can prescribe oral
pharmaceuticals in Alaska.
REPRESENTATIVE THOMAS recounted a time when he was visiting a
rural community and was suffering from diverticulitis. He was
surprised that the physician's assistant could prescribe
medication for him, while an optometrist could not. The
proposed legislation would enable the optometrists to practice
at the level at which they are trained. Representative Thomas
reminded the committee that the legislature had recently voted
in favor of a bill that would allow doctors trained in Asia to
come to the Alaska and practice. He said HB 204 is simply
asking that optometrists be allowed to use their background and
education to the full extent. He also noted that another bill
was recently supported that would allow a student to carry
his/her own syringe and self treat in the case of anaphylaxis,
while an optometrist is not allowed to treat for emergency
anaphylaxis.
REPRESENTATIVE THOMAS said, without question, vision is an
important aspect of a person's life and should be treated by a
trained eye care professional. Currently, optometrists must
refer outpatients to a general physician, physician's assistant,
or a nurse practitioner for oral treatment of ocular disease.
He said the proposed legislation would remove an extra step by
having the ocular treatment done by an eye care professional,
thereby saving the patient from undue complications and
financial costs. He said, for example, that a person coming to
Juneau from Kake for eye care would spend $200 roundtrip by
plane, or would have to take a circuitous route by ferry, which
is only offered twice a month.
REPRESENTATIVE THOMAS said ophthalmologists are specialists, and
he indicated that he is not trying to take anything away from
them. He said he just wants people from the Bush to get good
and timely eye care.
4:47:10 PM
CHAIR WILSON stated her intention to hold the bill because it is
"different than the one last year."
4:47:35 PM
REPRESENTATIVE GARDNER referred to Representative Thomas' asking
that optometrists be allowed to use their training. She stated
her understanding that ophthalmologists are doctors, whereas
optometrists are not, and she asked if that is correct.
REPRESENTATIVE THOMAS offered his understanding that
optometrists have been trained in the area of giving oral
medicine for eye care. He added that if that were not the case,
44 states would not have already allowed optometrists to
[prescribe oral eye medication]. He suggested that the experts
could enlighten the committee further.
REPRESENTATIVE GARDNER suggested that a person in the Bush could
get a prescription from a nurse practitioner.
REPRESENTATIVE THOMAS said the concern is that a person not
trained specifically in the care of eyes could make a
misdiagnosis.
4:50:40 PM
CARL ROSEN, M.D., President, Alaska Eye Physicians and Surgeons,
testified in opposition to HB 204. He told the committee that
he is an ophthalmologist who practices in Anchorage. He stated
that ophthalmologists attend college for four years, go through
four years of medical school into which only 1 in 200 get
accepted, serve a one-year internship in medicine or surgery,
and complete a three-year intensive residency, at which point
the ophthalmologist learns to diagnose, treat, and operate. The
residency is typically done in a large university or city
hospital where the ophthalmologist conditions him/herself to
deal with very sick people. The system filters out those who
can't handle the surgical anxiety that comes with the job. Dr.
Rosen said he completed a fellowship in addition to the three
years of residency to further train himself in orbital surgery
and neuro-opthomology.
DR. ROSEN said the issue of the rarity of finding an
ophthalmologist in a rural community is "yes and no." He
explained that the Native hospital travels frequently to various
Native communities and has its own patient population. He noted
that the U.S. Air Force also does that. His own practice has
doctors who travel to Kodiak, Cordova, and Sitka. He added that
there are [ophthalmologists] in both Juneau and Fairbanks.
DR. ROSEN confirmed that nurse practitioners have the ability to
prescribe medications, but they are specifically trained to "be
the first line." They treat with medication and also are
knowledgeable regarding the pharmacology of medicines. He said
anyone trained as an optometrist beyond five years ago did not
have the intensive training to understand the pharmacokinetics
and interaction of medicines. Optometrists also do not have
hospital-based privileges or interact with the medical community
on a regular basis. Dr. Rosen said he frequently consults other
medical specialists when multiple drugs are involved.
DR. ROSEN stated that HB 204 does not differentiate treating an
infant versus a ninety-nine-year-old. He said there is a danger
in "just allowing this to go forward." He said the subject of
the bill has been seen in the past and has consistently been
thwarted. He said, "If you read the bill, it's under the
jurisdiction of the optometric community, which is outside the
purview of the medical board and the medical community." He
said he thinks that's a dangerous problem.
DR. ROSEN said ophthalmologists in Alaska do take phone calls as
a courtesy to the people of the state. He said he is available
24 hours a day, 7 days a week. He said:
Some states do have this bill, but if you look at the
overall number of optometrists who use it, it's very
small .... Let's say there's 100 optometrists in New
Mexico who have this privilege; roughly 10-15 will
actually use medications on a consistent basis to be
considered familiar with medications. So, the vast
majority don't have the numbers. And in medical
school and in residency training, you're only allowed
to graduate if you can prove that you have the ...
capability to do this procedure or understand this
disease. That's how medical school training [works].
And optometric training will not have that, because
now they're outside of school and they're relying on
the optometric board to give them a go or a no-go on
this. So, I think that's also a problem.
4:57:53 PM
REPRESENTATIVE ANDERSON indicated that he would like to know if
there would be trouble if the bill is not passed.
DR. ROSEN answered no. He stated:
As long as you're able to communicate the clinical
symptoms and describe the ophthalmic condition to an
ophthalmologist, or even [to] the emergency room which
can transfer [that information] to the ophthalmologist
..., we're able to intervene and appropriately manage
and assess the patient and then prescribe any
medication, if any is necessary. ... There is no
public outcry for this, and I have not heard or [do
not] know of a problem where an optometrist has had a
dire condition and has not been able to contact an
ophthalmologist when needed. I just don't know of
one.
5:00:30 PM
REPRESENTATIVE CISSNA asked if "telemedicine" is involved.
DR. ROSEN said he not only supports telemedicine, but it's been
a hobby and avocation of his for the past seven years. He said
efforts are being made to get more of the medical community to
accept [telemedicine]. He listed some of the cases that he has
treated by telemedicine.
5:01:53 PM
DONALD J. CINOTTI, M.D., said that he is from the American
Academy of Ophthalmology and is "on the state affairs committee"
in New Jersey. He said he monitors similar bills across the
country and considers the ramifications of them. Dr. Cinotti
stated that the proposed legislation is by far the most
expansive of any bill he has seen in a long time, because of its
vague language. For example, the bill mentions pharmaceutical
agents, but does not specify oral pharmaceutical agents, which
he said would lead a person to believe that injectable
medications could be used, which he said is very troublesome.
He said another concern is in regard to the use of "off-label
medication." The treatments for ophthalmic disorders are
becoming very complex. He offered an example of medicine that
can be dangerous in the wrong hands, and he said some
complications can lead to death. He stated, "Certainly we don't
believe that the optometrists have the expertise or the
knowledge to recognize the complications of use of these
medications, nor the ability to treat them properly."
DR. CINOTTI said it's often mentioned that there are not enough
ophthalmologists around to take care of patients, but in
reality, there are, he said. He explained that when a patient
goes to an emergency room there is usually an arrangement
between that emergency room and an ophthalmologist on call who
can determine the proper treatment. He said the bill has no
oversight by physicians of optometrists; there would be no phone
call to an ophthalmologist to see if the medication or the
diagnosis is correct. He reiterated that the bill is a "very,
very dangerous" one.
5:05:58 PM
REPRESENTATIVE SEATON asked if the language in the bill that Dr.
Cinotti would like tightened is that on page 1, lines 9-10,
which read as follows:
(2) the pharmaceutical agent is prescribed
and used for the treatment of ocular disease or
conditions, ocular adnexal disease or conditions, or
emergency anaphylaxis;
DR. CINOTTI, in response, said many treatments for diseases are
progressing, and he offered examples. He reiterated that the
language does not specify oral versus injected medicine, but
only lists "pharmaceutical agent".
5:07:38 PM
DR. CINOTTI, in response to a follow-up question from
Representative Seaton, said adding "oral" before "pharmaceutical
agent" would help, but there would still be the need to consider
what is necessary for an optometrist to treat patients in a
rural area. For example, if the concern is that optometrists
should be able to use antibiotics, then the bill should
specifically list what antibiotics they may use. He stated that
an ophthalmologist, in practice, does not, in general, use
controlled substances. He said he has worked as a director of
ocular trauma in a major hospital for 22 years and has not
written a subscription for a narcotic in at least three years.
He added, "So, what is the point of giving the optometrist the
right to subscribe narcotics?"
5:09:08 PM
BOYD WALKER, O.D., testified in support of HB 204. In response
to remarks from the previous speakers, he said he believes it is
up to the individual practitioner to make the decision as to
whether something is within their scope of practice or not. He
said a family practice doctor may well be capable of delivering
a baby, but an obstetrician may think otherwise. Dr. Walker
said he is not arguing that an ophthalmologist's level of
training is [not] higher than that of an optometrist; however,
he stated that in routine practice, there are times when
individual optometrists - especially those in rural areas of
Alaska - need to have the ability to prescribe oral medications
and occasionally even inject medicine. He continued:
I recall back in the 70s, when optometrists were not
allowed to use any medications, whatever - not for the
purpose of diagnosing eye disease, nor for the purpose
of treating eye disease. And ophthalmology said,
"Gosh, people die from eye drops that dilate your
eyes." Well, I believe today that after 15 years of
experience that even our ophthalmology colleagues
would agree that optometry has served a great function
in terms of diagnosing eye disease that they would not
have been able to find had not pharmaceuticals been
allowed to optometry.
DR. WALKER said Dr. Rosen alluded to the fact that "even in
states like New Mexico that have the drugs, not everyone uses
them." He stated his belief that that proves that optometrists
are judicious in the use of the drugs; they only use them when
necessary and they probably do make a lot of referrals to
ophthalmologists who are readily available. In rural Alaska, he
said, there certainly are cases where individuals might need
immediate treatment and be unable to get it.
DR. WALKER said the education of an optometrist is similar to
that of a family practice physician and dentist, and in most
cases above that of a nurse practitioner and physician's
assistant. In conclusion, Dr. Walker stated his belief that
optometrists have the education and the credentials to use
"these medications" and will be careful in using them to the
best interest of their patients. He said he believes that rural
Alaskans would really benefit from [the proposed legislation],
in terms of not having to wait for treatment or having to take
the time to travel to a larger center where an ophthalmologist
may be available. He urged the committee to support HB 204.
5:13:35 PM
DR. WALKER, in response to a question from Chair Wilson,
outlined the training necessary to become an optometrist: four
years of undergraduate work, pre-optometry, or pre-medicine,
followed by an additional four years of post graduate training
in optometry school. Many optometrist elect to subsequently
complete either an internship or residency, although he said
that is not all that common.
5:14:47 PM
REPRESENTATIVE CISSNA noted that she has heard the subject of
the bill for seven years. She asked if there was some way that
the optometrists could augment their education so that the
concerns of the medical community could be solved.
DR. WALKER responded that optometric education already trains
individuals to use "these medications." He said it appears that
it is the ophthalmology community who is showing an
unwillingness to compromise. He clarified that he does not even
categorize that group as being the medical community.
Currently, statute requires that optometrists partake in
continuing medical education, which is regulated by the state.
Those optometrists that utilize pharmaceutical agents have to
have specific retraining on a biannual basis in order to renew
their licenses.
5:19:02 PM
REPRESENTATIVE GARDNER noted that a naturopathic doctor
undergoes eight years of training. She asked Dr. Walker if he
thinks they should have prescriptive rights.
DR. WALKER responded that he knows nothing about the training of
a naturopathic doctor and therefore cannot speak to that. He
said he thinks every professional who [prescribes] medication or
performs procedures should be willing to display his/her
curriculum of training. He said, "Those who have an M.D. behind
their name, once they've received their training and they have
their degree and their board exams behind them, really have no
one to answer to other than the medical board. ... All other
... limited license practitioners must come to ... the
legislature to develop regulation to delineate their scope of
practice."
5:21:01 PM
GRIFF STEINER, M.D., offered his medical training history and
told the committee that he is an ophthalmologist who has special
training in glaucoma and corneal surgery. He said that although
he has respect for Dr. Walker and the profession of optometry,
he must refute a number of Dr. Walker's assertions. First,
regarding Dr. Walker's claim that optometrists have the same
amount of training as family medical physicians and dentists, he
said that during their entire training period, physicians,
dentists, and nurse practitioners administer medications to
patients under the supervision of other physicians. At no time
during optometrists' training are they prescribing medications
under supervision, or at all. Dr. Steiner said in his practice
he has rarely had to prescribe oral antibiotics. He continued:
The only times I have had to prescribe oral
antibiotics is when the patient had a very dire
infection, the kind that could kill them - the thing
that would have to be referred. If an optometrist saw
lid swelling and treated it with oral antibiotics and
it was instead a diabetic infection of the sinuses,
that patient would die in a matter of days. It cannot
be overstated that optometrists have no practical
training in prescribing medications, other than eye
drops. During their training, they do not prescribe
oral antibiotics or pain medications to patients in
the hospital; they're not responsible for any patients
in the hospital during their entire training.
DR. STEINER agreed with the prior testimony of [Dr. Cinotti]
that HB 204 is dangerous because of its vagueness. If the bill
were to pass, he warned, optometrists would then have precedent
to apply to the federal drug enforcement agency to be allowed to
prescribe drugs that are "way outside their purview." He said
he thinks the bill would also be a stepping-stone in allowing
optometrists to do surgical things they are also not trained to
do.
DR. STEINER said the only way that optometrists are associated
with operations is by doing the post-operative care for an
itinerate physician who flies to Alaska from out of state,
performs surgery, and leaves the patient in the care of the
optometrist. He continued:
They're not trained to do this either. If we allow
them to do these prescriptions, they will keep
prescribing medications for patients they're not
trying to take care of in the first place, and they're
especially not allowed to prescribe the medications to
those patients. And they'll be no supervision as this
itinerate physician flies immediately back down to
Seattle. ... The itinerate physician himself has
said that he doesn't feel qualified to treat these
medical patients, so, ... as an M.D., he does not take
referrals from his optometric network. And the
optometrists are too embarrassed or reluctant to refer
to us, because of the arrangement with the itinerate
physician, which ..., albeit not illegal, ... allows
for a $200-400 per eye payment if they refer to the
itinerate physicians. They would get no money if they
referred to us. And so, ... the only M.D. that
they're strongly associated with feels unqualified to
treat patients and refers them back to the
optometrists, who then refer back and forth between
optometry. We've seen patients admitted to hospitals
treated by optometrists [with] medications that
they're not licensed to prescribe. ... I don't think
I can overstate this enough.
[HB 204 was heard and held.]
5:27:45 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at approximately 5:30 PM.
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