Legislature(2017 - 2018)BARNES 124
04/01/2017 01:00 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB103 | |
| HB124 | |
| HB36 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 124 | TELECONFERENCED | |
| *+ | HB 36 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 103 | TELECONFERENCED | |
HB 103-OPTOMETRY & OPTOMETRISTS
3:04:06 PM
CHAIR KITO announced that the first order of business would be
HOUSE BILL NO. 103, "An Act relating to the practice of
optometry; and providing for an effective date." [Before the
committee was CSHB 103(HSS).]
3:04:34 PM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, Juneau,
Alaska, as the sponsor, re-introduced HB 103. She explained
that HB 103 would update the Board of [Examiners in] Optometry
to be more in line with the practices that are consistent with
those other boards overseeing health professions throughout the
state of Alaska. It would give the board the authority to
regulate its own practice and would move management of
optometrists away from the legislature and into the board.
3:05:45 PM
CHAIR KITO moved to adopt Amendment 1, labeled 30-LS0459\J.5,
Bruce, 3/28/17, which read:
Page 2, lines 6 - 7:
Delete "standards for the practice of optometry
as provided"
Insert "whether optometry practice procedures or
policies comply with acceptable standards of the
practice of optometry, as provided"
3:05:57 PM
The committee took a brief at-ease.
3:06:34 PM
CHAIR KITO again moved to adopt Amendment 1.
3:07:04 PM
REPRESENTATIVE JOSEPHSON said he is unable to tell what the
[proposed] change is.
REPRESENTATIVE SPOHNHOLZ explained Amendment 1 would tighten the
definition of standard of practice in a manner that is
consistent with the exact language that is used by the Board of
Nursing. She said the amendment is at the recommendation of the
Department of Law to ensure that the definition of the standard
of practice is clearly defined as complying with acceptable
standards of practice of optometry. According to the Department
of Law, she added, this would tighten the definition of standard
of practice in a way that makes it more useful.
3:07:59 PM
There being no objection, Amendment 1 was adopted.
3:08:04 PM
The committee took a brief at-ease.
3:08:42 PM
REPRESENTATIVE JOSEPHSON moved to adopt Amendment 2, labeled 30-
LS0459\J.1, Bruce, 3/27/17, which read:
Page 1, line 9, following "disease":
Insert "as provided under AS 08.72.272"
CHAIR KITO objected for purposes of discussion.
3:08:52 PM
REPRESENTATIVE JOSEPHSON explained Amendment 2. He related that
in oral testimony and written comments, several ophthalmologists
stated that they don't prescribe anything more powerful than
hydrocodone, which, to his knowledge, was not controverted. He
further related that these ophthalmologists stated that eyes do
not respond well to pain medication. He said that as he reads
the bill, it would provide that optometrists could prescribe any
[pharmaceutical] ever invented.
REPRESENTATIVE JOSEPHSON further explained that Amendment 2 is
consistent with a forthcoming amendment which would repeal
language that would give optometrists the authority through
their board to prescribe anything they want to. Amendment 2, he
stated, would return to existing language in Alaska Statute (AS)
08.72.272. He said it would be hard to say optometrists didn't
make certain arguments about the need to oversee their own
practice. However, he continued, they didn't make any arguments
in testimony or in writing about why they needed to expand the
kinds of prescriptions they make. Given the crisis the state is
confronted with, he said he doesn't know why that expansion is
necessary, which is why he is offering Amendment 2.
3:11:13 PM
REPRESENTATIVE SULLIVAN-LEONARD inquired as to what AS 08.72.272
describes in detail.
REPRESENTATIVE JOSEPHSON replied that Amendment 2 would bring
this back to current law that exists under [AS 08.72.272],
Pharmaceutical Agents, subsection (a), which says optometrists
can prescribe for assorted things. Amendment 2, he said, says
the status quo will prevail and optometrists will have the
authority that they currently have to prescribe.
3:12:11 PM
REPRESENTATIVE SPOHNHOLZ rebutted that part of the intent of the
legislation was to simplify and to streamline the legislation
authorizing the [Board of Examiners in Optometry] to oversee
their practice. She related that [the board] has testified it
will continue to work with the four-day limitation on the supply
of opioids, for example. Also, she continued, other regulation
is being put into practice regarding the opioid epidemic, which
she strongly feels the legislature needs to address by advancing
HB 159 for that purpose. She said she understands the maker of
the amendment's concerns, but the statutory language currently
in place is outdated and leaves [legislators] in a position of
overseeing specific kinds of medications for which [legislators]
don't have the expertise to be managing. Therefore, it is
better to have this authority placed at the board level, she
stated.
3:13:19 PM
REPRESENTATIVE BIRCH spoke against Amendment 2. He recalled the
committee hearing testimony about what an optometrist could
prescribe and that nurses could not prescribe [narcotics].
However, he continued, he was informed by a friend who is a
nurse that nurses can prescribe narcotics in Alaska, have done
so for decades, and that nurses need the same Drug Enforcement
Administration (DEA) authority as a physician or any other
clinician. Therefore, he said, he is not troubled about
providing the latitude proposed [in HB 103].
3:14:01 PM
REPRESENTATIVE KNOPP asked whether Section 4, page 2, of the
bill does what the maker of the amendment is trying to do.
REPRESENTATIVE JOSEPHSON responded, "This brings us back to the
overall." What he means, he continued, is it makes the board
the ultimate decider about what those prescriptions should be,
and he is not comfortable with that. The people who testified
have spent more time than anyone else working on eye care and
they said they never use more than hydrocodone. Under current
law, he continued, "optometrists can do that very thing, but [HB
103] would lift that and say, 'prescribe what you want,' if that
[is] what the board says, 'prescribe what you will.'" He
further noted it means that the attorney general would have to
look at this language and determine whether the board acted
consistent with the language [of HB 103 in section 4, page 2],
and he would conclude that as long as they establish the what,
where, and why of what they were doing, maybe they would say
yes. "But," he added, "that is our point we'd make it valid
and ? there's that argument that the attorney general would have
to give them that authority."
3:16:00 PM
REPRESENTATIVE WOOL offered his understanding that optometrists
can already prescribe certain controlled substances. He said he
doesn't see that as being a problem in the past; it is a
responsibility that [optometrists] have handled.
3:16:30 PM
CHAIR KITO maintained his objection to Amendment 2.
A roll call vote was taken. Representatives Josephson voted in
favor of Amendment 2. Representatives Knopp, Sullivan-Leonard,
Wool, Birch, and Kito voted against it. Therefore, Amendment 2
failed by a vote of 1-5.
3:17:10 PM
REPRESENTATIVE JOSEPHSON moved to adopt Amendment 3, labeled 30-
LS0459\J.2, Bruce, 3/27/17, which read:
Page 2, lines 20 - 24:
Delete all material.
Renumber the following bill sections accordingly.
3:17:12 PM
CHAIR KITO objected.
REPRESENTATIVE JOSEPHSON explained Amendment 3. He said it is
the same argument as Amendment 2, and that he is not convinced
the board has the training, education, and experience to make
decisions about pharmaceutical agents in every case. While he
is comfortable in some cases, [the bill proposes] to expand this
in a way that is, in his view, far beyond [the board's] training
and therefore he is offering Amendment 3.
REPRESENTATIVE SPOHNHOLZ opposed Amendment 3. She said her
comments on the amendment are much the same as for Amendment 2.
The language in Section 4, she stated, is clear that the
pharmaceutical agent prescribed needs to be consistent with
their standards of practice. Like optometrists, there are other
professions that have the authority to practice within this
scope that have not gone to medical school and therefore are not
under the [State Medical Board].
REPRESENTATIVE BIRCH said he has similar concerns as he voiced
before in that if the board is recognized as having the capacity
and the ability to make those recommendations, it is not
dissimilar from other clinicians in that line of work.
3:19:00 PM
CHAIR KITO maintained his objection to Amendment 3.
A roll call vote was taken. Representative Josephson voted in
favor of Amendment 3. Representatives Birch, Sullivan-Leonard,
Knopp, Wool, and Kito voted against it. Therefore, Amendment 3
failed to be adopted by a vote of 1-5.
3:19:30 PM
REPRESENTATIVE JOSEPHSON moved to adopt Amendment 4, labeled 30-
LS0459\J.3, Bruce, 3/27/17, which read:
Page 2, following line 24:
Insert a new bill section to read:
"* Sec. 5. AS 08.72.273 is repealed and reenacted
to read:
Sec. 08.72.273. Non-invasive procedures. Except
as provided in AS 08.72.278, a licensee may perform
non-invasive procedures including
(1) removing superficial bodies from the
eye and its appendages;
(2) epilating misaligned eyelashes;
(3) placing punctal or lacrimal plugs;
(4) diagnosing dilation and irrigation of
the lacrimal system;
(5) performing orthokeratology;
(6) prescribing and fitting contact lenses
with the purpose of altering refractive error;
(7) using diagnostic instruments that use
laser or ultrasound technology; and
(8) other similar procedures within the
scope and practice of optometry."
Renumber the following bill sections accordingly.
Page 2, line 26, following "practice.":
Insert "(a)"
Page 2, following line 29:
Insert a new subsection to read:
"(b) A licensee may not perform ophthalmic surgery.
In this subsection, "ophthalmic surgery" means an
invasive procedure where human tissue is cut, ablated,
or otherwise penetrated by incision, laser, or other
means to treat diseases of the human eye, alter or
correct refractive error, or alter or enhance cosmetic
appearance; "ophthalmic surgery" does not include the
procedures described under AS 08.72.273."
CHAIR KITO objected.
3:19:42 PM
REPRESENTATIVE JOSEPHSON described Amendment 4 as critical.
Qualifying that he is speaking from memory, he said no fewer
than 20 optometrists wrote him stating that HB 103 is not about
surgery, but rather about controlling their own destiny and
practice. He explained Amendment 4 provides eight non-invasive
items that can be done by optometrists with adequate training.
These would be eight things in the law that optometrists don't
expressly have now, he continued, which would seem like a good
thing if he were an optometrist.
REPRESENTATIVE JOSEPHSON said Amendment 4 also clarifies the
opinion of optometrists. He recounted that the committee heard
from a doctor of optometry in Juneau who wanted to do a large
number of surgeries. There is some confusion about the
motivation for the optometrists, he continued. In the original
bill, optometrists wanted to do ophthalmic surgery and while
that is not before the committee, it is important to ask what
the motivation or intent is. He said page 2, subsection (b),
comes from Washington state law and delineates the things that
optometrists are not trained to do. The difference in training
is enormous and that is why the delineation should be made, he
stated. The [State Medical Board] says an ophthalmologist needs
four years from an accredited medical school; needs to pass
steps one, two, and three of general medical boards; needs a
year of internship consisting of intensive care, emergency
medicine, surgery, internal medicine, often in 80-100 hour work
weeks, including the performance of thousands of surgical
procedures; needs a three-year ophthalmic residency, which would
include laser and ophthalmic surgeries under close supervision;
needs one to two years of surgical fellowship consisting of
intensive education; and that the total education comprises
22,000 hours of work and training. [Ophthalmologists] also need
to complete an American Board of Ophthalmology exam on a 10-year
renewable cycle; need to have mandatory 60 hours of class, one
continuing medical education; an annual review; and license
renewal by the [State Medical Board].
REPRESENTATIVE JOSEPHSON said he feels that if the state doesn't
tightly regulate surgical eye care there's really no need in
regulating anything with great vigor. While that may sound
alarmist, he continued, he feels that this subject, in
particular, needs that sort of scrutiny, and Amendment 4 would
essentially mirror current Washington state practice. If the
bill passes, he pointed out, the current law will say that the
only type of invasive surgery an optometrist can perform is
removal of a foreign body from the eye, yet the rest of the
bill, CSHB 103(HSS), opens the door for much more. So, he said,
the bill already creates some odd complications and he therefore
asks for support of Amendment 4.
3:24:05 PM
REPRESENTATIVE KNOPP offered his appreciation for Representative
Josephson's concerns, but said he has always advocated for
allowing the board to regulate its profession within the scope
of the license, education, training, and experience - that is
the key point. He said Amendment 4 would gut the intent of the
bill and therefore he is against it. According to the sectional
analysis, he continued, Section 5 provides that the board may
not authorize any procedure beyond the scope of the licensee's
education and experience. The whole intent of the bill is to
allow optometrists to practice their business in the manner that
they went to school and were taught and trained to do. He said
he cannot see them doing anything outside of that scope;
therefore, he is speaking against Amendment 4 and in support of
the bill.
3:25:18 PM
REPRESENTATIVE SULLIVAN-LEONARD recalled discussions within the
Health & Social Services Standing Committee regarding the
formation of the board and the work of the board. She said her
hope is that additional information could come back to
legislators in a year or two that provides more detail about the
type of non-invasive procedures that optometrists do. She asked
whether this is something the sponsor thinks would work better
than to try to amend the bill with this concept now.
REPRESENTATIVE SPOHNHOLZ answered that, if the bill passes, the
legislature's role is to ensure that the law is being
implemented in ways that the legislature thinks are consistent
with its original intent. She added that having the board
provide presentations on the evolution of the board process
seems like a reasonable thing to do. Regarding the amendment as
a whole, she said she agrees with Representative Knopp's
characterization that it takes away the guts of the bill. The
intent of the bill is to delegate the authority to manage
optometrists and the practice of optometry to the [Board of
Examiners in Optometry].
REPRESENTATIVE SPOHNHOLZ added that she doesn't disagree with
Representative Josephson's characterization of the extensive
education of ophthalmologists who are trained surgeons. Using
an analogy, she noted that the distinction between dentistry and
oral surgeons is fairly similar the amount of education that
dentists receive is fairly similar to the amount of education
that optometrists receive. Dentists oversee their own scope of
practice through their board and there are not huge problems and
conflicts between oral surgeons and dentists. The problem is
not the distinction between optometry and ophthalmology, she
continued, but rather that the legislature is overseeing it.
Taking politics out of good governance in health programs, and
health practice in particular, is the way get the best evidence-
based efforts and management and that is why HB 103 proposes to
delegate that authority as described specifically to the [Board
of Examiners in Optometry].
3:28:30 PM
REPRESENTATIVE WOOL stated he is not able to list the procedures
that would be performable by an optometrist and doesn't want to
limit an optometrist's practice just to that. He said the bill
would allow the [Board of Examiners in Optometry] to say what
optometrists can and cannot do within the scope of their
training and practice.
REPRESENTATIVE WOOL related that over the last week he called
some optometrists in his home community who hadn't called in and
were not following this in committee and asked them whether they
wanted to do surgery. He said their reply was absolutely not.
One optometrist, he continued, told him there is a procedure
that optometrists are trained to do, but it cannot be done in
Alaska and will not be something optometrists will do if HB 103
passes. While he respects the argument for 20,000 hours, he
said every medical doctor goes through medical school whether to
be an ophthalmologist, heart surgeon, or podiatrist, and much of
those 20,000 hours is studying cardiology and cancer and other
things, and all those hours are not applicable exactly to the
eye. Optometrists spend a lot of hours studying specifically
the eye, he continued, and they do not want to do surgery out of
this bill; they just want to have control of their professions.
3:30:47 PM
CHAIR KITO maintained his objection to Amendment 4.
A roll call vote was taken. Representative Josephson voted in
favor of Amendment 4. Representatives Wool, Birch, Knopp,
Sullivan-Leonard, and Kito voted against it. Therefore,
Amendment 4 failed to be adopted by a vote of 1-5.
3:31:18 PM
CHAIR KITO announced that HB 103, as amended, was now before the
committee.
3:31:31 PM
REPRESENTATIVE JOSEPHSON offered comments for the legislative
record. He recalled the sponsor and her aide as both stating
that the bill does not touch AS 08.72.273. The only way to read
that, he said, is to derive the conclusion that the only type of
invasive surgery that would be allowed if this bill became law
is removal of a foreign body. This section for removal of a
foreign body is not intended to permit a licensee to perform
invasive surgery. He noted that Section 72 of the
aforementioned statute covers the entire optometrists' code.
So, he continued, it is not just about foreign bodies, it is
about all types of surgeries. He stated that his previous
amendment would have helped optometrists by saying that without
question those eight things can be done, but now there could be
a debate about that.
REPRESENTATIVE JOSEPHSON added that this reminds him in some
ways about his response to SB 91, which he is mentioning because
he tends to be cautious about things that can hurt people and
things that can hurt the natural environment. He pointed out
that the concerns of the ophthalmologists are almost entirely
not economic. Ophthalmologists have spent their lives working
in eye care and care about the standard of practice, he
continued, and while that is not to say that optometrists don't,
the way the bill is written optometrists can do any manner of
things. He recollected that in a March 14 hearing before a
different committee, [Assistant Attorney General Harriet] Milks
had stated that the attorney general would not intervene on
matters of policy or comment on how the optometrists regulate
themselves; if they are promulgating regulations within this
bill, they can do it. In some respects, this is just being
moved to a different venue, he said, and people are going to
continue reading about this in the newspaper.
3:34:23 PM
CHAIR KITO drew attention to Section 5 of the bill, which
states, "A licensee may perform the services of optometry as
defined in AS 08.72.300 only if the services are within the
scope of the licensee's education, training, and experience as
established by regulations adopted by the board." He said he is
familiar with this type of thing because he is an engineer
regulated under the [State Board of Registration for Architects,
Engineers, & Land Surveyors]. As an engineer, he noted, he
could theoretically design a bridge, but without any experience
designing a bridge that bridge could collapse and hurt people.
With his experience, he continued, he could design a roadway,
breakwater, sewer, or outfall, all of which he has done and in
which he has education, training, and experience. He said it is
his responsibility within that license to perform those duties
that he has the training for and it is up to him with the
knowledge of his education to know when and how to apply that
experience. Optometrists have much more education and training
in their field than he does in engineering, he stated, and they
should be allowed to identify what the scope of practice is that
is consistent with their experience, education, and training,
and he believes that this bill goes there. He said he does not
believe that optometrists will be practicing outside their
knowledge and experience and offered his support for the passage
of HB 103.
3:36:21 PM
REPRESENTATIVE WOOL moved to report CSHB 103(HSS), as amended,
out of committee with individual recommendations and the
accompanying fiscal notes. There being no objection, CSHB
103(L&C) was reported from the House Labor and Commerce Standing
Committee.