Legislature(2017 - 2018)HOUSE FINANCE 519

04/12/2017 01:30 PM FINANCE

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HOUSE BILL NO. 103                                                                                                            
     "An Act relating to the practice of optometry."                                                                            
3:27:21 PM                                                                                                                    
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, read a prepared                                                                          
     HB 103  gives authority  to the  Board of  Optometry to                                                                    
     regulate the practice of optometrists,  much as is done                                                                    
     by   doctors,  nurses,   midwives,  chiropractors   and                                                                    
     dentists. It  ensures that the Board  of Optometry will                                                                    
     have  the  opportunity  to  update  their  current  and                                                                    
     continuing  standards and  scope of  practice based  on                                                                    
     the best evidence available.                                                                                               
     The  bill  will  not   allow  optometrists  to  provide                                                                    
     services  outside  of  their  scope  of  practice  like                                                                    
     performing  invasive surgeries  which will  continue to                                                                    
     be illegal.                                                                                                                
     What it will  allow is for optometrists  to utilize the                                                                    
     State  of  Alaska's   rigorous  regulatory  process  to                                                                    
     manage  themselves just  as doctors,  nurses, midwives,                                                                    
     chiropractors and dentists do.                                                                                             
     HB 103  allows our  robust regulatory process  to work.                                                                    
     The process  for developing  new regulations  is public                                                                    
     and  transparent,  ensuring  that any  new  regulations                                                                    
     will be fully  vetted by the board, the  public and the                                                                    
     Department of Law before it becomes regulation.                                                                            
     The Board  of Optometry  has a  strong track  record of                                                                    
     regulating itself.  In fact, the Board  has implemented                                                                    
     higher   continuing   education    standards   on   the                                                                    
     profession  than   the  Legislature  has   required  in                                                                    
     statute which  makes a strong  case for why  this board                                                                    
     is more  than capable  of regulating its  own education                                                                    
     and   practice.  (Statute:   15  hours   of  continuing                                                                    
     education while  optometrists have  required themselves                                                                    
     to have 36 hours of continuing education.)                                                                                 
     It is my  hope that this bill will  get the Legislature                                                                    
     out  of the  business of  managing optometrists,  so we                                                                    
     can focus on our efforts  and energy on issues which do                                                                    
     require our attention and optometrists  can get on with                                                                    
     the business of caring for Alaskan's eye health.                                                                           
Co-Chair  Foster  invited  Dr.   Barney  to  the  table.  He                                                                    
reviewed a list of other available testifiers.                                                                                  
DR. PAUL BARNEY, DOCTOR OF OPTOMETRY, introduced himself.                                                                       
Representative  Wilson had  been asked  for a  definition of                                                                    
surgery. She  wondered if the  doctor would have  any issues                                                                    
if  a  definition   was  added  to  the   bill  for  further                                                                    
Representative  Spohnholz responded  that  she had  strongly                                                                    
resisted adding  a definition  of surgery  to the  bill. She                                                                    
was intentionally trying  to move the discussion  out of the                                                                    
legislature's hands.  She asserted that adding  a definition                                                                    
of surgery  would keep  the discussion in  the hands  of the                                                                    
legislature. An invasive surgery  was already not allowed in                                                                    
statute. It was unclear what  the scope of practice would be                                                                    
for optometrists  in 20  years, 30 years,  or 40  years. She                                                                    
provided an  analogous situation. She suggested  that when a                                                                    
person went to the dentist  20 years previously the things a                                                                    
hygienist did versus what a  dentist did were very different                                                                    
from what  they did presently. For  instance, currently, she                                                                    
visited the  dentist's office  twice per  year. She  saw the                                                                    
dentist at one visit and  the hygienist at both. A hygienist                                                                    
provided almost all  her oral health needs  with very little                                                                    
consultation from her dentist, which  20 years ago would not                                                                    
have  been imaginable.  She did  not  think the  legislature                                                                    
needed to  be a  part of such  a conversation.  She believed                                                                    
that the conversation should be  had between the health care                                                                    
professionals and  providers who  were keeping on  pace with                                                                    
the  standards of  practice and  educational standards.  She                                                                    
made  the case  that the  definition did  not belong  in the                                                                    
3:32:25 PM                                                                                                                    
Representative  Wilson  asked  for   the  reference  to  the                                                                    
definition  of invasive  surgery in  statute. Representative                                                                    
Spohnholz read the statute:                                                                                                     
     AS 08.72.273 Removal of foreign bodies.                                                                                    
     A licensee  may remove superficial foreign  bodies from                                                                    
     the  eye  and  its  appendages.  This  section  is  not                                                                    
     intended  to  permit  a licensee  to  perform  invasive                                                                    
Representative  Kawasaki referred  to  Section  3. He  asked                                                                    
about the  removal of language  regarding the  applicant and                                                                    
continuing    education    including   eight    hours    for                                                                    
pharmaceuticals  and  7  hours for  non-topical  therapeutic                                                                    
pharmaceutical agents.  The language would be  replaced with                                                                    
language that required  continuing education requirements as                                                                    
prescribed by  the board.  He asked  her to  clarify whether                                                                    
the goal was  to reduce the number of hours  or to allow the                                                                    
board  to determine  the  requirements.  Dr. Barney  replied                                                                    
that  8 hours  of pharmaceutical  requirements were  written                                                                    
into statute a couple of decades  prior. At the time the law                                                                    
was  written,  most  of  the education  did  not  deal  with                                                                    
pharmaceuticals.  The  legislature  wanted to  make  certain                                                                    
that pharmaceutical  education was required.  Currently, the                                                                    
education   available   had   changed   dramatically.   Most                                                                    
encompassed  pharmaceuticals  and   their  applications.  He                                                                    
stated  that  the board  was  more  likely to  increase  the                                                                    
number  of required  hours of  education rather  than reduce                                                                    
Representative Kawasaki  mentioned concerns about  the board                                                                    
overseeing  the establishment  of  regulations for  licensed                                                                    
optometrists,  as  they  could  permit  them  to  do  things                                                                    
outside of their  scope of practice. He asked  Dr. Barney to                                                                    
address  the issue.  Representative  Spohnholz relayed  that                                                                    
the primary concern  of the opposition to the  bill was that                                                                    
the board would start  authorizing practices well outside of                                                                    
practitioners' education  and expertise. There  were similar                                                                    
professional  distinctions such  as  those between  dentists                                                                    
and oral  surgeons. Dentists did  not perform  oral surgery,                                                                    
and  there was  no major  concern or  outcry that  they were                                                                    
expanding their  authority to do  so. It was not  within the                                                                    
scope of  their training and practice.  She highlighted that                                                                    
there was  a rigorous process for  drafting new regulations;                                                                    
they were  required to  be drafted  in partnership  with the                                                                    
Department  of  Law. The  goal  of  the  process was  to  to                                                                    
reconcile  any proposed  regulations with  existing statute.                                                                    
The  regulations were  also thoroughly  vetted and  included                                                                    
public input.  She was  confident that  the Ophthalmologists                                                                    
would  be happy  to  participate in  the  same process.  The                                                                    
Department of  Law would go  through a more  rigorous review                                                                    
of the  process following public comment.  She was confident                                                                    
that the  Department of Law  and the attorney  general would                                                                    
not allow for  an expansion of the scope  of practice beyond                                                                    
that which  optometrists were trained and  had the necessary                                                                    
3:36:52 PM                                                                                                                    
Representative  Kawasaki asked  how  a licensed  optometrist                                                                    
was   regulated  versus   a  hygienist.   He  wondered   how                                                                    
optometrists   were   qualified.  Representative   Spohnholz                                                                    
deferred to Dr. Barney.                                                                                                         
Dr. Barney responded  that to be eligible  for licensure, an                                                                    
optometrist  or student  of optometry  had to  take a  board                                                                    
examination.  The  board   process  started  when  optometry                                                                    
students  were in  school.  A person  had  to take  national                                                                    
boards  and pass  all sections  to be  eligible to  take the                                                                    
state license test.  For someone who graduated  in 1980, for                                                                    
example, the  statutes had not changed  significantly. There                                                                    
had been a  couple of scope-related bills  that passed. Each                                                                    
time  there  was  a  scope  expansion  in  which  continuing                                                                    
education  was required  everyone had  to get  the training.                                                                    
The  credits   were  offered   in  accredited   colleges  of                                                                    
optometry  and had  to be  taken and  successfully completed                                                                    
before optometrists  could conduct the  expanded procedures.                                                                    
The board would do something similar if HB 166 passed.                                                                          
Representative Kawasaki spoke to  the comment about a person                                                                    
being  licensed  in  1970  versus  presently.  He  mentioned                                                                    
driver's licenses. His  mom got her license in  1950 and did                                                                    
not have  to requalify for  a license or take  another test.                                                                    
He  wanted to  ensure  strict confines  of performance.  Dr.                                                                    
Barney conveyed that continuing  education was required on a                                                                    
yearly  basis.  If  anyone  were  to  fall  behind  on  that                                                                    
requirement their license would be in jeopardy.                                                                                 
Representative  Spohnholz   added  that  in   contrast  with                                                                    
Representative Kawasaki's  mother's driver's  license, which                                                                    
she believed required  a periodic update to  maintain it, an                                                                    
optometrist or another  healthcare professional was required                                                                    
to  do continuing  education to  demonstrate that  they were                                                                    
keeping pace with the changing profession over time.                                                                            
3:40:11 PM                                                                                                                    
Representative Wilson thought  that the statute AS.08.72.273                                                                    
did  not  define  invasive  surgery,  rather,  it  discussed                                                                    
foreign  bodies.  She  was looking  for  the  definition  of                                                                    
invasive surgery. Representative  Spohnholz understood there                                                                    
to be  a definition. She  had talked with the  Department of                                                                    
Law  recently   looking  for  the  definition   of  invasive                                                                    
surgery.  The   department  indicated   it  would   get  the                                                                    
definition of  invasive surgery from  the medical  board. If                                                                    
the medical board's standard was  used, the invasive surgery                                                                    
standard  would  be  the   same  for  dentistry,  optometry,                                                                    
podiatry,  across professions  for anyone  wanting to  use a                                                                    
laser or  knife to  cut someone open.  Representative Wilson                                                                    
wanted to hear from the Department of Law.                                                                                      
JOAN WILSON, ASSISTANT ATTORNEY  GENERAL, DEPARTMENT OF LAW,                                                                    
saw  no  definition for  invasive  surgery  in statute.  She                                                                    
furthered  the   board  would   likely  proceed   to  define                                                                    
standards   and  practices,   including   eye  surgery,   in                                                                    
regulations. A  three-fold review  process: the  board would                                                                    
draft  regulations  and a  public  notice  stating that  the                                                                    
board  was considering  new regulations.  The Department  of                                                                    
Law  would  then review  the  public  notice to  ensure  the                                                                    
adopting agency was identified,  the statutory authority and                                                                    
the   statutes  being   implemented  were   identified,  and                                                                    
deadlines were  set for comments.  The department  also made                                                                    
sure  that if  an oral  hearing was  held, it  was laid  out                                                                    
properly. The point was for due process and public input.                                                                       
Co-Chair Seaton  asked Representative  Wilson to  repeat her                                                                    
questions. Representative  Wilson wanted  to know  where the                                                                    
definition  could   be  found  in   statute.  Representative                                                                    
Spohnholz  relayed that  the definition  was not  in statute                                                                    
but it  was in  regulations. She relayed  that she  had been                                                                    
working  on   the  bill  with  Harriette   Milks,  Assistant                                                                    
Attorney General.  Joan Wilson  was pinch hitting  while Ms.                                                                    
Milks was unavailable.                                                                                                          
Ms. Wilson would look up the medical regulation.                                                                                
Co-Chair Seaton  indicated there would  be time to  find the                                                                    
definition,  as there  would be  additional hearings  on the                                                                    
3:45:21 PM                                                                                                                    
Vice-Chair Gara liked  the provision of the  law that stated                                                                    
that  an  optometrist could  remove  a  foreign object  from                                                                    
someone's eye in case of an  emergency. He asked what was in                                                                    
Alaska law  that prevented someone from  doing Lasik surgery                                                                    
compared  to the  laws of  other  states where  optometrists                                                                    
were able to conduct the  procedure. Mr. Barney replied that                                                                    
optometrists did not perform Lasik surgery in other states.                                                                     
Co-Chair Seaton asked if Dr. Barney had a statement he                                                                          
wanted to put on the record.                                                                                                    
Mr. Barney read a prepared statement:                                                                                           
     My name  is Dr.  Paul Barney, I  am an  optometrist and                                                                    
     the current chair  of the Alaska Board  of Examiners in                                                                    
     Optometry. I  am also  a past  president of  the Alaska                                                                    
     Optometric Association.  I   live   and   practice   in                                                                    
     Anchorage and have  done so for the past  17 years. I'm                                                                    
     here today in support of HB-103.                                                                                           
     I support  HB-103 because  it will  allow the  Board of                                                                    
     Optometry to  regulate the details  of the  practice of                                                                    
     Optometry,  which  is  how  Advanced  Practice  Nurses,                                                                    
     Dentists, and Medical Doctors  are regulated in Alaska.                                                                    
     This  legislation  will not  set  a  new precedence  in                                                                    
     health ca re,  nor will it be a risk  to Alaskans since                                                                    
     this  is already  the way  other health  care providers                                                                    
     are successfully regulated in Alaska.                                                                                      
     HB-103  will give  Optometrists  better opportunity  to                                                                    
     practice  to the  highest level  of their  education by                                                                    
     allowing the  Board of  Optometry to  write regulations                                                                    
     that  are commensurate  with educational  advances that                                                                    
     occur  with  new   technology.  The  current  Optometry                                                                    
     statute  was written  over 40  years  ago and  requires                                                                    
     Optometry  to pursue  a statute  change whenever  there                                                                    
     are advances in education  and technology. As you know,                                                                    
     statute changes are costly and time consuming.                                                                             
     You'll hear arguments  against this legislation stating                                                                    
     that  it will  be  dangerous to  allow Optometrists  to                                                                    
     regulate  themselves. But  like all  other professional                                                                    
     regulatory  boards,  the   Board  of  Optometry  cannot                                                                    
     promulgate  regulations  for  practices  or  procedures                                                                    
     that  are beyond  the  education  of Optometrists.  The                                                                    
     Board of Optometry is overseen  by the AK Department of                                                                    
     Law, just  like other  health care  boards, and  the AK                                                                    
     Department  of  Law  would ensure  that  the  Board  of                                                                    
     Optometry's  regulations  were   within  the  scope  of                                                                    
     Optometric education.                                                                                                      
     Other  safeguards  are  our medical  legal  system  and                                                                    
     insurance system. Any  healthcare provider who provides                                                                    
     care  outside   of  their   education  is   subject  to                                                                    
     disciplinary action by their  respective board, as well                                                                    
     as serious  medical legal  ramifications. Additionally,                                                                    
     insurance carriers  do not pay providers  for care that                                                                    
     they provide outside of their  scope of education. As a                                                                    
     result,  there  is  no  incentive  for  any  healthcare                                                                    
     provider to  provide care  outside of  their education,                                                                    
     and,   there  are   very  serious   consequences,  both                                                                    
     financially  and to  their licensure,  to practitioners                                                                    
     who do provide care outside of their education.                                                                            
     As  chair  of the  Alaska  Board  of Optometry,  I  can                                                                    
     assure you  that the  primary concern  of the  Board is                                                                    
     the safety of the public. In  the six years that I have                                                                    
     served on the Board we  have had no complaints from the                                                                    
     public  that  were  serious  enough  to  even  consider                                                                    
     disciplinary action.                                                                                                       
     Optometrists    are     conservative    and    cautious                                                                    
     practitioners  and  the  passage of  HB-103  would  not                                                                    
     change their conservative nature.                                                                                          
     I would  also like  to share with  you how  I practice.                                                                    
     I'm the  Center Director of Pacific  Cataract and Laser                                                                    
     Institute  in Anchorage.  Our  practice  is a  referral                                                                    
     only  practice and  we  specializeā€¢  in cataract  care,                                                                    
     laser  vision  correction,   and  medical  consultative                                                                    
     services. I  work with an  ophthalmologist and  a nurse                                                                    
     anesthetist. We all practice to  the highest level that                                                                    
     statutes will allow and by doing  so, as a team we ca n                                                                    
     provide high  quality, more  affordable care  to Alaska                                                                    
     ns.  I  have   a  very   good  relationship   with  the                                                                    
     ophthalmologist  that I  work with,  but if  I were  to                                                                    
     provide ca re that is  outside of my education it would                                                                    
     not   only   jeopardize   my  relationship   with   the                                                                    
     ophthalmologist  but  it  would   also  undermine  a  n                                                                    
     already very successful practice.                                                                                          
     Optometry  provides over  70% of  the eye  care in  the                                                                    
     U.S. In  some rural  areas of Alaska,  Optometrists are                                                                    
     the  only eye  care provider  in the  community. HB-103                                                                    
     would be  good for the  state of Alaska, the  bill puts                                                                    
     the  regulatory  details   regarding  the  practice  of                                                                    
     Optometry  in  the authority  of  the  Alaska Board  of                                                                    
     Optometry.  These changes  are important  to allow  the                                                                    
     profession  and practice  of  Optometry to  incorporate                                                                    
     new  technologies  and advances  in  eye  care as  they                                                                    
     occur. The citizens  of Alaska deserve to  be served by                                                                    
     a  profession  that is  allowed  to  stay current  with                                                                    
     advances  in  education  and new  technologies  in  eye                                                                    
     care. I respectfully urge you to support HB-103.                                                                           
3:50:52 PM                                                                                                                    
DAVID ZUMBRO,  SELF, ANCHORAGE (via teleconference),  was an                                                                    
eye physician  and surgeon  in Anchorage  and was  a partner                                                                    
with  Alaska Retina  Consultants.  He  strongly opposed  the                                                                    
legislation.  He indicated  that the  legislation was  not a                                                                    
simple house  cleaning bill. Rather, it  radically redefined                                                                    
a  profession. Although  the bill  seemed innocent  and safe                                                                    
and,  as  written,  would   allow  non-physicians  and  non-                                                                    
surgeons to  determine what medical and  surgical treatments                                                                    
could  be  done  to  an  eye. He  believed  it  was  special                                                                    
interest  legislation.  It was  not  safe  for patients.  He                                                                    
wondered where  the public outcry  was for  the legislation.                                                                    
He  asked  for  proof   that  current  practice  regulations                                                                    
adversely   affected   Alaska   patients  and   the   Alaska                                                                    
optometrists.  It had  been  stated that  the  bill was  not                                                                    
about surgery and that no  surgeries would be done for which                                                                    
optometrists  were   not  trained.  He  was   worried  about                                                                    
surgery. He relayed  that a local optometrist  told him that                                                                    
when the bill was first  crafted that optometrists wanted to                                                                    
perform  intraocular  injections  of  medications  currently                                                                    
performed  by retina  physicians. The  current bill  removed                                                                    
all previous regulations  preventing injections. He wondered                                                                    
why regulations would be  removed that prevented injections.                                                                    
He suggested that there were  many bills in many states that                                                                    
would allow optometrists to advance  their scope of practice                                                                    
into lasers  and surgery.  As a  result, several  states had                                                                    
adopted definition  of surgery  language in  their statutes.                                                                    
Alaska could do the same thing.  He opined that the bill was                                                                    
about advancing  the optometric scope  of practice  into the                                                                    
practice of medicine  for which they did  not have training.                                                                    
He used to teach ophthalmology  residents when he was active                                                                    
duty in  the US military.  One of the most  difficult things                                                                    
to impart to  young physicians in training was  when to take                                                                    
a  step  back  and  not   do  something.  He  spoke  of  the                                                                    
Hippocratic   Oath  which   all   medical  physicians   took                                                                    
requiring them to  do no harm. The surgical  maturity to sit                                                                    
back  and observe  a patient  did not  happen overnight.  It                                                                    
took  many  months of  direct  supervision  and guidance  by                                                                    
qualified   and  experienced   physicians.   The  field   of                                                                    
optometry did  not have such  a type of  training background                                                                    
when  it  came  to  procedures and  lasers.  They  were  not                                                                    
trained in any ophthalmic  procedures, lasers, or surgeries.                                                                    
He had  no problem  with the  Board of  Optometry regulating                                                                    
the  Optometry  profession  in the  practice  of  optometry.                                                                    
However,  if  the  bill became  law  optometrists  would  be                                                                    
regulating themselves  in the practice of  ophthalmology. As                                                                    
an ophthalmologist  he felt he had  a say in the  issue. The                                                                    
regulation  would  be  without   any  physician  or  surgeon                                                                    
oversight,   without   any   training   or   experience   or                                                                    
background,  and he  had concerns  about patient  safety and                                                                    
its dangers. He thanked the committee.                                                                                          
Co-Chair  Seaton asked  how  many  ophthalmologists were  in                                                                    
Alaska. Dr.  Zumbro responded that there  were approximately                                                                    
Vice-Chair  Gara agreed  with  not  wanting optometrists  to                                                                    
perform surgery.  The doctor prior  had indicated  there was                                                                    
no  intention of  optometrists doing  surgery. He  asked Dr.                                                                    
Zumbo if  he agreed  that in  other states  optometrists did                                                                    
not   perform  Lasik   surgery.  Dr.   Zumbro  agreed   that                                                                    
optometrists did not do Lasik surgery in the United States.                                                                     
3:55:32 PM                                                                                                                    
DR. JANEY CARL ROSEN,  SELF, ANCHORAGE (via teleconference),                                                                    
was   a    Doctor   of   Ophthalmology,    specifically   an                                                                    
oculoplastics surgeon and  neuro-ophthalmologist which meant                                                                    
he  was an  eyelid  surgeon and  worked  with neurology  and                                                                    
neuro surgery. He  took care of bumps and  cysts on eyelids.                                                                    
He   provided   more   information   on   his   professional                                                                    
background. He had  heard repeatedly the bill  was not about                                                                    
surgery,  optometry  had  no  business  doing  surgery,  and                                                                    
optometrists did  not want  to do  surgery. The  sponsor had                                                                    
said the bill was not about  surgery and her aide had stated                                                                    
that all surgery language was  removed from the bill. He had                                                                    
heard that as  time changed the scope of  practice should be                                                                    
modernized  by the  optometry board  and  should a  surgical                                                                    
procedure  be deemed  within the  scope of  practice by  the                                                                    
board they  did not  want to come  back to  the legislature.                                                                    
The  assistant  attorney   general  previously  stated  that                                                                    
public  testimony  would  help   decide  if  a  surgery  was                                                                    
appropriate for an optometrist.  He wondered if members were                                                                    
bothered  by those  statements. He  suggested that  not only                                                                    
would no  one have actual  surgical experience on  the board                                                                    
and  the  legislature would  ask  the  public for  help.  He                                                                    
thought  asking an  expert with  actual experience  was more                                                                    
appropriate. He  reviewed several examples of  problems from                                                                    
botched  surgeries.  Dental  boards and  nurse  practitioner                                                                    
boards  policed themselves  because they  learned procedures                                                                    
in  graduate  school.  Optometry students  did  not  perform                                                                    
surgery, lasers,  or injections on  real people. He  did not                                                                    
believe an 8-hour  class was enough training.  He was asking                                                                    
folks to  wake up and  consider what was being  proposed. He                                                                    
read from  the Journal  of the American  Medical Association                                                                    
about a  study done in  Oklahoma where they  performed laser                                                                    
surgeries. He believed the legislation  was racing towards a                                                                    
slippery  slope.  He thought  there  should  be more  public                                                                    
3:59:06 PM                                                                                                                    
DR. KELLY LORENZ, SELF,  ANCHORAGE (via teleconference), was                                                                    
a  board-certified Ophthalmologist  and strongly  opposed HB
103. She  believed the bill  was an  unprecedented expansion                                                                    
of  practice.  The  legislation would  allow  for  limitless                                                                    
surgical   procedures  without   any  defined   training  in                                                                    
surgical  techniques.   She  indicated  that  she   had  met                                                                    
patients that had been told  by their optometrist that there                                                                    
was only one cataract surgeon  that came to Alaska. The bill                                                                    
did  not have  the best  interest  of Alaskans  in mind  and                                                                    
there  was  no  public  outcry  for it.  She  spoke  of  the                                                                    
importance of  having a skilled  professional with  years of                                                                    
training under the supervision  of an experienced preceptor.                                                                    
She read  statistics from a  medical journal about  a recent                                                                    
study regarding  laser procedures  in Oklahoma and  the fact                                                                    
that optometrists had repeated the  laser more than twice as                                                                    
much as ophthalmologists. She thought  it was also essential                                                                    
to have  the ability to manage  the inevitable complications                                                                    
that arose  from laser and traditional  surgery. She brought                                                                    
up  other  serious  issues members  should  consider  before                                                                    
signing  what  she  considered  to be  a  blank  slate.  She                                                                    
advised members to be cautious  and to demand specifics. She                                                                    
urged members to oppose the bill in its current form.                                                                           
4:01:41 PM                                                                                                                    
DR. ANDREW  PETER, SELF, HOMER (via  teleconference), was an                                                                    
optometrist from Homer and asked  members to support HB 103.                                                                    
He  relayed a  list of  services he  provided. He  mentioned                                                                    
that the  clinic's daily schedule  could accommodate 4  to 6                                                                    
urgent care patients. It was  common for the appointments to                                                                    
be fully utilized.  He spoke to the challenges  of living in                                                                    
rural  Alaska.  He  quoted some  statistics  concerning  the                                                                    
number of  optometrists and  ophthalmologists in  the state.                                                                    
He encouraged  members to help  optometrists be  more nimble                                                                    
and accessible.  He thanked the  committee and  made himself                                                                    
available for questions.                                                                                                        
Representative Wilson thought the  definition of surgery was                                                                    
the key  issue. She wondered  if it would be  something that                                                                    
could  be discussed.  Dr. Peter  responded that  one of  the                                                                    
ophthalmologists  had defined  surgery as  cutting, blading,                                                                    
or altering  tissue. Under  that definition,  tattoo artists                                                                    
and  tattoo   removal  specialists  performed   surgery.  He                                                                    
relayed that if  a patient came in with a  piece of metal in                                                                    
their  eye  and  he  removed  it,  it  would  be  considered                                                                    
surgery. He provided other  examples of potential surgeries.                                                                    
He  hoped  the legislature  could  take  itself out  of  the                                                                    
business of managing optometry eyecare.                                                                                         
4:06:16 PM                                                                                                                    
DR. JILL  MATHESON, SELF,  JUNEAU (via  teleconference), was                                                                    
an  optometrist  in  Juneau.   She  spoke  of  her  previous                                                                    
experience on the  Board of Optometry. Over  the previous 25                                                                    
years  she  had  testified  numerous  times  before  several                                                                    
legislative committees  in support of changes  to the Alaska                                                                    
optometry statute.  Efforts had  been successful due  to the                                                                    
level of trust legislators  had given optometrists over time                                                                    
and after sifting through testimony.  She asked for member's                                                                    
support   in    having   the   optometry    board   regulate                                                                    
optometrists.  The  bill  did  not  give  any  expansion  of                                                                    
privilege to  optometrists. It  allowed the  optometry board                                                                    
to decide  what optometrists  were trained and  qualified to                                                                    
do via the regulatory process  of the board and within their                                                                    
scope  and training.  She assumed  that the  members of  the                                                                    
state board were appointed and  confirmed by the legislature                                                                    
to  do the  same. There  were separate  boards because  each                                                                    
profession was unique. She  suggested that only optometrists                                                                    
knew what  doctors of optometry  were trained  and qualified                                                                    
to do. She was aware members  were trying to figure out what                                                                    
"fiscally responsible" looked like.  The bill had been heard                                                                    
by  four committees  multiple times.  She suggested  that if                                                                    
the optometry board could  regulate optometrists there would                                                                    
still be  a very public  process via open  public testimony.                                                                    
Also,  boards had  to be  self-sufficient. The  bill allowed                                                                    
the  profession  of optometry  to  evolve.  She trusted  the                                                                    
appointed  optometry board  members  to  make any  necessary                                                                    
4:09:15 PM                                                                                                                    
DR. KURT  HEITMAN, AMERICAN ACADEMY OF  OPHTHALMOLOGY, SOUTH                                                                    
CAROLINA (via  teleconference), strongly opposed HB  103. He                                                                    
remarked that  the bill  was a surgery  bill. The  bill made                                                                    
two  crucial  changes  to existing  Alaska  law.  First,  it                                                                    
removed  surgery restrictions  already in  existing law.  It                                                                    
also  inserted a  new definition  of the  word optometry  in                                                                    
Section   6  that   included  the   words  "treatment"   and                                                                    
"procedures".  The insertion  of the  word treatment  put no                                                                    
limitations on  the type of  treatment. In other  words, all                                                                    
surgeries in the eye would  be allowed under the law because                                                                    
the  Board of  Optometry could  define invasive  surgery any                                                                    
way  they  wanted. HB  103  allowed  the board  cart  blanch                                                                    
authority to redefine their field  into a surgical field. He                                                                    
had  seen an  example in  North Carolina  where optometrists                                                                    
defined laser  as non-invasive.  He wondered  why proponents                                                                    
of the bill  opposed the inclusion of  language that clearly                                                                    
specified that surgery was outside  the scope of practice of                                                                    
optometrists   avoiding  patient   harm.  Without   specific                                                                    
language  restricting surgery,  Alaska  would  be the  first                                                                    
state  in the  country  to adopt  such broad,  unprecedented                                                                    
legislation. There would be  no restrictions of optometrists                                                                    
being  able  to   obtain  surgical  privilege.  Optometrists                                                                    
provided  a  valuable service  to  communities  and were  an                                                                    
integral part  of the eyecare  team. However, they  were not                                                                    
medical doctors  and did not  graduate from  a comprehensive                                                                    
surgical  residency.  There  were  only  three  states  that                                                                    
allowed  optometrists  restricted  surgical  authority.  The                                                                    
first  was  Oklahoma.  In  Oklahoma,  optometrists  expanded                                                                    
scope to  include surgeries  because of  language in  a bill                                                                    
similar  to  HB  103.  He continued  to  provide  background                                                                    
regarding  Oklahoma law.  He had  reminded the  board of  an                                                                    
incident at  the Palo Alto  VA hospital where  veterans were                                                                    
hardened because of poor glaucoma  follow-up. Because of the                                                                    
incident  the  VA  strengthened its  directives  prohibiting                                                                    
optometrists  from performing  laser procedures  - the  same                                                                    
procedures that would be allowed  by the current language in                                                                    
HB  103. He  disagreed that  the bill  was similar  to other                                                                    
bills  governing   professional  boards  such   as  nursing,                                                                    
dentistry,  or  engineers.  Unlike  nursing  and  dentistry,                                                                    
optometry school  was not a  medical or  surgical education.                                                                    
Optometrists   received  about   1900   hours  of   clinical                                                                    
education in their 4-year training  compared to 20,000 hours                                                                    
that ophthalmologists received,  about one-tenth the medical                                                                    
education. He  disagreed that the  bill was  about governing                                                                    
boards.  He  continued  to   provide  a  comparison  between                                                                    
education received by  optometrists and ophthalmologists. He                                                                    
thanked committee members.                                                                                                      
4:13:47 PM                                                                                                                    
DAVID  KARPIK,  SELF,  KENAI  (via  teleconference),  was  a                                                                    
Doctor  of Optometry.  He spoke  in  support of  HB 103.  He                                                                    
provided  information  on  his professional  background.  He                                                                    
suggested  that the  optometrist  might be  the only  doctor                                                                    
that  a  patient had  access  to  because of  Alaska's  wide                                                                    
geographic   distribution.  He   reported   that  a   recent                                                                    
publication  ranked Alaska  50th in  access to  health care.                                                                    
All health  care providers should practice  within the scope                                                                    
of their training.  He supported the legislation  due to its                                                                    
simplicity.  It would  replace the  aging current  optometry                                                                    
law that needed updating. He  asserted the delay in updating                                                                    
the  old optometry  statute hindered  access to  eyecare and                                                                    
increased  Medicaid   travel  costs  in  the   state.  Other                                                                    
prescribing  professions  such  as  dentistry  and  advanced                                                                    
practice  nurses were  regulated by  their state  board. The                                                                    
Board  of Optometry  ensured protection  of  the public  and                                                                    
timely  updates of  practice. He  thanked members  for their                                                                    
support of the  bill. He brought up the  procedures that had                                                                    
been performed for decades by  optometrists in their offices                                                                    
legally and  safely in Alaska. He  suggested that opposition                                                                    
had not familiarized themselves  with current law. Treatment                                                                    
was an integral  part of the profession. He  thanked him for                                                                    
his time.                                                                                                                       
Co-Chair Seaton  asked if there  was opposition  to removing                                                                    
laser  surgery  from  the  scope  of  practice.  Dr.  Karpik                                                                    
responded  that  training  and technology  changed  all  the                                                                    
time.  He thought  the purpose  of  the bill  was a  durable                                                                    
statute that  would stand  the test of  time like  the state                                                                    
constitution.  He  was  in  favor  of  the  current  statute                                                                    
language in the bill.                                                                                                           
4:18:44 PM                                                                                                                    
JEFF   GONNASON,   CHAIR,  ALASKA   OPTOMETRY   ASSOCIATION,                                                                    
ANCHORAGE (via  teleconference), spoke  in favor of  HB 103.                                                                    
He was  born and raised in  Ketchikan and Craig and  was the                                                                    
first Alaska  Native optometrist. He practiced  in Anchorage                                                                    
and performed  clinics in the  villages when he was  a young                                                                    
man.  He  suggested  that  HB  103  did  not  authorize  any                                                                    
optometrist  to do  anything. He  relayed that  of the  four                                                                    
independent prescribing professions  only optometry had been                                                                    
treated  unfairly for  several years.  The Alaska  Optometry                                                                    
Board deserved to  receive the same level of  trust as other                                                                    
health care professions. He opined  that the optometry board                                                                    
would  never authorize  any practice  outside  the scope  of                                                                    
education and  training. Doctors  of Optometry were  held to                                                                    
the same standard  of care as any  medical provider treating                                                                    
patients. Section  5 of HB 103  was clear on the  topic. The                                                                    
optometry  practice  definition  in Section  6  was  modeled                                                                    
after the exact wording from the Alaska dental statutes.                                                                        
Dr.  Gonnason continued  that two  opposition arguments  had                                                                    
prevailed  over the  course of  the previous  40 years.  The                                                                    
first argument  was that optometrists  were a danger  to the                                                                    
public.  The second  argument was  that optometry  education                                                                    
was not adequate. He thought  both arguments had been proven                                                                    
to  be   untrue.  Optometry   education  and   training  was                                                                    
identical  to the  dentist  model requiring  8  years to  10                                                                    
years  of   university  level  education   and  residencies.                                                                    
Optometrists were real doctors.  He relayed that optometrist                                                                    
had  been prescribing  medications  for  25 years  including                                                                    
prescribing scheduled  narcotics for the past  10 years with                                                                    
no  issues  of  harm. Alaska  optometry  supported  limiting                                                                    
opioid use.  Optometrists were  defined as  physicians under                                                                    
federal Medicare.  There had  never been  a case  of patient                                                                    
harm   before   the    state   optometry   board   involving                                                                    
prescriptions  of treatment.  Yet, over  the past  40 years,                                                                    
the opposition  had testified predicting terrible  harm that                                                                    
never occurred.                                                                                                                 
Dr.  Gonnason   argued  that   the  clinical   education  of                                                                    
optometrists   did  not   have  to   parallel  that   of  an                                                                    
ophthalmologist  any more  than  the education  of a  family                                                                    
physician having  to parallel  that of  a neuro  surgeon. He                                                                    
commented  that optometrists  and ophthalmologists  did very                                                                    
little of  the same things.  Optometrists did not do  any of                                                                    
the  advanced specialty  surgeries  done by  subspecialists.                                                                    
Rather,  they  did  minor  procedures  in  which  they  were                                                                    
competent. He  suggested that surgery would  be difficult to                                                                    
define in statute because  technically anything that touched                                                                    
human tissue  was surgery. He provided  examples of surgery.                                                                    
He thought  the definition  should be in  regulations rather                                                                    
than  in  statute  to  avoid  having to  come  back  to  the                                                                    
legislature for  changes. He pointed  to a letter  in member                                                                    
packets from  a VA hospital  where an optometrist  did laser                                                                    
procedures with  zero incidents of  harm. He referred  to an                                                                    
Oklahoma study which he thought was flawed. He was                                                                              
available for questions.                                                                                                        
4:23:20 PM                                                                                                                    
DR. GRIFF STEINER, SELF, ANCHORAGE (via teleconference),                                                                        
was an ophthalmologist in Anchorage. He read from a                                                                             
prepared statement:                                                                                                             
     The ophthalmologists  and others that oppose  this bill                                                                    
     (HB103)  in no  way want  to prevent  optometrists from                                                                    
     practicing to  the full extent  of their  specialty and                                                                    
     training. This boils down to  whether they intend to do                                                                    
     surgery, which would truly be inappropriate.                                                                               
     The bill should not pass as it currently written.                                                                          
     If the  optometrists want an  autonomous board,  but no                                                                    
     surgery,  then  a  concise definition  of  surgery  can                                                                    
     easily  be  added.  If  they  oppose  a  definition  of                                                                    
     surgery,  it  can  only  mean   they  want  to  perform                                                                    
     surgery. More  than one optometrist has  approached you                                                                    
     indicating a  desire to do  a type of laser  called YAG                                                                    
     laser  capsulotomy. They  have  not  used these  words,                                                                    
     because  capsulotomy  means  to   cut  a  hole  in  the                                                                    
     capsule. They  instead have described this  as "shining                                                                    
     a light  in the  eye to clear  up some  clouding." But,                                                                    
     the  laser  does not  shine  as  it is  invisible.  The                                                                    
     invisible  light  needs  a  second  laser  "HeNe"  beam                                                                    
     (Helium-neon) to focus the  primary cutting laser. This                                                                    
     laser cuts a  hole in the membrane that  holds the lens                                                                    
     implant  in  place   following  cataract  surgery  (the                                                                    
     removal  of  the  natural  lens   when  is  has  become                                                                    
     cloudy). This  is not a benign  procedure, particularly                                                                    
     in those  without proper surgical training.  This laser                                                                    
     cuts a hole  in a critical tissue in the  eye and there                                                                    
     is no shining involved.                                                                                                    
     This  is just  one example,  but is  the first  surgery                                                                    
     they intend to approve.                                                                                                    
     Ask  them  if they  want  to  do  surgery. It  was  not                                                                    
Dr. Steiner was available for questions.                                                                                        
Representative  Wilson clarified  that optometrists  did the                                                                    
procedure  currently. Dr.  Steiner indicated  that they  did                                                                    
not do the  procedure in Alaska. He thought only  one or two                                                                    
states allowed it, Oklahoma and  maybe Kentucky. He believed                                                                    
that it would  be the first procedure approved  by the Board                                                                    
of Optometrists.  It was the type  of procedure optometrists                                                                    
would advance  into - something  they have not  been trained                                                                    
to do or have ever done.                                                                                                        
Representative Wilson asked if  additional training had been                                                                    
offered  in the  two states  he mentioned.  Dr. Steiner  was                                                                    
aware  that a  weekend course  was offered  on how  to do  a                                                                    
laser procedure.  Following the training,  optometrists were                                                                    
approved by their boards.                                                                                                       
4:27:57 PM                                                                                                                    
AT EASE                                                                                                                         
4:28:10 PM                                                                                                                    
Co-Chair Foster CLOSED Public Testimony.                                                                                        
Co-Chair Foster relayed that amendments  were due by Monday,                                                                    
at 5:00 PM.                                                                                                                     
HB  103  was  HEARD  and   HELD  in  committee  for  further                                                                    
4:28:35 PM                                                                                                                    
AT EASE                                                                                                                         
4:31:48 PM                                                                                                                    
Co-Chair Foster  indicated that he  was going to  change the                                                                    
deadline for the amendments to  HB 103. He relayed that they                                                                    
were now due by Friday, April 14th by noon.                                                                                     

Document Name Date/Time Subjects
Sponsor statement - museum construction bill.pdf HFIN 4/12/2017 1:30:00 PM
HB 166
HB 166 lttrs supporting.pdf HFIN 4/12/2017 1:30:00 PM
HB 166
HB 151 Brief Explanation of Changes.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Sponsor Statement version N.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 1. OCS Office by Office Caseloads.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 2. High Caseloads How Do They Impact Health and Human Services 3.1.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 3. Children Waiting to be Adopted 2014.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 4. Applying the Science of Child Development in Child Welfare Systems (Excerpt).pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 5. NJ DCF Workforce Report (Excerpt).pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 6. Why the Workforce Matters.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 7. Creating a Permanence Driven Organization - Anu (Excerpt).pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 8. DHSS Memo OOH Growth.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 9. DHSS Memo NJ Standard and Workforce.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 10. Relevant Statistics.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 11. Supporting Article.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 12. Youth Essay.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 13. Youth Guide from FFCA.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Supporting Document 14. Letters of Support.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB103 Supporting Documents Optometrist's Education 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Support Letters 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Support Document Optometrists Practicing in AK 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Support Document Medical Liability Premiums Fact Sheet 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Support Document Board of the Examiners in Optometry 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Sponsor Statement 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Sectional Analysis 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Opposition Letters 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Explanation of Changes 4.03.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB103 Additional Documents Regulation Flow Chart 4.01.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB 151 Supporting Document 15. Casey Family Programs Testimony.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Explanation of Changes 4.10.17 version N to I.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Sectional Analysis Version I 4.10.17.pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 151 Sectional Analysis version N (no change from vers R).pdf HFIN 4/12/2017 1:30:00 PM
HB 151
HB 103 - Opposition Documents.pdf HFIN 4/12/2017 1:30:00 PM
HB 103
HB 151 Sponsor Statement version I.pdf HFIN 4/12/2017 1:30:00 PM
HB 151