Legislature(2005 - 2006)CAPITOL 106
03/17/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| HB185 | |
| HB156 | |
| HB151 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 151 | TELECONFERENCED | |
| *+ | HB 156 | TELECONFERENCED | |
| *+ | HB 185 | TELECONFERENCED | |
| = | HB 193 | ||
HB 151-RESPONSIBILITY FOR CARE AFTER EYE SURGERY CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 151 "An Act relating to provider responsibility for ocular postoperative care; and providing for an effective date." 4:21:38 PM WAYNE HAGERMAN, O.D., explained that he has been practicing as a private optometrist in Sitka, Alaska since 1984. He stated his opposition to HB 151 and that it will have a detrimental effect to the community of Sitka. In Sitka, he described, there is a community hospital and a visiting ophthalmologist that has provided service since 1997 and provides cataract surgery to the community members. He said that the ophthalmologist, Dr. Tim Gard, is from the Hillsboro Eye clinic in Oregon. He pointed out that [Dr. Gard] has provided these services to the community hospital as a benefit to the community, especially the senior citizens who are unable to travel elsewhere to have these surgical procedures attended to. He emphasized that he has worked closely with Dr. Gard for seven years and co-managed these patients without difficulty. He opined that it would cause undue hardship for Dr. Gard to have to remain in Sitka for five days following eye surgery and wishes the committee would reconsider the passing of HB 151. 4:23:31 PM REPRESENTATIVE ANDERSON inquired as to Dr. Hagerman's position if the bill were amended to require a two-day stay following post-operative surgery, as opposed to the original five-day stay. DR. HAGERMAN stated that there is not a resident ophthalmologist in Sitka so there is no possibility to refer patients to another surgeon. He said that the 48-hour change is amenable. REPRESENTATIVE ANDERSON asked if Dr. Hagerman preferred the two day amendment as opposed to the 5 day stay [following eye surgery]. DR. HAGERMAN said that he preferred a two-day requirement but that a 24-hour requirement would be more than adequate [for an ophthalmologist to stay in the area following eye surgery]. REPRESENTATIVE GARDNER inquired as to patients in Sitka needing the services of an ophthalmologist when one was not available. DR. HAGERMAN said that there is an understanding between himself and the ophthalmologist that when there is some complication that goes beyond the level of expertise [of the optometrist], the visiting ophthalmologist would stay and deal with it. REPRESENTATIVE GARDNER asked what would happen if the complication arose after the ophthalmologist left [Sitka]. DR. HAGERMAN stated that he and the ophthalmologist are in constant communication about the follow-up care of these patients and the situation described has not yet arisen. REPRESENTATIVE SEATON inquired as to the practicality of setting the two-day [ophthalmologist] stay requirement after eye surgery. He asked Dr. Hagerman what his opinion was concerning this stay requirement. DR. HAGERMAN said that generally, it is within a day or two days after the surgery. 4:26:17 PM CHAIR WILSON stated that HB 151 has been difficult [for her] and that she has been indecisive. She explained that she called Dr. Gard [the ophthalmologist serving Sitka] and learned that many of his patients are residents of the pioneer home and would be unable to leave [Sitka] for surgical procedures. She related that Dr. Gard informs his patients that they will have to fly to Seattle if there are complications after he leaves Sitka. She reported that Dr. Gard said that he could deal with the two-day stay requirement after surgery, and that he would still serve Sitka's needs. She stated that Dr. Gard had a question concerning the stay requirement and it extending to the patient. She said that he asked if the legislation would require the patient to stay two extra days after surgery, because many times they do not. REPRESENTATIVE ANDERSON interjected that there are no requirements related to the patient staying in the area where the surgery occurred. CHAIR WILSON explained that Dr. Gard had said that many times he has stayed to make sure that every patient was taken care of. She said that she had asked if there was any time when someone had to fly to Seattle [for emergency care] and [Dr. Gard] had said, "No, that has never happened." She opined that the 5-day requirement [for the ophthalmologist to stay in the area where surgery occurred] is too much. She mentioned a letter from the Medical Association which promoted the 5-day stay requirement for ophthalmologists, but acquiesced to the 2-day amendment. REPRESENTATIVE ANDERSON stated that in the packet, the Alaska State Medical Association sent a letter on March 4, 2005 which stated that they represent physicians across the state and they support HB 151. He said that they didn't reference the 2 versus 5 days [stay requirement] and there may be a discrepancy about which association is being discussed. The committee took an at-ease from 4:30:32 PM to 4:30:55 PM. 4:30:59 PM REPRESENTATIVE ANDERSON clarified that a letter from the American Academy of Ophthalmology, dated March 15, 2005 stated support of HB 151. He explained that this letter was an attempt to indicate the areas of concern regarding common surgical complications and they reference that within the first 48 hours certain complications can occur. CHAIR responded that Dr. Gard teaches future ophthalmologists and optometrists and he said that his concerns [for post- operative care] included increased pressure or infection. REPRESENTATIVE SEATON stated that in the letter from the American Academy of Ophthalmology, the listed complications are those that can occur in the first 48 hours [after surgery] but it is not clear that they support the 48-hour stay requirement as opposed to the original 5-day stay requirement. 4:33:15 PM CARL ROSEN, M.D., clarified that 48 hours will cover common complications and 5 days is preferred as it will cover all aspects of possible patient complications after cataract or interocular surgery. He stated that, "two days, if that's what it takes to get improved patient quality of care, then we can accept that." CHAIR WILSON stated that if there is no amendment there could be the risk of ophthalmologists refraining from serving remote areas within Alaska. REPRESENTATIVE ANDERSON noted that the letter from the American Academy of Ophthalmology states, "The enactment of HB 151 ... will insure that patients have access to a surgeon within the 48 hour window in which the complications from eye surgery could occur." REPRESENTATIVE SEATON said that as he reads the letter, it does not say that they are revising their recommendation from 5 days to 48 hours. He pointed out that the letter is saying that certain complications can occur within 48 hours. 4:35:39 PM REPRESENTATIVE ANDERSON stated that the American Academy of Ophthalmology encompasses all of the medical physicians who practice ophthalmology and they recommend [the ophthalmologist to remain after surgery] 5 days. He said that the House Health, Education and Social Services Standing Committee prefers the amended 2 day stay requirement. CHAIR WILSON said that it is obvious that American Academy of Ophthalmology is aware of the amendment and that they endorse HB 151 with the 2-day amendment. 4:36:32 PM ERIC CHRISTIANSON, O.D., said that he has been an optometrist in Ketchikan since 1990, and there is not a full time ophthalmologist. He explained that there is an ophthalmology group that rotates through Ketchikan one week a month and they perform surgeries. He mentioned that since 1990, he has been involved with 3 or 4 eye care emergencies and most occurred within a few days after surgery. He said that in Ketchikan, older surgical techniques are used and the results aren't as good. He said that he refers his patients to Seattle. He said: When I refer to a surgeon, I am counting on the skill of the surgeon and the ability of his particular team that he has put together to take care of the patient ... the outcomes of surgery are much better when you have a team and that includes the surgeon, but it also includes the other staff members in the office, including optometrists to manage the patient and return them at an appropriate time. The opposition that I have to this bill is ... the legislature shouldn't be regulating comanagement. It should be regulated by the boards. I was a board member ... for eight years ... I have never heard one peep from the Medical Board regarding any problems with comanagement with optometrists ... 4:39:54 PM CHAIR WILSON stated that she called the Medical Board and they don't meet until next month. She said that she considered holding this bill until next month to give the Medical Board a chance to respond to the issues related to HB 151. DR. CHRISTIANSON stated that his concern is that passing HB 151 is opening a "huge can of worms." He said that passing this legislation would affect comanagement decisions of health care professionals in rural communities. He emphasized that when referring for surgery, health care providers are counting on the clinical judgment of the surgeon that is being referred to. REPRESENTATIVE GARDNER asked how long patients stay in Seattle after their surgery is complete. DR. CHRISTIANSON said that, typically, a patient will see the surgeon, have the surgery completed, and see the surgeon the following day. Depending on the procedure, if a patient is stable enough there is no reason for them to stay longer. He related that he then sees the patient for a follow up 7 days after the surgery. He pointed out that his responsibility for the patient occurs as soon as they are released from the surgical facility. REPRESENTATIVE GARDNER asked if it was accurate to say, assuming there are no problems, that after a patient has surgery they are seen by the surgeon the following day and then can return home. DR. CHRISTIANSON replied that is correct. 4:42:42 PM REPRESENTATIVE SEATON stated that he has had a problem with HB 151 in that there is a "board process." He said that with [Dr. Christianson's] testimony, as the Chair of the State Medical Board, it is clear that this issue has not been addressed by ophthalmologists. DR. CHRISTIANSON clarified that he is a part of the "Optometry Board." REPRESENTATIVE SEATON said that the HESS committee is trying to get information from the State Medical Board because the issues surrounding HB 151 are within the Board's jurisdiction to regulate. He pointed out that there is no information on ophthalmologists appealing to the State Medical Board and asking for assistance with this issue. He added that he has real concern about legislating particular medical procedures in place of the State Medical Board. 4:44:39 PM REPRESENTATIVE MCGUIRE referred to HB 151 and said: on page 2, line 13 ... my understanding is that if the distance the patient would have to travel to the regular office of the operating surgeon would result in an unreasonable hardship of the patient ... it is an exception. DR. CHRISTIANSON pointed out that HB 151 states that co management agreements may occur only when the patient must endure an unreasonable hardship to travel to the operating surgeon. REPRESENTATIVE MCGUIRE said that in many places in Alaska, the situation of "unreasonable hardship" would apply. She inquired as to medical malpractice insurance requirements. DR. CHRISTIANSON replied that he carries $3 million in malpractice insurance. REPRESENTATIVE MCGUIRE inquired as to the amount of malpractice insurance that the ophthalmologist that Dr. Christianson works with carries. DR. CHRISTIANSON clarified that he does not work with the ophthalmologist; he refers patients to an ophthalmologist. He said that there is no financial connection. 4:47:04 PM REPRESENTATIVE MCGUIRE said: please understand that the sponsor's intentions are not to be disrespectful to you, nor are mine ... I got a couple of emails that said ... I was saying that I didn't think optometrists were valuable, or important, or professionals and that's just the absolute opposite of how I feel. I think that ... your profession is extremely important, valuable, that the patient care is great - I have an optometrist, I need them, I have terrible eyes - so, I just want to get that on record, but back to the medical malpractice insurance, when you enter into these comanagement agreements, is there a direct shift in liability that occurs ... one of the things ... I have a concern about is, when things go well they go well, and then when they don't, with the eyes, it's a disaster ... the surgeon comes in, does the surgery, gets on a plane, leaves, and now you're there and you are dealing with ... a problem on your hands. In the co-management agreement ... is the liability for medical malpractice then shifted to you for the primary act of the surgeon ... 4:48:44 PM DR. CHRISTIANSON stated that he is not well versed in medical malpractice. DR. ROSEN said that malpractice is shared, but the primary responsibility ultimately falls on the surgeon's hands. 4:49:34 PM CHAIR WILSON inquired as to when co management occurs. DR. CHRISTIANSON said that he refers patients to a specific surgeon after he has diagnosed them. He said that patients like to get back within a reasonable time frame to avoid high travel costs. He emphasized that he trusts the surgeon to return the patient at a time when they feel it is appropriate. CHAIR WILSON clarified that patients usually return home, from Seattle, by the second day after surgery. DR. CHRISTIANSON said that is correct except if they have other plans in Seattle, as well. REPRESENTATIVE ANDERSON stated his belief that this bill isn't about comanagement as much as it is about the surgeon staying for two days after surgery is performed. He reiterated Representative McGuire's comment that the distance an Alaskan patient would have to travel for surgery would constitute "hardship" and asked for a comment regarding this. DR. CHRISTIANSON stated that decisions related to patient care are for the surgeon to decide. He emphasized that the Alaska State Medical Board should decide if regulations are needed for specific situations regarding patient care and management. He opined that regulating patient care is not up to the legislature to mandate. He said that attempting to pass HB 151 is "precedent setting" legislation. 4:53:02 PM DR. WILLY SHIELDS, ophthalmologist, informed that he has specialty training in retina care. He said that he has patients referred to him from optometrists and from ophthalmologists and that though the bulk of his patients are referred from the state of Washington, there are some patients who come from Alaska. He said that, as a result, he is affected by the co-management relationship. He continued: I certainly have my opinions about how co management can work ... when I think about the state of Alaska and how things are spread out ... I, personally, think that it's going to be very difficult to take care of patients in the larger sense without having a co- management system. The problem that I see that surfaces when there is an attempt to have rules or regulations about co management, obviously you want to make sure that there is a certain level of quality that is adhered to, and I think that that is fundamentally our responsibility whether ophthalmologists or optometrists, but the major problem ... is ... it is difficult to set up co management ... rules that forgive ... co management relationships between rural settings ... and ... co management in a kind of urban ... setting. The challenge is , how do you say that it is okay to have co management in one setting and not the other. As Dr. Christianson has said ... if there is a good relationship and I know that kind of care that the optometrist can provide in their community then I am perfectly okay with the patient going back. CHAIR WILSON inquired as to Dr. Shields' opinion on the two-day stay requirement issue related to HB 151. DR. SHIELDS related that there are times when a patient will undergo surgery, and return home the following day. He said that, depending on the patient and the situation, the time frames change. He added that there are instances where patients would be advised to abstain from travel because of complications with healing process. REPRESENTATIVE MCGUIRE reminded Dr. Shields that HB 151 pertains to surgeons performing eye surgery in Alaska. She explained that it is not uncommon for the legislature to make different rules pertaining to rural parts of the state than for urban [areas in Alaska]. DR. SHIELDS thanked the committee and all participants for the efforts involved in understanding HB 151. He responded to line 14, within HB 151, and inquired as to the definition of "hardship." CHAIR WILSON stated that "hardship" can simply be that an individual would not be able to afford airfare [required for travel related to eye surgery]. REPRESENTATIVE GARDNER confirmed that Dr. Shields advocated for the practice of sending a patient home 24 hours after surgery. DR. SHIELDS said that is appropriate in many circumstances. He emphasized that follow-up care would be involved after surgery. REPRESENTATIVE ANDERSON asked Dr. Shields if he understood Representative McGuire's earlier clarification regarding HB 151 being applicable only within the state of Alaska; he asked if Dr. Shields had performed surgery in Alaska; he asked how Dr. Shields was contacted to testify before the committee. DR. SHIELDS said that he understood the clarification regarding HB 151; he replied that he had never performed surgery within Alaska; he said that he was contacted by Paul Barney, an optometrist who works for the Pacific Cataract Group in Anchorage and has received phone calls from Dr. Michael Bennett. REPRESENTATIVE GARDNER said, "Representative Seaton talked about a letter of support [for HB 151] from the "medical board" and ... in my packet I have a letter of support from the Alaska State Medical Association, which is an association of practitioners, not the board; am I missing something?" She said that she is hoping to clarify as there is a big distinction between the "medical board" and the "medical association." REPRESENTATIVE ANDERSON stated that Representative Gardner is correct and the Alaska State Medical Association endorses HB 151, not the Alaska Medical Board. 5:05:41 PM BOB FORD, M.D., ophthalmologist, said that he lives in Washington state but that he established an office [Pacific Cataract and Laser Institute] in Anchorage, seven years ago. He stated: I believe ... all of the ophthalmologists and the optometrists agree that the surgeon is the captain of the ship for post-operative care, and the surgeon feels that responsibility and he is going to be sure that it is done and there are two ways to do that: he can do it himself ... and that is good ... but it is also very legitimate to delegate things and if you have quality people that you trust, you can delegate. I come up typically on Monday and I'll typically operate for three days - Tuesday, Wednesday and Thursday and then I go home ... the only reason I'm comfortable doing that is because I have a very skillful optometrist that's the full-time doctor there ... my office is open 5 days a week ... for post- operative care. I've cared for, literally, thousands of patients with Dr. Barney and I know he's very quick ... to recognize ... [post-operative complications] ... I've done approximately 8,000 surgeries in the last 7 years, in Anchorage ... I have had three cases that have needed my attention post-operatively, none of them within the first 48 hours, interestingly enough, and those 3 cases I took care of, one of them three weeks after surgery ... so this bill wouldn't have addressed that ... my thoughts and feelings on this are very colored by my experience with my father. My father was a family doctor and I watched him work with surgeons and I could tell that my dad's patients trusted my dad ... and the surgeons trusted my dad too, and they'd get the patients right back to my dad for post-operative care ... it was good for the patients because my dad knew them better than anybody else did ... I believe that patients nowadays want the same thing for their eye surgery. If their doctor is a surgeon, they'll want their doctor to do the surgery and care for them afterward, if their doctor isn't a surgeon, which is the case of 80 percent of the patients in Alaska because 80 percent of the eye doctors are not surgeons in Alaska ... they're going to ask their doctor ... who should do my surgery and their doctor will set that up and then they're going to want to be right back in the care of their doctor as soon as possible. I don't see that you can set a specific time that works ... I haven't had a single case, not one case, where the fact that I went home Thursday night caused any harm to any patients ... if you pass this legislation, then I will certainly cooperate with it, and I'll spend another two days up here at the end ... I don't think the legislation is needed and it would hamper the way I practice, which a lot of patients like and a lot of doctors like ... but ... I trust your judgment and ... I'll cooperate to the best of my ability. 5:11:01 PM CHAIR WILSON inquired as to the costs associated [for patients] if HB 151 passes and Dr. Ford would be required to stay in Anchorage for an additional day; she asked if the passing of HB 151 would make Dr. Ford hesitate about coming to Alaska to perform surgery. DR. FORD replied that if he were required to stay an additional day after surgery, he would not charge patients extra. He clarified that he does not pay optometrists for comanagement, and that they bill separately. In response to Chair Wilson's second question, Dr. Ford stated that he might hesitate but that he feels a strong commitment to serve with his colleagues at their practice. REPRESENTATIVE GARDNER said that a surgeon that performs eye surgery in this state can delegate the responsibility of post- operative care to another ophthalmologist, according to HB 151. She pointed out that Dr. Ford could easily delegate and one of his partners could provide post-operative care, and that his practice would, in essence, not be affected by HB 151. 5:13:00 PM DR. FORD stated: my partner, the one that sees all of my patients, "post-op" up here, Dr. Barney, he is an optometrist, not an ophthalmologist. And I feel that this bill ... is anti-optometry, it really is, because the spirit behind this bill is optometrist's are not capable of doing first quality, post-operative care ... I believe the way I do it is first rate ... I believe Dr. Barney is just as able to screen for problems, as anybody else. In fact, he's probably seen more cataract surgeries, "post-op" than the average ophthalmologist has. 5:13:39 PM REPRESENTATIVE ANDERSON inquired as to Dr. Ford's opinion regarding the Academy of Ophthalmology's guidelines on post- operative surgical care. DR. FORD said that the typical ophthalmologist is opposed to comanagement. He explained that there is a conflict between optometrists and ophthalmologists because optometry is a group of forward looking, ambitious people and they've moved forward in their ability to diagnose and treat disease, which is threatening to ophthalmologists. The American Academy of Ophthalmology is fundamentally not very supportive of comanagement, he related, and there's hard feelings between ophthalmology and optometry at the leadership levels because of the struggle of the expansion of practice. He added that he is more pro-comanagement than the leadership of the American Academy of Ophthalmology is and respectfully disagrees with the Academy on this subject of comanagement. REPRESENTATIVE MCGUIRE inquired as to whether Dr. Ford takes "call." DR. FORD replied that he does not take "call" [ability to be available for of-hours medical emergency calls] and it has created negative feelings between him and some of the other ophthalmologists. He explained that he has recently decided that it would be fair to take "call" and is in the process of setting the situation up so that he can rotate call with other ophthalmologists in his office. REPRESENTATIVE MCGUIRE said: at the root of this bill I think there are some of us that are supportive of it for the reason that we want to attract ... retain ... more medical doctors, ophthalmologists, to our community that are going to live in our community and be here to service the needs of the people that live in our state ... I suspect ... that if I said "Would you be willing to fly your plane up here, on a moment's notice, to take care of somebody that had a very serious eye emergency that had not paid you for an eye treatment" ... you would probably say no and that's kind of the point I am getting at ... it's an opportunity to come in, I understand ... but that being said, you don't stick around and I appreciate what you said on the record today about the "call." CHAIR WILSON interrupted and stated that Representative McGuire's comments are not related to HB 151. REPRESENTATIVE MCGUIRE said: the point of this is that if we allow certain procedures to create a market, then we deter some people from entering the market ... the only other final analogy I have is, paralegals, ... I have met some paralegals that are some of the most competent people ... I have met paralegals that are smarter than a lot of the lawyers that I have met and so life experience, and working on the job can make you extremely competent. So, this is not about optometrists not being competent ... the choice that's made at the outset is your own, about whether you choose to get a medical degree or whether you choose to get an optometry degree ... 5:20:23 PM REPRESENTATIVE SEATON inquired as to Dr. Ford participating in comanagement arrangements. DR. FORD said that for the last 20 years, almost all of his patients have been comanaged. SAM TRIVETTE said that he had eye surgery in Seattle and could have instead [had eye surgery] in Anchorage, and if he had, this bill would have had impact. He explained that he was referred [for surgery] to an ophthalmologist by his optometrist in Juneau and after the surgery, was seen by his local optometrist for follow-up post-operative care. He said that if the follow-up care had to have been done by an ophthalmologist, he would have had real difficulty as there is only one ophthalmology group in Juneau and he has had negative past experiences with them. He explained, "if I had to stay for 48 hours because an ophthalmologist would not do a comanagement, I would have to eat that money and that's expensive, hotels are not cheap anymore, and meals are not either. I feel this bill is unnecessary and I don't think the legislature should be forcing this on the medical system." He emphasized that this is an issue that is between him and his physician and he does not understand why statute is necessary. 5:24:58 PM FRANK BICKFORD said that Dr. Ford spoke of a potential war between optometry and ophthalmology in his testimony and there is a need to clarify this. He informed that optometrists do a good job at what they do and what they are trained to do and that optometrists and ophthalmologists get along in Alaska. He said: The frustrating point that I heard today, was Dr. Ford stating, if he can't come back to Anchorage, he'll have his optometrist come from Outside. There are ophthalmologists in Anchorage, why not add those ophthalmologists as part of the comanagement agreement. It's very simple, there is no reason why the ophthalmologists in Anchorage can't be part of this ... after 48 hours the optometrists are back in the system under this bill, so they're not taking optometrists out of the whole picture, they are part of the picture but those first 48 hours are critical in eye care and that's why the American Academy of Ophthalmology endorses this bill with that change. CHAIR WILSON inquired as to the insurance paying all involved, if in fact there were situations where two ophthalmologists and an optometrist treated one patient. CARL ROSEN replied yes, and that there is a fee split that Medicare and the "OIG" (Office of the Inspector General) has deemed appropriate for appropriate comanagement that is in place and it is usually "80/20" for the typical relationship. 5:27:48 PM CHAIR WILSON said that what she is hearing over and over is the fact that the patient is going to feel comfortable most with the person the patient knows the best. She questioned whether it really makes a difference in terms of who does the follow-up care after eye surgery. DR. ROSEN argued that the patient usually does not understand what the comanagement relationship is and that's what the "OIG" and Medicare expect. He said: I would just say the litmus test for you people who are making these decisions ... would you prefer to have your physician take care of you, and to make decisions or would you prefer to have someone who does not do the cutting, someone who does not do the sewing, who does not make the difference in your visual system in the operating room ... I am not anti- optometrists. I think that we're going to improve eye care, we're going to set a precedent, we're going to say look, you operate, you need to take care of that patient, and after that , we can go about our business as usual. REPRESENTATIVE ANDERSON added, "isn't it true that a patient after back surgery might feel more comfortable ... with their massage therapist, that doesn't mean that they're healthier with a massage therapist." DR. ROSEN reiterated that the average person is unaware of the difference between optometrists and ophthalmologists. He opined that it is the job of the pathologists to make the best decisions because ophthalmologists know more [about eye care] than constituents and patients. 5:31:58 PM DR. MICHAEL BENNETT, stated that throughout the course of the committee meeting, optometrists have been compared to paralegals, massage therapists, and other ancillary medical personnel. He emphasized that optometrists are not ancillary medical personnel. He explained that optometrists are doctorate level physicians and are trained in optometry school to do post- operative care. He said, "the whole gist seems to be ... are we willing to settle for this ... second standard of care in post- surgical care, as opposed to having the "real" doctor look at the patient, and ... I don't know that it's gotten across very well, it's the whole notion of that, that is offensive. I have spent a long time doing post-operative care; I feel equally qualified to recognize the problems that are being talked about here, through the general ophthalmologists. And, obviously the surgeons that I have referred patients to ... feel likewise, or they would not be sending the patients back to me." REPRESENTATIVE MCGUIRE said that a medical degree, which takes about eight years to complete, is different than a degree in optometry. DR. BENNETT clarified that an optometry degree takes eight years before it is completed. REPRESENTATIVE MCGUIRE inquired as to the difference between optometrists and ophthalmologists. She said, "Why not just become a medical doctor?" DR. BENNETT replied that he didn't want to become a medical doctor. REPRESENTATIVE MCGUIRE opined that people make a choice about a degree they want, and then they come [to the legislature] and demand additional powers to be granted in their profession. 5:36:19 PM DR. BENNETT informed that optometry has grown and changed considerably in the past few decades. He said that practitioners are continually expanding their capabilities and their level of knowledge. He explained that medical doctors can obtain training and determine their competency to utilize new techniques with patients, while optometrists cannot. REPRESENTATIVE MCGUIRE said that people make a choice about a profession and that the legislature cannot grant additional "powers" to suit changing needs. DR. BENNETT said that comanagement with optometry has been regulated by the federal government since 1980 and optometrists made the choice to have the capability to comanage [and have been comanaging] for 25 years. He clarified that [optometrists] are not asking for an expansion of authority in comanagement, but that [the legislature] does not rescind [optometrist's] authority in comanagement. He continued: to become the only state in the country, where optometrists, after 25 years of successful comanagement, are now prohibited from doing so, for whatever time period. This is not something new, you're actually trying to turn the tables back 25 years ... I'm not here asking you to give me something I don't already have, I'm asking you not to take something away I've been doing successfully for a long time. There have been a number of studies, two of the major ones, authored by ophthalmologists, looking at comanagement, looking at thousands and thousands of retrospective cases and looking for outcome differentials between optometry comanaged patients and patients who are followed by the surgeon, they can't find the problem, there's no difference in outcome. 5:40:52 PM CHAIR WILSON asked Dr. Rosen if there is any other state has passed legislation similar to HB 151. DR. ROSEN said that four states have looked at similar legislation. He opined that HB 151 will benefit people and optometrists will get a chance to participate [in eye care]. 5:42:47 PM REPRESENTATIVE ANDERSON moved to adopt a Conceptual Amendment, as follows: I move amendment number 1 which would change on page 1, line 12, 120 hours to 48 hours, and then on page 2, line 1, 120 hours to 48 hours. And have the legal services make it a conceptual amendment so it's conforming in case I've missed any applicable language that doesn't reference 48 hours that needs to be changed. 5:43:10 PM REPRESENTATIVE SEATON objects. He stated his concern that the 48-hour amendment is arbitrary and that the testimony has shown that most complications [after eye surgery] do not occur within the 48-hour timeframe. He opined that, "we are just changing to 48 hours because maybe we can pass the bill with 48 hours and we can't pass it with what the ophthalmologists themselves recommend ... and so, I'll withdraw my objection for that, but I have a problem with doing ...". REPRESENTATIVE ANDERSON said that the American Academy of Ophthalmology is stating that 48 hours is acceptable and the idea of the bill is that doctors stay an extra day after surgery. CHAIR WILSON noted that Representative Seaton's objection was withdrawn. There being no further objection, [Conceptual] Amendment 1 was adopted. 5:45:03 PM REPRESENTATIVE KOHRING offered that the committee hold this legislation over until the next meeting because there seems to be real hesitation among members and concerns from the community. REPRESENTATIVE ANDERSON opined that HB 151 can move. He said: We've waited nine days ... we've had about 5 hours of testimony duplicative for the optometrists, duplicative of Dr. Rosen, and have another committee of referral. And, we also have the ability for people to allow it to pass, but vote do not pass or "no rec" on the file and report if they're worried about the record. The committee took an at-ease from 5:46:21 PM to 5:47:02 PM. 5:47:08 PM REPRESENTATIVE ANDERSON moved to report HB 151 out of committee with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE SEATON made an objection and stated: I think that we've had a lot of testimony here, and I think the testimony has come down to ... surgeons should use their medical expertise and should determine when, within their medical expertise, a person should be able to leave and what we are trying to do is insert ourselves between the medical doctors and their decisions and say that the medical doctor that says that his patient is free to go in 24 hours is making a bad decision, an incorrect decision, and we are going to insert the legislature into a medical decision and say ... that we know better ... I think that that is a very big mistake. I also think that on page 2, line 12 where we say "this doesn't apply to rural Alaska", [we are saying] it doesn't matter about the care there, it only applies to Anchorage and Fairbanks, basically ... I have a real problem with aspects if the bill but, especially, that we're inserting ourselves ... in the state medical board's place. 5:48:49 PM REPRESENTATIVE KOHRING said that he has concerns about the legislation but that he will not object to move the bill to the next committee. He explained that the bill will have more opportunities for those that oppose this legislation to convince members of other committees to prevent the bill from going forth. He shared that his concerns are similar to Representative Seaton's and he will vote to move the bill but mark a "do not pass" recommendation on the "sheet." 5:50:04 PM REPRESENTATIVE GARDNER she said that it is clear that this bill addresses a problem that doesn't exist. She mentioned that she agreed with Representative Seaton's comments. CHAIR WILSON noted that she agreed with Representatives Seaton and Gardner. She highlighted that this is not normal [legislation] for Alaska. She said, "We try to make sure that what we do doesn't have any ramifications in other areas and I ... am concerned that this is setting a precedent and the wishes of the committee is that we move this bill and so we have an objection, so I will go ahead and call the role." 5: 51:03 PM A roll call vote was taken. Representatives Kohring, McGuire, Anderson, and Cissna voted in favor of HB 151. Representatives Seaton, Gardner, and Wilson voted against it. Therefore, CSHB 151(HES) passed and was reported out of the House Health, Education and Social Services Standing Committee by a vote of 4- 3.
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