Legislature(2007 - 2008)CAPITOL 106
03/20/2007 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB135 | |
| HB178 | |
| HB113 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 135 | TELECONFERENCED | |
| *+ | HB 178 | TELECONFERENCED | |
| *+ | HB 113 | TELECONFERENCED | |
| *+ | HB 173 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 113-OPTOMETRISTS' USE OF PHARMACEUTICALS 4:18:46 PM CHAIR WILSON announced that the final order of business would be HOUSE BILL NO. 113, "An Act relating to the prescription and use of pharmaceutical agents, including controlled substances, by optometrists." 4:19:16 PM REPRESENTATIVE NEUMAN moved to adopt CSHB 113, Version 25- LS0411\K, Bullard, 3/5/07. There being no objection, Version K was before the committee. 4:19:35 PM REPRESENTATIVE RALPH SAMUELS, Alaska State Legislature, speaking as the prime sponsor, paraphrased from the sponsor statement, which read as follows [original punctuation provided]: House Bill 113 would allow optometrists to prescribe systemic (oral) medication to treat a patient's eyes or for an allergic shock reaction. Currently Alaskan optometrists are limited to prescribing only topical medications, while optometrists in 45 states, the District of Columbia and Guam are able to prescribe systemic (oral) medications. The course of study that optometrists undergo is comparable or exceeds that required of their peers in the health care professionals who are already granted the ability to prescribe medications. Optometry programs include several semesters of pharmacology, in addition to studies in human anatomy, physiology, and biochemistry. Optometrists, like dentists and podiatrists, attend four years of graduate school after receiving their undergraduate degree, while nurse practitioners and physicians assistants only complete two years of graduate school. Yet of these professions, only optometrists are limited to prescribing topical agents. Regulations are already in place to ensure that only qualified optometrists may prescribe systemic medications. Optometrists must pass an exam, such as the "Treatment and Management of Ocular Disease" from the National Board of Examiners in Optometry, and must show that they have completed the necessary continuing education in pharmacology each year in order to prescribe any medications authorized under statute. Increasing optometrists' prescribing authority will be of benefit to Alaskan patients, preventing those who require oral or inject-able prescriptions from having to visit a general practitioner in addition to their regular optometrist. This will save patients time and money, and allow optometrists greater participation in their patients' care. REPRESENTATIVE SAMUELS cautioned the committee that it will hear much testimony that may not support the bill; however, it is important and necessary. 4:21:36 PM CHAIR WILSON clarified that this bill will enable optometrists to treat anaphylactic reaction and other conditions. REPRESENTATIVE SAMUELS said that HB 113 is especially for the benefit of rural Alaskans, and these services are commonly performed across the country in less rural areas. 4:22:44 PM REPRESENTATIVE GARDNER asked how many communities in Alaska have an optometrist, but do not have an ophthalmologist or a physician. REPRESENTATIVE SAMUELS answered that there are twenty ophthalmologists in six locations, and one hundred and nine optometrists in eighty-five locations. 4:24:02 PM REPRESENTATIVE CISSNA asked how many optometrists are located on the road system. REPRESENTATIVE SAMUELS deferred answering her question to his staff. 4:24:48 PM CHAIR WILSON requested a description of Version K. 4:24:58 PM SYDNEY MORGAN, Staff to Representative Ralph Samuels, Alaska State Legislature, prime sponsor, explained that Version K specifies the scope of the prescriptive authority and educational requirements. She said that additions in Sec. 1 clarify that the endorsement allows the prescription of pharmaceutical agents if the applicant passes the exam on ocular pharmacology, completes 23 hours in an approved non-topical therapeutic pharmaceutical agent course, and completes seven hours in an injections course. She continued to say that a new subsection is included in Sec. 2, that adds endorsement renewal requirements of eight hours of continuing education concerning the use and prescription of pharmaceutical agents, seven hours of continuing education concerning injections, and other board requirements. In addition, new language in Sec. 3 defines what controlled substance the endorsement allows the licensee to prescribe. An allowable controlled substance is prescribed and used for the treatment of ocular disease or conditions, ocular adnexal disease or conditions, or emergency anaphylaxis; is not a schedule 1, 2, or 6 drug; is not prescribed for more that four days of use; is not injected into the eyeball. In addition, the licensee must have a physician-patient relationship and a Drug Enforcement Administration (DEA) registration number. 4:28:17 PM REPRESENTATIVE FAIRCLOUGH asked for a definition of a physician- patient relationship. MS. MORGAN expressed her understanding that it would have to do with the payment for the service and she offered to supply a clear definition at a later date. REPRESENTATIVE FAIRCLOUGH referred to page 3, line 5, and asked for clarification of the term "physician-patient relationship." She asked whether an optometrist will be considered a physician in the interpretation of the term. 4:29:59 PM CHAIR WILSON noted that the bill states, "as defined by the board in regulation." 4:30:13 PM MS. MORGAN added that further testimony will be provided on this subject. 4:30:27 PM REPRESENTATIVE SEATON asked whether the four-day limit on the prescription will prevent a patient from completing a course of antibiotics. 4:31:12 PM MS. MORGAN offered that optometrists can address the majority of issues brought before them within the time limit. 4:31:42 PM CHAIR WILSON pointed out that the four-day limit only pertains to a controlled substance, such as pain medication, not an antibiotic. She opined that a patient who needs pain medication for more than four days will need to be referred to a doctor. 4:32:31 PM CINDY BRADFORD, Doctor of Ophthalmology, American Academy of Ophthalmology; Assistant Professor, Dean A. McGee Eye Institute, Department of Ophthalmology, University of Oklahoma Health Center, University of Oklahoma, stated her opposition to HB 113. She informed the committee that she teaches ophthalmology and eye surgery to internal medicine and family practice resident medical students. Dr. Bradford stated that HB 113 is an expansion of what is legal in most of the other states. Oklahoma allows for the broadest of authority of optometry, and the Alaska bill will be broader than all but Oklahoma. It is important, she said, that optometry and ophthalmology work together to serve the large number of patients. However, this bill removes the limits of the pharmaceutical rights of optometry and expands the rights to medications that affect the entire body. She opined that narcotics are rarely needed for eye conditions unless a patient has had retinal surgery. These systemic medications interact with other medications being taken by a patient and, in fact, factors can be involved on a level that an optometrist would not be trained to diagnose and prescribe for the type of treatment that is covered in HB 113. Dr. Bradford described the training involved for optometry versus ophthalmology. She concluded by saying that quality care for patients means that they are treated by professionals who have been trained to diagnose and prescribe appropriately. 4:40:11 PM REPRESENTATIVE ROSES asked about drug and drug interaction training for ophthalmologists. DR. BRADFORD replied that there is a one year internship treating patients with many diseases, and supervised by an attending physician. She reviewed the teaching process regarding pharmacology. REPRESENTATIVE ROSES further asked about the percentage of training time that is dedicated to drug interaction and pharmaceuticals. DR. BRADFORD responded that every day of medical school, students are learning about medications and drugs. 4:42:06 PM REPRESENTATIVE ROSES asked Dr. Bradford to estimate the time optometrists spend learning about drug interaction and the use of the pharmaceuticals that are endorsed by HB 113. DR. BRADFORD opined that this bill endorses a large group of systemic pharmaceuticals that affect the entire body, and that optometrists would never have encountered. REPRESENTATIVE ROSES restated his question. DR. BRADFORD emphasized that the medications that this bill allows are beyond an optometrist's clinical experience. 4:44:21 PM CHAIR WILSON asked about an ophthalmologist's internship. DR. BRADFORD answered that, during the one-year internship, students are not working in the eye clinic but are studying internal medicine and are managing a variety of patients. 4:46:55 PM LESLEY L. WALLS, Physician of Optometry, Medicine, and president of the Southern California College of Optometry, stated his support for HB 113. CHAIR WILSON asked for a description of Dr. Walls' medical training. DR. WALLS responded that he is a board certified family doctor, an optometrist, and is a former associate dean of the University of Oklahoma. He opined that Alaska's optometrists are able to safely and effectively use the drugs and treatments allowed in the bill. Dr. Walls said that the four year continuing education requirement is more than adequate, together with the four year degree that optometrists hold. He described the training that optometrists receive and disagreed with the previous testifier. Dr. Walls assured the committee that, upon graduation, optometrists have the clinical experience and the pathological and pharmacological qualifications to manage patients. 4:51:28 PM REPRESENTATIVE ROSES asked what percentage of training an optometrist receives for the dispensing of, and interaction with, the drugs authorized by HB 113. DR. WALLS replied that it is difficult to say; however, it is a major part of every examination. In addition, an optometrist's clinical experience is with patients who have potential drug interactions. 4:52:31 PM REPRESENTATIVE ROSES asked whether Dr. Walls is familiar with Alaska's licensing exam for optometrists, and whether the test is adequate to determine the ability of the state optometrists to administer these drugs. DR. WALLS, calling on his experience as a Dean of Optometry at the Southern California College of Optometry, and as a former member of the National Board of Examiners in Optometry, assured the committee that it is a rigorous examination. In fact, he said that he has been involved in the development of training and testing for the courses of injectable and systemic medications in other states. REPRESENTATIVE ROSES asked whether Dr. Walls could compare the optometrist's and ophthalmologist's state certifications regarding the use of pharmaceuticals. DR. WALLS responded that ophthalmologists automatically hold full prescriptive authority by their state medical license. In answer to a question, he added that optometrist's licensing falls under state statute. 4:55:15 PM REPRESENTATIVE NEUMAN asked what role a pharmacist would play in dispensing the correct prescription drugs. DR. WALLS replied that his college recommends to its students the use of pharmacists as a resource in many areas. 4:56:03 PM REPRESENTATIVE ROSES asked Dr. Walls to compare Alaska with the licensing tests in other states that currently allow optometrists to prescribe pharmaceutical agents. DR. WALLS responded that Alaska's test will be more rigorous because it requires more hours of training on injectables; however, testing on prescribing systemic drugs is similar to that of other states. 4:56:57 PM REPRESENTATIVE ROSES asked whether Dr. Wall knew what kind of insurance and malpractice insurance coverage an optometrist or ophthalmologist would be required hold. DR. WALLS informed the committee that malpractice insurance has not increased in the states that allow optometrists the expanded responsibilities authorized by HB 113. 4:57:51 PM REPRESENTATIVE GARDNER asked whether there is a large range of limitations in the 45 states that allow expanded authority by optometrists. DR. WALLS noted that, except for medical and osteopathic doctorates, individual legislatures set the licensing requirements. Therefore, there are no identical laws between states. 4:59:20 PM REPRESENTATIVE FAIRCLOUGH asked what the major, new responsibilities are that optometrists are allowed to perform in various states. 5:00:12 PM DR. WALLS answered that some states don't allow injections, or may have restrictions on certain medications. REPRESENTATIVE FAIRCLOUGH further asked Dr. Walls to compare Alaska's law with the other 45 states and requested the specific disparity between the state's regulations. 5:02:10 PM DR. WALLS referred to information that can be provided by the American Optometric Association and that describes state by state prescriptive authority. 5:02:38 PM MICHAEL BENNETT, Doctor of Optometry; President, Alaska Optometry Association, informed the committee that he is in private practice in Juneau. Dr. Bennett said that he received his education in Michigan and also has research experience. 5:04:59 PM REPRESENTATIVE GARDNER asked whether his degree is a Doctorate in Optometry. DR. BENNETT answered yes. He explained that optometrists have been recognized as physicians by Medicare and insurance carriers since the 1970s. REPRESENTATIVE GARDNER asked whether all optometrists are doctors. DR. BENNETT responded yes. He added that there is an accreditation board for optometry schools. Optometrists attend four years of medical school, including 200 hours of pharmacology, plus anatomy and clinical work. Dr. Bennett continued to say that optometrists, who see many patients, are the gate keepers to eye care. All day long his patients come in with multiple health issues. Dr. Bennett said that he makes frequent contact with his patient's primary care physician. In response to a question, he explained that his is a standard practice and his training is similar to others in his field. CHAIR WILSON observed that all optometric schools require 200 hours of pharmacology. She then asked about undergraduate requirements. DR. BENNETT replied that the criterion is an undergraduate degree, just as though a student was applying to any other medical school. CHAIR WILSON confirmed that all optometric schools require four years of study. 5:09:51 PM REPRESENTATIVE ROSES asked Dr. Bennett about the percentage of his patients that have been referred to ophthalmologists for care. DR. BENNETT responded that, over the length of his practice, between 15 to 20 percent have been referred. 5:11:04 PM REPRESENTATIVE ROSES asked whether the passage of HB 113 will affect the percentage of referrals. DR. BENNETT estimated that the change would not decrease the referrals by one percent. What is primarily addressed in this bill is the treatment of eyelid infections, and the majority of these are very minor. 5:12:13 PM REPRESENTATIVE ROSES questioned whether the passage of this bill is a way for optometrists to begin to perform laser and corrective surgery. DR. BENNETT disagreed. REPRESENTATIVE ROSES asked whether the passage of this bill will significantly increase Dr. Bennett's income stream. DR. BENNETT answered, "I don't think it's going to change my income stream at all." He explained that a patient is charged when they are seen, whether they are referred or not. He opined that HB 113 will result in a small percentage of increased cases. 5:13:57 PM REPRESENTATIVE ROSES asked whether Dr. Bennett has any concerns about patient care if HB 113 passes. DR. BENNETT empathized with the committee's responsibility to deal with an unknown entity. However, he opined that the track record is impeccable for optometrists and the committee should not have too much concern. The states with similar regulations that were polled by the Alaska State Medical Board in 2001, do not have problems to report or an increase in malpractice insurance cases. 5:16:15 PM REPRESENTATIVE GARDNER requested a copy of the 2001 survey. 5:17:00 PM BOB LOESCHER informed the committee that he is a life long Juneau resident and has traveled extensively in rural Alaska. Mr. Loescher explained that he is opposed to HB 113. As a kidney transplant patient and a diabetic, he is under the care of an ophthalmologist. His sight is lost in one eye, and there is no regaining what is lost. As a citizen with many eye care conditions, he urged the committee to consider the importance of the eyes to patients. His optometrist did tests but, within a week, his diabetes took his eyesight. The optometrist did not know about his other medical conditions. Also, he is on steroids, and a doctor's care is important to manage these types of drugs. He suggested that the prescription of drugs is of critical importance and asked the committee to err on the side of medical doctors and support ophthalmology. 5:23:07 PM REPRESENTATIVE ROSES commented that this bill has brought testimony from doctors, but that Mr. Loescher is the first individual citizen to come forward. 5:23:43 PM CHAIR WILSON related a personal story of misdiagnosis, and observed that, regardless of the title, a doctor may or may not be competent. 5:25:10 PM JILL GEERING MATHESON, Doctor of Optometry, and chair of the Alaska State Board of Examiners in Optometry, stated her personal support for HB 113. She said that the board has not issued an official position; however, she assured the committee that if HB 113 passes, the board will cooperate with the department to pass regulations. 5:26:21 PM REPRESENTATIVE ROSES repeated his question about optometrists trying to get approval to perform laser surgery. DR. GEERING MATHESON answered that laser surgery is not included in HB 113. REPRESENTATIVE ROSES asked whether Dr. Geering Matheson's revenue stream will be increased by the passage of the bill. DR. GEERING MATHESON said no. 5:27:26 PM CHAIR WILSON announced that HB 113 would be held over for further testimony. 5:27:32 PM REPRESENTATIVE GARDNER asked the sponsor to have the Alaska State Medical Board provide an opinion on the bill.
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