Legislature(2001 - 2002)
02/25/2002 03:20 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
HB 215-OPTOMETRISTS AND PHARMACEUTICALS Number 373 CHAIR MURKOWSKI announced the final order of business, HOUSE BILL NO. 215, "An Act relating to the use of pharmaceutical agents in the practice of optometry; and providing for an effective date." [HB 215 was sponsored by the House Labor and Commerce Standing Committee by request. Version L, 22-LS0538\L, Lauterbach, 1/31/02, had been adopted as a work draft on 2/22/02.] Number 381 REPRESENTATIVE KOTT moved to adopt Amendment 1, labeled 22- LS0538\L.1, Lauterbach, 2/25/02, which read: Page 3, following line 22: Insert a new bill section to read; "* Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to read: EXISTING ENDORSEMENTS. Notwithstanding AS 08.72.175, as amended by sec. 1 of this Act, and AS 08.72.272, as amended by secs. 2 and 3 of this Act, an endorsement issued before the effective date of this Act does not authorize a licensee to prescribe or use a pharmaceutical agent by systemic administration until the licensee applies to the Board of Examiners in Optometry for authorization to prescribe or use a pharmaceutical agent by systemic administration and the board finds either (1) the person's initial license to practice optometry was issued after December 31, 1999; or (2) the person has attended and passed a course covering systemic administration of pharmaceutical agents that was offered by an accredited college of optometry and approved by the Board of Examiners in Optometry." Renumber the following bill section accordingly. CHAIR MURKOWSKI asked whether there was any objection. There being no objection, Amendment 1 was adopted. CHAIR MURKOWSKI said Amendment 1 addresses the concern of endorsement without the training from the governor's veto letter [dated May 10, 2000, regarding the veto by Governor Knowles of SB 78]. She asked about the subject of "additional training". She explained that the committee had heard that the optometrists felt additional training wasn't required because of their schooling and hours in pharmacology. She asked Ms. Reardon to address this issue. Number 408 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Community and Economic Development, referred to page 3, Section 4, of Version L. She said the transitional provision of uncodified law seems to say, "In order to get this endorsement for systemic drugs, one has to have either graduated or gotten an initial license after 1999 or had a course." She said she assumes that the purpose of the transitional provision is because newer graduates will have received this type of training in their schooling, while there are earlier graduates of optometry school who may not have received this training. She noted that the committee may have addressed the issue of "additional training" in the transitional provision, but couldn't say for certain that this would satisfy the governor's concern. MS. REARDON addressed another concern in the governor's veto letter, that existing endorsements would unintentionally be upgraded. She referred to page 3, lines 18-19 [Version L], which read, "the person's initial license to practice optometry was issued after December 31, 1999". She asked if that means one's initial license anywhere, or in Alaska. CHAIR MURKOWSKI responded, "Their initial license to practice optometry." Number 437 MS. REARDON said she doesn't know whether, after 1999, this type of course has been in the curriculum of all the schools. She asked why Section 4 is a transitional provision instead of a regular piece of the legislation. CHAIR MURKOWSKI said she was now confused with Amendment 1. She remarked, "So, we have a transitional provision in Section 4, and then the new Section 5 is the existing endorsements." Number 444 MS. REARDON said that is correct. She offered that Amendment 1 deals with existing [endorsements], and said she is confused why Section 4 is described as uncodified law rather than regular law. She mentioned that it looks as though two of the topics in the governor's veto letter were addressed. Number 456 REPRESENTATIVE KOTT said he thinks the main issue in HB 215 addresses qualifications. When one asks if ophthalmologists are more qualified than optometrists, the answer is usually a resounding yes. He offered that the issue is whether or not the optometrists are qualified [to prescribe oral or systemic drugs], which he thinks they are. REPRESENTATIVE KOTT told members he was disturbed by a comment made last week by a gentleman who'd testified, suggesting the rural community, especially the Native community, is opposed to [HB 215]. He explained that this gentleman "assumed a position himself with the local ANB [Alaska Native Brotherhood] chapter", which Representative Kott called the local camps. Representative Kott indicated he himself had talked to six individuals in the "Grand Camp," which the local camp responds to - the executive committee on the Grand Camp makes a recommendation on behalf of the ANB community; Representative Kott reported that "those discussions never took place." He therefore offered his belief that the testifier was - in accordance with what he himself knows about the parameters of the organizational structure - completely out of place. Representative Kott indicated he was also told that the Alaska Federation of Natives (AFN) has not taken a position on HB 215. Number 477 REPRESENTATIVE KOTT said he thinks [HB 215] is an important piece of legislation for the rural communities. He explained that [HB 215] bridges the gap between urban and rural [communities]. He offered that people should have the opportunity to visit the optometrist if there isn't an ophthalmologist in the community. Number 479 REPRESENTATIVE MEYER said he thinks optometrists aren't trying to take over the ophthalmologists' jobs, but rather are asking for the ability to prescribe drugs. He said the optometrists aren't asking to do any surgical type of work. He said to his understanding, the optometrists are just trying to prescribe drugs that are necessary and needed in case of an emergency - and in rural Alaska this situation could come up frequently. Number 486 REPRESENTATIVE HALCRO, referring to a handout in the packet, addressed the issue of various state actions on similar legislation. He remarked, "When you look at all of these states that have defeated initiatives having to do with widening the scope of optometry, ... it seems to me it's pretty significant. I'm just wondering why these various states defeated these initiatives." He offered that possibly the initiatives were defeated because of the questions relating to qualifications to be able to dispense some of [the drugs], or that the ophthalmologists didn't have a very effective lobbyist in these states. Number 497 REPRESENTATIVE KOTT mentioned that because of its rural communities, Alaska is a little different from some states that have defeated similar legislation. He said if Alaska had an ophthalmologist in every major city with the ability to get to that major city within an hour of driving, he would probably defeat the initiative. He added, "We don't have that luxury." Number 510 CHAIR MURKOWSKI acknowledged a nationwide movement to expand the scope of optometric practice to include laser surgery. She told members, "I, for one, am absolutely, positively, dead-set against that." She offered that if some initiatives in other states have expanded to include laser surgery, as Oklahoma has done, then the states were right in rejecting that expansion and practice. CHAIR MURKOWSKI said her concern with [HB 215] has been that it is "the camel's nose under the tent" in terms of the practice and whether the next step is laser [surgery]. She said [the committee] has seen in writing that this has been attempted in other states. She added, "We did have the testimony of Jeff Gonnason saying, 'They tried it. They saw it wasn't going to work here, so they've disbanded it.'" Chair Murkowski said she is not entirely convinced "that they're not going to come back and try to do it again, but there is a point there where you say no." She added, "You want to cut somebody's eyeball open, you go all the way through to medical school." Number 525 REPRESENTATIVE CRAWFORD said right now, he thinks Alaska has about five times as many optometrists as ophthalmologists. His concern is that if Alaska continues to broaden the scope of what optometrists are allowed to do, it will probably shrink the market for ophthalmologists even more. He said this may be one unintended consequence of [HB 215]. Number 532 REPRESENTATIVE HAYES asked what the comment of the state medical board is [on HB 215]. He said he'd thought the board was going to work together with the ophthalmologists and the eye doctors to come up with some resolution. CHAIR MURKOWSKI replied, "They met. They talked about possibly having a subcommittee. No one can quite recall if anyone was put on that subcommittee or whether it worked." She said as she understands it, the state medical board didn't come to a resolution. CHAIR MURKOWSKI asked Ms. Reardon if it is fair to say the state medical board objects to HB 215 as it currently is. MS. REARDON said yes. CHAIR MURKOWSKI said as far as [the committee] knows, there's no ongoing effort for the ophthalmologists and the optometrists to further work things out. Number 547 MS. REARDON said there isn't an effort with enough momentum that is going to bring answers in a timeframe that she thinks will be helpful to this legislative session. REPRESENTATIVE HALCRO offered that it seems a good deal of the motivation behind HB 215 is to make services available in rural Alaska, where there aren't many ophthalmologists. He asked if it is possible and makes sense to maybe limit the authority [optometrists] have - in dispensing and in doing certain activities - to communities under a certain population. He asked, "If the intent truly is because Alaska is so geographically diverse, and we have several small communities without ophthalmologists, and this just makes it easier and more cost-effective, should we limit it to those communities?" He said this would prevent someone in Anchorage from dispensing services that rightfully an ophthalmologist does, since there are plenty of [ophthalmologists] in Anchorage. Number 558 MS. REARDON said she thinks there have been several different arguments put forward by supporters HB 215. She mentioned that there has been some reference to rural services, but she wasn't sure that was the sole purpose of HB 215. She added, "I don't think that's one of the variations that's been discussed by the optometry board or the medical board, perhaps because if it's safe, ... there isn't a reason to prevent it in the urban areas, and if it's not safe - if it actually is risky - perhaps maybe we shouldn't inflict that upon the rural areas." She mentioned that there are licensing laws with population indexes because sometimes there has to be that decision in rural areas. She asked if lesser public protection is better because there will be more access. She referred to a list of communities and the mailing addresses of the optometrists. She said, "They're not widely dispersed in what you think of as rural Alaska." [Tape flips back to beginning of Side A] TAPE 02-24, SIDE A Number 001 MS. REARDON said, "From my perspective, you don't see a lot of people in Fort Yukon or anything like that." REPRESENTATIVE KOTT offered that market conditions in urban areas would probably dictate who a person is going visit to get something taken care of. He said when given the choice, he would visit the doctor who is more qualified, because he is going to pay the same amount for the deductible, and he wants the best health care. He implied that most people would do the same. Therefore, he said he doesn't think it's necessary to restrict it based on population base. Representative Kott mentioned that similar legislation had overwhelming support a couple of years ago, with - to his recollection - only four votes in both houses against it. He said he thought it was a good idea back then, and still thinks it's a fairly good idea. Number 019 REPRESENTATIVE KOTT moved to report CSHB 215 [version 22- LS0538\L, Lauterbach, 1/31/02, as amended] out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 215(L&C) was moved out of the House Labor and Commerce Standing Committee.
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