Legislature(2007 - 2008)CAPITOL 17

04/11/2007 03:00 PM LABOR & COMMERCE


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Audio Topic
03:07:46 PM Start
03:08:19 PM HB113
04:54:57 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 162 MORTGAGE LENDING TELECONFERENCED
Scheduled But Not Heard
+= HB 113 OPTOMETRISTS' USE OF PHARMACEUTICALS TELECONFERENCED
Moved CSHB 113(HES) Out of Committee
+= HB 195 LIMITED LIABILITY COMPANIES TELECONFERENCED
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE LABOR AND COMMERCE STANDING COMMITTEE                                                                         
                         April 11, 2007                                                                                         
                           3:07 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Kurt Olson, Chair                                                                                                
Representative Mark Neuman, Vice Chair                                                                                          
Representative Carl Gatto                                                                                                       
Representative Gabrielle LeDoux                                                                                                 
Representative Jay Ramras                                                                                                       
Representative Robert L. "Bob" Buch                                                                                             
Representative Berta Gardner                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 113                                                                                                              
"An Act relating to the prescription and use of pharmaceutical                                                                  
agents, including controlled substances, by optometrists."                                                                      
                                                                                                                                
     - MOVED CSHB 113(HES) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 162                                                                                                              
"An Act relating to mortgage  lenders, mortgage brokers, mortgage                                                               
originators,  state  agents  who collect  program  administration                                                               
fees,  and other  persons who  engage in  activities relating  to                                                               
mortgage lending; relating to  mortgage loan activities; relating                                                               
to  an  originator  fund;  relating to  fees  for  mortgage  loan                                                               
transactions; and providing for an effective date."                                                                             
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
HOUSE BILL NO. 195                                                                                                              
"An Act relating to limited liability companies."                                                                               
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 113                                                                                                                  
SHORT TITLE: OPTOMETRISTS' USE OF PHARMACEUTICALS                                                                               
SPONSOR(s): REPRESENTATIVE(s) SAMUELS                                                                                           
                                                                                                                                
01/30/07       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/30/07       (H)       HES, L&C                                                                                               
03/20/07       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/20/07       (H)       Heard & Held                                                                                           
03/20/07       (H)       MINUTE(HES)                                                                                            
03/31/07       (H)       HES AT 12:30 AM CAPITOL 106                                                                            
03/31/07       (H)       Moved CSHB 113(HES) Out of Committee                                                                   
03/31/07       (H)       MINUTE(HES)                                                                                            
04/02/07       (H)       HES RPT CS(HES) 4DP 1NR 2AM                                                                            
04/02/07       (H)       DP: CISSNA, SEATON, NEUMAN, FAIRCLOUGH                                                                 
04/02/07       (H)       NR: GARDNER                                                                                            
04/02/07       (H)       AM: ROSES, WILSON                                                                                      
04/11/07       (H)       L&C AT 3:00 PM CAPITOL 17                                                                              
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE RALPH SAMUELS                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 113.                                                                                          
                                                                                                                                
REPRESENTATIVE BILL THOMAS                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Spoke as a joint prime sponsor of HB 113.                                                                  
                                                                                                                                
CYNTHIA BRADFORD, M.D.                                                                                                          
American Academy of Ophthalmology (AAO)                                                                                         
Edmond, Oklahoma                                                                                                                
POSITION STATEMENT:  Testified during hearing on HB 113.                                                                        
                                                                                                                                
ERIC COULTER, M.D.                                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during hearing on HB 113.                                                                        
                                                                                                                                
CARL E. ROSEN, M.D., President                                                                                                  
Alaska State Ophthalmological Society                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during hearing on HB 113.                                                                        
                                                                                                                                
DANIEL BRICELAND, M.D.                                                                                                          
American Academy of Ophthalmology (AAO)                                                                                         
Sun City West, Arizona                                                                                                          
POSITION STATEMENT:  Testified during hearing on HB 113.                                                                        
                                                                                                                                
MICHAEL BENNETT, O.D., President                                                                                                
Alaska Optometric Association (AKOA)                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 113.                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR KURT  OLSON called  the House  Labor and  Commerce Standing                                                             
Committee meeting to order at  3:07:46 PM.  Representatives Buch,                                                             
Gardner, Neuman,  and Olson  were present at  the call  to order.                                                               
Representatives Gatto, LeDoux, and  Ramras arrived as the meeting                                                               
was in progress.                                                                                                                
                                                                                                                                
HB 113-OPTOMETRISTS' USE OF PHARMACEUTICALS                                                                                   
                                                                                                                                
CHAIR OLSON  announced that the  only 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."                                                                                                                  
                                                                                                                                
3:08:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RALPH SAMUELS,  Alaska State  Legislature, stated                                                               
that  in 45  other states,  optometrists are  allowed to  perform                                                               
more functions  than those in  Alaska.   He said that  Alaska has                                                               
many remote  communities, and the  legislature should  strive for                                                               
anything  that will  increase access  to healthcare.   He  stated                                                               
that allowing  optometrists to  have a  larger scope  of practice                                                               
has not caused  problems in the aforementioned states.   He noted                                                               
that there would be testimony both  for and against the bill.  He                                                               
then  gave a  detailed comparison  of the  education requirements                                                               
for  optometrists, dentists,  physician's  assistants, and  nurse                                                               
practitioners.     He  pointed  out  that   while  the  education                                                               
requirements  are  similar,  only  optometrists  are  limited  to                                                               
prescribing topical  agents.  He  opined that because  Alaska has                                                               
many rural  areas, the  legislature needs  to do  what it  can to                                                               
provide better access  to healthcare.  He shared  his belief that                                                               
this is "extremely reasonable."                                                                                                 
                                                                                                                                
3:10:57 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:12 PM to 3:24 PM.                                                                          
                                                                                                                                
3:23:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  BILL  THOMAS,  Alaska  State  Legislature,  joint                                                               
prime sponsor,  pointed out  that during a  hearing in  the House                                                               
Health, Education and Social  Services Standing Committee (HHES),                                                               
the ophthalmologists  admitted that Haines is  the only community                                                               
in his  district that is visited.   He shared his  belief that it                                                               
is  important  to allow  optometrists  to  provide treatment  for                                                               
certain  eye diseases.    He stated  that  some communities  have                                                               
Southeast  Alaska Regional  Health  Consortium (SEARHC)  clinics,                                                               
although  the cost  to transport  a patient  to a  clinic can  be                                                               
high.  He  said that if an optometrist could  work with the nurse                                                               
practitioner or a physicians assistant,  this would be beneficial                                                               
to remote communities.                                                                                                          
                                                                                                                                
3:26:06 PM                                                                                                                    
                                                                                                                                
CINDY BRADFORD,  M.D., American  Academy of  Ophthalmology (AAO),                                                               
said that she  is a practicing Ophthalmologist.   She stated that                                                               
she is  not opposed  to optometry,  and works  with optometrists.                                                               
She expressed  concern that the  bill allows optometrists  to use                                                               
medications that  effect the  entire body.   She opined  that the                                                               
committee needs  to consider what  measuring stick is  being used                                                               
to decide whether the education  of an optometrist is adequate to                                                               
prescribe  systemic  medications.   She  questioned  whether  the                                                               
hours  of education  are  enough  to do  this,  or whether  other                                                               
authorities have been examined.   She opined that the question of                                                               
whether  the  hours  of  education  are  enough  has  yet  to  be                                                               
answered,  noting  that the  training  given  to optometrists  is                                                               
different than  medical school.   She  questioned whether  the 45                                                               
states  actually allow  this scope  of practice.   She  suggested                                                               
that members  take a  closer look at  what these  states actually                                                               
allow.   She understands that  Alaska has remote areas,  and said                                                               
"We certainly want everybody to be  ... taken care of."  However,                                                               
she stated  that "the eye  is not the tooth,"  and is one  of the                                                               
most complex organs of the body.   She opined that vision is "the                                                               
most  precious  sense that  the  body  has,"  and said  that  the                                                               
diagnosis and  treatment of an  eye disease  is not simple.   She                                                               
said that if  a patient needs specialty care he  or she will need                                                               
to see  an ophthalmologist, regardless  of location.   She stated                                                               
that the training cannot be  replaced simply because of location.                                                               
She said that this might result in a delayed diagnosis.                                                                         
                                                                                                                                
3:31:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RAMRAS asked when Dr. Bradford visited Alaska.                                                                   
                                                                                                                                
DR. BRADFORD  replied that  she has  never been  to Alaska.   She                                                               
said that  she was raised in  Texas, and is aware  that there are                                                               
significant  differences.    She  said "I  do  know  that  people                                                               
deserve treatment that allows them to  be cared for."  She shared                                                               
her belief  that allowing someone  without the training  to treat                                                               
patients "is not getting us anywhere."                                                                                          
                                                                                                                                
REPRESENTATIVE  RAMRAS  asked  whether Dr.  Bradford  feels  that                                                               
Oklahoma and Texas have extensively developed road systems.                                                                     
                                                                                                                                
DR. BRADFORD  replied that while  many people complain  about the                                                               
roads, there are no mountains.   She acknowledged that this makes                                                               
travel easier.   In response to an additional  question, she said                                                               
that in Oklahoma, most places can be reached by road.                                                                           
                                                                                                                                
3:32:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  noted Dr.  Bradford's concern  with regard                                                               
to  the statement  that  45 states  give  optometrists a  broader                                                               
scope of practice.   She asked which states allow  this and which                                                               
states do not.                                                                                                                  
                                                                                                                                
DR.  BRADFORD  said that  this  information  was previously  made                                                               
available.   She  said that  the  statutes differ  from state  to                                                               
state, and  there are  not 45 states  that allow  this currently.                                                               
She offered to provide this information.                                                                                        
                                                                                                                                
REPRESENTATIVE LEDOUX  replied that  she would  like to  see this                                                               
information.   She  asked whether  Dr. Bradford  is aware  of any                                                               
states that have similar legislation.                                                                                           
                                                                                                                                
DR. BRADFORD replied that Oklahoma  has the most liberal practice                                                               
act for optometry.                                                                                                              
                                                                                                                                
REPRESENTATIVE LEDOUX  questioned whether there is  evidence that                                                               
the quality of eye care has diminished as a result of this.                                                                     
                                                                                                                                
DR. BRADFORD shared her belief  that the majority of optometrists                                                               
do not  do this,  as it  is not needed.   She  shared a  story in                                                               
which a  patient almost went blind  as a result of  being treated                                                               
with the  wrong medication.  She  said that she has  seen a delay                                                               
in treatment  because the optometrist  thought he or she  had the                                                               
ability to  manage the condition,  adding that some of  the cases                                                               
were "a block away from an ophthalmologist."                                                                                    
                                                                                                                                
3:35:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN,  in regard  to the "measuring  stick" that                                                               
is being used,  referred to the sponsor statement  and shared his                                                               
belief that the measurement is clearly stated.                                                                                  
                                                                                                                                
DR.  BRADFORD  replied that  the  wording  is "very  impressive,"                                                               
however, this simply says that  what is being taught in optometry                                                               
school is adequate to allow  an optometrist to prescribe systemic                                                               
medications.   She questioned  what the  "gold standard"  is, and                                                               
shared her belief  that the "gold standard"  is attending medical                                                               
school to  learn how different  medications affect  the different                                                               
systems of  the body.  She  questioned how, if a  person does not                                                               
take care  of patients  and learn the  lessons taught  in medical                                                               
school,  he or  she would  know  that the  education provided  by                                                               
optometry school is adequate.                                                                                                   
                                                                                                                                
3:38:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN  asked if optometrist school  is considered                                                               
a medical school.                                                                                                               
                                                                                                                                
DR. BRADFORD  replied that  optometrist school  is not  a medical                                                               
school.                                                                                                                         
                                                                                                                                
CHAIR OLSON stated  that New York, Rhode Island,  New Jersey, and                                                               
Florida do  not currently  allow an  extended scope  of practice.                                                               
He opined that  the aforementioned states have  a different level                                                               
of expertise than Alaska.                                                                                                       
                                                                                                                                
DR. BRADFORD  replied that this is  the "easy list."   She shared                                                               
her belief  that the remaining  45 states  do not allow  the same                                                               
scope of practice that is allowed by HB 113.                                                                                    
                                                                                                                                
3:39:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  noted that  there is  a lot  of variation                                                               
with respect  to what is allowed.   She said that  the handout in                                                               
members' packets  is "a little  inaccurate," as it  suggests that                                                               
all 45 states allow everything [that  is allowed by HB 133].  She                                                               
pointed  out  that the  lists  shows,  state  by state,  what  is                                                               
allowed.                                                                                                                        
                                                                                                                                
CHAIR OLSON shared  his understanding that the  handout says that                                                               
"some level" is allowed.                                                                                                        
                                                                                                                                
REPRESENTATIVE  LEDOUX,  with  regard  to  the  "gold  standard,"                                                               
questioned whether the same argument  could be made for different                                                               
medical  schools.    She commented  that  the  credential  should                                                               
provide a  certain amount of  comfort, as the human  anatomy does                                                               
not change.                                                                                                                     
                                                                                                                                
DR.  BRADFORD replied  that optometry  schools  have a  different                                                               
system  for accreditation  than  medical schools.   Graduates  of                                                               
medical school  must pass a  national board exam.   Additionally,                                                               
medical  school  faculty  must have  certain  credentials.    The                                                               
process  for medical  school is  different from  the process  for                                                               
optometry school.  The education  received at a medical school is                                                               
the same across the board, as is the testing.                                                                                   
                                                                                                                                
REPRESENTATIVE LEDOUX shared her  understanding that doctors with                                                               
medical  degrees from  other countries  are  allowed to  practice                                                               
medicine in  the United States,  although the  education received                                                               
may not be up to the same standards.                                                                                            
                                                                                                                                
DR.  BRADFORD explained  that these  individuals take  a separate                                                               
test, which many foreign graduates do  not pass.  She said that a                                                               
person  is  not  board  certified   in  ophthalmology  unless  an                                                               
American residency in ophthalmology is completed.                                                                               
                                                                                                                                
REPRESENTATIVE   LEDOUX   shared   her  understanding   that   an                                                               
ophthalmologist  can administer  the same  drugs and  treatments,                                                               
regardless of whether or not he or she is board certified.                                                                      
                                                                                                                                
DR.  BRADFORD said  that  ophthalmologists must  take  a test  to                                                               
ensure that  he or she  is able  to prescribe the  medication and                                                               
provide treatments.                                                                                                             
                                                                                                                                
3:44:50 PM                                                                                                                    
                                                                                                                                
ERIC  COULTER,  M.D.,  began  by  stating  that  he  is  a  board                                                               
certified ophthalmologist,  and a member of  the American Academy                                                               
of Ophthalmology.   He stated that there  are differences between                                                               
an optometrist and  an ophthalmologist.  He  said that throughout                                                               
the  50 states,  ophthalmologists  are  considered surgical  sub-                                                               
specialists,  adding  that  ophthalmologists  receive  a  medical                                                               
license,  while optometrists  do  not.   Ophthalmologists  attend                                                               
allopathic  medical schools,  and  optometrists attend  optometry                                                               
school.   He said that  the Alaska  State Medical Board  does not                                                               
offer a  medical license  to optometrists,  and hospitals  do not                                                               
allow  optometrists on  staff.    He said  that  there are  seven                                                               
ophthalmologists  who take  call  for  the entire  state.   If  a                                                               
person is admitted to the emergency  room with an eye injury, the                                                               
on-call  ophthalmologist handles  this.   He stated  that he  has                                                               
received the same training as an orthopedic surgeon.                                                                            
                                                                                                                                
DR.  COULTER  stated that  he  does  not  have any  problem  with                                                               
optometrists, and feels that they  provide a "wonderful service."                                                               
However, he shared  his belief that this is  similar to comparing                                                               
an  orthopedic  surgeon  to  a  paramedical  profession  such  as                                                               
chiropractic  care.    He  questioned  the  point  at  which  the                                                               
prescribing  authority  is  limited for  [chiropractic  care  and                                                               
optometry].   He  opined that  it is  inappropriate to  legislate                                                               
laws that  determine medical  competency.   He shared  his belief                                                               
that this  is a  task that reaches  farther than  the legislative                                                               
process.   He expressed concern  that these issues have  not been                                                               
discussed  with  the  Alaska  State   Medical  Board  or  medical                                                               
schools.   He stated  that if he  had a crisis  on his  hands, he                                                               
would not call  an optometrist for assistance,  and would contact                                                               
the  Alaska  State  Medical  Board   if  he  was  overwhelmed  or                                                               
overburdened with  call duties.   However, this is not  the case.                                                               
He  shared his  belief  that  if optometrists  wish  to have  the                                                               
ability to  dispense medications, they should  be responsible for                                                               
tracking down  the cause of  an eye disease.   He said  that this                                                               
brings  up other  concerns, and  "seems like  an oxy-moron."   He                                                               
opined that a more appropriate course  of action would be for the                                                               
optometrists  to   present  concerns  regarding   limitations  of                                                               
practice to  the State  Medical Board.   He  said that  the State                                                               
Medical Board  is really in tune  with the pulse of  medical care                                                               
in  Alaska.   He shared  his belief  that it  is not  possible to                                                               
legislate medical competency.  In  closure, he expressed his hope                                                               
that members  would understand what  the ophthalmologists  do for                                                               
the state  and the rigors  gone through  to reach their  level of                                                               
responsibility.   He said that this  is not a "turf  battle," but                                                               
an  interest in  promoting  what is  best for  the  patient.   He                                                               
stated  that he  is not  aware of  any ophthalmologists  that are                                                               
"screaming for  assistance."  If  the Alaska State  Medical Board                                                               
decides  to present  optometrists  with a  medical  license as  a                                                               
result of presentations  made by the optometrists,  he feels this                                                               
is fine.  However, he feels that  to "open the door a little bit"                                                               
is irresponsible.                                                                                                               
                                                                                                                                
3:56:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN  referred to a handout  in members' packets                                                               
from the  Alaska Optometric Association titled  "Frequently Asked                                                               
Questions," and pointed  out that the Alaska  State Medical Board                                                               
surveyed other medical  boards throughout the nation  to find out                                                               
if   there  were   problems  in   states   that  passed   similar                                                               
legislation.  He noted that no  problems were reported.  He asked                                                               
if Dr.  Coulter is aware  of any  problems that the  Alaska State                                                               
Medical Board is not.                                                                                                           
                                                                                                                                
DR.  COULTER shared  his belief  that in  Alaska, the  optometric                                                               
community "does  a great job"  of caring  for patients.   He said                                                               
that the Alaska State Medical  Board does not have much authority                                                               
over the optometric profession in  Alaska.  He questioned whether                                                               
the  medical  board  is  sponsoring  the  bill,  and  shared  his                                                               
understanding  that the  Alaska State  Medical Board,  along with                                                               
the  Alaska  State  Medical Association,  is  not  interested  in                                                               
promoting  the   expansion  of  a  paraprofessionals'   scope  of                                                               
practice.                                                                                                                       
                                                                                                                                
REPRESENTATIVE NEUMAN  reiterated that  the Alaska  Medical Board                                                               
surveyed medical  boards across the  nation and did not  find any                                                               
problems.                                                                                                                       
                                                                                                                                
DR.  COULTER  said  that  he  can appreciate  this,  and  is  not                                                               
suggesting that  cataclysmic problems  have occurred.   He stated                                                               
that he  is simply  pointing out the  difference between  the two                                                               
professions, and sharing his belief regarding the legislation.                                                                  
                                                                                                                                
4:00:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX asked if  general practitioners are allowed                                                               
to address eye-related problems or concerns.                                                                                    
                                                                                                                                
DR.  COULTER  replied  that general  practitioners  are  able  to                                                               
practice based  on the  standard of  care in  the community.   He                                                               
explained  that general  practitioners  can  treat and  prescribe                                                               
medication.   For a  general practitioner to  operate on  the eye                                                               
depends on  the availability of  ophthalmologic care.   He stated                                                               
that  when a  general  practitioner is  not  seeing results  from                                                               
efforts  to  improve a  condition,  the  patient  is sent  to  an                                                               
ophthalmologist.                                                                                                                
                                                                                                                                
REPRESENTATIVE LEDOUX asked  if an optometrist would  also send a                                                               
patient  to   an  ophthalmologist   if  the  condition   was  not                                                               
improving.                                                                                                                      
                                                                                                                                
DR. COULTER  replied that this happens  often.  He said  that the                                                               
difference is that one is a  medical doctor and the other is not.                                                               
He reiterated that he does  not have a problem with optometrists.                                                               
He  questioned  whether  the  medical   knowledge  of  a  general                                                               
practitioner is equitable  with that of an optometrist.   He said                                                               
that if  it was, optometrists  would be given a  medical license.                                                               
He pointed out that this is not true in any state.                                                                              
                                                                                                                                
4:05:57 PM                                                                                                                    
                                                                                                                                
CARL  E. ROSEN,  M.D., President,  Alaska State  Ophthalmological                                                               
Society, began  by giving  a brief explanation  of his  work, and                                                               
stated  that  he is  not  in  favor of  HB  113.   He  said  that                                                               
clarification   is  needed   with   regard  to   the  number   of                                                               
ophthalmologists  versus optometrists  in the  state.   He stated                                                               
that there  are around 40  ophthalmologists and  87 optometrists.                                                               
Additionally,  there are  two  ophthalmologists  that serve  nine                                                               
communities.   This is  a larger number  of communities  than was                                                               
stated  by Representative  Samuels  during  a previous  committee                                                               
hearing.   He  stated  that there  is no  public  outcry for  the                                                               
passage of HB 113.                                                                                                              
                                                                                                                                
4:09:09 PM                                                                                                                    
                                                                                                                                
DR.  ROSEN  went  on  to  say that  it  is  difficult  to  submit                                                               
complaints  to  the Alaska  Optometric  Board.   He  stated  that                                                               
claims that  no complications have occurred  are untrue, pointing                                                               
out that two  letters from patients experiencing  problems are in                                                               
members'  packets.   He stated  that injecting  medication around                                                               
the eye can be very complex,  and said that steroids are the most                                                               
common  injection.   He  said that  steroids  can cause  systemic                                                               
complications,  adding  that he  does  not  do  this often.    He                                                               
questioned why this  would be done by someone who  does not do it                                                               
frequently.   He  then shared  a story  involving an  experienced                                                               
physician that accidentally penetrated  a patient's eye, and said                                                               
that  errors  can  still  occur.    With  regard  to  access,  he                                                               
explained  that  photo  screening   and  telemedicine  are  being                                                               
adopted by more medical practitioners,  and will result in better                                                               
access  to  care.    He  said  that  there  is  no  concern  with                                                               
optometrists  giving  anaphylactic  injections,  adding  that  in                                                               
fifteen years,  he has not had  to do this.   Finally, he pointed                                                               
out  that many  states,  including California,  require that  the                                                               
optometrist  work  with  an  ophthalmologist,  prior  to  working                                                               
independently.   He stated that  oftentimes, optometrists  do not                                                               
reach the level  of experience needed to work  independently.  He                                                               
then shared his personal residency  experience, pointing out that                                                               
he was  required to  perform 150  supervised injections  prior to                                                               
graduating from the program.                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  asked whether  there  is  a shortage  of                                                               
care, absent the photo screening and telemedicine technology.                                                                   
                                                                                                                                
DR. ROSEN  replied that this  depends on the perspective.   While                                                               
there are  more optometrists  than ophthalmologists,  the Medical                                                               
Board  is  not  being  called   with  concerns  or  requests  for                                                               
additional ophthalmologists.  He  said that more ophthalmologists                                                               
are being  recruited, although he does  not feel that there  is a                                                               
shortage.                                                                                                                       
                                                                                                                                
DR. DANIEL  BRICELAND, American  Academy of  Ophthalmology (AAO),                                                               
shared  his   understanding  that  the  Board   of  Examiners  in                                                               
Optometry did a survey and said  that there were no complaints in                                                               
other states  where a broader scope  of practice is allowed.   He                                                               
expressed concern with this, and  stated that Arizona has had two                                                               
cases go to trial based  on complaints from the optometric board.                                                               
He  opined that  it is  unfair that  unrealistic information  has                                                               
been  given.   He then  said that  the education  received by  an                                                               
ophthalmologist and  the education received by  an optometrist is                                                               
not  comparable, and  detailed the  education required  before an                                                               
individual can practice ophthalmology.                                                                                          
                                                                                                                                
4:31:41 PM                                                                                                                    
                                                                                                                                
MICHAEL BENNETT,  O.D., President, Alaska  Optometric Association                                                               
(AKOA), stated that  HB 113 is "a very narrow  bill."  He pointed                                                               
out  that it  does  not  allow prescription  of  the most  abused                                                               
substances,  and  specifically  prohibits injections  inside  the                                                               
eye.    It  does  not grant  surgical  privileges,  and  mandates                                                               
continuing  education and  competency testing.   While  he agrees                                                               
that  ophthalmologists   are  different  than   optometrists,  he                                                               
pointed out  that optometry is  a "doctor level" profession.   He                                                               
detailed  the   education  received  by  an   optometrist,  which                                                               
requires  four years  of coursework  beyond a  bachelor's degree.                                                               
This includes  200 hours  in pharmacology  course work,  and over                                                               
2,000  hours  of supervised  patient  care.    He stated  that  a                                                               
medical case history  is taken every time a patient  is seen, and                                                               
drug interactions are  considered.  He pointed out  that for many                                                               
years optometrists have been  licensed to prescribe beta-blockers                                                               
for the treatment  of glaucoma, which can run  into many systemic                                                               
problems.   These  problems are  always considered,  and this  is                                                               
part of  the optometric training.   He said that  all medications                                                               
can  be  absorbed and  may  have  systemic side-effects,  whether                                                               
topical or  in the form  of an eye drop.   He commented  that the                                                               
majority of  patients seen are middle  aged or older, and  may be                                                               
on  multiple  medications,  adding  that  part  of  his  training                                                               
included clinical rotations in a Veterans Affairs (VA) hospital.                                                                
                                                                                                                                
DR. BENNETT  went on  to say that  the entrance  requirements and                                                               
course  load for  both optometric  and ophthalmology  schools are                                                               
similar.  With regard to  entrance difficulty, he stated that the                                                               
school he attended was second in  the state of Michigan.  He said                                                               
"The notion that we are  bringing in second-rate people who can't                                                               
get into medical school is just  simply not accurate."  He stated                                                               
that the scope of practice is  a very difficult issue.  While the                                                               
optometrists  would  like to  have  uniform  licensure, it  is  a                                                               
legislated  profession.   He referred  to a  handout in  members'                                                               
packets titled "Prohibitions and  Restrictions on the Practice of                                                               
Optometry Checklist,"  and explained that Alaska  would fall into                                                               
the second group, which is not a "leap."                                                                                        
                                                                                                                                
4:39:43 PM                                                                                                                    
                                                                                                                                
DR.  BENNETT explained  that graduates  of optometry  school must                                                               
complete  a  series of  exams,  much  like graduates  of  medical                                                               
school.   The exams are not  widely different from one  school to                                                               
another, with strict credentials for  the minimum number of hours                                                               
and required coursework.  Additionally,  optometrists must take a                                                               
series of national board exams  prior to receiving licensure.  He                                                               
said that when he moved to  Alaska, the Alaska Board of Examiners                                                               
in Optometry  required that he  have all current portions  of the                                                               
national board exam, and he took  the entire exam over again.  He                                                               
said "I'm  not ... here to  tell you that no  optometrist ... has                                                               
ever  made  a wrong  clinical  judgment  and had  an  unfortunate                                                               
outcome."   He  stated that  optometrists are  very conservative,                                                               
and  have  a "great  track  record."    He  pointed out  that  an                                                               
optometrist  pays  $511  per  year,   for  $1  million  worth  of                                                               
malpractice insurance coverage, while  an ophthalmologist pays 38                                                               
times this  amount.  The  major optometric  malpractice insurance                                                               
carrier  conducted  a study  that  examined  states that  have  a                                                               
limited scope  versus those  that have  allowed a  more expansive                                                               
scope.   This study found  that there was no  correlation between                                                               
the scope  of practice and the  number of malpractice cases.   He                                                               
reiterated that optometrists are not "angling to be surgeons."                                                                  
                                                                                                                                
4:45:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RAMRAS  expressed concern regarding the  amount of                                                               
time  spent discussing  this  issue,  and stated  that  he is  in                                                               
support of this legislation.                                                                                                    
                                                                                                                                
4:47:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN referred to a  letter from the Alaska State                                                               
Medical Association (ASMA), which  states that "No parameters are                                                               
provided  concerning the  educational or  post graduate  training                                                               
criteria that the Board of Optometry  would apply."  He asked Dr.                                                               
Bennett  to describe  the education  and  post graduate  training                                                               
criteria that the [Board of Examiners in Optometry] would apply.                                                                
                                                                                                                                
DR. BENNETT  replied that  this is addressed  in the  most recent                                                               
version of  the bill.   He surmised,  then, that this  letter may                                                               
refer to the original version of bill.                                                                                          
                                                                                                                                
4:49:05 PM                                                                                                                    
                                                                                                                                
DR.  BENNETT,  in  response to  a  question  from  Representative                                                               
Gardner,  said that  Oklahoma  has the  "most  liberal" scope  of                                                               
practice,  while  North  Carolina   has  the  "longest  standing"                                                               
extended scope  of practice.  He  stated that both are  among the                                                               
states which allow the broadest scope of practice.                                                                              
                                                                                                                                
REPRESENTATIVE   GARDNER,  referring   to   the  handout   titled                                                               
"Prohibitions  and  Restrictions  on the  Practice  of  Optometry                                                               
Checklist," pointed out  that North Carolina is  among the states                                                               
that prohibit all drug injections.                                                                                              
                                                                                                                                
DR.  BENNETT replied  that  this information  is  incorrect.   He                                                               
offered to contact  the board, and shared  his understanding that                                                               
North Carolina is  among the seven states that  have very little,                                                               
if  any  restrictions.    Injections  into  the  eyeball  may  be                                                               
restricted.   He  shared his  understanding that  the information                                                               
included in the  handout was taken from the  internet, and stated                                                               
that the  information offered  by the AOA  was gathered  from the                                                               
various state boards.                                                                                                           
                                                                                                                                
4:51:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  NEUMAN shared  his understanding  that the  House                                                               
Health, Education  and Social  Services Standing  Committee added                                                               
language  regarding   the  parameters  for  education   and  post                                                               
graduate training.                                                                                                              
                                                                                                                                
DR. BENNETT agreed that this  is correct, and reiterated that the                                                               
aforementioned  concerned  individuals  must not  have  seen  the                                                               
committee substitute  that added this  language.  He  then stated                                                               
that the  survey of state medical  boards was done by  the Alaska                                                               
State  Medical  Board.   Although  the  ophthalmologists in  some                                                               
states did not  like the expanded scope of  practice, no problems                                                               
were reported.   He  commented that the  State Medical  Board has                                                               
nothing to do with optometry.                                                                                                   
                                                                                                                                
REPRESENTATIVE  GARDNER,  referring to  Section  3  of the  bill,                                                               
asked   Dr.    Bennett   to   discuss    the   "physician-patient                                                               
relationship."                                                                                                                  
                                                                                                                                
DR. BENNETT  replied that  he is  "a little  puzzled" as  to this                                                               
language.  He surmised that this  might be an attempt to restrict                                                               
optometrists from selling medication over  the internet.  He said                                                               
that whenever a  patient is seen in the office  or spoken to over                                                               
the phone, this type of a relationship exists.                                                                                  
                                                                                                                                
CHAIR OLSON closed public testimony.                                                                                            
                                                                                                                                
4:54:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  NEUMAN  moved  to  report CSHB  113(HES)  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSHB  133(HES)  was                                                               
reported from the House Labor and Commerce Standing Committee.                                                                  
                                                                                                                                
4:54:57 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Labor and Commerce Standing Committee meeting was adjourned at                                                                  
4:55 PM.                                                                                                                        
                                                                                                                                

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