Legislature(2001 - 2002)
05/11/2002 09:47 AM House RLS
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 270-DISPENSING OPTICIANS:EXTEND BD/REGULATION CHAIR KOTT announced that the final order of business would be CS FOR SENATE BILL NO. 270(L&C), "An Act extending the termination date of the Board of Dispensing Opticians; relating to the regulation of dispensing opticians; and providing for an effective date." Chair Kott noted that there is an HCS, Version 22-LS1382\U, Laurterbach, 5/10/02. Number 1845 HEATHER BRAKES, Staff to Senator Gene Therriault, Joint Committee on Legislative Budget & Audit, Alaska State Legislature, testified on behalf of the sponsor, the Joint Committee on Legislative Budget & Audit. She explained that SB 270 was drafted per the audit recommendations with regard to dispensing opticians. The legislation makes changes to licensing requirements that would remove barriers to entry into the profession. These changes are reflected in Sections 1-11 of [Version U]. Furthermore, intent language stating the need for the Board of Dispensing Opticians to address its deficit was inserted. The intent language also specifies that the next legislative audit review the board's progress in that area. MS. BRAKES turned attention to Section 2, page 2, line 1. She recalled her testimony before the House Finance Committee when she stated that the sponsor wouldn't have any problem with a one-year extension. She explained that the one-year extension was seen as a way to send a message to the board. However, a one-year extension would mean that the legislative auditor would have to begin the review now and thus the board wouldn't have the opportunity to address the deficit situation. Therefore, she suggested changing the extension to 2004. CHAIR KOTT recalled that the 2004 extension was the date specified when the bill left the House Labor and Commerce Standing Committee. Although he understood that the House Finance Committee wanted to send the board a message via a one- year extension, Chair Kott said he understood that many boards operate in the red. The division sets the fees, he noted. Number 1748 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Community & Economic Development (DCED), agreed that the division sets the fees and is ultimately responsible for any failure to be financially self-sufficient. She also agreed that various boards fall into deficit at various times while other boards have a surplus. For those in surplus situations, the division adjusts their fees so that deficits are repaid. Therefore, it isn't unusual for a board to be in a deficit and have its fees adjusted in order to repay the deficit. Ms. Reardon said that she would appreciate a 2004 sunset in order that the auditors can see that the fees are increased and the result of the increased fees. It seems that the process would be more valuable if the sunset is 2004, she said. REPRESENTATIVE BERKOWITZ inquired as to what would happen if there is no extension. MS. REARDON explained that next year would be the wind-down year and the board would disappear if there is no intervening legislative action. However, there would be a question regarding whether the division is to continue to license in the absence of the board. Therefore, in such a situation the legislature would need to make conforming amendments changing references to the board to the department. REPRESENTATIVE BERKOWITZ asked if the wind-down status would adversely impact the health of Alaskans seeking optician services. MS. REARDON answered that business would continue as usual if it seems that the legislature is likely to continue the board. "There isn't a lot to do to wind down," she said. REPRESENTATIVE BERKOWITZ pointed out the reduction in the training equivalent from 6,000 hours to 1,800 hours. He inquired as to the reason for that reduction. He also inquired as to the national standard. MS. REARDON informed the committee that approximately half of all states regulate and issue licenses for dispensing opticians. For those states that do, all but two have licensing boards and a 2-3 year apprenticeship requirement. She noted that 1,000 hours equals about six months. The current requirement is about three years and this would reduce it to about one year, and therefore she didn't view the reduction as out of line. Although the board would've preferred 3,000 hours, the legislative auditors felt 3,000 [training] hours was too much. On the other hand, this legislation adds that a board approved course, such as the Career Progression Program, be passed before licensure. Therefore, she viewed that requirement as sort of offsetting the reduction in training. Number 1549 REPRESENTATIVE JOULE posed a situation in which the board is gone, and inquired as to how the part of the bill related to the expansion of the use of pharmaceutical agents by optometrists is tied to the portion of the bill related to the extension of the [board]. MS. REARDON explained that if the Board of Dispensing Opticians and the regulations for the dispensing opticians are eliminated, the Board of Optometry will still exist and regulate optometrists. The second half of the bill addresses optometrists. Ms. Reardon didn't see that the two sections of the bill impacted each other. CHAIR KOTT closed public testimony. REPRESENTATIVE McGUIRE announced that she doesn't like HB 215, which relates to the to the use of pharmaceutical agents in the practice of optometry. Therefore, she also announced that she would vote against [HCS CSSB 270] on the House floor. Similar measures have been rejected in five other states this year alone, she pointed out. She remarked that this is a dangerous course to take. She specified that it's more than medical school, it's the residency requirements that provide ophthalmologists extra experience with regard to how drugs interact with other drugs and diseases. Furthermore, she expressed concern with the impact to rural Alaska. Number 1357 REPRESENTATIVE KOHRING moved to adopt HCS CSSB 270, Version 22- LS1382\U, Lauterbach, 5/10/02, as the working document. REPRESENTATIVE BERKOWITZ objected. A roll call vote was taken. Representatives Porter, Kohring, Morgan, and Kott voted to adopt Version U. Representatives McGuire, Berkowitz, and Joule voted against adopting Version U. Therefore, Version U was adopted by a vote of 4:3. Number 1298 CHAIR KOTT moved that the committee adopt the following conceptual amendment: Page 2, line 2, Delete "2003" Insert "2004" There being no objection, the conceptual amendment was adopted. Number 1275 REPRESENTATIVE JOULE moved the following amendment: Page 3, lines 16 and 18, Delete "1,800" Insert "3,000" MS. BRAKES explained that the training hours were reduced to 1,800 due to testimony from opticians and its board. Originally, SB 270 specified 3,000 [apprenticeship] training hours. The board testified that under the 6,000 apprenticeship training hours requirement, people weren't passing the practical exam. The board felt that this was happening due to the lack of training received by the opticians. Therefore, the board expressed the need to add the educational piece, which averages between a 12-36 month course. Upon adding the educational piece, the apprenticeship training hours were reduced to 1,800. Ms. Brakes informed the committee that those states that regulate opticians have a 6,000 hour requirement but don't have an educational piece. REPRESENTATIVE JOULE withdrew the amendment. REPRESENTATIVE BERKOWITZ turned to the optometrist section on page 7 and inquired as to why it's in the uncodified section of the law. Number 1060 LINDA SYLVESTER, Staff to Representative Kott, Alaska State Legislature, explained that the transitional provision addresses the transition in which the opticians would be able to prescribe medication. This provision deals with the licensees. She said that the intention is to eliminate the ability to grandfather and thus clarify that those graduating from an optometry school prior to a specified point wouldn't be able to prescribe. This provision isn't appropriate in statute because it discusses a transitional period that will go away at a particular point in time. REPRESENTATIVE BERKOWITZ said that he interpreted the provision to say that one couldn't obtain this license unless that person received their initial license after 1999. MS. SYLVESTER said she has seen that referred to as 2000 and later. REPRESENTATIVE BERKOWITZ asked, "So only the young optometrists or the new optometrists are going to have this license." MS. SYLVESTER pointed to the Transitional Section paragraph (2) and said that the optometrists would need to have "passed a course covering systemic administration of pharmaceutical agents that was offered by an accredited college of optometry". REPRESENTATIVE BERKOWITZ highlighted that the Transitional Section is written in the disjunctive due to the use of "or." MS. SYLVESTER informed the committee that there are four optometrists practicing in Alaska who graduated from optometry school prior to 1968, which was before the medical model was instituted in schools of optometry. The intent was to specifically not qualify those optometrists. She recalled that this requirement was mentioned in the governor's veto letter. REPRESENTATIVE BERKOWITZ said that under this language one could have conceivably received their license to practice after 1999 and not have taken one of those courses, while still being authorized to prescribe a pharmaceutical agent. MS. SYLVESTER recalled testimony indicating that those graduating after 1999/2000 are fully trained with a four-year degree in optometry, which includes 3,000 hours of clinical and laboratory training. REPRESENTATIVE BERKOWITZ pointed out that this [language] speaks to the initial license not graduation. Therefore, one could have graduated in 1960 and not obtain the initial license until 2000. REPRESENTATIVE McGUIRE noted her agreement with Representative Berkowitz's reading. Number 0843 MS. REARDON related her belief that although Section 16 was described as a transitional provision, she read it as a permanent part of law and thus, perhaps, not most appropriate as part of the uncodified law. She interpreted [Section 16] to say that no one can be issued an endorsement to their optometry license that allows prescription of systemic drugs unless they obtain an initial license after 1999 or have the specified courses. She read those two qualifications as being in addition to the requirements in AS 08.72.175 on page 5. If the language is to mean one's initial Alaskan license, then individuals could be [coming on per their] credentials. REPRESENTATIVE BERKOWITZ asked whether one could [practice in Alaska] with an initial license obtained from another country. MS. REARDON answered that the term isn't defined, and therefore [the initial license] could be obtained in another country, she imagined. If the objective is to require a training course either within the regular degree course or afterwards, then she assumed that those graduating after 1999 would have the course and could provide [proof] of taking the course in their transcripts in order to meet qualification (2). Therefore, it's conceivable that qualification (1) isn't necessary because those graduating after 1999 with the training could provide proof of that course in systemic administration. MS. REARDON turned to Section 17, which addresses existing endorsements. She informed the committee that currently optometrists can have endorsements on their license that allows them to prescribe. This law expands the type of things that optometrists can prescribe. Currently, [optometrists] are carrying endorsements that allow them to prescribe topical drugs, not systemic drugs. Therefore, [Section 17] addresses what to do with those [with an endorsement to prescribe topical drugs]. As mentioned earlier, the governor had the same concern with legislation introduced last year. Number 0574 REPRESENTATIVE PORTER asked if [Section 17] paragraph (2), which refers to the course covering systemic administration of pharmaceutical agents, is presumed to have occurred for those who have graduated after 1999. MS. REARDON replied yes. REPRESENTATIVE PORTER asked whether the confusion could be reduced with the elimination of [Section 17] paragraph (1). MS. SYLVESTER related her belief that this [Section 17 paragraph (2)] was important in increasing a comfort level. MS. REARDON recalled concern that there was a course training people in [systemic administration]. [Section 17] paragraph (2) is very specific, while [Section 17] paragraph (1) is a bit vague. Therefore, [Section 17] paragraph (2) is preferable. MS. SYLVESTER recalled testimony from Linda Kasser, Dean, University of the Pacific, where most Alaskan optometrists are trained. Ms. Kasser testified that there are 17 optometric colleges. Although Ms. Kasser said that she has never done a side-by-side analysis of the curriculum, she believes they're the same. CHAIR KOTT related his confusion with regard to the necessity of [Section 17] paragraph (1). MS. SYLVESTER returned to Representative Berkowitz's earlier question regarding reciprocity. She explained that reciprocity [statutes] specify that an individual has to have a current license by examination in another state or province of Canada. MS. REARDON highlighted that what Ms. Sylvester is referring to is the qualification for obtaining a license by reciprocity, while [the language in the bill] refers to obtaining an endorsement. Number 0355 REPRESENTATIVE BERKOWITZ inquired as to whether there is a standard [for the content] of the courses. MS. REARDON replied no, but pointed out that the bill specifies that the course must be approved by the Board of Examiners in Optometry. In further response to Representative Berkowitz, Ms. Reardon explained that generally the board would write regulations specifying that the board approves courses meeting specified parameters. REPRESENTATIVE McGUIRE expressed her concern that the Board of Examiners in Optometry is not made up of medical doctors who don't have training in systemic drugs and their interactions with the body and other diseases. That board is now going to establish qualifications for the group that will prescribe systemic drugs. Therefore, why wouldn't the medical board be more logical to oversee this area, she asked. MS. SYLVESTER said that the testimony hasn't been that these people aren't trained. She informed the committee that in 1968 optometrists were basically opticians, then a revolution of training occurred and colleges adopted the medical model. Therefore, optometrists today have four years of optometry school and have the medical training. Ms. Sylvester also informed the committee that all 50 states allow optometrists to prescribe topical drugs and 38 states allow optometrists to prescribe systemic drugs. She mentioned that systemic drugs are mainly antibiotics for the treatment of ocular disease. REPRESENTATIVE McGUIRE interjected that systemic drugs are more than [antibiotics for the treatment of ocular disease]. "There is the potential for it to be a lot more than that," she pointed out. She indicated that she might not have that much of a problem with this if the language was narrowly crafted such that it referred to the prescription of [antibiotics for the treatment of ocular disease]. However, the language is broad and this same group returns to the legislature every couple of years requesting more. She expressed concern with the "slippery slope" effect. She questioned why one would go to medical school [if this avenue exists]. TAPE 02-13, SIDE A MS. SYLVESTER stressed that not everyone wants to be a medical doctor; some people want to be dentists. Dentists, who don't attend medical school, are able to provide systemic medications to their patients for dental. Furthermore, podiatrists aren't medical doctors yet are authorized in statute to prescribe medications. The concept is that the medical field is expanded to include a number of different fields. Number 0061 REPRESENTATIVE BERKOWITZ inquired as to the process by which the other professions mentioned by Ms. Sylvester prescribe drugs and are licensed to do so. MS. REARDON explained that generally professions such as dentists, advanced nurse practitioners, physician assistants, and osteopaths, don't have a separate endorsement allowing them to prescribe. The training received in dental school, which is about the same length as optometry school, has been viewed such that it's safe for a dentist to prescribe [drugs]. REPRESENTATIVE BERKOWITZ asked whether any of the aforementioned professions have the authority to prescribe pharmaceutical agents by systemic administration. MS. REARDON replied yes, they all do. REPRESENTATIVE BERKOWITZ inquired as to how those professions are licensed. Is that licensure process consistent with the proposal in this bill, he asked. MS. REARDON pointed out that each licensing system is slightly different. For dentists, when the dentist receives his/her license, he/she can prescribe systemic drugs; there's no extra qualification process to do so. Advanced nurse practitioners who want to prescribe controlled substances have to show that they have specific training in addition to their basic qualifications. REPRESENTATIVE BERKOWITZ asked whether [those two professions] are required to have any affiliation with a physician. MS. REARDON specified that dentists and advanced nurse practitioners are not required to have any affiliation with a physician. MS. SYLVESTER interjected: Today in Alaska you have a situation where an optometrist who is fully trained to do this must go to someone who is lesser trained to prescribe the medication because Alaska statute doesn't allow these people to practice at the full level of their training. The question isn't: Are ophthalmologists more qualified. They are. The question is: Are optometrists qualified? And yes they are. Number 0319 REPRESENTATIVE BERKOWITZ moved that the committee adopt the following amendment, Amendment 1: Page 7, lines 10 and 23, Delete "that was" There being no objection, Amendment 1 was adopted. Number 0466 REPRESENTATIVE McGUIRE moved that the committee adopt the following amendment, Amendment 2: Page 7 Delete lines 7-8 and 20-21 Page 7, line 19, Delete "either" There being no objection, Amendment 2 was adopted. REPRESENTATIVE PORTER noted that Amendment 2 would require conforming numbering changes. Number 0509 REPRESENTATIVE BERKOWITZ questioned whether the course requirement without guidance as to the content of the course is problematic. REPRESENTATIVE JOULE pointed out that the Board of Examiners of Optometry decides the content of the course. REPRESENTATIVE BERKOWITZ pointed out that there could be a situation in which someone could take a course in systemic administration of pharmaceutical agents but want to prescribe different pharmaceutical agents. MS. REARDON remarked on the difficulty in having a law that requires an individual to take a course in prescribing a particular systemic agent because new drugs are developed daily. She pointed out that there is a continuing education requirement for optometrists who have endorsements to prescribe. REPRESENTATIVE BERKOWITZ clarified that wasn't what he was suggesting. He specified that there are different systemic administrations. MS. SYLVESTER informed the committee that these are established courses by schools of optometry. Optometrists, including those in Alaska, are already taking these courses. If this bill were to become law, optometrists in Alaska would take the course again. REPRESENTATIVE BERKOWITZ said, "There's a piece of me that wants to say, 'and approved by the Boards of Examiners in Optometry and Ophthalmology meeting in joint session'." REPRESENTATIVE McGUIRE concurred, and mentioned inclusion of the medical board as well. Number 0693 REPRESENTATIVE McGUIRE inquired as to the inclusion of anaphylaxis. MS. SYLVESTER explained that the current law prevents optometrists from injecting, which is how anaphylaxis is administered. Therefore, the inclusion allows this particular injection for first aid. REPRESENTATIVE McGUIRE asked why a law is necessary for this and why it's included in a licensing requirements. She viewed this as opening up an entire area of practice. MS. REARDON recalled that there is concern that the law would prevent an optometrist from administering an anaphylactic injection because their prescriptive authority wouldn't allow it in a medical emergency. REPRESENTATIVE McGUIRE characterized it as a liability issue, and asked if it is. MS. REARDON said that she didn't know. MS. SYLVESTER noted that the liability issue was never discussed. From discussions with optometrists, the concern was that they are the one group that aren't allowed to perform injections per statute. Therefore, one could argue that the liability is skewed in the other direction. Number 0892 REPRESENTATIVE BERKOWITZ turned to the requirements for ophthalmologists and referred to page 3 of the bill. He highlighted the requirement of passing the examination with an acceptable score versus merely passing a course. [The optometrist requirements that are being established] don't specify a requirement for an acceptable score. Furthermore, there is no experience requirement [for optometrists]. MS. REARDON said that the assumption is that "passing the course" means that the individual successfully completed the course. She mentioned that this would be based on what the school requires for passing its courses. She pointed out that this is the case with other professions. Number 1035 CHAIR KOTT asked whether there is a problem with removing paragraph (1) from Sections 16 and 17. MS. REARDON replied no. REPRESENTATIVE McGUIRE inquired as to what would happen if this bill doesn't pass. MS. REARDON said that the opticians would go into a wind-down year and would return to the legislature and request introduction of legislation continuing the board. CHAIR KOTT mentioned the concern that a wind-down year would have some negative effect. MS. REARDON specified that it depends upon the board. In terms of occupational licensing boards, there isn't much disturbance created. However, for those boards involved with the regulation of an industry, such as with the RCA, there could be different implications. Ms. Reardon said the closer to adjournment, the more of a problem it may become because of scheduling, anxiety of applicants, and concern as to whether the profession will be left unregulated. Number 1215 REPRESENTATIVE KOHRING moved to report HCS CSSB 270, Version U, as amended out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HCS CSSB 270(RLS) was reported from the House Rules Standing Committee.
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