Legislature(2017 - 2018)SENATE FINANCE 532
05/10/2017 09:00 AM FINANCE
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CS FOR HOUSE BILL NO. 103(FIN) "An Act relating to the practice of optometry; and providing for an effective date." 10:22:52 AM REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, introduced the bill. She relayed that HB 103, as amended in the house, would not allow optometrists to perform services outside of their scope of practice; performing invasive surgery would continue to be illegal. She said that if optometrists wanted to perform procedures beyond what was currently allowed in statute and regulation, they would only be allowed to do so if the licensee had been educated and trained in the procedure at one of the accredited schools of optometry. Additionally, procedures would need to be authorized by regulations adopted by the board. She stated that there should be room for innovation in the healthcare sector, but that optometrists should only practice procedures that had been taught by a credited school of optometry. She noted that the ophthalmologist definition of "surgery" was used in the bill, which expressly stated that optometrists would not practice any of the listed surgeries, with narrow exceptions. She relayed that the definition of "surgery" was broad and that some of the things that optometrists currently practiced met the definition of surgery. She added that there had to be an allowance for narrow exceptions, which would change over time as the skills and training of optometrists continued. She offered a personal anecdote pertaining to the nebulous definition of surgery under the current law. She concluded that the bill would allow for the board of optometry to regulate itself in an ongoing and iterative fashion that would allow for evolution in best practices. 10:27:29 AM BERNICE NISBETT, STAFF, REPRESENTATIVE IVY SPOHNHOLZ, discussed the sectional analysis for HB 103: Notes differences between HB 103 v. U and SB 36 v. J Section 1 - The Board of Examiners of Optometry will regulate prescriptive authority and develop standards for the practice of optometry. No difference. Section 2 - The board will publish advisory opinions regarding standards for the practice of optometry. Language was changed by the House Labor & Commerce committee: expanded to state that the Board of Examiners of Optometry will be allowed to publish advisory opinions to the public regarding whether the standards of practice of optometry comply with what is currently written in statute. Section 3 - The licensee must provide evidence that they have completed their continuing education hours during the preceding licensing period. No difference. Section 4 - A licensee can prescribe pharmaceuticals in a manner that is consistent with board regulations and complies with the limitation on practice in section 5. No difference. Section 5 - Limits an individual licensee to performing services that are within the scope of the licensee's education, training, and experience. No difference in subsection (a). Subsections (b) and (c) were added in the House Finance committee: (b) added setting a limitation on performing ophthalmic surgery unless a licensee has received education and training from an accredited school of optometry and the procedure is authorized in regulations set by the Board of Examiners of Optometry. Subsection (c) has been added to define ophthalmic surgery. Section 6 - The definition of optometry has been updated. No difference. Section 7 - Section 2 is effective July 17, 2017. No difference. 10:29:11 AM Representative Spohnholz stressed the importance that the board have the flexibility to evolve, while also addressing the issue of access to healthcare. She said that there were 26 ophthalmologists, verses 160 optometrists, providing the majority of eye healthcare throughout the state. She thought that allowing the board to manage itself would help to increase access to high quality eye healthcare in rural Alaska. 10:30:40 AM Senator Hughes asked about Page 2, line 29. She asked about the word "experience" and wondered how it applied to someone fresh out of school. She wondered how experience would be measured. Representative Spohnholz explained that there were optometrists practicing in the state that had been trained in procedures that they had not had the opportunity to provide in 20 years. She said that before those doctors could practice those procedures they would be expected to be retrained in updated methods. Senator Hughes remained confused about how the experience levels would be measured. Representative Spohnholz referred the question to the board of optometry. Co-Chair MacKinnon OPENED public testimony. 10:33:41 AM DAVID ZUMBRO, OPHTHALMOLOGIST, ANCHORAGE (via teleconference), spoke in opposition to HB 103. He spoke to the assertion that the statutes pertaining to optometry had not been updated in 40 years; he countered that multiple times in the past 25 years legislation had been passed and signed into law that expanded the scope of practice. He contended that optometry and ophthalmology educations were not equivalent or similar. He encouraged members to further study the accreditation requirements for completing an ophthalmology residency. He said that his opposition to the bill had nothing to do with economics. He contended that the reason behind standards and board certification was patient safety, and that the only way to expand medical and surgical scope of practice was proper education and not legislation. 10:36:58 AM JEFF GONNASON, CHAIR, ALASKA OPTOMETRY ASSOCIATION, ANCHORAGE (via teleconference), spoke in support of the bill. He believed that the bill was innocuous and would do very little to the practice of optometry in the state. He noted that he had sent a letter to the committee (copy on file). 10:38:34 AM GRIFF STEINER, OPHTHALMOLOGIST, ANCHORAGE, testified in opposition to the bill. He asserted that the bill pertained to surgical procedures. He stated that optometrists were not qualified to perform surgery. He relayed that the cost for care would increase under the legislation. 10:40:47 AM ANDREW PETER, SELF, HOMER (via teleconference), spoke in support of HB 103. He believed that the bill would create board autonomy, which would remove the legislature from the position of managing optometry. He noted that optometrists catered to a diverse section of the state's population. He offered some details as to how his practice worked on a day-to-day basis. He contended that emergency cases in rural areas of the state posed the need for immediate attention, which occasionally called for optometrists to perform services like ophthalmologists. 10:44:07 AM CARL ROSEN, OPHTHALMOLOGIST, ANCHORAGE (via teleconference), testified in strong opposition to the bill. He highlighted that the optometry board should not have the authority to decide which surgical procedures, laser procedures, and injections were possible. He argued that optometrists were not qualified to perform the same medical procedures as ophthalmologists because they did not have the same rigorous medical training. He believed that the bill would work if the word "unless" was removed from the language pertaining to surgery and optometry. 10:46:43 AM REBEKAH SAWERS, SELF, HOONAH (via teleconference), spoke in opposition to the bill. 10:47:08 AM LUCRETIA DENNIS, SELF, ANCHORAGE (via teleconference), testified in opposition to the bill. She provided a comparison between armed and unarmed security officers, and ophthalmologists versus optometrists. 10:50:13 AM DAVID KARPIK, SELF, KENAI (via teleconference), spoke in support of HB 103. He testified that optometrists were sometimes the only eyecare providers in rural Alaska. He said that as an optometrist he supported practices that provided comprehensive eyecare services and referred to sub-special services, which enhanced patient care and lowered costs by allowing primary eyecare to be provided locally. He referred to a U.S News and World report study published in early 2017, that ranked Alaska as last in access to healthcare. He believed that the delays to healthcare that were currently written into statute hindered access to eyecare. He believed that the legislation would create an optometry statute that would be durable and would allow for the incorporation of new technology in the field. 10:52:38 AM DAVID KATZEEK, SELF, JUNEAU (via teleconference), spoke in opposition to HB 103. He testified of the delicate nature and importance of the human eye. He asserted that eyes "speak" in a way understood by optometrists and ophthalmologists. He worried that the bill was being used as a political tool at the expense of the eye health of Alaskans. He warned that the legislation passed by the committee should protect the eyes of current and future Alaskans. He stressed the importance of teaching young people to maintain a health whole body, which included their eyes. 10:57:28 AM STANLEY FULLER MD, SELF, FAIRBANKS (via teleconference), testified in opposition to the bill. He noted that the expansion of the scope of practice for optometrists was an issue that was being discussed on the national level, and what more than just a housekeeping issue. He believed that the legislation would allow optometrists to perform surgery, which would result in dangerous and unsafe practices. He stressed that optometrists were not trained in surgical procedures, and that optometry schools did not offer training in surgical procedures. He agreed that access to healthcare in Alaska was a problem, but he felt that access to providers that were appropriately trained to safely perform procedures should be germane to the conversation. 11:00:35 AM MARY NANUWAK, SELF, BETHEL (via teleconference), spoke in opposition to the bill. She provided remarks in Yup'ik. She thanked the committee for allowing her to testify. She believed that optometrists should not be performing eye surgery. 11:03:22 AM JILL GEERING MATHESON, OPTOMETRY, JUNEAU, spoke in support of the bill. She believed that the intent of the legislation was to allow the Alaska State Board of Optometry to regulate optometrists in the state. She asserted that the bill would not expand the privileges allowed to optometrists, but would give the optometry board the ability to decide what optometrists were trained and qualified to perform and then provide for regulation. She believed that the opposition was employing fear tactics concerning surgery to sway public opinion on the bill. She argued that the board needed to be able to act quickly, via the regulatory process, to make changes as technology advanced. 11:07:00 AM PAUL BARNEY, BOARD OF OPTOMETRY, JUNEAU, testified in support of the bill. He discussed his experience in the field. He believed that the bill would allow for the board of optometry to regulate the details of the practice of optometry, and would allow optometrists to practice to their highest education level. He felt that the bill clearly defined "surgery". 11:10:31 AM Senator Olson asked what kind of complaints the board received from licensees. Dr. Barney relayed that he had been on the board for the past 6 years and in that time the board had received zero complaints. Senator Olson asked whether Dr. Barney was familiar with the Oklahoma study that had been referenced earlier in the meeting. Dr. Barney replied that he was familiar with the study. He said that the study was regarding a laser trabeculoplasty, which was a surgery used to lower pressure in glaucoma. He said that the study examined billing codes. He spoke to the details of the study and concluded that it had not accurately examined outcomes of different surgery procedures. 11:12:52 AM Senator von Imhof stated that she had researched an optometry school in Ohio. She felt that an accredited school of optometry could license a person to perform ophthalmic surgery non-invasively. Dr. Barney stated that he performed procedures daily that were considered surgery. He added that there were different levels to ophthalmic surgery. 11:14:35 AM Co-Chair MacKinnon CLOSED public testimony. 11:14:57 AM RECESSED 2:37:40 PM RECONVENED Co-Chair MacKinnon discussed housekeeping. Senator Olson asked whether the Alaska Native Tribal Health Consortium (ANTHC) supported the legislation. Ms. Nisbett responded that ANTHC had not provided any comments regarding HB 103. Senator Olson understood that the Southcentral Foundation had provided an opinion on the legislation. Ms. Nisbett relayed that the bill carried with it a letter of support from the Southcentral Foundation, in addition to one from the Alaska Native Health Board. Senator Olson commented that healthcare was primarily handled by tribal health corporations in Western and Southern Alaska. He asked whether the sponsor had been in contact with tribal health corporations regarding HB 103. Ms. Nisbett stated that the sponsor's office had not reached out to those organizations, but would be willing to do so. 2:40:06 PM Senator Hughes referred to her earlier question about how experience would be quantified for new optometrists. She wondered whether Dr. Barney could speak to the issue. Dr. Barney provided that as part of their clinical training optometrists would experience any procedures that needed to be done, which would provide them with the necessary experience upon graduation. Senator Hughes asked what procedures a newly graduated optometrist in the state was trained to do, but could not currently execute due to current statutes. Dr. Barney provided the example of removal of minor eye lid lesions. He said that optometrists would receive education and training for the procedure during optometry school, but that state statute currently did not allow for optometrists to perform the procedure. Senator Hughes understood that the bill would give the board the authority through regulation to allow for practices within the scope of the licensee's education and training from an accredited school of optometry. She asked how, as a board member, Dr. Barney would make decisions as to whether a procedure could be performed by an optometrist. Dr. Barney explained that the federal accreditation process for optometry schools within the state was overseen by the U.S. Department of Education. He said that there would be federal oversight into the curricula to assure that it was complete and thorough. He stated that an optometrist that had been practicing for 20 years that wanted to perform a board approved procedure would be required by the board to acquire the proper updated training. 2:44:48 PM Vice-Chair Bishop discussed FN2(CED) for the bill. 2:46:15 PM Co-Chair MacKinnon noted that Senator Giessel had sponsored the Senate companion bill for HB 103. SENATOR CATHY GIESSEL, remarked that she supported the changes that had been made in the house version of the legislation. 2:46:58 PM Vice-Chair Bishop MOVED to report CSHB 103(FIN) out of Committee with individual recommendations and the accompanying fiscal note. There being NO OBJECTION, it was so ordered. CSHB 103(FIN) was REPORTED out of committee with "no recommendation" and with one previously published fiscal impact note: FN2(CED). 2:47:30 PM AT EASE 2:49:40 PM RECONVENED Co-Chair MacKinnon discussed housekeeping for SB 79 and HB 111. She stated that each member's office had received a Senate Finance Committee Resolution that pertained to the Real ID Act and the handling of Alaskan's private data.