Legislature(2017 - 2018)BUTROVICH 205
02/03/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB36 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 36 | TELECONFERENCED | |
SB 36-OPTOMETRY & OPTOMETRISTS
1:30:38 PM
CHAIR WILSON announced the consideration of SB 36.
1:31:08 PM
SENATOR CATHY GIESSEL, sponsor of SB 36, Alaska State
Legislature, Juneau, Alaska, read the sponsor statement for SB
36 as follows:
SB 36 would update the Alaska optometry statutes,
aligning it with optometrists' modern day scope of
practice and allow the Board of Optometry to regulate
that profession as other boards do. The current Alaska
statute defining the practice of optometry is 41-years
old.
She revealed that she had been on the Alaska Board of Nursing
for seven years and explained that a regulation project takes
about a year to process. She detailed the board regulation
process as follows:
· The board writes regulations with an assistant attorney
general who is present and assists with the writing.
· Regulations go out for a public-comment period.
· Alaska Department of Law reviews the regulations and
comments.
· Regulations go to the lieutenant governor for signing.
She pointed out that the regulatory process is not rapid and
reiterated that the process takes about a year. She specified
that the Legislature enacts statutes which are broad statements
of authority that a board then defines out the specifics in
regulation; all boards go through this same process when
regulating a profession.
SENATOR GIESSEL disclosed that the Board of Optometry consists
of four professional members and one public member. She noted
that including one or two public board members is a common
procedure for professional regulatory boards because their
purpose is to address the public's safety and concerns. She
revealed that board memberships are typically four-year terms
with an optional second-term renewal.
She pointed out that while board members may change, the law
does not change. She detailed that an assistant attorney general
is always present to assist and oversee the regulation writing.
She asserted that regulation writing is not done on a whim, the
process is highly overseen and board members take their role
very seriously.
1:34:47 PM
She asserted that understanding the health-care industry's
prescription "drug schedules" is a nuance that a lot of people
don't know. She pointed out that optometrists can prescribe a
prescription drug, noted as "controlled substance" in Section 3,
page 2, lines 12-15 in SB 36. She said she would talk about
controlled substances to illustrate the problem that
optometrists face.
She explained that "controlled drugs" are classified by the U.S.
Drug Enforcement Administration (DEA) and the state of Alaska;
the drugs are controlled due to their potential for abuse or
dependency and are ranked in different "schedules." She detailed
the five distinct categories or "schedules" as follows:
1. Schedule I
a) Schedule I drugs, substances, or chemicals are defined
as drugs with no currently accepted medical use and a
high potential abuse.
b) Schedule I examples:
¨ Heroin
¨ LSD
¨ Marijuana
¨ Ecstasy
¨ Peyote
2. Schedule II
a) Schedule II drugs, substances, or chemicals are
defined as drugs with a high potential for abuse, with
use potentially leading to severe psychological or
physical dependence. These drugs are considered
dangerous.
b) Schedule II examples:
¨ Cocaine
¨ Vicodin (Hydrocodone)
¨ Methadone
¨ Fentanyl
¨ OxyContin
3. Schedule III
a) Schedule III drugs, substances, or chemicals are
defined as drugs with a moderate to low potential for
physical and psychological dependence. Schedule III
drugs abuse potential is less than Schedule I and
Schedule II drugs but more than Schedule IV.
b) Schedule III examples:
¨ Codeine
¨ Ketamine
¨ Testosterone
4. Schedule IV
a) Schedule IV drugs, substances, or chemicals are
defined as drugs with a low potential for abuse and
low risk of dependence.
5. Schedule V
a) Schedule V drugs, substances, or chemical are defined
as drugs with lower potential for abuse than Schedule
IV.
1:38:26 PM
SENATOR GIESSEL reiterated that SB 36 calls out "controlled
substance." She pointed out that a bill was passed in 2014 in
response to a federal government schedule change when
hydrocodone was changed from Schedule III to Schedule II, a
necessity because optometrists are only permitted to prescribe
Schedule III medication. She noted that if the Board of
Optometry had its full authority, legislation would not have
been required and the board would have simply been able to
update their regulations. She set forth that her previous
example illustrates why it's so important for the Board of
Optometry to have some latitude to update their regulations and
their scope of practice as technology changes or drug schedules
change.
SENATOR GIESSEL divulged that optometrists cannot prescribe
Schedule I, Schedule II, or any drug without authorization from
the DEA. She pointed out that health-care providers require
federal authorization to receive an identification number to
prescribe controlled substances, a highly vetted process that
shows the level of care given to optometrists to use controlled
substances.
1:40:49 PM
She emphasized that SB 36 does not expand the scope of practice
of optometry. She said a clear majority of Alaskans visit one or
more of the state's 150 optometrists that take care of their
eye-care needs, vision tests, eyewear prescriptions, and general
eye exams. She pointed out that optometrists are spread
throughout Alaska; by contrast, there is an access to care issue
due to the approximate 20 ophthalmologists in the state.
She set forth that the state's optometrists are credible and
safe health-care providers. She asserted that the bill's
significant pushback is unwarranted. She reiterated that SB 36
does not expand optometrists' scope of practice and emphasized
that optometrists are very safe clinicians with a sound
education program that are carefully vetted by their board.
She noted that the previous year's Medicaid reform legislation
contained a significant reform that she championed for mental-
health therapists to practice more fully in their scope of
practice. She detailed that mental-health therapists were
restricted due to a high-bar presence requirement for
psychiatrists that added to the cost of health care. She
referenced a committee meeting that occurred earlier in the day
where the high cost of health care was a concern for the
teaching staff throughout the state. She summarized that the
Legislature has some control over the limitation of health-care
professionals.
1:44:05 PM
She set forth that one of the measures for clinician-safety is
their malpractice insurance cost. She pointed out that
optometrist malpractice insurance rates are very low and suggest
that insurance agencies do not see them as high-risk clinicians.
She affirmed that SB 36 would simply allow optometry to conduct
itself just like all the other health-care professions. She
pointed out that the three other prescribing professions'
statutory board language for nursing, pharmacy and dentistry
have a common phrase for practice, "under regulations adopted by
the board," a common practice also seen for chiropractic
examiners, dentistry, occupational therapists, and pharmacy. She
summarized that it is time for the Board of Optometry to have
the same ability to regulate their profession.
1:46:19 PM
SENATOR BEGICH asked if the lower malpractice insurance rates
could be driven by the statutory limitations on less invasive
surgeries.
SENATOR GIESSEL replied that Senator Begich's question would be
addressed by an insurance agency or optometrist.
SENATOR VON IMHOF asked if a particular Schedule II drug should
be specified in SB 36 like hydrocodone was in 2014. She assumed
that a Schedule III drug that is changed to a Schedule II is
done for a reason and inquired why a doctor that is not allowed
to prescribe a Schedule II drug can receive an exemption.
1:49:15 PM
SENATOR GIESSEL replied that the current statute specifies that
an optometrist may use a pharmaceutical agent containing
hydrocodone. She added that if a drug used by optometrists was
moved up to a Schedule II, then another bill would have passed.
She addressed Senator von Imhof's second question and said the
bill allows an optometrist to continue using a drug that is
moved into a new schedule. She specified that the bill states,
"Including a controlled substance in the practice of optometry
if the pharmaceutical agent is used in a manner consistent with
standards adopted by the board."
SENATOR VON IMHOF asked how often drugs are reclassified into a
new schedule.
SENATOR GIESSEL replied that she could not respond.
CHAIR WILSON asked for a sectional analysis of SB 36.
1:53:05 PM
JANE CONWAY, Staff, Senator Giessel, Alaska State Legislature,
Juneau, Alaska, provided a sectional analysis on SB 36 as
follows:
Section 1:
AS 08.72.050 allows the board to continue to adopt its
regulations updated to its current practice.
Section 2:
Moves the continuing education requirements back into
regulation, something that the Department of Commerce,
Community, and Economic Development had desired.
Continuing education is still required by current
statute; however, it could be noted that the hours and
subjects to be determined by the board as with other
professions. Our current regulations for continuing
education hours and the Board of Optometry regulations
are higher than what is actually in statute, so this
is a very obsolete section of the bill that we would
like to change.
Section 3:
AS 08.72.272(a) clarifies the current statute for the
board to determine prescribed drug schedules which
Senator Giessel has outlined in detail, including
standards and limitations on practice determined by
the board.
Section 4:
AS 08.72 sets limitations on practice, ensuring that
no licensee may perform any procedure beyond the scope
of the licensee's education, training, and experience
as established by the regulatory board; this allows
for future new and improved diagnostics and
therapeutic procedures as determined by the board
while not having to return to the Legislature for
every new development or technological advance.
Section 5:
AS 08.72.300(3) updates the definition of "optometry"
because it is decades old and it was repealed and
reenacted and rewritten by the legal department to
keep it current with current practice and be more
readable.
1:55:49 PM
SENATOR BEGICH noted that the old definition being eliminated
specifically prohibited "Other than by use of laser, x-ray,
surgery, or pharmaceutical agents." He asked why the old
definition is being eliminated.
MS. CONWAY explained that optometrists currently can order x-
rays and use diagnostic lasers. She specified that the new
wording parallels optometrists' current authorities and makes
the former definition obsolete.
1:57:18 PM
At ease.
1:58:17 PM
CHAIR WILSON opened public testimony on SB 36.
1:58:41 PM
DR. FORREST MESSERSCHMIDT, optometrist, Juneau, Alaska, revealed
that he has been an optometrist in Juneau for 28 years and
recently completed a four-year term on the State Board of
Optometry. He read a statement in support of SB 36 as follows:
I believe SB 36 is good legislation, it modernizes the
statutes, allows details of regulation to be
determined by the state board as is the current
standard through dentistry, nurse practitioners, and
medicine. There's no question that Alaskan optometric
physicians should be held to the same high standard of
care as other medical professionals, but it is absurd
to suggest that other professions can regulate their
own and optometry can't, there really is no good
reason for that.
Over 28 years of practice, much has changed in eye
care, more than half of my practice is medical in
nature, routinely diagnosing and managing complex
cases that have required referral even a few years
ago. Many of these cases require close working
relationships with eye surgeons, mutual trust allows
me to consult with other medical providers on a daily
basis; conditions that used to require travel south,
Seattle or Anchorage, are now managed competently and
effectively with reduced travel or no travel at all.
Even though much of what we do now was not allowed a
few short years ago, state law has been incredibly
slow, 41-years slow in recognizing the rapid
improvements in skills and training of current
optometrists and new graduates. You will hear some
concern with regard to surgery and its definition,
it's important that you know Alaskan optometrists
perform surgery now as defined by the medical
community. We routinely do things such as foreign-body
removal, incision and drainage of eyelid cysts,
corneal scraping or debridement, lacrimal dilation and
irrigation, even things as simple as eyelash removal
is considered surgery.
All surgery is not invasive surgery, no optometrist
wants to perform procedures that we aren't trained
for. We simply want to do what we can do and what we
are trained to do, competently. You will hear other
"cry wolf" about patient harm that will occur once
again if SB 36 is passed, when they know for the past
40 years of optometry law that this has not been the
case. Optometry malpractice insurance, as you've
heard, are the lowest of all doctoral-level providers
for a reason and I urge you to review that Senate
document that you should have regarding malpractice
insurance. Opponents of this bill miss the point of
why it is important, it's about the patient's best
interest and it's not about us doctors.
Simple math, no matter how you look at it, there are
not enough skilled ophthalmologists to serve our
rapidly aging population. As skills and training
expand, we need all eye-care physicians onboard to be
able to practice for a full level of training and
expertise. As a former board member, I can tell you
that nothing is more important than protection of the
public.
I don't foresee any dramatic change in how optometric
physicians practice in Alaska with the passage of this
bill, it certainly will not change how I practice.
Optometrists will continue to provide quality care
protecting our patient's wellbeing as they would their
own. I do foresee a streamlining of the legislative
process to take on more pressing issues and a
tremendous savings in time, effort and money wasted
debating issues that should be common sense.
Optometry is a well-trained and highly-skilled
profession that provides the majority of first-line
eye care in Alaska. As our educational and
professional standards evolve, we should be able to
practice to the highest level of care consistent with
our training and education. Optometry has always been
a cautious profession and will continue to be so into
the future. I have no doubt that the board is fully
capable of providing oversight and maintaining
standards needed to safeguard the public.
SB 36 is good for optometry, it removes a reoccurring
burden for precious legislative time and most
importantly it is good for Alaskans.
2:03:44 PM
SENATOR VON IMHOF noted that lasers were previously mentioned as
being used for making diagnoses. She asked to verify that
optometrists do not use lasers to cut the eye or anything along
that line.
DR. MESSERSCHMIDT replied correct. He specified that optometry
does not perform any procedures that physically penetrate the
eye in a cutting manner; however, there are three states that
use lasers in a therapeutic manner that is considered surgery.
SENATOR VON IMHOF asked to confirm that the therapeutic use of
lasers does not penetrate the eye.
DR. MESSERSCHMIDT specified that the laser's light penetrates
the eye, but a laser does not cut except where it is focused, so
it's just like regular daylight coming into your eyes until it
is actually focused, so you can cut inside the eye without
cutting to penetrate the eye. The procedure is called laser
posterior capsulotomy which is done as a secondary procedure
after cataract surgery, but there are a few states where the
procedure is performed by optometrists.
SENATOR VON IMHOF asked if posterior capsulotomy is performed by
optometrists in Alaska.
DR. MESSERSCHMIDT answered no.
SENATOR VON IMHOF pointed out that the same legislation has been
forwarded to the Legislature for several years. She noted that
Dr. Messerschmidt served on the Board of Optometry and asked
what are the opponents' concerns, particularly with lasers, and
how can their concerns be mitigated.
2:05:22 PM
DR. MESSERSCHMIDT replied that mitigating their concerns is
something that he is not necessarily concerned about. He pointed
out that he has been practicing for 30 years and uses non-
focusing lasers every day for diagnostic purposes, but he is not
going to be performing posterior capsulotomy on his patients. He
noted that doctors coming out of Oklahoma are fully trained in
posterior capsulotomy and if they graduated and are licensed in
Oklahoma, then they can do those procedures.
SENATOR VON IMHOF asked if Oklahoma doctors trained in posterior
capsulotomy can perform the procedure anywhere in the U.S.
DR. MESSERSCHMIDT replied that as long as the law allows the
procedure. He added that there may be some oversight involved.
He said everything is changing and a "turf war" has resulted
because new abilities to treat disease has changed. He asserted
that optometrists with the education, background, training, and
can perform a procedure competently, optometrists should be able
to perform the procedure. He pointed out that an enucleation
(removal) of the eye would obviously would require medical
school and medical training that an ophthalmologist has, but
that's not what optometrists do. He said pulling eyelashes out
is a surgical example of a procedure that optometrists do.
2:07:11 PM
SENATOR MICCICHE noted that Dr. Messerschmidt referenced
Oklahoma's optometric training for posterior capsulotomy and
asked if the procedure is a state requirement or out of a
certain university.
DR. MESSERSCHMIDT answered certain universities and noted that
several states allow for the practice of various procedures
under law.
SENATOR MICCICHE asked if there is reciprocity in Alaska for
individuals that graduate from a university with a program that
Dr. Messerschmidt described.
DR. MESSERSCHMIDT answered that the individual would have to be
licensed in the state. He said there is reciprocity, but pointed
out that just because an individual comes into the state of
Alaska does not mean they can practice more than what the state
of Alaska allows, adding that the Board of Optometry also
provides oversight through regulation.
SENATOR MICCICHE asked if the university graduates will have an
optometrist degree with a separate certification or noted
qualification.
DR. MESSERSCHMIDT surmised that graduates are going to have a
section of their education and clinical training that specifies
their abilities as part of their degree.
SENATOR MICCICHE asked how the board might look at regulations
regarding an optometry graduate with the extra certificate.
DR. MESSERSCHMIDT answered that the board would be pretty
guarded and there would have to be some sort of oversight,
particularly with a new graduate. He said as long as the person
passes muster with the attorney general's office and public
comment, then yes, as long as the person is trained and can
perform competently.
2:09:40 PM
SENATOR BEGICH noted that Louisiana, Oklahoma and Kentucky allow
surgical procedures by optometrists. He set forth that "turf
wars" do not matter to him, but public safety does. He said one
of his concerns is that surgery in Oklahoma was explicitly not
allowed by its board, but by its legislature. He addressed an
American Medical Association (AMA) report where out of 1100 eyes
that received laser trabeculoplasty (LTP) surgery for glaucoma,
17 percent that were done by ophthalmologists had to be redone,
and 36 percent done by optometrists had to be redone. He stated
that he is concerned by the AMA report as a public safety issue,
but acknowledged the respect that optometrists need to regulate
themselves. He revealed that he reviewed curricula for different
universities that had high ratings for optometry and
ophthalmology and pointed out that there is a radical difference
between how an optometrist is educated and how an
ophthalmologist is educated.
DR. MESSERSCHMIDT explained that an optometrist goes straight
from undergraduate to primarily concentrate on the eye, the rest
is secondarily with the body and systemic health. He confirmed
that the surgical portion of on ophthalmologist's training is
something optometry does not get.
SENATOR BEGICH asked if the legislation's debate is over the
surgery component and the removal of the definition of surgery
for a tighter and clearer definition.
2:12:43 PM
DR. MESSERSCHMIDT set forth that the problem with the surgery is
optometrists perform surgery now. He asserted that optometrists
do not want to lose what they already have and what they do on a
daily basis. He said surgery can be very minor in the doctor's
eyes, whether an ophthalmologist, brain surgeon or optometrist.
He summarized that integrity didn't stop getting doled out with
ophthalmology. He said, "We're all professionals, we all need to
be able to practice to where the standard we are trained and
almost all of us, there are bad apples everywhere, regard the
patient's interests, wellbeing, quality of care as the utmost of
what we do every day."
2:14:19 PM
CHAIR WILSON opined that the committee should invite some
experts back to give expert testimony to go further with what
Dr. Messerschmidt addressed.
SENATOR GIESSEL revealed that she had served on the Board of
Nursing and noted two cases that the board reviewed and provided
opinions on. She detailed that the board determined based on
individual review that two neonatal-nurse practitioners were
qualified to do circumcisions, a surgical procedure; whereas,
fluoroscopy performed by advanced nurse practitioners,
registered nurses, licensed practical nurses, or nurse
assistances was found to be beyond their scope of practice for
administering x-rays without additional education. She pointed
out that the two cases she referenced were the kinds of things
that are done by a regulatory board and asked if the Board of
Optometry has ever been able to regulate in a similar manner.
DR. MESSERSCHMIDT answered that during his limited time on the
board that he did not see any instances were an individual was
approved to perform a task and not another. He recalled that
during his career, optometrists where ultimately allowed to use
diagnostic and topical drugs.
2:17:12 PM
SENATOR GIESSEL remarked that the example provided by Dr.
Messerschmidt would be the type of thing where training was
evaluated, and a slight expansion was approved for qualified
individuals to function under their profession.
DR. MESSERSCHMIDT answered yes.
CHAIR WILSON announced that the committee would adhere to a
public testimony format and call optometrist and ophthalmologist
experts back for future committee testimonials.
2:18:11 PM
DR. DAVID ZUMBRO, M.D., ophthalmologist, Anchorage, Alaska,
testified in opposition to SB 36. He explained that he was not
testifying for a "turf war," but rather to educate the
differences between ophthalmologists and optometrists regarding
eye-care training and experience.
DR. ZUMBRO set forth that SB 36 is not a simple housekeeping
bill for the Board of Optometry. He opined that SB 36 would
dramatically redefine a profession and allow non-medical
doctors, doctors of optometry, to do eye surgery. He explained
that optometry does not include surgical training, does not
provide the same experience, and does not require a mastery of
the entire human body's different systems.
He opined that the term "non-invasive surgery" is misleading and
all surgery has risks and complications no matter who performs
the surgery or how minimal the surgery may seem. He set forth
that patient safety is paramount and the one performing the
surgery should have the proper training. He stated that the
current eye surgeons and physicians should be part of crafting
regulations. He asserted that SB 36 would allow "globe
injections" and the ability for licensees to prescribe
controlled substances in a manner consistent with standards of
the board.
He summarized that he is for the Board of Optometry to regulate
the practice of optometry, but asserted that there is a
difference between ophthalmology and optometry. He set forth
that the pathway already exists for an optometrist to perform
surgery by becoming an ophthalmologist via medical school,
residency, and board certification.
2:25:58 PM
DR. RACHEL REINHARDT, M.D., ophthalmologist, advocate for the
American Academy of Ophthalmology, Mill Creek, Washington,
testified in opposition to SB 36 for the following reasons:
· Optometrists state that there is no increase in claims
because they do not have report to a national database like
medical doctors have to do.
· Optometrists and ophthalmologists receive the same
reimbursement from Medicare and private payers, the cost of
care is identical.
· Malpractice insurance increases when surgery is done.
· Lasers are as sharp as a scalpel and are a surgical tool.
· SB 36 would allow optometrists to perform any and all
surgeries including scalpels, lasers, and needles.
· SB 36 would have a profound effect on patient safety by
making Alaska the only state that allows the Board of
Optometry to have total self-regulation over scope of
practice.
· SB 36 would allow non-medical doctors and non-surgeons to
completely redefine the practice of optometry into a
surgical specialty.
· The glaucoma-laser-surgery study in Oklahoma illustrated a
189 percent increased hazard requiring additional surgeries
when performed by an optometrist versus ophthalmologist.
· The ratio of ophthalmologists to the population is similar
for the states of Washington and Alaska.
· The state of Washington has a definition of surgery that
optometrists helped write and agreed to that is very
specific.
· Narcotic deaths are the number one cause of unintended
death in the U.S. and legislators should be thinking about
how to take away the right to prescribe medications in
certain groups.
· A national consumer league showed that 95 percent of those
polled want only a medical doctor to operate on the eye.
DR. REINHARDT summarized that optometrists' and
ophthalmologists' separate skill sets should be respected for
good patient care.
2:34:32 PM
DR. LADD NOLIN, optometrist, President of the Alaska Optometric
Association (AOA), Anchorage, Alaska, testified in support of SB
36. He set forth that AOA believes that authorizing the Board of
Optometry, who will work with the Alaska Department of Law, to
do its job and regulate its own profession within the scope of
its education will better serve the patients of Alaska. He
asserted that SB 36 allows the Board of Optometry to do what the
boards of the other prescribing professions in Alaska are
already doing.
2:36:08 PM
DR. JEFF GONNASON, optometrist and advocate for the Alaska
Optometric Association, Anchorage, Alaska, testified in support
of SB 36 and made the following claims:
· Optometry is a professional doctors' degree with four-year
undergraduate degree, four-year graduate professional
doctor program with available one to two-year residency for
advanced education. The first two years at many schools,
the medical and optometry students attend the same classes.
· Alaska became the fiftieth and last state in 1988 to
authorize optometrists to use drugs in practice. The delay
was due to opposition from organized ophthalmology
protecting their "turf."
· Medicine, dentistry, optometry, and advanced nurse
practitioner nurses are all independent with their own
boards and authorization by Alaska law to prescribe drugs,
including controlled narcotics with DEA numbers.
· Alaska optometrists have had narcotic drug prescribing
authority for the past ten years with no issues and the
board will continue to limit narcotic supply.
· Section 3 in SB 36 states that the standards must include
limitations on practice.
· Optometrists are defined as physicians under federal
Medicare and are held to the same standard of care for
Medicare and Medicaid patients.
· Optometrists are on the preferred provider insurance panels
in Alaska.
· Optometry's low malpractice insurance rates in Alaska is
the same as in states that have broader authority:
Kentucky, Oklahoma, and Louisiana.
· Optometrists in Alaska provide the vast majority of eye
care, serving over 80-remote locations. The local
optometrists are called upon in rural hospitals for their
expertise.
· Treatment and travel costs increase greatly when routine
care is provided by urban specialists, the cost is often
travel and loss of work.
· Alaska needs the best new doctors of optometry and the
state's antiquated statutes are a barrier to attracting the
best and brightest.
· SB 36 does not authorize any optometrist to do anything.
· SB 36 updates 45-year-old statutes and gives the board
authority to regulate with emphasis on protecting the
public, the same as dentists and advanced-practice nurses.
· SB 36 allows optometry to not have to return for
legislation for every new advance in education or
technology.
· Statutes for the boards of dentistry, medicine, and nursing
do not have extensive lists of procedures that cannot be
done, their boards set the details in regulation.
· The Legislature licenses professionals which includes
professional judgement as to when to refer patients to
specialists.
· Current optometry statutes still require optometrists to
refer to medical doctors when appropriate.
· Optometrists do not perform any of the invasive eye
surgeries that ophthalmologists perform that are outside of
their scope of education, all cases are referred out, the
same as family doctors refer to orthopedic surgeons and
dentists refer to oral surgeons.
· Family doctors are not trained the same as a neurosurgeon,
but there is nothing in the state law that tells what the
family doctor can and cannot do, that's all board
regulated.
· The optometry board would never authorize optometrists to
perform anything they are not educated, trained and
qualified to do as specified in Section 4 of SB 36.
DR. GONNASON summarized that every time optometrists come to any
state legislature over the past 45 years, the ophthalmologists and
their national academy have testified using outrageous scare tactics
that optometrists will cause tragic harm to the public.
2:41:50 PM
DR. PAUL BARNEY, optometrist and Chairman for the Alaska Board
of Examiners in Optometry, Alaska Department of Commerce,
Community, and Economic Development, Anchorage, Alaska,
testified in support of SB 36. He noted that he is an
optometrist at the Pacific Cataract and Laser Institute (PCLI)
in Anchorage. He detailed that PCLI is a referral center limited
to medical and surgical eye care. He specified that his practice
is entirely devoted to medical eye care in pre-and post-surgical
eye care. He said he works with an ophthalmic surgeon and a
certified registered-nurse anesthetist and together they provide
quality, affordable, surgical eye care to Alaskans. He specified
that PCLI's approach to eye care is to work collaboratively as a
team and optimize each practitioners' training and skills,
noting that he performs pre-surgical examinations, pre-operative
counseling, and post-operative care. He explained that PCLI's
nurse anesthetist administers anesthesia for surgery and PCLI's
surgeon performs the cataract surgery.
He pointed out that the committee has heard arguments against SB
36 from both organized optometrists and ophthalmologists; those
arguments are exclusionary and state that only an
ophthalmologist is trained medically and only an ophthalmologist
is capable of performing the very tasks that the he and PCLI's
nurse anesthetist have performed on a daily basis for years. He
pointed out that modern health care is often delivered
collaboratively with team members from multiple professions, an
approach that maintains the quality of care that provides
patients with better access to care that is frequently more
affordable. He opined that exclusionary attitudes and approaches
suggesting that only someone who has attended medical school can
deliver medical care are antiquated and do not assure better
quality; in fact, they often limit patient access to care.
DR. BARNEY noted that the committee also heard opposition to the
bill where optometrists will be allowed to do surgery and
perform procedures that they are not trained to do, even though
the bill specifically states the board cannot write regulations
or procedures that licensees aren't trained and educated to do.
The Alaska Department of Law oversees all health-care boards,
including optometry, to ensure that regulations written by those
boards are within the confines of the statutes. He assured the
committee that while he is on the Board of Optometry, the board
will not write regulations allowing optometrists to do
procedures that they are not trained to do.
He specified that SB 36 does allow the Board of Optometry to
determine the details of the practice of optometry, but noted
that previous arguments where the board cannot be trusted to
establish and enforce regulations. He asserted that as Chairman
of the Alaska Board of Optometry, the primary concern of the
board is the safety of the public. He revealed that in the six
years that he has served on the board, the board has never
received a public complaint that was serious enough to even
consider disciplinary action, a track record that he is doubtful
in many other health-care professions in Alaska can claim.
He set forth that optometrists are conservative and cautious
practitioners and the passage of SB 36 would not change their
conservative nature. He said SB 36 would be good for the state
of Alaska by placing the regulatory details regarding the
practice of optometry in the authority of the Board of
Optometry. He asserted that the changes from SB 36 are important
to allow the profession and practice of optometry to incorporate
new technologies and advances in eye care as they occur. He
pointed out that current statute requires optometry to come to
the Legislature to incorporate changes. He summarized that SB 36
would allow optometry to regulate itself similar to dentistry,
advanced-practice nurses, and medicine.
2:47:19 PM
DR. KELLY LORENZ, M.D., ophthalmologist, Anchorage, Alaska,
testified in opposition to SB 36 because the bill is too vague
for any serious consideration. She specified her opposition as
follows:
· Section 1, page 1, line 13: there is no definition for what
is considered ophthalmic surgery or what a non-invasive
procedure is, and the definition is left up to the Board of
Optometry at some later date which is irresponsible and
should be defined now and not later.
· Section 2, page 2, lines 1-10: specific recommendations for
continuing education regarding pharmaceuticals and
injections are noted, but no recommendations are given
regarding proposed surgical procedures, an omission that is
again to be determined at some later date by the Board of
Optometry without any input from the Alaska State Medical
Board.
· Section 3, page 2, lines 21-23, how will a licensee's
education, training and experience be evaluated to
determine whether they are fit to perform surgery, and what
kind of training would be required.
She disclosed that she has four years of full-time surgical
training that is beyond medical school and a surgical
internship. She inquired if an optometrist's training will be
comparable to what he has received, or will the training be an
occasional weekend course. She set forth that the larger
question is whether the Board of Optometry can solely make
decisions without any oversight from the Alaska State Medical
Board. She noted that she practices under both the Board of
Ophthalmology and the Alaska State Medical Board. She summarized
that in the interest of the public that the issues regarding SB
36 be addressed now to allow for a fully informed decision
rather than claiming the bill is a general update that leaves
details to be determined later.
2:49:32 PM
DR. JILL MATHESON, optometrist, Juneau, Alaska, testified in
support of SB 36. She asserted that having broad language in SB
36 allows the Board of Optometry to react with the shorter
regulatory process to changes in technological advances. She set
forth that the public is protected by optometrists who are all
called to practice as professionals at the highest level. She
pointed out that optometrists are the first line of eye care in
nearly every community in the state and can treat Alaskans with
the most modern methods without costly referral to specialists.
She contended that optometrists know best as to methods and what
the education should be to perform the methods.
DR. MATHESON revealed that she has served on the Board of
Optometry and asserted that board members in the past, present
and future are and will be conservative. She pointed out that
the Legislature will not be totally out of the loop and noted
their indirect oversight via the board member approval process.
She summarized that checks and balances exist in addition to
regulations that go through the Alaska Department of Law.
2:51:49 PM
DR. SCOTT LIMSTROM, M.D., ophthalmologist and President of the
Alaska Association of Eye Physicians and Surgeons, Anchorage,
Alaska, testified in opposition of SB 36. He said the bill is
the most expansive optometric scope of practice legislation in
the nation. He said SB 36 would give the optometric board full
authority to determine which invasive, diagnostic and surgical
procedures optometrists may perform on patients' eyes. He
revealed that the optometry board consists of four optometrists
and one layperson. He pointed out that the optometry board makes
decisions regarding medical treatments and surgeries without
having a medical doctor or surgeon as a member. He reiterated
previous testimony that optometrists lack the education and
training to perform surgeries. He summarized that the care of
patient sight is a privilege earned through many years of
education and should not be taken lightly. He stated that the
protection of the public is paramount.
2:54:42 PM
DR. DAVID KARPIK, optometrist, Kenai, Alaska, testified in
support of SB 36. He disclosed that he owns the largest eye-care
facility on the Kenai Peninsula. He detailed that his business
receives referrals from medical specialists throughout the
region and provides vision care for injuries, infections, and
chronic-systemic diseases with eye implications. He added that
referrals occur back and forth to various primary-care
providers, sub-specialists, and ophthalmologists throughout
Alaska, state of Washington and beyond.
He disclosed that he had moved to Alaska 12-years previously
despite the state's antiquated optometry law that initially did
not allow him to practice to the full scale of his training. He
noted that the optometry law was patched and improved in 2007,
but times and training has continued to advance in the past
decade.
DR. KARPIK specified that his support for SB 36 is due in part
to its simplicity as well as replacement of a patched together,
rigid and aging optometry law that has needed to be continually
changed to keep up with updates and practice. He said the
prescribing professions are typically regulated by their state
boards as is the case with dentistry, medicine, and nursing; SB
36 sets up an elegant framework parallel to these boards.
He summarized that education, technology and research
continuously change best practices. He set forth that regulation
by the Board of Optometry ensures protection of the public
alongside timely updates in practice which allow for optimum
care for Alaskans.
2:57:44 PM
CHAIR WILSON closed public testimony and announced he would hold
SB 36 in committee for future consideration.