Legislature(1997 - 1998)

04/22/1997 03:03 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                HOUSE HEALTH, EDUCATION AND SOCIAL                             
                    SERVICES STANDING COMMITTEE                                
                          April 22, 1997                                       
                             3:03 p.m.                                         
 MEMBERS PRESENT                                                               
 Representative Con Bunde, Chairman                                            
 Representative Joe Green, Vice Chairman                                       
 Representative Al Vezey                                                       
 Representative Brian Porter                                                   
 Representative Fred Dyson                                                     
 Representative J. Allen Kemplen                                               
 MEMBERS ABSENT                                                                
 Representative Tom Brice                                                      
 COMMITTEE CALENDAR                                                            
 CS FOR SENATE BILL NO. 13(RLS)                                                
 "An Act relating to taxes on cigarettes and tobacco products and to           
 the use of the proceeds of those taxes, and increasing by at least            
 35.5 mills the amount of excise tax levied on each cigarette                  
 imported or acquired in the state; and providing for an effective             
      - MOVED HCS CSSB 13(HES) OUT OF COMMITTEE                                
 HOUSE BILL NO. 127                                                            
 "An Act relating to the citizen review board and panels for                   
 permanency planning for certain children in state custody; renaming           
 the Citizens' Review Panel For Permanency Planning as the Citizens'           
 Foster Care Review Board; extending the termination date of the               
 Citizens' Foster Care Review Board; and providing for an effective            
      - MOVED CSHB 127(HES) OUT OF COMMITTEE                                   
 HOUSE BILL NO. 195                                                            
 "An Act relating to licensure of optometrists; and providing for an           
 effective date."                                                              
      - HEARD AND HELD                                                         
 (* First public hearing)                                                      
 PREVIOUS ACTION                                                               
 BILL:  SB  13                                                                 
 SHORT TITLE: INCREASE TOBACCO TAXES                                           
 SPONSOR(S): SENATOR(S) SHARP, Ellis                                           
 JRN-DATE     JRN-DATE             ACTION                                      
 01/03/97        17    (S)   PREFILE RELEASED 1/3/97                           
 01/13/97        17    (S)   READ THE FIRST TIME - REFERRAL(S)                 
 01/13/97        17    (S)   HES, FIN                                          
 02/05/97              (S)   HES AT  9:00 AM BUTROVICH ROOM 205                
 02/05/97              (S)   MINUTE(HES)                                       
 02/10/97              (S)   HES AT  9:00 AM BUTROVICH ROOM 205                
 02/10/97              (S)   MINUTE(HES)                                       
 02/14/97              (S)   HES AT  9:00 AM BUTROVICH ROOM 205                
 02/14/97              (S)   MINUTE(HES)                                       
 02/14/97       355    (S)   HES RPT  CS  2DP 2NR      NEW TITLE               
 02/14/97       355    (S)   DP:WILKEN, ELLIS, NR: WARD, GREEN                 
 02/14/97       355    (S)   FISCAL NOTE TO SB (REV)                           
 02/24/97       468    (S)   FISCAL NOTE TO CS (REV)                           
 02/24/97       468    (S)   ZERO FISCAL NOTE TO CS (REV)                      
 04/04/97              (S)   FIN AT 10:00 AM SENATE FINANCE 532                
 04/04/97              (S)   FIN AT  6:00 PM SENATE FINANCE 532                
 04/07/97      1024    (S)   FIN RPT  CS  4DP 2NR      SAME TITLE              
 04/07/97      1024    (S)   DP:  PEARCE, SHARP, ADAMS, TORGERSON              
 04/07/97      1024    (S)   NR:  PHILLIPS, PARNELL                            
 04/07/97      1024    (S)   FN TO CS (REV)                                    
 04/10/97      1077    (S)   RLS RPT  CS  CALENDAR AND 1DP                     
                             NEW TITLE                                         
 04/10/97      1078    (S)   PREVIOUS FN APPLIES (REV-#4)                      
 04/10/97      1080    (S)   READ THE SECOND TIME                              
 04/10/97      1080    (S)   RLS  CS ADOPTED UNAN CONSENT                      
 04/10/97      1081    (S)   AM NO  1     OFFERED BY ELLIS                     
 04/10/97      1081    (S)   AM NO  1     FAILED  Y7 N12 A1                    
 04/10/97      1082    (S)   AM NO  2 OFFERED AND WITHDRAWN                    
 04/10/97      1085    (S)   ADVANCED TO THIRD READING                         
                             UNAN CONSENT                                      
 04/10/97      1085    (S)   READ THE THIRD TIME  CSSB 13(RLS)                 
 04/10/97      1086    (S)   PASSED Y16 N4                                     
 04/10/97      1086    (S)   EFFECTIVE DATE(S) SAME AS PASSAGE                 
 04/10/97      1086    (S)   WARD  NOTICE OF RECONSIDERATION                   
 04/11/97      1106    (S)   RECON TAKEN UP - IN THIRD READING                 
 04/11/97      1106    (S)   PASSED ON RECONSIDERATION Y15 N4 E1               
 04/11/97      1107    (S)   EFFECTIVE DATE(S) SAME AS PASSAGE                 
 04/11/97      1107    (S)   TRANSMITTED TO (H)                                
 04/14/97      1094    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 04/14/97      1095    (H)   HES, FINANCE                                      
 04/22/97              (H)   HES AT  3:00 PM CAPITOL 106                       
 BILL:  HB 127                                                                 
 SHORT TITLE: FOSTER CARE REVIEW BOARD                                         
 SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES                               
 JRN-DATE     JRN-DATE             ACTION                                      
 02/12/97       318    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 02/12/97       318    (H)   HES, FINANCE                                      
 03/27/97              (H)   HES AT  3:00 PM CAPITOL 106                       
 03/27/97              (H)   MINUTE(HES)                                       
 04/10/97              (H)   HES AT  3:00 PM CAPITOL 106                       
 04/10/97              (H)   MINUTE(HES)                                       
 04/22/97              (H)   HES AT  3:00 PM CAPITOL 106                       
 BILL:  HB 195                                                                 
 SHORT TITLE: LICENSURE OF OPTOMETRISTS                                        
 JRN-DATE     JRN-DATE             ACTION                                      
 03/14/97       667    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 03/14/97       667    (H)   HES                                               
 04/22/97              (H)   HES AT  3:00 PM CAPITOL 106                       
 WITNESS REGISTER                                                              
 SENATOR BERT SHARP                                                            
 Alaska State Legislature                                                      
 Capitol Building, Room 516                                                    
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 465-3004                                                    
 POSITION STATEMENT:  Sponsor of CSSB 13(RLS)                                  
 GLENN PRAX                                                                    
 1015 Meadow Rue                                                               
 North Pole, Alaska  99705                                                     
 Telephone:  (907) 488-2400                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 WALTER GAUTHIER                                                               
 P.O. Box 2246                                                                 
 Homer, Alaska  99603                                                          
 Telephone:  (907) 235-2809                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES) and in                
                      support of CSHB 127(HES)                                 
 DIANE BUFFINGTON                                                              
 Kodiak, Alaska                                                                
 Telephone:  (907)                                                             
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 JOANNE LOVITZ-EDMISTON                                                        
 347 Dailey Street                                                             
 Anchorage, Alaska  995151                                                     
 Telephone:  (907) 349-8358                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 TESHA SANCHEZ                                                                 
 5630 South Tahiti                                                             
 Anchorage, Alaska  99507                                                      
 Telephone:  (907) 561-6699                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 BOBBY SCOTT                                                                   
 521 Izembek                                                                   
 Anchorage, Alaska  99508                                                      
 Telephone:  (907) 338-8257                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 NICHOLAS ZERBINOS                                                             
 P.O. Box 371                                                                  
 Glennallen, Alaska  99588                                                     
 Telephone:  (907) 822-3451                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 KEN JACOBUS                                                                   
 425 G Street, Number 920                                                      
 Anchorage, Alaska  99501                                                      
 Telephone:  (907) 277-3333                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 SUZANNE FISHCHETTI                                                            
 10336 Stewart Drive                                                           
 Eagle River, Alaska  99577                                                    
 Telephone:  (907) 694-7944                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES)                       
 JODI OLMSTEAD, Founder                                                        
 Concerned Parents for Reform                                                  
 1995 Athena Drive                                                             
 North Pole, Alaska  99705                                                     
 Telephone:  (907) 488-0334                                                    
 POSITION STATEMENT:  Testified against HCS CSSB 13(HES) and in                
                      support of CSHB 127(HES)                                 
 JOHN CYR, President                                                           
 National Education Association-Alaska (NEA-Alaska)                            
 114 Second Street                                                             
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 586-3090                                                    
 POSITION STATEMENT:  Testified in support of HCS CSSB 13(HES)                 
 RUPERT E. ANDREWS, Representative                                             
 American Association of Retired Persons (AARP)                                
 9416 Long Run Drive                                                           
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 789-7422                                                    
 POSITION STATEMENT:  Testified in support of HCS CSSB 13(HES)                 
 BLAIR McCUNE, Assistant Public Defender                                       
 Central Office                                                                
 Public Defender Agency                                                        
 Department of Administration                                                  
 900 West Fifth Avenue, Suite 200                                              
 Anchorage, Alaska  99501-2090                                                 
 Telephone:  (907) 264-4400                                                    
 POSITION STATEMENT:  Testified on CSHB 127(HES)                               
 PATTI SWENSON, Legislative Assistant                                          
    for Representative Bunde                                                   
 Alaska State Legislature                                                      
 Capitol Building, Room 104                                                    
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 465-4843                                                    
 POSITION STATEMENT:  Testified on CSHB 127(HES)                               
 DR. JEFFREY A. GONNASON., O.D.                                                
 2211 East Northern Lights, Number 202                                         
 Anchorage, Alaska  99508                                                      
 Telephone:  (907) 276-2080                                                    
 POSITION STATEMENT:  Testified in support of HB 195                           
 DR. SAM McCONKEY, M.D.                                                        
 351 Gold Claim Avenue                                                         
 Fairbanks, Alaska  99701                                                      
 Telephone:  (907) 456-7760                                                    
 POSITION STATEMENT:  Testified against HB 195                                 
 DR. PETER E. CANNAVA, M.D.                                                    
 161 North Binkley Street                                                      
 Soldotna, Alaska 99669                                                        
 Telephone:  (907) 262-4462                                                    
 POSITION STATEMENT:  Testified against HB 195                                 
 DR. RONALD ZAMBER, M.D.                                                       
 3044 Riverview                                                                
 Fairbanks, Alaska  99709                                                      
 Telephone:  (907) 479-4317                                                    
 POSITION STATEMENT:  Testified against HB 195                                 
 DR. ROBERT FORD, M.D.                                                         
 1600 A Street, Suite 200                                                      
 Anchorage, Alaska  99501-5146                                                 
 Telephone:  (907) 272-2423                                                    
 POSITION STATEMENT:  Testified in support of HB 195                           
 DR. HANS KELL, O.D.                                                           
 1600 A Street, Suite 200                                                      
 Anchorage, Alaska  99501-5146                                                 
 Telephone:  (907) 272-2423                                                    
 POSITION STATEMENT:  Testified in support of HB 195                           
 DR. GORDON PREECS, M.D.                                                       
 15795 Glacier Highway                                                         
 Juneau, Alaska 99801                                                          
 Telephone:  (907) 789-2290                                                    
 POSITION STATEMENT:  Testified on HB 195                                      
 TAPE 97-32, SIDE A                                                            
 Number 0000                                                                   
 CHAIRMAN CON BUNDE called the House Health, Education and Social              
 Services Standing Committee meeting to order at 3:03 p.m.  Members            
 present at the call to order were Representatives Bunde, Green,               
 Porter and Kemplen.  Representative Vezey arrived at 3:12 p.m. and            
 Representative Dyson arrived at 3:15 p.m.  Representative Brice was           
 absent.  This meeting was teleconferenced to Anchorage, Fairbanks,            
 Glennallen, Homer and Kodiak.                                                 
 SB 13 - INCREASE TOBACCO TAXES                                                
 Number 0040                                                                   
 CHAIRMAN BUNDE announced the first item on the agenda, CSSB
 13(RLS), "An Act relating to taxes on cigarettes and tobacco                  
 products and to the use of the proceeds of those taxes, and                   
 increasing by at least 35.5 mills the amount of excise tax levied             
 on each cigarette imported or acquired in the state; and providing            
 for an effective date."  He referred to an amendment located in the           
 committee file.                                                               
 Number 0092                                                                   
 SENATOR BERT SHARP, Sponsor of CSSB 13(RLS), stated that the                  
 amendment takes out the intent of using the tobacco tax for a                 
 dedicated purpose.                                                            
 Number 0186                                                                   
 CHAIRMAN BUNDE said the tobacco tax is separate from the cigarette            
 tax.  The cigarette tax existed before statehood and is already a             
 dedicated tax.  The tobacco tax refers to a tax on all tobacco,               
 except cigarettes.  This tax was instituted after statehood and               
 therefore is not allowed to be a dedicated tax.                               
 Number 0226                                                                   
 SENATOR SHARP explained that Section 1 details the legislative                
 intent.  The dedicated school fund portion, otherwise known as the            
 cigarette tax, will derive the largest portion of the proposed                
 revenue.  The school fund is one of three dedicated funds                     
 established prior to statehood and is legitimately constituted as             
 a dedicated fund.  This fund only allows for the rehabilitation,              
 construction or repair of state schools or facilities.  The other             
 portion of the bill is the Senate version which is to use the                 
 tobacco tax, constituting $2.5 million to $3 million according to             
 the Department of Revenue estimates, for anti-tobacco campaigns,              
 enforcement of present tobacco laws and things of that sort.                  
 Grants would be given to municipalities to detect, apprehend and              
 prosecute adults who make tobacco products available to children.             
 The intent of these grants would be affected by the proposed                  
 Amendment 1.                                                                  
 SENATOR SHARP stated that the tax in this bill is increased by 71             
 cents a pack to make the total tax equal $1.                                  
 Number 0354                                                                   
 CHAIRMAN BUNDE referred to the chart located in the committee file            
 regarding the existing tax, the tax if this bill passes with the              
 dedication and the final scenario of the bill passing with the                
 dedication found to be unconstitutional.  He asked if this                    
 indicated the 71 cents or the $1.                                             
 Number 0389                                                                   
 SENATOR SHARP indicated it was 71 cents, for a total tax of $1.               
 The fiscal note addresses the reduction down to a 71 cent total,              
 with a corresponding reduction in the tobacco product tax.  The               
 tobacco tax has the same percentage increase as the cigarette tax.            
 SENATOR SHARP felt CSSB 13(RLS) was a bill addressing health care,            
 education and revenue.  Up to 80 percent of the funds could be                
 dedicated to the schools.  He said, "The other thing in the bill is           
 a case of a constitutional challenge that would negate the                    
 dedication.  There's a fail safe retroactive road block to make               
 sure the tax stayed in effect and would not be lost or have to be             
 refunded, that would only be subject to court decision, a negative            
 decision as far as the ability to dedicate the funds to the                   
 dedicated account.  That depending on who you talk to, there is               
 nothing that prohibits an increased funding on cigarettes to go               
 into that dedicated tax.  We didn't want to entice a challenge to             
 avoid the tax, if they should challenge the constitutionality of              
 that.  That was the purpose of the last few sections in the                   
 retroactive section in the bill.  It has nothing to do with                   
 retroactive taxes."                                                           
 Number 0592                                                                   
 CHAIRMAN BUNDE said the bill would increase the existing tobacco              
 taxes by 71 cents with those taxes on cigarettes dedicated to the             
 school construction and maintenance fund.  Those taxes on other               
 forms of tobacco, if the committee adopts Amendment 1, would go to            
 the general fund and could be appropriated, by the legislature, for           
 the purposes discussed by Senator Sharp.                                      
 SENATOR SHARP answered that this money could also be used to close            
 the fiscal gap.                                                               
 Number 0607                                                                   
 CHAIRMAN BUNDE mentioned the briefing by Grant Woods, the attorney            
 general from the state of Arizona, who began the lawsuit against              
 Liggett.  Some members of the general public feel that raising the            
 fee would not serve as an economic barrier.  Grant Woods referred             
 to discussions held with the Chief Executive Officer (CEO) of                 
 Phillip Morris, who said that if the cost of cigarettes went up by            
 $1 a pack, nationwide, use would go down by 45 percent.  He                   
 commented that this information is vastly different from the                  
 lobbying effort which claims that raising the tax would not have an           
 impact on use.                                                                
 Number 0660                                                                   
 SENATOR SHARP was a firm believer in the price signal concept.                
 Most business people recognize that there is a definite price                 
 signal in regards to any product.                                             
 Number 0670                                                                   
 CHAIRMAN BUNDE asked him if he had a problem with Amendment 1.                
 Number 0682                                                                   
 SENATOR SHARP answered that he didn't have a problem and he didn't            
 feel the Senate would object, as far as concurrence.  The main                
 concern, of the Senate, regarded the dedication.                              
 Number 0708                                                                   
 REPRESENTATIVE BRIAN PORTER made a motion to adopt Amendment 1,               
 dated April 22, 1997\T.7.  Hearing no objection, Amendment 1 was              
 Number 0770                                                                   
 GLENN PRAX testified next via teleconference from Fairbanks.  He              
 was opposed to HCS CSSB 13(HES) and to the tax on cigarettes.  He             
 did not feel the state should assume more responsibility for taking           
 care of citizens.  Taking care of a person's health and well being            
 sets a dangerous precedent for the state and is not an appropriate            
 method for influencing public behavior.  If the focus could be                
 limited to taxing tobacco and nothing else, then maybe it would be            
 okay.  Often government gets some authority to do something and it            
 soon gets out of hand.  He cited the income tax and prohibition as            
 examples where government tried to do something good, but it                  
 MR. PRAX did not feel the tax would have the desired effect, to               
 reduce consumption.  He indicated that there are studies which                
 indicate both results.  Tobacco was a product used to illustrate              
 inelastic demand when he studied economics as it isn't that                   
 responsive to the influence of price.  Once people get hooked, they           
 will pay whatever the amount needed to get the product.  He said              
 some people might stop, but it won't be as significant as some                
 MR. PRAX felt the tax would lead to smuggling.  Kids would become             
 involved in the black market in order to save money to buy                    
 cigarettes.  He felt a sunset clause should be added to the bill.             
 If the reaction isn't what the proponents of this bill say it is,             
 then it should be repealed.                                                   
 Number 0915                                                                   
 CHAIRMAN BUNDE stated that nothing this legislature does would bind           
 a future legislature.  A future legislative body could chose to               
 amend, change or repeal this bill if they felt it was not working.            
 He appreciated the acknowledgement that there were different points           
 of view and different studies, but asked why he felt it wouldn't be           
 an economic deterrent for young people beginning to smoke.  He                
 referred to his testimony that once people are addicted, it is                
 harder to change their behavior.  He said the legislature hoped the           
 economic deterrent would affect people before they're addicted.               
 CHAIRMAN BUNDE explained that people who are addicted to tobacco              
 products cost the state a considerable sum of money every year in             
 health related expenses.  He asked if he had a view on user fees.             
 Number 0968                                                                   
 MR. PRAX advocated getting out of the business of taking care of              
 people who are silly enough to smoke.  It is obvious that the                 
 health effects of cigarettes are detrimental.  People chose to                
 smoke knowing the risks.  The government cannot be so paternalistic           
 as to think that society must take care of them when they choose to           
 take foolish risks.  He did not think this tax was an appropriate             
 solution to this problem.                                                     
 Number 1011                                                                   
 CHAIRMAN BUNDE agreed, he would rather have people be responsible             
 for themselves.  He used the example of people who get into car               
 accidents and are still taken to the hospital.  He felt that on a             
 humanitarian level, it would be difficult to change this type of              
 Number 1022                                                                   
 WALTER GAUTHIER testified next via teleconference from Homer.  He             
 opposed any tobacco tax, no matter what shape or form in which it             
 was done.  He contended that it is a shell game, that any money               
 dedicated to the Department of Education (DOE) will mean that less            
 money will be included in the DOE budget.  This money will be                 
 available to continue to fund a whole lot of state employees to               
 push paper from one desk to another.  The Republicans were elected            
 to cut the budget.  Any kind of tax is a revenue issue.  He                   
 believed that when you talk about it being a health issue, the                
 smokers costing the state of Alaska a certain amount of money then            
 you have to realize that fat people, people who drink too much                
 coffee, people who eat too many candy bars and get diabetes and               
 people who drink alcohol cost the state a certain amount of money.            
 People who are working for the DOE, the Department of Health and              
 Social Services (DHSS) and non-profit agencies see their budgets              
 shrinking.  Those departments and agencies believe that by                    
 targeting the evil smokers they can get enough money until a                  
 Democratic legislature comes into power.  He stated that this is a            
 revenue issue, not a health issue.                                            
 Number 1121                                                                   
 DIANE BUFFINGTON testified next via teleconference from Kodiak.               
 She stated that HCS CSSB 13(HES) was not a education, health nor a            
 revenue bill.  This piece of legislation is a tax bill.  This bill            
 purports to dedicate some of the funds to educate children on the             
 hazards of smoking.  Over the past five years, the public service             
 announcements have not decreased any type of drug use in our youth.           
 Drug use is up 150 percent for cocaine and marijuana.  An education           
 campaign is not going to work.  Education needs to begin at the               
 family level.  Taxing families is not going to decrease smoking.              
 Fourteen states, in the past two years, have increased their                  
 cigarette tax.  Most of those states have seen a rise in cigarette            
 usage by teenagers.  The state of Washington, who currently has the           
 highest tax on cigarettes, is now attempting to lower their tax.              
 MS. BUFFINGTON referred to enforcement costs.  She referred to                
 literature stating that it would cost more for enforcement, that              
 several more employees would need to be added to the budget.  She             
 said 70 percent of the DHSS budget is slated for employees.  The              
 tax revenue would not filter down to the local municipalities and             
 communities.  This bill would violate the constitution.  Taxes,               
 according to Mr. Chenoweth, would remain at the same "2.5 which it            
 is currently getting."  The state should not enact any laws which             
 would automatically trigger a judicial challenge.  The fiscal gap             
 needs to be closed through budget cuts.                                       
 Number 1282                                                                   
 JOANNE LOVITZ-EDMISTON testified next via teleconference from                 
 Anchorage.  She said it was an extraordinary abuse of governmental            
 power to propose stealing money from a small group of people via              
 taxation to provide for the education and the anti-smoking                    
 sentiments of others.  She questioned how the legislature could               
 justify having this small group of smokers pay for the education of           
 other people's children above what is already paid for in property            
 taxes dedicated to education.  She did not have any children in the           
 school system.  If all people benefited, then all people should               
 fund it.  She questioned punishing smokers.  She did not think that           
 Alaskans would pay more money to fund increased governmental                  
 spending.  As a member of Alaskans for Tax Reform she did not                 
 approve of increased taxation.                                                
 MS. LOVITZ-EDMISTON described her upbringing where she learned that           
 it was wrong for a conscience to escape the parameters of personal            
 behavior and conduct.  She said that Representatives Bunde and                
 Green have repeatedly expressed that routine smoking and tobacco              
 taxation are a matter of conscious.  While she respected their                
 sense of conscious in this matter, she believed that it was her               
 responsibility to state that it is most inappropriate to use one's            
 power to subjugate other free thinking adults who do not share in             
 the same beliefs and values on taxes.                                         
 Number 1458                                                                   
 CHAIRMAN BUNDE respectfully disagreed with her testimony.  He                 
 stated that 71 percent of people support this issue according to              
 the Dittman Poll.                                                             
 Number 1508                                                                   
 TESHA SANCHEZ testified next via teleconference from Anchorage.               
 She is in opposition to HCS CSSB 13(HES).  She has heard both sides           
 of the tobacco issue.  She felt putting a tax on people who smoke             
 because it will stop kids from smoking was wrong.  Kids can afford            
 alcohol, drugs, Air Jordan tennis shoes.  A dollar a pack won't               
 mean a thing to them.  She felt it was her responsibility to teach            
 her children morals at home.                                                  
 Number 1554                                                                   
 BOBBY SCOTT testified next via teleconference from Anchorage.  He             
 did not condone the use of tobacco by minors.  He stated that it              
 was illegal right now for minors to have tobacco products in their            
 possession.  He has heard school principals, coaches and teachers             
 say that they have watched students walk out of school to take a              
 smoke break during school.  He asked why these people weren't                 
 stopping these students if they were truly concerned.  He said when           
 you are a student you will get whatever you need to be popular no             
 matter what it costs.  Students don't care about price.  It was his           
 job to teach his kids respect, honesty and responsibility.                    
 MR. SCOTT works for (Indisc.) Distributing.  He feared for the                
 local retailer who would soon be out of business because of these             
 laws.  He felt HB 159 should be promoted, rather than the tax bill.           
 The tax bill will not stop the kids, enforcement will.                        
 Number 1686                                                                   
 CHAIRMAN BUNDE asked him if he would be willing to pay a cop to               
 watch every kid to ensure that children wouldn't smoke.                       
 MR. SCOTT asked if the chair would be willing to pay a cop for                
 every kid to ensure that children didn't use drugs.                           
 CHAIRMAN BUNDE answered that he was not willing.                              
 MR. SCOTT said he would not be willing to do so either.                       
 CHAIRMAN BUNDE then questioned him why he felt enforcement would              
 MR. SCOTT referred to a police report located in the committee                
 file.  He felt that HCS CSSB 13(HES) would cause people to break              
 into trucks.                                                                  
 CHAIRMAN BUNDE asked if young people, under the age of 19, should             
 MR. SCOTT answered that he did not children should smoke.                     
 CHAIRMAN BUNDE commented that the average Alaskan begins smoking at           
 age 14 and becomes addicted at that age.                                      
 Number 1746                                                                   
 NICHOLAS ZERBINOS testified next via teleconference from                      
 Glennallen.  He said this tax bill is the silliest thing he has               
 every heard.  He talked with legislators who said that they knew              
 this bill was not going to stop kids from smoking, but money can be           
 made on the taxes which can be used for something else.                       
 Legislators are not interested in the kids, they are interested in            
 the money.  He said the name of the legislators were confidential.            
 He said tax money is not going to stop kids from smoking.  Smoking            
 is something that if you take too much of it, it will hurt you.  He           
 cited foods on the market that people can't eat including soft                
 drinks, tomatoes and oranges.  He suggested taxing these products.            
 Taxes will not help anything, they will only allow the legislature            
 to spend money on things they want.                                           
 Number 1867                                                                   
 KEN JACOBUS testified next via teleconference from Anchorage.  He             
 did not think you needed to increase the tax on tobacco to keep               
 children from smoking.  He felt the tobacco companies were going to           
 have to increase their prices because of the settlements from the             
 nationwide lawsuits.  He felt it would be possible to test the                
 legislative theory when this occurred.  Alaska's lower income                 
 group, including many Alaska Natives smoke in disproportionate                
 numbers.  He did not think we should force the increased cost of              
 government onto Native Alaskans because they got hooked onto a bad            
 product when they were younger.                                               
 Number 1932                                                                   
 SUZANNE FISHCHETTI testified next via teleconference from                     
 Anchorage.  She opposed HCS CSSB 13(HES).  "Last Tuesday over 61              
 percent of the Anchorage voters passed a ballot proposition that              
 required 60 percent majority vote to have a sales tax in Anchorage            
 and I think that's the poll that the legislators should be                    
 listening to, not the Dittman Poll."  She suggested that the state            
 should try to recover the $100 million in defaulted student loans             
 before they started raising tax revenue.  Schools should be able to           
 teach our students about smoking.  The Centers for Disease Control            
 have conducted studies, in Illinois, Nebraska and Hawaii where                
 taxes were raised, which showed kids smoking increased.                       
 Number 1977                                                                   
 JODI OLMSTEAD testified next via teleconference from Fairbanks.               
 She was opposed to the tobacco tax.  She stated that this tax is              
 against Alaskan Natives because a disproportionate high number of             
 them smoke.  It has always been illegal for kids to smoke, drink              
 and do drugs.  She questioned why the state's permanent fund monies           
 were invested in Phillip Morris.  She has talked to many people and           
 has found no one who agrees with this bill.  Kids say that the                
 price increase will not change whether or not they smoke.  She                
 thought there were other things behind this tax, it did not have              
 anything to do with children.  She asked why we are going to have             
 another law which will say that it is still against the law for               
 kids to smoke.  She did not feel that money should be invested to             
 save people from themselves.                                                  
 Number 2102                                                                   
 JOHN CYR, President, National Education Association-Alaska (NEA-              
 Alaska), said his organization supports the passage of HCS CSSB
 13(HES).  The increased cost of tobacco products will serve as a              
 deterrent to use by Alaskan students.  He said the age when most              
 kids start to smoke is age 13 and 14 and this is the most price               
 sensitive age.  Tobacco use is the leading cause of death in                  
 Alaska.  One out of five deaths are tobacco related.  The United              
 States Centers for Disease Control estimates that 18,000 Alaskans,            
 currently under the age of 18, will die from tobacco related                  
 diseases.  He said this is absolutely a health bill and something             
 that is long overdue in this state.                                           
 MR. CYR stated that schools in Alaska have suffered under deferred            
 maintenance for years.  There are schools with trash cans                     
 collecting the spring runoff.  The schools in this state need the             
 money that will be generated from this bill.  His organization felt           
 that this bill will be one of the best pieces of legislation that             
 will be passed this year.  It will positively affect the lives of             
 children into the foreseeable future and it will make schools                 
 better places to be.                                                          
 Number 2202                                                                   
 RUPERT E. ANDREWS, Representative, American Association of Retired            
 Persons (AARP), stated that the state legislative committee of AARP           
 was in favor of any increased taxes on tobacco products.  Last fall           
 a survey was done in the membership.  Currently there are 40,000              
 plus AARP members in Alaska, fifty years and older.  A sample of              
 4,000 was chosen for the survey, 2,200 forms were returned.  Some             
 of the questions had to do with the tobacco tax.  About 79 percent            
 responded that they were in support of a tobacco tax as a health              
 issue.  Alaska has an informed electorate that sees this tax as an            
 effective means to discourage children from starting to smoke.  He            
 felt this 79 percent fit in well with the Dittman Poll.                       
 Number 2268                                                                   
 REPRESENTATIVE JOE GREEN commented that none of the testimony given           
 against the bill cited where that money would go; children and                
 aggressive prosecution of those who sell tobacco products to                  
 children.  He said this bill prevents children from becoming                  
 addicted to tobacco products.                                                 
 TAPE 97-32, SIDE B                                                            
 Number 0000                                                                   
 REPRESENTATIVE PORTER made a motion to move HCS CSSB 13(HES) out of           
 Number 0007                                                                   
 REPRESENTATIVE AL VEZEY objected to the motion.  He then withdrew             
 his objection.                                                                
 CHAIRMAN BUNDE stated that hearing no further objection, HCS CSSB
 13(HES) was moved out of the House Health, Education and Social               
 Services Standing Committee.                                                  
 HB 127 - FOSTER CARE REVIEW BOARD                                             
 Number 0130                                                                   
 CHAIRMAN BUNDE announced the next item on the agenda as HB 127, "An           
 Act relating to the citizen review board and panels for permanency            
 planning for certain children in state custody; renaming the                  
 Citizens' Review Panel For Permanency Planning as the Citizens'               
 Foster Care Review Board; extending the termination date of the               
 Citizens' Foster Care Review Board; and providing for an effective            
 date."  He referred to an amendment before the committee.                     
 Number 0215                                                                   
 REPRESENTATIVE PORTER made a motion to adopt Amendment 1 to HB 127.           
 This amendment would remove two of the three attorney positions on            
 the board, limiting it to one position.  Hearing no objection,                
 Amendment 1 was adopted.                                                      
 BLAIR McCUNE, Assistant Public Defender, Central Office, Public               
 Defender Agency, Department of Administration, testified next via             
 teleconference from Anchorage.                                                
 Number 0362                                                                   
 CHAIRMAN BUNDE asked if a representative from the Public Defender             
 Agency attended the Title IV-E review with the Division of Family             
 and Youth Services (DFYS).                                                    
 Number 0366                                                                   
 MR. McCUNE answered that this occurs sometimes.  The agency does              
 not have the staffing to cover all Title IV-E reviews so their                
 attendance is rare.                                                           
 Number 0391                                                                   
 CHAIRMAN BUNDE asked if the fiscal note included the cost of this             
 rare attendance.                                                              
 Number 0400                                                                   
 MR. McCUNE stated that currently the Title IV-E review doesn't                
 generate a report used or submitted for a court disposition.  The             
 court has to make a finding about reasonable efforts to provide               
 services.  Under this bill, in Section 23, "the local panel shall             
 submit a final report to Anchorage Court and temporary custody                
 orders and dispositional hearings and reviews".  He said this                 
 language has changed from the current language.  If the foster care           
 review panels are going to be set up as entities whose views are              
 considered in court hearings, then his agency ought to be there to            
 provide representation and input.  If the review panels are not               
 used for that purpose and are done on a more internal procedures              
 basis, like the current Title IV-E procedures, then his agency                
 would not have to attend.  This bill expands the scope of the                 
 Number 0529                                                                   
 REPRESENTATIVE PORTER asked if he was referring to the review                 
 panel's consideration of their report in terms of the agency having           
 to be present or being present when this report is presented in               
 Number 0546                                                                   
 MR. McCUNE answered that he was referring to attending the local              
 review panel hearings.  Currently the review panels only review a             
 third of the cases in Anchorage.  If this system was implemented              
 statewide for all out-of-home placement greater than 90 days, then            
 he thought the agency should be a participant.                                
 Number 0608                                                                   
 REPRESENTATIVE PORTER observed that it was interesting that prior             
 to the adoption of Amendment 1, an agency staff would have been on            
 the Citizens' Foster Care Review Board, setting policy for the                
 review committee.  He suggested that his agency would want to be a            
 advocate for their client, not as someone who sets policy for the             
 review committee and acts in the best interest of the child.  The             
 attorney general's position and the public defender's position were           
 eliminated from the Citizens' Foster Care Review Board, leaving the           
 director or his designee from the Office of Public Advocacy.                  
 Number 0675                                                                   
 JODI OLMSTEAD, Founder, Concerned Parents for Reform, testified               
 next via teleconference from Fairbanks.  She referred to public law           
 96-272, the Child Welfare Assistance Act.  This law says this                 
 review system works as a tool to cut back on the abuses.                      
 Nationally 28 percent of abuses happen within the foster care                 
 system.  Our nation has the highest number of allegations and                 
 abuses of our children.  These numbers play a role in overzealous             
 social workers.  The review panels serve as a check and balance for           
 the foster care system.  She referred to a case of her nephew who             
 suffered abuse while in foster care.  Fairbanks has a big foster              
 care drift.                                                                   
 MS. OLMSTEAD stated that citizen oversight will decrease the amount           
 of cases which go through the foster care system.  We need people             
 to be there through every single case plan of each child and the              
 programs they go through.  No one has time to listen to the whole             
 thing in the judicial system.  Citizens on these review panels need           
 to follow everything that goes on with the child, need to follow              
 them from the beginning to the end and they need to report what               
 they find.  The Nebraska review panel tells what is done wrong and            
 how it could be made right.                                                   
 MS. OLMSTEAD clarified that CSHB 127(HES) was extended to June 30,            
 2000.  She asked to hear discussion on this point.  There are a lot           
 of children in foster care in Fairbanks and something needs to be             
 done about it.  Litigation does not have to be the answer.  The               
 interior delegation have been inundated with complaints about this            
 Number 0917                                                                   
 WALTER GAUTHIER testified next via teleconference from Homer.  He             
 was in support of CSHB 127(HES), but had some concerns.  He                   
 referred to page 3, "The board consists of five public members                
 appointed by the Governor".  He suggested that part of the problem            
 with the whole social services system is that it is all under the             
 Department of Health and Social Services (DHSS) which is all under            
 the Governor.  He cited an example of a program that was cut from             
 the budget last year which DHSS then funded out of another fund.              
 The legislature has no power over DHSS.                                       
 MR. GAUTHIER stated that for every Child in Need of Aid (CINA) case           
 there are probably nine agencies, public and private, whom are                
 concerned about the child.  No one seems to be concerned about the            
 parents or the family as a whole.  The last review panel on foster            
 care report stated that efforts were made to get the children into            
 foster care.  Once the children were in foster care, they were                
 practically forgotten about and were in the system for an average             
 of 18 months to two years.  He thought the problems stemmed from              
 the DHSS autonomy.                                                            
 MR. GAUTHIER referred to page 10, "at the child's request, a child            
 who is ten years of age or older shall be allowed to be present at            
 interviews of the review panel, that concerns that child's case               
 unless the panel determines that for a good cause the child's                 
 presence would be contrary to the best interests of the child or              
 there is other good cause for denying the child's request".  He               
 felt confidentiality has been used to shield mistakes and creates             
 an overzealous approach.  Any time these decisions are going to be            
 made, the child should be allowed to be there.  A large percentage            
 of children recant previous testimony, a child will renounce things           
 that a social worker states.  On a whole, he is in favor of CSHB
 Number 1103                                                                   
 CHAIRMAN BUNDE assured him that the Citizens' Foster Care Review              
 Board will be created and administered by the Department of                   
 Administration.  The board will then recruit the volunteers, so               
 this process will be removed from the Governor and his influence.             
 Number 1149                                                                   
 CHAIRMAN BUNDE explained that current laws are inadequate, they               
 don't give enough power to local panels.  The panels are a weak               
 duplication of DFYS.  In many cases it is important that there be             
 an outside citizen review of government functions.  He was not                
 saying that DFYS intentionally does things wrong, but it is                   
 important to have an additional review.  He said CSHB 127(HES)                
 amends the existing foster care review statutes and gives needed              
 power to local panels, stressing local oversight and local panels.            
 These local panels do not have the power to advocate for children             
 in a court of law.  This legislation allows local review panels to            
 place their recommendations into the court record, this might                 
 reduce the number of cases where children get lost in the system.             
 This provision gives the panels the power to be heard at the same             
 level as the case worker, public defender, guardian ad litem and              
 other parties who speak in court on the behalf of families.  He               
 felt that you couldn't discuss the welfare of a child without also            
 acknowledging the importance of the family.                                   
 CHAIRMAN BUNDE commented that another problem with the existing               
 statutes is the duplication of services between DFYS and the local            
 review panels.  The DFYS completes federally mandated Title IV-E              
 reviews for eligible children in out-of-home care every 180 days.             
 The review process allows DFYS to collect federal funds for                   
 eligible children.  The local review panels review the same                   
 children with a more thorough process every 180 days.  The two                
 separate reviews are seen as a duplication of effort, the                     
 legislation will not fund a board that duplicates functions of an             
 existing department.  This legislation gives the authority to the             
 local review panels to do the Title IV-E and take some of the                 
 burden off DFYS.                                                              
 Number 1270                                                                   
 REPRESENTATIVE FRED DYSON mentioned his concern over the fiscal               
 note.  He though Alaska's social problems, including dysfunctional            
 families and dislocated children, would be assisted by the                    
 citizens' review panels.  The DFYS is in stress.  Their credibility           
 and the credibility of all state government is in question.  The              
 panels provide an objective outside review and oversight.  It                 
 builds confidence in what government is or should be doing.  He               
 stated that his wife, who served on the Anchorage panel, found it             
 Number 1379                                                                   
 REPRESENTATIVE GREEN asked someone to explain why the panel might             
 determine that the child's future shouldn't be witnessed by the               
 Number 1409                                                                   
 PATTI SWENSON, Legislative Assistant for Representative Bunde,                
 stated that the panel doesn't really decide whether the child is              
 present or not.  This decision is made in conjunction with advice             
 given by the Court Appointed Special Advocate (CASA) and the                  
 Guardian ad litem.  Some children don't want to come to these                 
 Number 1455                                                                   
 REPRESENTATIVE GREEN commented that the way in which CSHB 127(HES)            
 is written states that the child may be there unless the panel                
 determines that they should not be there.  He clarified that she              
 was saying that the panel does not make this determination.                   
 Number 1463                                                                   
 MS. SWENSON stated that the board works closely with all of the               
 people who are in contact with the children.  A child would not be            
 invited if it would harm them in any way.                                     
 Number 1480                                                                   
 REPRESENTATIVE GREEN felt this language would create a restriction            
 if the child wanted to attend the review.                                     
 Number 1495                                                                   
 MS. SWENSON explained that some children feel they need to support            
 their parents no matter how abusive their parents have been.  The             
 child might say that they want to go back to their parents, when in           
 actuality that isn't what they want.  Children that age don't                 
 necessarily tell the truth, no matter what their current situation            
 is.  The board makes the determination of a child's attendance                
 based on those people who know the child best.  A child might say             
 something that could be misconstrued.                                         
 Number 1524                                                                   
 REPRESENTATIVE GREEN verified that the court determined age 14 to             
 be the age of reason.  He clarified that the reason why a child               
 wouldn't be invited to this review process is because their                   
 psychological make-up wouldn't stand a review process.                        
 Number 1553                                                                   
 CHAIRMAN BUNDE stated that first the Guardian ad litem, then the              
 social worker and finally the review panel would help the child               
 make the decision whether or not to attend the review.  He shared             
 his concern that if a child wants to attend, there might be three             
 different entities describing why they shouldn't attend.                      
 Number 1571                                                                   
 REPRESENTATIVE GREEN felt that the board had the ultimate decision            
 making power as contained in the language of CSHB 127(HES).                   
 Number 1581                                                                   
 MS. SWENSON said she has not seen this happen.                                
 Number 1583                                                                   
 CHAIRMAN BUNDE explained that the panel works on the advice of                
 Number 1597                                                                   
 REPRESENTATIVE PORTER made a motion to move CSHB 127(HES) as                  
 amended with individual recommendations and attached fiscal notes.            
 There being no objection, CSHB 127(HES) was moved from the House              
 Health, Education and Social Services Standing Committee.                     
 HB 195 - LICENSURE OF OPTOMETRISTS                                            
 Number 1629                                                                   
 CHAIRMAN BUNDE announced the next item on the agenda was HB 195,              
 "An Act relating to licensure of optometrists; and providing for an           
 effective date."                                                              
 Number 1634                                                                   
 JEFFREY A. GONNASON, O.D., stated that he has been licensed as a              
 optometrist since 1976.  He has been in an Anchorage practice for             
 over 20 years.  On behalf of Alaska Optometric Association he                 
 wanted to thank the committee for hearing HB 195.  The association            
 represents approximately 80 Alaskan doctors of optometry.  He said            
 150 years ago dentistry progressed out of the barber shop and                 
 optometry progressed out of the jewelry store.  Both professions              
 have expanded their scope of practice over the years in accordance            
 with technological advances.  Today optometry is a primary health             
 care profession that examines, diagnoses and treats disorders of              
 the human eye.  It utilizes medications and procedures in                     
 accordance with professional training and competency.                         
 DR. GONNASON explained that, historically, medical doctors have               
 enjoyed unlimited legislative trust in their scope of practice.               
 Alaska's optometrists have had their scope of practice unduly                 
 restricted by old state statutes which do not account for modern              
 advancements in education and training.  This bill, HB 195, was               
 carefully drafted to give the board the authority to authorize the            
 use of advanced methods and procedures for those optometrists who             
 meet additional board qualifications.  Currently optometry school             
 graduates, trained in modern technology, cannot fully utilize their           
 training in Alaska.                                                           
 DR. GONNASON said the bill will allow the board to determine the              
 scope of practice through regulation within limited guidelines.               
 This is currently done for dentistry and nurse practitioners.  The            
 limited use of lasers and other modern technology and limited non-            
 evasive surgical procedures may be allowed through the board under            
 this bill.  Dentists and podiatrists perform surgery and do not               
 attend medical school.  He questioned why optometry should be                 
 subject to discrimination.                                                    
 DR. GONNASON stated a laser is a tool used in many different facets           
 in health care as well as industry.  This legislature trusted                 
 optometry in 1988 and in 1992, passing diagnostic and therapeutic             
 medication legislation.  Optometrists have shown themselves to be             
 reasonable, competent and trustworthy under the expanded                      
 privileges.  Previous testimony on the 1988 and 1992 legislation              
 described the great harm that would occur to patients, including              
 death and blindness, if optometrists were allowed to expand their             
 scope.  As of now, there have been no complaints of harm to the               
 Division of Occupational Licensing in regard to the expansion of              
 optometrists' privileges.  Malpractice insurance rates have                   
 remained the same in states where the scope of optometric practice            
 has been expanded.                                                            
 DR. GONNASON referred to the state audit report of the Board of               
 Examiners in Optometry which concluded that, "the 1992 Optometry              
 legislation benefited the public and furthered the public interest            
 health and welfare and that the board does provide assurance that             
 licensees are qualified and act in a competent manner."                       
 Optometrists are held to the same standards of care as medical                
 doctors and other health care professionals.                                  
 DR. GONNASON stated that HB 195 would provide better access to                
 quality, affordable and cost effective health care.  This is                  
 especially true for many of the smaller towns and villages which              
 are only served by an optometrist.  Optometrists are reasonable,              
 educated and caring professionals.  They are licensed by the state            
 with strict standards.  They are regulated by the state board, by             
 legal liability concerns, community opinion, by medicine and by the           
 legislature looking carefully over their shoulders.  The state                
 Board of Optometry should be allowed to determine the scope of                
 practice through regulations, as is done by other health                      
 professions in Alaska, to keep current with advances in health                
 care.  No optometrist would attempt to perform a procedure or                 
 treatment that he or she was not trained or comfortable with doing.           
 Optometrists should be treated as the trusted, learned                        
 professionals that they are.                                                  
 Number 1859                                                                   
 REPRESENTATIVE DYSON received letters from people in the medical              
 community which informed him that no other state currently allows             
 the expansion of responsibilities as would occur with the passage             
 of HB 195.  He stated that 47 states currently prohibit optometric            
 surgery, 30 of these states have passed this legislation since                
 Number 1886                                                                   
 DR. GONNASON said 37 states say that optometrists cannot use                  
 lasers.  The reason why the Alaskan law says that optometrists                
 cannot use lasers is because, in order to get the 1988 legislation            
 passed, optometrists had to accept language prohibiting this                  
 procedure.  Lasers are used by optometrists in four or five states.           
 Optometrists do not use lasers because there is specific language             
 stating that they can use them, but because they are not prohibited           
 in their state.  The use of lasers is currently taught in optometry           
 school.  Dr. Maynard Falconer, a recent retiree, has a daughter who           
 just graduated from college and is trained in lasers.  He                     
 emphasized that there are types of laser procedures that                      
 optometrists are not trained in such as retina treatment.  There              
 are also laser procedures which are straightforward and simple to             
 use.  Lasers are tools.                                                       
 DR. GONNASON referred to a study done by John Hopkins University              
 which shows an Alaskan Native woman in the "slit lamp" laser.  The            
 article states that paraprofessionals and technicians, can learn to           
 perform this sight saving procedure in a matter of minutes with no            
 complications.  This bill would specifically say that optometrists            
 could use lasers as determined by the board based on the proper               
 credentials and qualifications.  Some older optometrists are not              
 trained in the more modern procedures and would not be allowed to             
 perform these additional procedures.                                          
 Number 1985                                                                   
 REPRESENTATIVE DYSON stated that this bill allowed optometrists to            
 prescribe more prescription drugs and asked if this was done in               
 other states.                                                                 
 DR. GONNASON answered that there are 33 or 34 states which allow              
 optometrists to go beyond topical medications and prescribe                   
 systemic medications.  The department was concerned whether or not            
 the board would need to ask for more credentials.  Currently those            
 optometrists who use medications need to have an endorsement on               
 their license.  The board designed this endorsement to include the            
 ability to prescribe systemic medications.  In 1992, the oral                 
 portion of the bill was compromised in order to pass the bill.                
 This left the ability to administer topical medications in the                
 endorsement.  The bill, HB 195, specifically excludes controlled              
 substances, schedules I and II.  Those drugs are considered                   
 TAPE 97-33, SIDE A                                                            
 Number 0000                                                                   
 DR. SAM McCONKEY, M.D., testified next via teleconference from                
 Fairbanks.  He said he has been a board certified ophthalmologist             
 with the eye clinic in Fairbanks since 1975.  As a physician he is            
 morally and ethically obligated to advocate for the patient.  There           
 are two important issues to identify in this discussion.  The first           
 issue is patient care and who is qualified to deliver it.  He said            
 a physician has a college degree followed by four years of medical            
 school and three or more years of specialty training in medical and           
 surgical diseases of the eye.  This adds up to at least 12 years of           
 school after high school.  An optometrist has, in most cases, a               
 college degree and four years of optometric school.  Clinical                 
 training and experience is the path to competency, not legislation.           
 It is difficult for the lay public to understand that even the                
 drops used to treat eye problems can cause strokes, cardiac arrest,           
 high blood pressure, depression, suicide and shock.                           
 DR. McCONKEY stated that the committee was being deceived by                  
 organized optometry.  This bill by request is all about money.  It            
 has nothing to do with patient care.  It has to do with the medical           
 care dollar and how it is divided.  For the last 25 to 30 years,              
 organized optometry has realized that there are too many                      
 optometrists in the United States and cannot make a decent living             
 fitting glasses and contact lenses.  Optometric school                        
 administrators do not want their students to realize that there are           
 too many optometrists because their schools would not remain full.            
 DR. McCONKEY explained that practicing optometrists are not to be             
 blamed for this, they are only the pawns in the larger scenario.              
 This is an ingenious, well thought out, well financed, political              
 strategy.  It has been successful.  Unsuspecting state assemblies             
 have legislated optometrists into positions of medical care givers.           
 Passage of these bills convinces state and federal agencies that              
 optometrists should be included in the split of the health care               
 dollar.  He referred to the 1988 and 1992 bills, the legislature              
 asked the two separate components to resolve this issue outside of            
 the legislative process.  Optometrists were given a few low risk              
 drops to treat minor eye problems.  The quid pro quo for this                 
 agreement was that optometrists would not initiate legislative                
 initiatives until they received proper education, training and                
 medical testing by someone other than their board.                            
 DR. McCONKEY said HB 195 would allow (indisc.) medical prescription           
 drugs except narcotics, cataract surgery, eye muscle surgery on               
 children, surgery for injuries and laser procedures.  He said these           
 items have to do with training and experience.  The citizens of the           
 state of Alaska do not deserve to be confused further about who is            
 qualified and who has the responsibility for the medical and                  
 surgical care of their eyes.                                                  
 Number 0386                                                                   
 DR. PETER CANNAVA testified next via teleconference from Kenai. He            
 presented a scenario where he was a flight attendant who has                  
 decided that he wanted to fly the airplane because he was no longer           
 content with being a flight attendant.  If someone asked him why he           
 wanted to be a flight attendant pilot, he could answer that his               
 flight attendant school gave a course in piloting and that they               
 will tell him when he is qualified to pilot and will regulate him.            
 He would redefine what a pilot is.  His definition says that a                
 pilot is going to be someone who only flies above 20,000 feet so it           
 will be non-dangerous or non-invasive flying.  There is a precedent           
 for this shown by helicopters, jet pilots and test pilots who are             
 only regulated by their boards.  The legislature might retort that            
 all the people mentioned are pilots by training, from the beginning           
 of their school, whereas a flight attendant has no historical basis           
 or schooling.  The legislature might say that it is not the                   
 function of the legislature to give sanctions to born again                   
 professions and that to be a real pilot, he should go to the proper           
 schools, pass the proper tests and be regulated by the proper                 
 authorities and stop trying to short circuit the system.                      
 DR. CANNAVA mentioned that the committee would hear some testimony            
 by a physician who claims that optometrists are well trained.  He             
 encouraged them to ask this physician how much of his income is               
 generated by optometric referrals and how much he has just invested           
 in a clinic solely dedicated to take care of optometric referrals.            
 DR. CANNAVA stated that if HB 195 was as innocuous as Dr. Gonnason            
 explained, they would not have redefined non-invasive surgery as              
 surgery done without a general anesthetic.  Physicians and surgeons           
 are currently doing everything under local anesthetic including               
 neural surgery, knees, hips, hysterectomies, gall bladders and                
 appendectomies.  For optometry to be so naive as to classify all of           
 these things as non-invasive, simply because they are done under              
 local anesthetic, indicates the paucity of their training.                    
 DR. CANNAVA commented that the other part of HB 195 that should be            
 questioned is where optometrists claim they need to use systemic or           
 oral antibiotics and pain killers.  Part of his responsibilities              
 include plastic surgery, repairing broken sinuses and treating                
 infections of the face and paranasal sinuses.  It is only in                  
 treating sinuses, skin infections and things like that where he               
 uses systemic antibiotics.  The eye rarely needs antibiotics, other           
 than by drop form.  When antibiotics are needed it involves an                
 injection into the eye.                                                       
 DR CANNAVA said optometrists claim they need oral pain killers.  He           
 probably writes three prescriptions for pain killers by mouth a               
 year.  There are topical medications which adequately take care of            
 Number 0739                                                                   
 DR. RONALD ZAMBER, M.D., testified next via teleconference from               
 Fairbanks.  He described his education and background.  He spent no           
 less than 20,000 hours of intense medical and surgical training to            
 develop the competency to administer and prescribe appropriate                
 medical therapeutics and surgical remedies.  Despite this training,           
 he could assure the committee that he was not overtrained.  There             
 are no groups in this nation qualified to provide complete medical            
 and surgical management of eye diseases other than                            
 ophthalmologists.  Neurosurgeons are not qualified to provide                 
 complete medical and surgical management of eye diseases.                     
 DR. ZAMBER said this bill addresses more than vision, it addresses            
 general medical well being.  During those 20,000 hours of training            
 as an intern and surgical resident, he saw dozens and dozens of               
 patients who had been prescribed medication which appeared benign             
 but ultimately wound up causing multi-system failures.  The issue             
 is one of competency and qualifications.  This bill talks about               
 lasers, about instruments that can in a microsecond blind a                   
 Number 0959                                                                   
 DR. ROBERT FORD, M.D., said he is an ophthalmologist and the                  
 founder of Pacific Cataract and Laser Institute which has 11 sites            
 in the Northwest including one in Anchorage.  He is licensed in               
 Alaska.  When he finished his ophthalmology training he came out              
 with the same bias that other witnesses have presented.  Shortly              
 after he went into private practice, he started to indirectly work            
 with optometrists.  He began to work more closely with a particular           
 optometrist who won his respect.  He began to make the gradual                
 transition to respecting optometrists.  Ophthalmologists do have              
 more training and are going to need to do the more complicated                
 procedures, but optometrists are legitimately going to be the ones            
 in the future of health care who will do the primary eye care.  He            
 has chosen to work cooperatively with optometry.  Optometrists do             
 the primary care and they refer patients to him to do surgery and             
 then patients are referred back to do post operative care.                    
 DR. FORD mentioned the two previous pieces of legislation.  He said           
 these bills involved risk, but the risk was balanced by the reward.           
 Time has proven that the risk was worth the reward.  Now is the               
 next phase of expansion of the optometric practice.  The decision             
 to expand optometric practice has not been an easy one for him.               
 This bill would allow optometrists to use a YAG laser which                   
 accounts for a significant portion of the revenue that the company            
 gets.  It is harder and harder to make the books balance in                   
 medicine.  A cataract surgeon's fee is about half what it used to             
 be.  He questioned whether or not the company could float                     
 financially if the YAG laser procedure was used by optometrists.              
 He decided to maintain his commitment to principle that by giving             
 to another profession, he would feel good about himself.                      
 DR. FORD stated that an honest reading of the Idaho law suggested             
 that optometrists could do these laser treatments, so optometrists            
 did these laser procedures.  Over a hundred of these procedures               
 were done, without any problems.  A number of years ago it was felt           
 this procedure could legally be done by a physician's assistant.              
 In summary, he felt it was the American way to allow professions to           
 grow.  Optometry has grown a lot in the last ten years, it is a               
 different profession than it used to be and he would like to see              
 them continue to grow.  We should allow them to further expand                
 their practice.                                                               
 Number 1213                                                                   
 HANS KELL, O.D., cited his education and clinical background.                 
 Optometry is a profession which has grown progressively more                  
 sophisticated and capable.  Currently, doctors of optometry                   
 complete eight to nine years of professional training; four years             
 of undergraduate and four years of graduate training in optometry             
 and a residency program.  The training in optometry includes basic            
 sciences, preclinical education and clinical experience.  Admission           
 requirements and tests are similar to those for dental and medical            
 schools.  Biomedical science taught in the first two years of                 
 optometry and medical schools are comparable and often share the              
 same textbooks and instructors.  In some universities the                     
 optometry, dental and medical students attend these classes                   
 together.  Optometry schools are accredited by the same national              
 agencies that accredit medical schools.  Clinical training for                
 optometry occurs in various clinics, Health Maintenance                       
 Organizations, Public Health, and Veterans' Administration                    
 DR. KELL said this training prepares doctors of optometry to                  
 provide primary eye care similar to the family dentist providing              
 general dental care or the family medical doctor providing primary            
 health care.  To establish perspective, there is value in comparing           
 the education of optometry with that of medicine.  In 1980, Dr.               
 Rushmer conducted a review which observed that the professions of             
 optometry, dentistry, podiatry and medicine all have similar state            
 and national board requirements.  These professionals attend                  
 accredited educational institutions.  He further stated that, "the            
 basic educational experience of these professions is remarkably               
 similar and cannot account for consistent underutilization of non-            
 medical health professionals."                                                
 Number 1347                                                                   
 DR. KELL stated that optometry training in pharmacology, the use of           
 lasers and other methods for the diagnosis and treatment of the eye           
 are of the same quality as those methods taught to                            
 ophthalmologists.  While the clinical application of these tools is           
 relatively straightforward, their justification for use and                   
 providing follow up care is the most difficult component of                   
 treatment.  Optometrists have safely and effectively used their               
 clinical judgement to evaluate, recommend treatment and perform               
 follow up care for many years.                                                
 Number 1396                                                                   
 REPRESENTATIVE DYSON asked if this was a turf war.  He referred to            
 the similar chiropractic issue.                                               
 Number 1432                                                                   
 DR. GONNASON agreed, on the national level, optometrists are paid             
 to do Medicare procedures and there is competition for those                  
 patients.  In managed care plans there is competition as to who               
 gets to be the gate keeper.  If the optometrist is the gate keeper,           
 then there are a lot less surgeries done.                                     
 Number 1456                                                                   
 REPRESENTATIVE DYSON did not want to imply that the medical doctors           
 were only looking after their vested interest.                                
 Number 1472                                                                   
 DR. KELL agreed that we are all honorable people.  Ophthalmologists           
 as well as optometrists are patient advocates.  He thanked the                
 legislature for the bill that passed in 1992 which has given                  
 optometrists the privilege of following patients after surgery.               
 Currently, optometrists examine the patient and, if necessary, the            
 patient is referred for surgery.  After surgery, those patients are           
 followed up with medications.  He stated that there are many types            
 of lasers and their applications.  Some procedures are much more              
 straightforward than others.  He felt the most important thing was            
 the justification for the procedure and the correct follow-up of              
 potential complications which could occur and what to do.  The                
 money really lies in the procedure itself.                                    
 Number 1532                                                                   
 REPRESENTATIVE GREEN asked for a definition of non-invasive.                  
 Number 1547                                                                   
 DR. GONNASON answered that a non-invasive procedure is one which              
 does not open the globe.  A pimple on the eyelid might be drained             
 under surgical conditions.  He said clipping your fingernails is              
 surgery.  There are procedures currently being done that were                 
 authorized in the 1992 legislation, one of which is the removal of            
 foreign bodies.  In this procedure the eye is numbed with a                   
 medication, the metal is picked out and then a battery powered                
 drill is used to grind out the rust.  If that metal had penetrated            
 the eye ball, then it would be under the realm of the specialty               
 Number 1620                                                                   
 REPRESENTATIVE GREEN asked how the laser would be used.                       
 Number 1626                                                                   
 DR. GONNASON explained that the best example is one is called a               
 Peripheral Iridotomy.  Alaska Eskimos have the highest percentage             
 of Acute Angle Closure Glaucoma.  As compared with other forms of             
 glaucoma where pressure slowly goes up, this glaucoma is an attack.           
 The pressure of your eye builds as if the eyeball is going to                 
 burst.   The eye will go blind if it is not treated within 24 or 48           
 hours.  This is a definite medical emergency.  The treatment is to            
 poke a hole in the iris so that fluid can go from the front to the            
 back.  A laser focused inside the cornea burns a tiny hole which              
 relieves that pressure and the patient is cured.  He cited an                 
 example of the time and inconvenience caused when an optometrist              
 could not do this procedure in Anchorage.  He questioned what would           
 have happened if this situation had occurred in Kotzebue or Barrow.           
 Number 1711                                                                   
 REPRESENTATIVE PORTER asked if a neutral party could testify on               
 this bill; someone outside of optometry and ophthalmology.  He                
 assumed giving optometrists the ability to perform these things               
 would lower health care costs.                                                
 Number 1759                                                                   
 REPRESENTATIVE GREEN asked what sort of things an optometrist might           
 want to treat rather than submitting it to an ophthalmologist.                
 Number 1786                                                                   
 DR. KELL answered that the most common procedure is a laser                   
 procedure called a YAG Capsulotomy.  After cataract surgery a thin            
 membrane of the patient's lens is removed.  He clarified that the             
 lens is removed during cataract surgery with the skin or the back             
 of that lens left behind with an implant inserted in front of that.           
 In approximately 33 percent of the eyes that membrane becomes                 
 opacified or cloudy.  Years ago this was treated by having an                 
 ophthalmologist go inside the eye to make a hole in the eye.  A               
 laser is able to make a hole in the center which opens it up and              
 allows the patient to see.  Currently, optometrists evaluate these            
 patients often and refer these patients for this procedure.  The              
 procedure itself takes a minute, then patients are referred back to           
 the optometrists for potential complications like retina                      
 detachment.  He said this is one procedure that optometrists feel             
 that they could treat.                                                        
 Number 1851                                                                   
 REPRESENTATIVE GREEN asked about the other types of illnesses.                
 Number 1859                                                                   
 DR. KELL mentioned Acne Rosacea which affects the lipid or fat                
 producing glands around the eyelid.  The glands and the vessels               
 surrounding them become infected affecting either the make-up or              
 atrophy of these glands so they don't produce the oil layer which             
 helps keep tears from evaporating.  This produces dry, scratchy               
 eyes.  One of the best treatments for this condition, besides the             
 use of artificial tear lubrication, is to take tetracycline.                  
 Tetracycline is a simple, oral medication with minimal                        
 Number 1900                                                                   
 REPRESENTATIVE GREEN mentioned the amount of study for both                   
 professions and asked what the differences were once you got past             
 the basic courses.                                                            
 Number 1928                                                                   
 DR. KELL answered that ophthalmologists, after four years of                  
 medical school, have a year of internship which usually occurs in             
 a hospital setting.  Currently ophthalmology residency programs are           
 three years, followed by a voluntary sub-specialty training.  At              
 the Bascom Palmer Eye Institute, the first year ophthalmology                 
 residents are not trained in surgery except for some of these                 
 limited, minor surgical procedures discussed.  The ophthalmologists           
 see the indigent patients.  During the second year, an                        
 observational clinic occurs where the residents observe different             
 sub-specialists.  Ophthalmologists that have gone into sub-                   
 specialty training might focus only on the retina, pediatrics or              
 neuro-ophthalmology.  Those residents observe as well as begin to             
 learn the procedures of their sub-specialties.  The third year is             
 when the residents hone their surgical skills.  Ophthalmologists              
 have a wonderful training, it is more extensive and more                      
 DR. KELL said that HB 195 proposes that optometrists not perform              
 these specialized procedures, but to perform the more non-invasive,           
 simple procedures.                                                            
 Number 2008                                                                   
 DR. ZAMBER said ophthalmology training varies a little from Dr.               
 Kell's description in that the internship is a surgical, medical or           
 rotating internship.  Residents are often involved in emergency               
 care settings, intensive care unit settings and clinical oncology             
 cancer treatment settings.  These settings expose the residents to            
 the management of patients with various medical conditions.  The              
 purpose of that training is to develop a respect and competency for           
 this process.  He was appalled at the lack of respect for this                
 issue.  There are no shortcuts, those 20,000 hours were hours well            
 served.  Those are 20,000 hours beyond what an optometrist gets in            
 training, treating the patients as a whole.                                   
 DR. ZAMBER explained that the oral medications which would be                 
 allowed to be administered by HB 195 can kill patients.  He has               
 seen dozens of patients who have experienced Steven's Johnson                 
 Syndrome, a severe allergic reaction which is often life                      
 threatening and results in a scalded skin type syndrome and creates           
 a ventilatory dependent state.  This syndrome is the result of                
 medications which would be allowed under this bill.  Sulfa is the             
 primary offending agent in these types of reactions.  Many of the             
 oral therapeutics used to treat glaucoma have a sulfa moiety.                 
 DR. ZAMBER explained that he is a published expert on complications           
 related to topical and systemic beta blockers including the                   
 promotion and induction of beta blocker induced lupus, a life                 
 threatening condition.  He emphasized that he is not overtrained.             
 This is not a turf war, it is about patient care.  He suggested               
 having an O.D.M.D. testify.  Those are optometrists who then went             
 on to receive full medical and surgical training, with most                   
 training to be ophthalmologists.                                              
 TAPE 97-33, SIDE B                                                            
 Number 0000                                                                   
 GORDON PREECS, M.D., said he trained eight years ago with three               
 other people in his residency level.  One of whom was a doctor of             
 osteopathy, another form of allopathic medicine.  This type of                
 doctor has full licensure and authority to practice medicine in               
 Alaska and most of the states.  This person was the son of an                 
 optometrist and was an optometrist himself.  He went back to                  
 medical school and received ophthalmologic training.                          
 DR. PREECS stated that during the first year of residency they did            
 the dirty work; the injuries, the irritations and red eyes.  Their            
 main task, in part, was to screen the people who came through to              
 determine what was serious and what wasn't.  The osteopathy                   
 resident used to say that he saw more in one day working in the               
 walk-in clinic, than he saw in his whole senior year of optometric            
 school.  His goal in optometric school was to learn how to fit                
 contacts and work in a complimentary role to the process of vision            
 care and refractive services.  Eye disease was directed to medical            
 care.  He felt that if there had been a revolution in what is going           
 on in the course and the exposure of realistic activities in                  
 optometric school, it simply escaped him.                                     
 Number 0191                                                                   
 DR. PREECS addressed Section 7 (6), invasive surgery, which showed            
 a remarkable lack of understanding of the process.  He felt                   
 invasive surgery was anything that removed, damaged or intruded the           
 tissue.  Non-invasive procedures are those which allow you to                 
 visualize, allow you to inspect but do not allow you to change the            
 tissue.  Invasive surgery is changing tissue, cutting holes,                  
 drilling passage ways, making new affects.  The fact that a knife             
 is not use does not mean that it is non-evasive.  YAG Capsulotomy             
 is a rather simple procedure, but he did not think that allowing              
 optometrists to do this procedure would reduce the cost.  The goal            
 would be to acquire access to that well-paid process.  He felt that           
 American medicine was over-equipped.  There are competing hospitals           
 duplicating services and trying to impress the provider and client            
 communities that they have the best facilities.  A ton of money is            
 spent duplicating these processes.                                            
 DR. PREECS felt discouraged by this subject.  He commented that it            
 seemed the medical community would be pecked to death as the state            
 de-professionalizes the process of rendering care at every level,             
 from every source.  Every managed health care plan which wants to             
 reduce the access to care by pushing decision-making power farther            
 down stream in a gate keeper mode.  Telephone nurses rather than              
 on-site physicians, screening telephone technicians who will                  
 understand whether their care will be authorized.  He felt this was           
 a part of the process which says we will save money by trying to              
 eliminate the expensive provider, ensure that we have enough cheap            
 providers to go around and hope we don't make many mistakes.  He              
 shared in his colleague's concern that ophthalmologists were going            
 to be slowly but surely, biannually by biannually, nickeled with              
 these opportunities to expand and exchange the nature of medical              
 Number 0389                                                                   
 REPRESENTATIVE GREEN explained that he only has one eye and as a              
 result he is nervous about allowing anyone, without the best                  
 possible training working, to treat his other eye.  He agreed that            
 there were procedures which both professions could learn to do.  He           
 refer to his wife's experience, who is a dental hygienist, and                
 their expansion of care.  She stated that she preferred to have a             
 doctor available in case of a medical emergency.                              
 REPRESENTATIVE GREEN stated that there were some procedures which             
 could be done by both professions; dentists and dental hygienists,            
 chiropractors and medical doctors, and optometrists and                       
 ophthalmologists.  He felt there had to be a limit put on those               
 procedures because of the possible side effects.  He asked if there           
 was a concern among professions that a condition, which isn't                 
 obvious, might be overlooked.                                                 
 Number 0559                                                                   
 DR. PREECS referred to some of his first year textbooks which                 
 contained something of a warning poised in the image of a cartoon.            
 It was titled, "A patient seen by the ophthalmologist".  It                   
 depicted a person in a nice two piece suit with a fedora and an               
 eyeball over his shoulders.  The warning to the ophthalmologists,             
 as physicians, was not to hone in on the eyeball and forget that              
 they were operating on an entire human process.  Optometrists learn           
 about the human system components.  How hormones result in life               
 stage changes in the eyes in which neurologic and physiologic                 
 changes involve the eye, but are not limited to the eye.  Medical             
 practice in the United States is based on the principle that we               
 will start with a profound base of training, a large body of                  
 experience and that we all have to do it no matter what we want to            
 do when we finish.                                                            
 DR. PREECS referred to a personal experience when his father-in-law           
 finally addressed his cataract which covered up a devastating                 
 retinal detachment.  This condition was not able to be treated.  He           
 felt that he understood how critical this situation is for his                
 patients and said it is imperative that we understand that we need            
 to have concern the entire patient in the training.                           
 Number 0750                                                                   
 CHAIRMAN BUNDE stated that, as is usual, this is the first time the           
 bill is heard and so the committee will not take action on it                 
 There being no further business to conduct, CHAIRMAN BUNDE                    
 adjourned the meeting of the House Health, Education and Social               
 Services Standing Committee at 5:30 p.m.                                      

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