Legislature(2001 - 2002)

04/24/2001 03:08 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                                                                         
                       STANDING COMMITTEE                                                                                     
                         April 24, 2001                                                                                         
                           3:08 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Fred Dyson, Chair                                                                                                
Representative Peggy Wilson, Vice Chair                                                                                         
Representative John Coghill                                                                                                     
Representative Gary Stevens                                                                                                     
Representative Vic Kohring                                                                                                      
Representative Sharon Cissna                                                                                                    
Representative Reggie Joule                                                                                                     
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
HOUSE BILL NO. 255                                                                                                              
"An Act establishing the Statewide Suicide Prevention Council;                                                                  
and providing for an effective date."                                                                                           
     - MOVED CSHB 255(HES) OUT OF COMMITTEE                                                                                     
HOUSE BILL NO. 247                                                                                                              
"An Act relating to the detention of delinquent minors and to                                                                   
temporary detention hearings; amending Rule 12, Alaska                                                                          
Delinquency Rules; and providing for an effective date."                                                                        
     - MOVED HB 247 OUT OF COMMITTEE                                                                                            
HOUSE BILL NO. 215                                                                                                              
"An Act relating to the use of pharmaceutical agents in the                                                                     
practice of optometry; and providing for an effective date."                                                                    
     - MOVED HB 215 OUT OF COMMITTEE                                                                                            
HOUSE BILL NO. 197                                                                                                              
"An Act relating to directives for personal health care services                                                                
and for medical treatment."                                                                                                     
     - MOVED CSHB 197(HES) OUT OF COMMITTEE                                                                                     
HOUSE BILL NO. 112                                                                                                              
"An  Act  relating  to  information  and  services  available  to                                                               
pregnant women  and other persons; and  ensuring informed consent                                                               
before an abortion  may be performed, except in  cases of medical                                                               
     - SCHEDULED BUT NOT HEARD                                                                                                  
PREVIOUS ACTION                                                                                                               
BILL: HB 255                                                                                                                  
SHORT TITLE:STATEWIDE SUICIDE PREVENTION COUNCIL                                                                                
SPONSOR(S): REPRESENTATIVE(S)PORTER                                                                                             
Jrn-Date   Jrn-Page                     Action                                                                                  
04/24/01     1163       (H)        READ THE FIRST TIME -                                                                        
04/24/01     1163       (H)        HES, FIN                                                                                     
04/24/01                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
BILL: HB 247                                                                                                                  
SHORT TITLE:DETENTION OF DELINQUENT MINORS                                                                                      
SPONSOR(S): REPRESENTATIVE(S)MEYER                                                                                              
Jrn-Date   Jrn-Page                     Action                                                                                  
04/18/01     1031       (H)        READ THE FIRST TIME -                                                                        
04/18/01     1031       (H)        HES, JUD                                                                                     
04/24/01                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
BILL: HB 215                                                                                                                  
SHORT TITLE:OPTOMETRISTS AND PHARMACEUTICALS                                                                                    
SPONSOR(S): LABOR & COMMERCE BY REQUEST                                                                                         
Jrn-Date   Jrn-Page                     Action                                                                                  
03/26/01     0730       (H)        READ THE FIRST TIME -                                                                        
03/26/01     0730       (H)        HES, L&C                                                                                     
04/24/01                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
BILL: HB 197                                                                                                                  
SHORT TITLE:HEALTH CARE SERVICES DIRECTIVES                                                                                     
SPONSOR(S): REPRESENTATIVE(S)HUDSON                                                                                             
Jrn-Date   Jrn-Page                     Action                                                                                  
03/19/01     0649       (H)        READ THE FIRST TIME -                                                                        
03/19/01     0649       (H)        HES, JUD                                                                                     
03/28/01     0762       (H)        COSPONSOR(S): KERTTULA                                                                       
04/10/01                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
04/10/01                (H)        <Bill Postponed to 4/17>                                                                     
04/17/01                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
04/17/01                (H)        Heard & Held                                                                                 
04/19/01                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
04/19/01                (H)        Heard & Held                                                                                 
04/24/01                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
WITNESS REGISTER                                                                                                              
REPRESENTATIVE BRIAN PORTER                                                                                                     
Alaska State Legislature                                                                                                        
Capitol Building, Room 208                                                                                                      
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified as sponsor of HB 255.                                                                            
KAREN PERDUE, Commissioner                                                                                                      
Department of Health & Social Services                                                                                          
PO Bon 110601                                                                                                                   
Juneau, Alaska 99811                                                                                                            
POSITION STATEMENT:  Testified on HB 255.                                                                                       
THOMAS WRIGHT, Staff                                                                                                            
to Representative Brian Porter                                                                                                  
Alaska State Legislature                                                                                                        
Capitol Building, Room 208                                                                                                      
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Answered questions on HB 255.                                                                              
REPRESENTATIVE KEVIN MEYER                                                                                                      
Alaska State Legislature                                                                                                        
Capitol Building, Room 110                                                                                                      
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified as sponsor of HB 247.                                                                            
ROBERT BUTTCANE, Legislative and Administrative Liaison                                                                         
Division of Juvenile Justice                                                                                                    
Department of Health & Social Services                                                                                          
PO Box 110634                                                                                                                   
Juneau, Alaska 99811                                                                                                            
POSITION STATEMENT:  Testified on HB 247.                                                                                     
JEFF GONNASON, O.D, Chair                                                                                                       
Alaska Optometric Association Legislative Committee                                                                             
2211 East Northern Lights Boulevard                                                                                             
Anchorage, Alaska 99508                                                                                                         
POSITION STATEMENT:  Testified on HB 215.                                                                                       
LINDA CASSER, Optometric Physician                                                                                              
Associate Dean for Academic Programs                                                                                            
Pacific University College of Optometry                                                                                         
2043 College Way                                                                                                                
Forest Grove, Oregon 97116                                                                                                      
POSITION STATEMENT:  Testified on HB 215.                                                                                       
BOB PALMER, Director                                                                                                            
State Governmental Affairs                                                                                                      
American Academy of Ophthalmology                                                                                               
(No address provided)                                                                                                           
POSITION STATEMENT:  Testified in opposition to HB 215.                                                                         
CARL ROSEN, Ophthalmologist                                                                                                     
542 West 2nd Avenue                                                                                                             
Anchorage, Alaska 99508                                                                                                         
POSITION STATEMENT:  Testified in opposition to HB 215.                                                                         
MICHAEL LEAVITT, Manager                                                                                                        
State Governmental Affairs                                                                                                      
American Academy of Ophthalmology                                                                                               
(No address provided)                                                                                                           
POSITION STATEMENT:  Testified in opposition to HB 215.                                                                         
MELANIE LESH, Staff                                                                                                             
to Representative Bill Hudson                                                                                                   
Alaska State Legislature                                                                                                        
Capitol Building, Room 502                                                                                                      
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified on behalf of the sponsor of HB
ACTION NARRATIVE                                                                                                              
TAPE 01-50, SIDE A                                                                                                              
Number 0001                                                                                                                     
CHAIR FRED  DYSON called the  House Health, Education  and Social                                                               
Services  Standing  Committee  meeting  to  order  at  3:08  p.m.                                                               
Representatives Dyson,  Wilson, Coghill,  Cissna, and  Joule were                                                               
present  at  the call  to  order.   Representatives  Stevens  and                                                               
Kohring arrived as the meeting was in progress.                                                                                 
HB 255-STATEWIDE SUICIDE PREVENTION COUNCIL                                                                                   
[Contains discussion of SB 198, the companion bill]                                                                             
CHAIR DYSON announced that the first order of business would be                                                                 
HOUSE BILL NO. 255, "An Act establishing the Statewide Suicide                                                                  
Prevention Council; and providing for an effective date."                                                                       
REPRESENTATIVE BRIAN PORTER, Alaska State Legislature, came                                                                     
forth as sponsor of HB 255.  He stated:                                                                                         
     It is  devastating to  lose someone  to suicide  at any                                                                    
     age,  but  it is  especially  tragic  to lose  a  young                                                                    
     person  who  has so  much  to  live  for.   Suicide  is                                                                    
     preventable.    In  1999,  the  United  States  Surgeon                                                                    
     General issued  "A Call to Action"  to prevent suicide.                                                                    
     The report  made 15 recommendations categorized  in the                                                                    
     areas  of  awareness,  intervention,  and  methodology.                                                                    
     House Bill  255 is another  step in answering  both the                                                                    
     state's and the national call to action.                                                                                   
     House  Bill  255  will establish  a  statewide  suicide                                                                    
     prevention  council made  up of  14 private  and public                                                                    
     members  representing  rural  and urban  Alaska.    Two                                                                    
     members from  both the House  and the Senate  would sit                                                                    
     on  the  council.    The  governor  would  appoint  ten                                                                    
     members,  including  experts  in  substance  abuse  and                                                                    
     mental  health,  as  well  as   people  who  have  been                                                                    
     directly impacted  by suicide  and who would  work with                                                                    
     youth across the state.                                                                                                    
     Suicide is  an ongoing  epidemic in  many parts  of the                                                                    
     state.   In rural  Alaska and in  the Matanuska-Susitna                                                                    
     Valley, the  numbers are at  an all-time high.   We all                                                                    
     must  work  together  to reduce  the  toll  suicide  is                                                                    
     having on  the people of  our state.  The  council will                                                                    
     focus on finding ways to  reduce suicide rates, broaden                                                                    
     public  awareness of  the  suicide  warning signs,  and                                                                    
     enhance  suicide   prevention  services   and  programs                                                                    
     throughout  the state.   Each  March  the council  will                                                                    
     submit  a report  to the  legislature and  the governor                                                                    
     with its findings and recommendations.                                                                                     
REPRESENTATIVE PORTER stated  that he has spent a lot  of time in                                                               
law  enforcement, and  when these  tragedies occur  [he would  be                                                               
among] the  first to respond.   He said  that has made  a lasting                                                               
impression on  his life, to the  extent that he was  on the board                                                               
of  Crisis, Inc.,  in Anchorage  after retiring  from the  police                                                               
department.  He  remarked that it is an unfortunate  fact of life                                                               
that the emphasis  of these types of tragedies is  cyclic.  While                                                               
progress was  being made in this  area in Alaska, other  types of                                                               
critical  events have  occurred, and  the emphasis  and attention                                                               
that this should get have diminished.                                                                                           
Number 0515                                                                                                                     
REPRESENTATIVE JOULE  asked if there are  any differences between                                                               
this bill and the bill that is coming over from the Senate.                                                                     
REPRESENTATIVE PORTER answered that they are companion bills.                                                                   
REPRESENTATIVE  COGHILL  stated  that  the  House  State  Affairs                                                               
Standing  Committee  heard  a  bill that  had  House  and  Senate                                                               
members on  another board.  He  said there was debate  on whether                                                               
that would be appropriate.                                                                                                      
REPRESENTATIVE  PORTER   remarked  that  the  wording   has  been                                                               
constructed in the  bill so that the members and  the board would                                                               
be  advisory.   He said  the advisory  designation overcomes  the                                                               
difficulty of having two commissions.                                                                                           
REPRESENTATIVE  COGHILL remarked  that the  bill states  that the                                                               
advisory board  would have terms  of four year, while  the [House                                                               
members of the]  legislature only have two-year terms.   He asked                                                               
if it  was intended  that the  members would  only serve  out the                                                               
time that they are in the legislature.                                                                                          
REPRESENTATIVE PORTER  responded that Representative  Coghill was                                                               
correct.   He stated that  every two years the  presiding officer                                                               
would have the option of appointing new members.                                                                                
Number 0646                                                                                                                     
KAREN  PERDUE,  Commissioner,  Department   of  Health  &  Social                                                               
Services (DHSS),  came forth  and stated that  suicide is  a very                                                               
big  problem  in  Alaska.   She  said  Representative  Bunde  had                                                               
mentioned   that  the   Attorney  General   convened  a   special                                                               
conference on  suicide in  1999, and  in gathering  that material                                                               
together  [the  Attorney  General]   highlighted  the  fact  that                                                               
suicides  actually  account for  [more]  deaths  in America  than                                                               
homicide.  She noted that in  1988 the state legislature took the                                                               
leadership on suicide [prevention]  under Senator Willie Hensley.                                                               
Out of that effort came the existing available programs.                                                                        
REPRESENTATIVE  JOULE   asked  how  many  positions   within  the                                                               
department specifically deal with suicide.                                                                                      
COMMISSIONER  PERDUE  answered  that  [DHSS]  does  not  have  an                                                               
individual who is exclusively devoted to  this work.  She said an                                                               
earlier piece of  this support did give [DHSS]  some resources to                                                               
begin  working directly  with the  communities that  are most  at                                                               
risk.   As  a  result,  [DHSS] will  have,  for  the first  time,                                                               
someone available  to work on suicide  at the local level.   This                                                               
bill, she said, will give [DHSS]  the ability to have the council                                                               
staffed with a coordinator who focuses on the planning.                                                                         
CHAIR DYSON stated  that he has seen at least  one similar effort                                                               
in the past  five years that has been successful,  which was when                                                               
[DHSS] put the right person in  to work on the FAS (fetal alcohol                                                               
syndrome) and FAE (fetal alcohol effect) problem.                                                                               
Number 0857                                                                                                                     
REPRESENTATIVE WILSON remarked  that, like Representative Porter,                                                               
when  she worked  with the  ambulance squad  she was  one of  the                                                               
first on  the scene when something  like this has happened.   She                                                               
said it  is devastating for the  people involved, as well  as for                                                               
the  people who  come upon  the scene.   She  stated that  she is                                                               
surprised  to learn  that this  is  an ongoing  epidemic in  many                                                               
parts  of the  state, such  as  rural Alaska  and the  Matanuska-                                                               
Susitna Valley.                                                                                                                 
CHAIR  DYSON asked  Commissioner Perdue  if she  anticipates that                                                               
the  Denali  Commission  or  other   sources  might  be  able  to                                                               
financially help out.                                                                                                           
REPRESENTATIVE PORTER  answered that Jeff Jessee  of the [Alaska]                                                               
Mental   Health  Trust   has   already   indicated  interest   in                                                               
participating and furnishing  half of the fiscal note.   He added                                                               
that when  this kind  of idea reaches  fruition, it  is presented                                                               
with  a  fiscal   note  that  has  the   ability  for  successful                                                               
Number 1001                                                                                                                     
REPRESENTATIVE  JOULE  remarked  that  he  would  like  to  thank                                                               
Representative Porter for bringing  this legislation forward.  He                                                               
     Sometimes when  you're young in life  you think nothing                                                                    
     ever happens  to you.   Then you  get on in  your years                                                                    
     and  you start  reflecting back,  and a  whole lot  had                                                                    
     happened. ...  You were just so  busy in it. ...  I had                                                                    
     the  unfortunate experience  of losing  a member  of my                                                                    
     family to suicide.  And  you talk about a life-changing                                                                    
     experience. ... There's a tarnish  that goes along with                                                                    
     it to  those of us  who are survivors. ...  Very seldom                                                                    
     do  we ever  hear about  those attempts,  which are  so                                                                    
     many  more numerous  than those  that [are]  completed,                                                                    
     and where  there is such  hopelessness for  people. ...                                                                    
     Something that  is oftentimes a permanent  solution ...                                                                    
     could  be,  if the  right  resources  are in  place,  a                                                                    
     temporary problem.                                                                                                         
REPRESENTATIVE CISSNA stated that she  has worked on crisis lines                                                               
and has  worked with quite a  few people who have  been suicidal.                                                               
She  said  the  rate  of  suicide in  the  state  is  horrifying,                                                               
especially  in   rural  Alaska.     She   remarked  that   it  is                                                               
unbelievable because  all living things seek  to continue living;                                                               
therefore, the  fact that  here are  so many  people who  want to                                                               
stop  [living]  says something  deeper  about  what needs  to  be                                                               
REPRESENTATIVE  COGHILL stated  that  page 5,  line 14,  mentions                                                               
strengthening  existing  and  building new  partnerships  between                                                               
public and  private [entities].   He  said it  would be  his hope                                                               
that the  faith-based community be  included in  that discussion,                                                               
because all  the things that go  along with suicide are  not just                                                               
economic or  alcohol- and drug-related,  but certainly  get right                                                               
to the spirit of the person.                                                                                                    
REPRESENTATIVE  PORTER responded  that [the  Senate] has  already                                                               
made that adjustment [in SB 198].                                                                                               
Number 1270                                                                                                                     
CHAIR  DYSON  asked  if  it  would  be  appropriate  to  adopt  a                                                               
conceptual amendment to include that in the bill.                                                                               
THOMAS  WRIGHT,  Staff  to Representative  Brian  Porter,  Alaska                                                               
State Legislature, responded  that the Senate has  added a member                                                               
to the council from the faith-based community.                                                                                  
REPRESENTATIVE  PORTER   stated  that  he  would   think  that  a                                                               
conceptual amendment mirroring that language would be in order.                                                                 
Number 1303                                                                                                                     
REPRESENTATIVE  WILSON   made  a   motion  to   adopt  conceptual                                                               
Amendment 1, to add a member  of the faith-based community to the                                                               
board  in a  similar  fashion to  what has  been  adopted in  the                                                               
Senate Health,  Education and Social Services  Standing Committee                                                               
[SB198].   There being no  objection, conceptual Amendment  1 was                                                               
REPRESENTATIVE JOULE moved  to report HB 255, as  amended, out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There being  no objection,  CSHB 255(HES)  moved                                                               
from  the House  Health, Education  and Social  Services Standing                                                               
HB 247-DETENTION OF DELINQUENT MINORS                                                                                         
CHAIR DYSON  announced that the  next order of business  would be                                                               
HOUSE  BILL  NO.  247,  "An  Act relating  to  the  detention  of                                                               
delinquent minors  and to temporary detention  hearings; amending                                                               
Rule  12,   Alaska  Delinquency  Rules;  and   providing  for  an                                                               
effective date."                                                                                                                
Number 1380                                                                                                                     
REPRESENTATIVE KEVIN MEYER, Alaska  State Legislature, came forth                                                               
as sponsor of HB 247 and said:                                                                                                  
     The State  of Alaska receives federal  grant funding to                                                                    
     implement  mandates  of   the  Juvenile  Justice  [and]                                                                    
     Delinquency Prevention Act of  1974.  And Alaska stands                                                                    
     to  lose  $168,000  of federal  funds  because  of  the                                                                    
     number of  youth temporarily held  in rural  and remote                                                                    
     jails  throughout  Alaska  prior to  an  initial  court                                                                    
     hearing  and transport  to a  youth facility.  ... [For                                                                    
     example], when a juvenile commits  a serious offense in                                                                    
     a rural or remote community [he  or she] may need to be                                                                    
     detained upon  arrest in order  to protect  the public,                                                                    
     depending on what the juvenile has done.                                                                                   
     ...  There  are  only six  juvenile  detention  centers                                                                    
     through  Alaska,  so   serious  juvenile  offenders  in                                                                    
     remote  communities  often  end  up  in  village  adult                                                                    
     lockup facilities  or jails awaiting ...  relocation to                                                                    
     a juvenile facility.   Federal regulations require that                                                                    
     juveniles in adult facilities not  be held more that 24                                                                    
     hours; however,  the regulations also allow  a state to                                                                    
     extend those  time limits  because of  adverse weather,                                                                    
     limited transportation  options, and  other conditions,                                                                    
     which certainly pertain to us  here in Alaska.  Such an                                                                    
     extension is  only available,  though, in  states where                                                                    
     juveniles  must make  an  initial  appearance in  court                                                                    
     within 24 hours of arrest.                                                                                                 
     ... House Bill 247  would require an initial appearance                                                                    
     in court  within 24  hours, instead  of the  current 48                                                                    
     hours  ... for  juveniles placed  in an  adult jail  or                                                                    
     lockup,   and  would   place  the   federal  regulation                                                                    
     exception language  into state  statute.   [This] would                                                                    
     then secure the federal  funds that we most desperately                                                                    
Number 1479                                                                                                                     
ROBERT   BUTTCANE,   Legislative  and   Administrative   Liaison,                                                               
Division  of  Juvenile Justice,  Department  of  Health &  Social                                                               
Services, came  forth and pointed  out that this bill  would only                                                               
impact the process  for juveniles held in adult  facilities.  The                                                               
48-hour arraignment schedule that applies  to those that are held                                                               
in  the juvenile  facilities would  not be  changed.   This would                                                               
afford some additional  rights to juveniles who are  held in "bad                                                               
beds" for  the court to  have the  opportunity to make  sure [the                                                               
youth] are  being treated properly,  and to encourage  the system                                                               
to move  them as  quickly and safely  as is  practically possible                                                               
into  one  of the  juvenile  facilities.    He stated  that  this                                                               
doesn't happen to an extensive number  of cases in the state, but                                                               
when it does, it jeopardizes the federal funding.                                                                               
CHAIR DYSON  asked if there is  a track record of  children being                                                               
abused while being held in adult facilities.                                                                                    
MR. BUTTCANE  responded that he  cannot say he is  directly aware                                                               
of  that.    [The  Division  of Juvenile  Justice]  does  have  a                                                               
contract with the University of  Alaska Anchorage Justice Center,                                                               
which annually  tracks all of the  juveniles who are held  in the                                                               
adult facilities.                                                                                                               
CHAIR  DYSON  asked  why  this   is  occurring  so  late  in  the                                                               
[legislative] session.                                                                                                          
MR. BUTTCANE stated that he does not have the answer for that.                                                                  
Number 1614                                                                                                                     
REPRESENTATIVE CISSNA  asked if  there is a  protocol for  when a                                                               
minor is placed in an adult prison.                                                                                             
MR.  BUTTCANE responded  yes, that  training is  provided to  the                                                               
rural jail  supervisors.  He  said there are some  specific rules                                                               
such as that  juveniles are not to  be put in the  same cell with                                                               
adults and that there ideally is  sight and sound separation.  He                                                               
said  there are  situations  in  which jails  are  small and  may                                                               
consist of  one or two  rooms.   When that happens,  the juvenile                                                               
may be  in one room and  the adult in the  other.  He said  he is                                                               
aware that  some jails will  release adult prisoners in  order to                                                               
hold juvenile  offenders pending transport into  a regional youth                                                               
facility.   He  stated that  there are  supervision requirements,                                                               
time-schedule requirements as  to how often the  youths should be                                                               
checked,    juvenile    probation   and    parent    notification                                                               
requirements, and  requirements that the youth  be transported as                                                               
quickly and  safely as  is practical.   He  noted that  last year                                                               
signs were printed  up that outlined some of the  major rules and                                                               
were sent to  each community with an adult holding  facility.  He                                                               
stated that  there is follow-up  paper work  that is sent  to the                                                               
division as well as the University of Alaska.                                                                                   
REPRESENTATIVE  WILSON stated  that  in  her district,  Wrangell,                                                               
there are several  times when a juvenile is held,  but because of                                                               
weather, planes  can't get out.   She asked  if this would  be an                                                               
uncontrollable reason [for holding a juvenile].                                                                                 
MR. BUTTCANE answered that she was  correct.  He stated that this                                                               
bill is  not asking  that juveniles be  held in  these facilities                                                               
any  longer; it  is  an  opportunity to  allow  [the Division  of                                                               
Juvenile  Justice] to  claim  some  administrative exemptions  in                                                               
order to continue receiving federal funding.                                                                                    
Number 1802                                                                                                                     
REPRESENTATIVE MEYER  stated that one  of the changes  being made                                                               
in the bill  is that in order to keep  the juveniles longer, they                                                               
have to  be given a  court hearing  within 24 hours;  the current                                                               
state law is  48 [hours].  He  added that there is  a zero fiscal                                                               
note; however,  by having these  court hearings within  24 hours,                                                               
the hearings could  be held on the weekends, which  could mean an                                                               
additional cost.                                                                                                                
REPRESENTATIVE COGHILL asked if  magistrate access is anticipated                                                               
in the more remote areas.                                                                                                       
MR. BUTTCANE responded that the  court can appoint magistrates to                                                               
hear children's cases  in emergencies.  Sometimes  the court will                                                               
appoint  standing masters  for ongoing  children's cases.   If  a                                                               
local community does  have a magistrate, the  juvenile taken into                                                               
custody   will  oftentimes   make   an   appearance  before   the                                                               
magistrate.  However, other parties  might be there by telephone.                                                               
In communities that don't have  a magistrate, someone will appear                                                               
on the phone  from a regional hub.   He stated that  based on the                                                               
fiscal  year  2000  cases  in  which  children  were  taken  into                                                               
custody, there would have been  an additional 31 cases that would                                                               
have required  an appearance in  court one day earlier  than what                                                               
is allowed now.                                                                                                                 
Number 1968                                                                                                                     
REPRESENTATIVE  JOULE moved  to report  HB 247  out of  committee                                                               
with individual recommendations and  the accompanying zero fiscal                                                               
notes.   There being no  objection, HB  247 moved from  the House                                                               
Health, Education and Social Services Standing Committee.                                                                       
CHAIR DYSON called  for an at-ease at 3:45 p.m.   The meeting was                                                               
called back to order at 3:47 p.m.                                                                                               
HB 215-OPTOMETRISTS AND PHARMACEUTICALS                                                                                       
CHAIR DYSON  announced that the  next order of business  would be                                                               
HOUSE   BILL  NO.   215,  "An   Act  relating   to  the   use  of                                                               
pharmaceutical  agents   in  the   practice  of   optometry;  and                                                               
providing for an effective date."                                                                                               
Number 2070                                                                                                                     
JEFF  GONNASON,   O.D.,  Chair,  Alaska   Optometric  Association                                                               
Legislative Committee, came forth and stated:                                                                                   
     Optometry is  a primary  health care  profession [that]                                                                    
     examines, diagnoses, and treats  disorders of the human                                                                    
     eye.      [It]    uses   diagnostic   and   therapeutic                                                                    
     medications,  methods,   and  procedures.     Education                                                                    
      consists of a bachelor's degree, followed by a four-                                                                      
       year professional program of didactic and clinical                                                                       
     training to  receive a  doctorate of  optometry degree,                                                                    
     known  as  an  O.D.     Many  graduates  also  take  an                                                                    
     additional  one-year  residency  specialty.    This  is                                                                    
     identical to the training in  dentistry.  The course of                                                                    
     instruction and pharmacology and  the use of medication                                                                    
     are  equivalent,  in  scope and  hours,  [to  what  is]                                                                    
     taught  in   medical  school,  dentistry   school,  and                                                                    
     podiatry school,  with many more  hours of  emphasis on                                                                    
     treating the eye.                                                                                                          
     ... In 1988, after 12  years of effort testifying here,                                                                    
     Alaska's statutes  were updated to  allow optometrists,                                                                    
     [who] were  qualified, to use diagnostic  drugs. ... We                                                                    
     were the 49th  state out of 50 to enact  that.  In 1992                                                                    
     the  prescribing  of  therapeutic drugs  to  treat  eye                                                                    
     diseases  was  authorized,  and  Alaska  was  the  32nd                                                                    
     state.  However,  due to a compromise  in that original                                                                    
     bill,  the  oral  medications were  dropped,  so  drugs                                                                    
     prescribable were  just limited  to topical only:   eye                                                                    
     drops and  salves. ... Currently in  the United States,                                                                    
     all  50  states  authorize  optometrists  to  prescribe                                                                    
     drugs -  37 of those  states allowing oral drugs  to be                                                                    
     prescribed,  including  controlled substances,  and  21                                                                    
     states allowing  some form of injectable  drugs.  House                                                                    
     Bill  215 before  you  will bring  Alaska  up to  where                                                                    
     North Carolina started back in  1976, 25 years ago. ...                                                                    
     This  is   not  new  ground.     One  state,  Oklahoma,                                                                    
     authorizes optometrists to perform laser surgery.                                                                          
     Five years  ago, a bill  was introduced and  heard that                                                                    
     would allow the  state board to determine  the scope of                                                                    
     practice  of  optometry,  as  is  the  case  for  nurse                                                                    
     practitioners.  This bill would  have not only included                                                                    
     all medications for  the eye, but also  advanced use of                                                                    
     lasers   and  some   minor   surgical  procedures   for                                                                    
     qualified  optometrists.    That  bill  did  not  pass.                                                                    
     Three years  ago, Senate Bill  [SB] 78  was introduced.                                                                    
     ... It was  highly compromised, and it  did not contain                                                                    
     any expanded scope of practice  such as lasers or minor                                                                    
     surgery, even though those are  currently taught in the                                                                    
     schools.    The  SB  78   simply  removed  the  topical                                                                    
     restriction on  our drug allowance,  allowing optometry                                                                    
     to use the necessary tools  of treatment. ... There was                                                                    
     no testimony opposing  the bill other than  a couple of                                                                    
     written letters  in two  years of  hearings.   The bill                                                                    
     passed the  House 37  to 2 last  year and  concurred in                                                                    
     the Senate 19  to 0 last May.  The  governor vetoed the                                                                    
     bill,  citing possible  inadequate  board oversight  of                                                                    
     training   and  testing   and  concern   regarding  eye                                                                    
Number 2230                                                                                                                     
DR. GONNASON continued, stating:                                                                                                
     For 2001  ... this  current bill is  similar to  SB 78,                                                                    
     but with  further limitations  and board  authority for                                                                    
     ensuring  competency.   It  will  change  the scope  of                                                                    
     board-endorsed    optometrists    to   prescribe    the                                                                    
     additional  medications  beyond topical  for  treatment                                                                    
     related  only to  the eye  - they  can't do  stomach or                                                                    
     gout  medicine,  ...   unlike  our  nurse  practitioner                                                                    
     friends,  who can  treat  anything  within their  level                                                                    
     with one  year less training.   And this bill  also has                                                                    
     Section 3  added, which  prohibits injections  into the                                                                    
     globe of the eye.                                                                                                          
     ...  Malpractice  carriers   report  no  difference  in                                                                    
     premiums  or  claims  between states  with  or  without                                                                    
     pharmaceutical   authority.     And  optometrists   are                                                                    
     considered  physicians  under   federal  Medicare  law.                                                                    
     Now, the  state audit committee reported  that eye care                                                                    
     was improved  in Alaska  by allowing  optometrists [to]                                                                    
     prescribe drugs,  and [have] saved money  on travel and                                                                    
     double  visits.    House Bill  215  will  allow  Alaska                                                                    
     optometrists  to  practice  at the  currently  accepted                                                                    
     level of care.  The  rural optometrist often has to get                                                                    
     the  PA (physician's  assistant) or  the health  aid to                                                                    
     authorize  the  needed  medication.   Alaska's  90-plus                                                                    
     optometrists are  located in  over 18 towns  and travel                                                                    
     to  many  villages,   while  the  ophthalmologists  are                                                                    
     located mostly in  Anchorage - 18 of them -  with a few                                                                    
     in Fairbanks -  4, Juneau - 2, and  the Kenai Peninsula                                                                    
     - 2.                                                                                                                       
     ... Now we're faced with  the difficulty of getting new                                                                    
     graduates to  come back to  Alaska to  practice because                                                                    
     we're so far  behind the times.   And also, ironically,                                                                    
     Alaska  Statute 08.72.240  requires that  optometrists,                                                                    
     "keep   informed  of   and  use   current  professional                                                                    
     theories   [or]   practices."   ...  The   Academy   of                                                                    
     Ophthalmology  argues that  an ophthalmologist  is more                                                                    
     qualified  to  treat diseases  of  the  eye.   This  is                                                                    
     partly  true, in  that they  are trained  in specialty,                                                                    
     tertiary care and  surgery of the eye  as a specialist,                                                                    
     just  as  a heart  surgeon  is  specialized.   But  the                                                                    
     optometrist  is   specialty-trained  for   primary  and                                                                    
     secondary care and limited surgery.   One of the things                                                                    
     we currently do is remove  foreign bodies from the eye;                                                                    
     that's in our statute. ...                                                                                                 
     Included    in    our     training    is    prescribing                                                                    
     pharmaceuticals. ...  The question  is not who  is more                                                                    
     qualified, but rather  should qualified optometrists be                                                                    
     allowed to practice at their  highest level of training                                                                    
     with  the current  standard of  care?   After carefully                                                                    
     examining  the  facts,  we're confident  that  you  can                                                                    
     trust a  board-endorsed Alaskan optometrist  to provide                                                                    
     confident,  primary   and  secondary  care   for  their                                                                    
     patients, and refer to  the ophthalmologist when needed                                                                    
     for  their  advanced  specialty care.    [This  is]  no                                                                    
     different [from] when family  doctors refer to heart or                                                                    
     cancer specialists.                                                                                                        
     The  legislature  offers  full authority  to  M.D.s  to                                                                    
     perform anything  they wish, by trusting  they will not                                                                    
     practice above  the level of  their training  and refer                                                                    
     to  specialists.   The  same  applies  to dentists  and                                                                    
     nurse  practitioners in  Alaska, where  their scope  of                                                                    
     practice is determined ...                                                                                                 
TAPE 01-50, SIDE B                                                                                                              
DR. GONNASON continued, stating:                                                                                                
     ...   by  their   own  state   board  and   the  Alaska                                                                    
     legislature   trusting  them   to   practice  only   as                                                                    
     qualified.      Why,    then,   are   optometrists   so                                                                    
     untrustworthy  and untrainable,  when we  actually have                                                                    
     more education in applying the  same standards to these                                                                    
     health professions?                                                                                                        
Number 2284                                                                                                                     
LINDA CASSER,  Optometric Physician, Associate Dean  for Academic                                                               
Programs, Pacific University College  of Optometry, testified via                                                               
teleconference  in  support  of  HB   215.    She  explained  the                                                               
following seven key points to the committee:                                                                                    
     The doctor  of optometry degree program  is a four-year                                                                    
     graduate level program.  It  is comprised of 180 credit                                                                    
     hours,  which   equate  to   4,315  contact   hours  of                                                                    
     education.  Secondly, the  prerequisite course of study                                                                    
     is  rigorous and  comprehensive.   It is  comparable to                                                                    
     that  completed by  premedical and  predental students.                                                                    
     Thirdly,  preoptometry students  are  required to  pass                                                                    
     the optometry admissions  testing examination, which is                                                                    
     comparable  to  the  MCAT  [medical  college  admission                                                                    
     test] examination  required of  medical students.   The                                                                    
     OAT [optometry admission  test] examination is actually                                                                    
     administered by the American Dental Association.                                                                           
     Fourthly, students  in the doctor of  optometry program                                                                    
     are thoroughly  educated in the basic  sciences so that                                                                    
     diseases and  disorders of the  eye are  understood and                                                                    
     treated  in  their  proper  context.    (Indisc.)    In                                                                    
     several institutions,  optometry students  sit side-by-                                                                    
     side with  medical and dental  students in  these basic                                                                    
     science courses.   Fifthly, 255 classroom  hours within                                                                    
     the   curriculum   are   assigned  to   the   area   of                                                                    
     pharmacology, including  the use of topical,  oral, and                                                                    
     ingestible medications in the  treatment of the eye and                                                                    
     the study  of its  structure.   This cited  figure does                                                                    
     not   include  the   additional  165   classroom  hours                                                                    
     pertaining to the  diagnosis, treatment, and management                                                                    
     of  ocular disease  as well  as  the extensive  patient                                                                    
     care    clinical    experience     in    which    these                                                                    
     pharmacological  concepts  are  actively applied.    My                                                                    
     sixth  point is  that studies  indicate that  optometry                                                                    
     isn't   receiving    comparable   course    hours   and                                                                    
     pharmacology  as   is  medical  and   dental  students.                                                                    
     Students  in the  doctor of  optometry program  receive                                                                    
     added training and education in ocular pharmacology.                                                                       
     And   finally,  our   students  begin   their  clinical                                                                    
     activity in their first year.   Patient care experience                                                                    
     increases  in complexity  and (indisc.)  throughout the                                                                    
     program.    The  fourth  year  is  spent  in  full-time                                                                    
     patient care activity.  Two  of the three semesters are                                                                    
     spent  at  off-campus   clinical  preceptorships  in  a                                                                    
     variety  of  health  care  settings.    In  total,  our                                                                    
     students spend  at least 2,000 contact  hours examining                                                                    
     diverse  patient  populations  who have  (indisc.)  and                                                                    
     systemic diseases.   In  closing, doctors  of optometry                                                                    
     are thoroughly  prepared to provide safe  and effective                                                                    
     eye  and vision  care  services for  the patients  they                                                                    
     serve, including the use of systemic medication.                                                                           
Number 2100                                                                                                                     
CHAIR DYSON  remarked that  it has been  represented to  him that                                                               
one  of  the  reasons  optometrists  should not  to  be  able  to                                                               
dispense drugs is  that if a patient is taking  a second drug for                                                               
another condition,  the optometrist  is untrained  to be  able to                                                               
determine  any   possible  negative   interactions  of   the  two                                                               
DR.  CASSER responded  that that  could not  be farther  from the                                                               
truth.     She   said  [optometric]   students  receive   general                                                               
pharmacology training,  which includes  a full  understanding and                                                               
education of the side effects from the interaction of drugs.                                                                    
CHAIR DYSON  asked Dr. Casser if  what she listed as  part of the                                                               
training   at  Pacific   University  College   of  Optometry   is                                                               
comparable to other schools in the country.                                                                                     
DR.  CASSER answered  yes.   She said  there are  17 schools  and                                                               
colleges   throughout  North   America,  and   the  training   is                                                               
comparable at all of those institutions.                                                                                        
Number 2020                                                                                                                     
REPRESENTATIVE  WILSON  asked  Dr.  Casser  how  far  back  these                                                               
educational requirements go.                                                                                                    
DR.  CASSER responded  that  it  would be  difficult  for her  to                                                               
answer  specifically without  taking  each of  the curricula  and                                                               
putting them side-by-side  through the varying years.   She noted                                                               
that she graduated  from Indiana University in 1978  and she took                                                               
an oncology course in 1975, which  was the same course offered to                                                               
the medical students.   She stated that she would  venture to say                                                               
that 20 years would be a safe [estimation].                                                                                     
REPRESENTATIVE STEVENS  asked what  the difference is  between an                                                               
optometrist and an ophthalmologist.                                                                                             
DR.  GONNASON   responded  that   the  ophthalmologist   goes  to                                                               
undergraduate [school],  four years  of medical school,  and then                                                               
takes  a  three-year residency,  just  like  a person  would  for                                                               
family practice  or gynecology.   He explained that  a three-year                                                               
residency    is     basically    on-the-job     training.    Some                                                               
ophthalmologists, he said, will go  on to an advanced specialty -                                                               
a  fourth  year  -  and  be   a  retina  surgeon  or  a  glaucoma                                                               
specialist.   Optometry  is the  same  as for  dentistry; it's  a                                                               
four-year  undergraduate  degree  and  a  four-year  professional                                                               
program.   The basic  sciences are  the same.   The  problem that                                                               
comes in is that people are  told that optometrists are lumped in                                                               
with  naturopaths  and  chiropractors,   who  are  some  sort  of                                                               
alternative [medical  providers].  He  stated that they  are not.                                                               
[Optometrists]  take  the  same  basic  sciences,  use  the  same                                                               
medical  and  pharmacology  books,   and  study  under  the  same                                                               
professors [as ophthalmologists].  He  added that the majority of                                                               
what he knows was taught  to him by ophthalmologists.  Basically,                                                               
he   said,   [optometrists]   are  generalists   in   eyes,   and                                                               
[ophthalmologists] are specialists in eyes.                                                                                     
DR.   GONNASON    stated   that   the   optometrists    and   the                                                               
ophthalmologists  have had  a turf  battle  for 30  years as  the                                                               
education  moved into  a more  advanced training.   Around  1968,                                                               
[optometry] went to a full  four-year program, and in some states                                                               
have been prescribing drugs for 25 years.                                                                                       
REPRESENTATIVE   STEVENS   asked   if  an   ophthalmologist   has                                                               
necessarily been trained as an optometrist.                                                                                     
DR. GONNASON responded  that a person is required to  have a M.D.                                                               
(medical doctorate) degree to take a residency in ophthalmology.                                                                
Number 1772                                                                                                                     
REPRESENTATIVE JOULE stated that in  the hub communities in rural                                                               
areas there are eye doctors.   He asked if they would more likely                                                               
be optometrists or ophthalmologists.                                                                                            
DR. GONNASON replied that they are all optometrists.                                                                            
CHAIR DYSON stated that often  it is the optometrist who realizes                                                               
that  the  patient needs  some  medication.    He asked  if  [the                                                               
optometrist]  would  have  to  go  to a  PA  or  [advanced  nurse                                                               
practitioner] to get [the prescription].                                                                                        
DR. GONNASON answered that he was correct.                                                                                      
CHAIR DYSON asked if [PAs  and advanced nurse practitioners] have                                                               
had less training [than an optometrist].                                                                                        
DR. GONNASON answered yes, that a  health aid with three weeks of                                                               
training [can prescribe medications  under federal authority with                                                               
the Public Health Service].                                                                                                     
REPRESENTATIVE WILSON added that a  health aid can only prescribe                                                               
under certain conditions.                                                                                                       
Number 1684                                                                                                                     
BOB PALMER, Director, State Governmental Affairs, American                                                                      
Academy of Ophthalmology, testified via teleconference.  He                                                                     
     Although  HB 215  is  short,  the policy  ramifications                                                                    
     that it  can have  on [the]  Alaska health  policy care                                                                    
     system,  specifically  regarding  eye health  care,  is                                                                    
     very complex.   And  due to  the time  constraints that                                                                    
     you  are  now facing,  you  may  find it  necessary  to                                                                    
     complete  this review  during the  interim.   From  our                                                                    
     perspective, HB  215 gives  the optometry  profession a                                                                    
     ...  blank  check  for  prescribing  oral  drugs,  with                                                                    
     little supervision  and pharmaceutical training.   Last                                                                    
     year,  this type  of legislation  was rejected  in such                                                                    
     states   [as]  Florida,   Georgia,  Hawaii,   Maryland,                                                                    
     Mississippi, New York,  Pennsylvania, and South Dakota,                                                                    
     and  Washington   state.  ...   This  year,   the  same                                                                    
     provisions were again rejected  in Washington state and                                                                    
     several other states.                                                                                                      
     ...  I  think   you  would  agree  that   ...  you  and                                                                    
     legislators all across the  United States are seriously                                                                    
     questioning   the   wisdom   of   enacting   additional                                                                    
     legislation that would  further expand optometric drug-                                                                    
     prescribing authority.   The  question that  you really                                                                    
     must address from a policy  standpoint is, "What is the                                                                    
     bill  and why  is  it  before you?"    The citizens  of                                                                    
     Alaska,  to  our knowledge,  are  not  calling for  the                                                                    
     [enactment]  of  this  type of  broad  drug-prescribing                                                                    
     authority,  only [the]  optometry profession.   To  our                                                                    
     knowledge there's  been no  claims or  [delays] getting                                                                    
     appointments  with  ophthalmologists when  symptoms  of                                                                    
     disease are present.   And if there  are such problems,                                                                    
     the  ophthalmologists  would  want to  know  and  would                                                                    
     gladly work with you to remedy any such delay.                                                                             
     This can  be easily accomplished without  the change in                                                                    
     the law.  For example,  right now ophthalmologists from                                                                    
     the  Alaska State  Society are  examining rural  health                                                                    
     care delivery. ... The objective  is further to improve                                                                    
     the quality of rural health  care services at less cost                                                                    
     to  Alaska's system.   In  conclusion,  we believe  the                                                                    
     far-reaching health  policy implication  may not  be in                                                                    
     the best  interest of  the citizens  of Alaska.   House                                                                    
     Bill 215  does not improve  the access to  health care,                                                                    
     does not  open up  new (indisc.),  it does  not provide                                                                    
     new services  to the citizens  of Alaska,  and finally,                                                                    
     this  bill does  not  cover the  health  care cost  for                                                                    
CHAIR DYSON remarked that there  are about 217 or 218 communities                                                               
in  the state  that don't  have an  ophthalmologist, and  maybe a                                                               
third of  them have an optometrist.   He asked Mr.  Palmer how he                                                               
can make  the claim that doing  this wouldn't expand the  care to                                                               
those villages that have an optometrist.                                                                                        
MR.  PALMER  responded that  from  his  information, there  is  a                                                               
strong  telemedicine  presence  in  Alaska.    The  Alaska  State                                                               
Society is working on improving it  so that if there is something                                                               
that happens in  the Bush where there is  not an ophthalmologist,                                                               
the  clinician can  immediately  call an  ophthalmologist to  get                                                               
information on what needs to be  done.  He added that that system                                                               
seems to be working very well.                                                                                                  
CHAIR  DYSON  asked  Mr.  Palmer   if  he  is  recommending  that                                                               
ophthalmologists serve as supervisors to  the optometrists in the                                                               
prescription of these drugs.                                                                                                    
MR.  PALMER  stated  that  that  would fall  upon  the  board  of                                                               
medicine, which is the governing board for the state of Alaska.                                                                 
Number 1424                                                                                                                     
CHAIR DYSON  asked Mr. Palmer  if he  knows of anything  that Dr.                                                               
Casser told  the committee about  the training  of [optometrists]                                                               
that is untrue.                                                                                                                 
MR. PALMER responded no.                                                                                                        
REPRESENTATIVE  JOULE  remarked  that while  telemedicine  is  an                                                               
"exciting" thing, there are many  villages that are still without                                                               
Number 1307                                                                                                                     
CARL ROSEN,  Ophthalmologist, testified  via teleconference.   He                                                               
stated  that 2,000  hours of  training is  certainly commendable,                                                               
but he  probably has 24,000 hours  of training.  He  said he went                                                               
to  Amherst  College,  obtained  a  graduate  degree  at  Harvard                                                               
University,  and went  to medical  school  at Boston  University.                                                               
After that he  did an internship for a year,  being on call every                                                               
second and third night at  Albert Einstein College of Medicine in                                                               
New  York.    He  explained  that he  not  only  rotated  through                                                               
medicine,  oncology, neurology,  and the  cardiac care  unit, but                                                               
also took  care of very  sick patients.   He added  that although                                                               
the training may sound similar, it is very different.                                                                           
DR. ROSEN stated that Dr. Ford  wrote a letter in support of this                                                               
bill; however, he  explained that Dr. Ford  is an ophthalmologist                                                               
who lives in another state and  comes to [Alaska] to operate.  He                                                               
then co-manages with optometrists to  care for his patients.  Dr.                                                               
Ford  is not  part of  the ophthalmology  community in  Anchorage                                                               
because he does not take calls with the other ophthalmologists.                                                                 
DR.  ROSEN remarked  that as  far as  reaching the  outlying area                                                               
where there  aren't ophthalmologists, [the  ophthalmologists] are                                                               
working hard  to allow for  patient information  collection, data                                                               
collection including  images and sound files,  and server storage                                                               
allowing Internet connections so  that [ophthalmologists] can see                                                               
that information  and respond quickly.   He added that he  was in                                                               
Washington, D.C.,  and met with  (U.S.) Senator Stevens'  aid and                                                               
the  Native group  at the  Alaska Native  Hospital, and  they are                                                               
trying  to develop  these systems  to  forge ahead  and create  a                                                               
working, functional telemedicine system.                                                                                        
Number 1215                                                                                                                     
CHAIR  DYSON stated  that  [HB 215]  even  further restricts  the                                                               
range of drugs  and the method of delivering them.   He asked Dr.                                                               
Rosen if that is his understanding.                                                                                             
DR.  ROSEN  answered   no.    He  said  that  it   is  under  the                                                               
jurisdiction of  the optometric board,  which is not  the medical                                                               
board.  He offered his  opinion that petitioning for the granting                                                               
of  individuals' rights,  skills, and  talents that  aren't truly                                                               
earned could be representative of bad judgment.                                                                                 
CHAIR DYSON stated that it  doesn't seem to him that optometrists                                                               
are   doing   nearly   as   profound   a   medical   service   as                                                               
ophthalmologists are.  He asked Dr.  Rosen to respond to the fact                                                               
that optometrists in the  more rural areas have to go  to a PA or                                                               
an advanced  nurse practitioner  who have  the authority  to make                                                               
prescriptions, while the optometrists can't.                                                                                    
DR. ROSEN  responded that he  has not heard  of a problem  with a                                                               
patient in that  situation.  He said the telephone  is being used                                                               
and the plan is to extend telemedicine.                                                                                         
Number 0911                                                                                                                     
MICHAEL  LEAVITT, Manager,  State Governmental  Affairs, American                                                               
Academy  of  Ophthalmology,  testified via  teleconference.    He                                                               
stated  that he  read  in  an optometry  trade  magazine that  on                                                               
average optometrists  prescribe one  drug script per  week, while                                                               
ophthalmologists prescribe  61 per  week.   From a  public policy                                                               
perspective, that  explains three  things.   First, this  bill is                                                               
not going to  materially improve the delivery of  better eye care                                                               
in Alaska.   Second, optometrists cannot get  the experience they                                                               
need   to   safely   prescribe    systemic   drugs   safely   and                                                               
appropriately.    To put  this  in  perspective, he  stated  that                                                               
during a  hospital internship a medical  doctor personally writes                                                               
30,000 prescriptions.   Some of  these people being  treating may                                                               
be taking 10  or 15 other drugs concurrently.   This is where the                                                               
doctor  learns   the  fundamental   drug  interactions   and  the                                                               
interplay of diseases.                                                                                                          
MR.  LEAVITT  stated  that  during  a  three-year  residency  for                                                               
ophthalmology,  the ophthalmologists  will  write another  30,000                                                               
prescriptions in  learning the intricacy  of ocular disease.   He                                                               
asked, "Where  is the optometrist  going to get  that experience?                                                               
By whom is  the optometrist going to be taught?   And who's going                                                               
to supervise their training?"   Third, he said the statistic that                                                               
he cited  [earlier] has led him  to the conclusion that  [HB 215]                                                               
is really for a few optometrists  with the best of intentions who                                                               
want  to  dabble  in  the   treatment  of  complex  eye  disease.                                                               
However, this  is unfair to the  citizens of Alaska.   Last year,                                                               
Public Opinions  Strategy, a public  relations firm,  conducted a                                                               
survey  of  400 people  that  showed  50  percent of  the  public                                                               
believes  that optometrists  went  to medical  school.   However,                                                               
once the  public was  given specific knowledge  of the  fact that                                                               
ophthalmologists  went to  medical  school  and optometrists  did                                                               
not,   84  percent   said  it   was   important  to   go  to   an                                                               
ophthalmologist  for  the  treatment  of an  eye  infection  with                                                               
medication, and 96  percent thought it was important to  go to an                                                               
ophthalmologist for emergency care for  severe eye pain or vision                                                               
MR. LEAVITT  concluded by saying  no ophthalmologist is  going to                                                               
go  out  of business  because  of  this  bill, but  diseases  and                                                               
degeneration  of  the  visual  system  [require  a  person  with]                                                               
medical training.                                                                                                               
Number 0704                                                                                                                     
DR. GONNASON, in response, stated:                                                                                              
     I send Dr.  Rosen all of my orbital  and lid surgeries,                                                                    
     because I  certainly don't do orbital  lid surgery. ...                                                                    
     As far  as taking [calls],  we've offered to  help with                                                                    
     the [calls] in Anchorage,  but we're optometrists [and]                                                                    
     they don't  want to let  us take the call,  even though                                                                    
     what  happens   is  we  operate  at   the  primary  and                                                                    
     secondary level;  therefore, if there's  something that                                                                    
     needs ophthalmological care, [the  patient is] flown to                                                                    
     Anchorage  from Bethel  and Nome  and Kotzebue;  [he or                                                                    
     she is]  ambulanced to the hospital  for that specialty                                                                    
     care.  But  for eyelid infections, we  handle them just                                                                    
     fine.  [With]  90 percent of the  emergency room things                                                                    
     coming in - you got something  in your eye or you got a                                                                    
     scratch on  your eye -  that's what's going on.  ... We                                                                    
     could easily  take the call, and  the right instruments                                                                    
     are right there. ...                                                                                                       
     Of  telemedicine,  that's  great,   but  you  need  the                                                                    
     microscope to be there. ...  No laws have been repealed                                                                    
     in the  30 years that  these have  been going on.   All                                                                    
     those  states [Mr.  Palmer]  cites  as being  rejected,                                                                    
     that  just simply  means the  bill didn't  move through                                                                    
     the  committees and  pass. ...   The  locations of  the                                                                    
     ophthalmologists,  like I  say,  they're in  Anchorage,                                                                    
     [a] couple  [are] in Fairbanks,  Juneau, and  the Kenai                                                                    
     Peninsula; they  aren't out there  and available.   The                                                                    
     optometrist is the one on  call in Nome, the one called                                                                    
     at two in  the morning.  If they can't  handle it, [the                                                                    
     patient is] shipped to town. ...                                                                                           
     There's  been  two  studies done  [in]  California  and                                                                    
     Kansas [that]  looked at  the effectivity  of treatment                                                                    
     and   the  cost-effectiveness   with  ophthalmologists,                                                                    
     optometrists, and  nurse practitioners, and  they found                                                                    
     that ... the  public was indeed safe  and well treated.                                                                    
     I write  one to six  prescriptions a day in  my office,                                                                    
     depending on what comes in.   I take a thorough medical                                                                    
     history.  I know if  they are diabetic, whether they're                                                                    
     controlled, uncontrolled,  and what they're on  and all                                                                    
     their medicines, and I treat at my comfort level.                                                                          
Number 0518                                                                                                                     
CHAIR DYSON asked what level of prescription Dr. Gonnason is                                                                    
allowed to do under existing law.                                                                                               
DR.  GONNASON responded  that  since  1992 he  has  been able  to                                                               
prescribe topical [drugs] such as eye drops or ointments.                                                                       
CHAIR DYSON stated  that [optometrists] are now  trying to expand                                                               
that to oral  [drugs].  He asked  if there are any  limits [in HB
215]  on the  oral prescription  [optometrists] will  be able  to                                                               
DR. GONNASON  answered, yes,  that this bill  will not  allow for                                                               
schedule one and  two narcotics.  Schedule one  includes the most                                                               
dangerous  and  abused  drugs  such   as  heroine  and  morphine.                                                               
Schedule two  includes narcotic painkillers.   He stated  that he                                                               
would  rather that  schedule one  only be  excluded, because  the                                                               
nurse  practitioners, in  their  regulations,  are authorized  to                                                               
prescribe schedules one through five.                                                                                           
CHAIR  DYSON asked  Dr.  Gonnason how  many times  a  day in  his                                                               
practice he  has to get  another medical professional to  write a                                                               
prescription for him.                                                                                                           
Number 0376                                                                                                                     
DR. GONNASON responded, probably twice a week.                                                                                  
CHAIR DYSON asked Dr. Gonnason what  he thinks it is like for the                                                               
optometrists in the villages that are not on the road system.                                                                   
DR. GONNASON replied  that they are using  oral medications quite                                                               
a bit.   He added that [the ophthalmologists']  argument could be                                                               
said for dentists,  and asked, "Why don't they  suddenly slap the                                                               
dentists with  restrictions or supervision?"   He stated  that he                                                               
thinks he has enough training  and education that he doesn't need                                                               
supervision with these medications.                                                                                             
REPRESENTATIVE JOULE  asked if  there are  instances of  abuse in                                                               
states where optometrists  are given this latitude.   He asked if                                                               
this  is something  that has  caused the  repeal of  laws in  any                                                               
DR. GONNASON responded that no  law has ever been repealed; there                                                               
has only  been expansion and  amplification.  He said  there have                                                               
been  no  problems  in  the 25  years  since  optometrists  first                                                               
started prescribing drugs.   He added that Tennessee  has had the                                                               
exact same  law as  this bill  for nine  years, and  there hasn't                                                               
been  one complaint  to the  state board  of misuse  of drugs  by                                                               
Number 0128                                                                                                                     
DR.  CASSER  remarked  that  in   response  to  Mr.  Palmer,  who                                                               
referenced  the blank  check for  prescribing  authority, HB  215                                                               
very clearly states  that these drugs would be used  to treat the                                                               
eye and its  appendages that are very  specific and appropriately                                                               
limiting  for optometry.   In  response to  Mr. Palmer's  comment                                                               
about   little   training,    she   stated   that   optometrists'                                                               
pharmacology  training is  comparable to  other professions  that                                                               
are using oral  and systemic medications.  She  said she believes                                                               
it is  appropriate for the  optometry board to be  the overseeing                                                               
body because  optometry is an  independent profession  and should                                                               
be regulated  by the rules  of the state  board.  In  response to                                                               
Dr. Rosen's comments  regarding 2,000 hours of  training as being                                                               
regrettable,  she  said  that  the  2,000-hour  figure  she  used                                                               
referred only to the clinical portion  of the program.  The total                                                               
program  is  in excess  of  4,300,  which  does not  include  the                                                               
undergraduate  work.   She remarked  that Mr.  Leavitt asked  who                                                               
teaches  [the  optometry students],  and  she  answered that  the                                                               
systemic disease course series [at  Pacific University] is taught                                                               
by  a physician  who is  a specialist  in Portland.   It  is also                                                               
instructed  by an  individual who  is a  pharmacist, optometrist,                                                               
and in a PA program.                                                                                                            
TAPE 01-51, SIDE A                                                                                                              
Number 0043                                                                                                                     
MR. PALMER  remarked that he does  not have any knowledge  of the                                                               
Alaska  Medical  Board  working  on   any  type  of  language  or                                                               
compromised  language  dealing with  this  bill.   Regarding  the                                                               
information  concerning   the  patients,  he  stated   that  that                                                               
information is very  anecdotal.  He said the state  of Florida is                                                               
considering  a bill  dealing with  comanagement  between the  two                                                               
professions.  Emergency physicians  have testified in the Florida                                                               
legislature  that there  ends up  being a  "dumping" of  patients                                                               
from optometry into the emergency room.                                                                                         
MR. LEAVITT stated that concerning  one of the bill's focuses, on                                                               
controlled  substances,  a  professor of  ophthalmology  whom  he                                                               
knows  tells  her  first-year  residents, "If  you  have  got  to                                                               
prescribe  a  controlled  substance,   you  probably  missed  the                                                               
Number 0210                                                                                                                     
CHAIR DYSON called  for an at-ease at 4:47 p.m.   The meeting was                                                               
called back to order at 4:50 p.m.                                                                                               
CHAIR  DYSON   declared  that  Dr.   Gonnason  is   his  personal                                                               
REPRESENTATIVE   CISSNA  remarked   that   Dr.   Gonnason  is   a                                                               
constituent of hers.   She said she helped him  work on this bill                                                               
last year, and he ran against her.                                                                                              
CHAIR  DYSON stated  that  it  can be  argued  that  both he  and                                                               
Representative Cissna have a conflict  of interest, and that this                                                               
can be  viewed in terms of  its ethics.   He said he is  going to                                                               
rule, however,  that both  he and  Representative Cissna  have to                                                               
REPRESENTATIVE  CISSNA remarked  that she  did work  on the  bill                                                               
last year and  voted for it.  She then  discovered that the piece                                                               
that was missing  was that the medical board had  not weighed in.                                                               
When  they weighed  in with  the governor,  it was  vetoed.   She                                                               
stated that  she did call  the [medical  board] this year  on the                                                               
basis  of last  year's rejection,  and they  said they  wanted to                                                               
work with  the optometrists in  perfecting this bill so  it would                                                               
actually   meet   everyone's  needs.      She   added  that   her                                                               
understanding  is  that  the  governor's   office  has  the  same                                                               
CHAIR DYSON stated  that Representative Cissna has  told him that                                                               
the State Medical Board had written  to the Board of Optometry to                                                               
discuss this in the fall.                                                                                                       
Number 0403                                                                                                                     
REPRESENTATIVE  JOULE moved  to report  HB 215  out of  committee                                                               
with individual recommendations and  the accompanying zero fiscal                                                               
REPRESENTATIVE COGHILL objected.                                                                                                
Number 0439                                                                                                                     
A  roll call  vote was  taken.   Representatives Stevens,  Joule,                                                               
Kohring,  and   Dyson  voted  in   favor  of  moving   the  bill.                                                               
Representatives  Wilson, Cissna,  and Coghill  voted against  it.                                                               
Therefore,  HB 215  moved from  the House  Health, Education  and                                                               
Social Services Standing Committee by a vote of 4-3.                                                                            
HB 197-HEALTH CARE SERVICES DIRECTIVES                                                                                        
CHAIR DYSON announced  that the final order of  business would be                                                               
HOUSE BILL NO.  197, "An Act relating to  directives for personal                                                               
health care services and for medical treatment."                                                                                
MELANIE LESH,  Staff to Representative Bill  Hudson, Alaska State                                                               
Legislature, came  forth on behalf of  the sponsor of HB  197 and                                                               
stated  that reference  has  been made  in the  bill  on page  2,                                                               
Section 2 [of the proposes  committee substitute (CS) for HB 197,                                                               
22-LS0712\C,  Bannister,  4/12/01],  that the  Five  Wishes  form                                                               
containing the health care directives  is more or less sanctioned                                                               
by  the state.   It  states, "a  person may  use a  form that  is                                                               
substantially  similar  to  the   Five  Wishes  form  for  making                                                               
directives  [related  to the  person's  health  care and  death,]                                                               
including designating  another person  to act as  an attorney-in-                                                               
fact or other agent".                                                                                                           
Number 0628                                                                                                                     
REPRESENTATIVE JOULE made  a motion to adopt the  proposed CS for                                                               
HB 197, 22-LS0712\C, Bannister, 4/12/01,  as a work draft.  There                                                               
being no objection, Version C was before the committee.                                                                         
REPRESENTATIVE WILSON stated that  she wasn't present during [the                                                               
first hearing of the bill], and asked for an explanation.                                                                       
CHAIR DYSON  explained that a  group of  people who have  been in                                                               
hospice care  and deal  with people  who are  dying have  come up                                                               
with the Five Wishes of what  people can indicate what they would                                                               
like to have done as they are dying.                                                                                            
Number 0743                                                                                                                     
REPRESENTATIVE  STEVENS  moved  to   report  [CS]HB  197  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
zero fiscal note.  [His motion was not addressed.]                                                                              
REPRESENTATIVE  COGHILL stated  that  he  thinks referencing  the                                                               
form and  having a list  of definitions is good.    He  asked, if                                                               
everything [in the  bill] is permissive and  nothing is mandated,                                                               
whether this is going to be sufficient.                                                                                         
MS. LESH  responded that the  other states that  have implemented                                                               
this  also  have  a  more  permissive  statutory  structure  that                                                               
enables this  to be  something a citizen  can take  advantage of,                                                               
but it's  not a mandatory  form.  People  in the legal  field [in                                                               
Alaska] have weighed  in on this and said that  they do wills and                                                               
trusts for businesses,  but would like this form  to be available                                                               
for people who can't hire attorneys.                                                                                            
REPRESENTATIVE  COGHILL   stated  that  this  is   a  contractual                                                               
framework that  would already be  legitimate if  the [legislature                                                               
didn't pass this bill].  He  said he is trying to understand that                                                               
MS.  LESH  stated  that  it is  her  understanding,  through  the                                                               
information received from Aging  With Dignity, that Alaska's laws                                                               
do conflict  and don't allow this.   [Alaska] is one  of the only                                                               
states that  has statutory inhibitions  to allowing this  form to                                                               
be  used legally  by  the average  person who  wants  to find  it                                                               
himself or herself.                                                                                                             
Number 0920                                                                                                                     
REPRESENTATIVE  CISSNA   moved  to  report  [CS]HB   197  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
zero fiscal note.                                                                                                               
REPRESENTATIVE  WILSON stated  that [the  hospital she  works in]                                                               
already has  advanced directives.   She  asked if  most hospitals                                                               
have them.                                                                                                                      
MS. LESH  responded that the  advanced directives  [in hospitals]                                                               
are living-will advanced  directives that don't go  to the extent                                                               
of the  Five Wishes.   This expands  extensively the  options for                                                               
terminally ill individuals.                                                                                                     
REPRESENTATIVE COGHILL remarked that it  has to be expressed with                                                               
caution that many  times these forms can be filled  out in a very                                                               
leading way.                                                                                                                    
Number 1017                                                                                                                     
CHAIR DYSON  announced that  there being  no objection,  CSHB 197                                                               
(HES)  was moved  from  the House  Health,  Education and  Social                                                               
Services Standing Committee.                                                                                                    
The  House   Health,  Education  and  Social   Services  Standing                                                               
Committee meeting was  recessed to the call of the  chair at 5:05                                                               

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