Legislature(2003 - 2004)

04/01/2003 03:02 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 1, 2003                                                                                          
                           3:02 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Carl Gatto, Vice Chair                                                                                           
Representative John Coghill                                                                                                     
Representative Paul Seaton                                                                                                      
Representative Kelly Wolf                                                                                                       
Representative Sharon Cissna                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Mary Kapsner                                                                                                     
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 142                                                                                                              
"An Act relating to provider responsibility for ocular                                                                          
postoperative care; and providing for an effective date."                                                                       
                                                                                                                                
     - MOVED HB 142 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 171                                                                                                              
"An Act repealing the charter school grant program; and                                                                         
providing for an effective date."                                                                                               
                                                                                                                                
     - MOVED HB 171 OUT OF COMMITTEE                                                                                            
                                                                                                                                
PREVIOUS ACTION                                                                                                               
                                                                                                                                
BILL: HB 142                                                                                                                  
SHORT TITLE:RESPONSIBILITY FOR CARE AFTER EYE SURGERY                                                                           
SPONSOR(S): REPRESENTATIVE(S)HEINZE                                                                                             
                                                                                                                                
Jrn-Date   Jrn-Page                     Action                                                                                  
03/03/03     0358       (H)        READ THE FIRST TIME -                                                                        
                                   REFERRALS                                                                                    
03/03/03     0358       (H)        HES, FIN                                                                                     
04/01/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
                                                                                                                                
                                                                                                                                
BILL: HB 171                                                                                                                  
SHORT TITLE:REPEAL CHARTER SCHOOL GRANTS                                                                                        
SPONSOR(S): RLS BY REQUEST OF THE GOVERNOR                                                                                      
                                                                                                                                
Jrn-Date   Jrn-Page                     Action                                                                                  
03/05/03     0445       (H)        READ THE FIRST TIME -                                                                        
                                   REFERRALS                                                                                    
03/05/03     0445       (H)        EDU, HES, FIN                                                                                
03/05/03     0445       (H)        FN1: (EED)                                                                                   
03/05/03     0445       (H)        GOVERNOR'S TRANSMITTAL LETTER                                                                
03/11/03                (H)        EDU AT 11:00 AM CAPITOL 124                                                                  
03/11/03                (H)        Heard & Held                                                                                 
03/11/03                (H)        MINUTE(EDU)                                                                                  
03/13/03                (H)        EDU AT 11:00 AM CAPITOL 124                                                                  
03/13/03                (H)        Moved Out of Committee                                                                       
03/13/03                (H)        MINUTE(EDU)                                                                                  
03/14/03     0539       (H)        EDU RPT 5DP 2DNP                                                                             
03/14/03     0539       (H)        DP: WILSON, COGHILL, SEATON,                                                                 
                                   WOLF,                                                                                        
03/14/03     0539       (H)        GATTO; DNP: KAPSNER, GARA                                                                    
03/14/03     0539       (H)        FN1: (EED)                                                                                   
03/20/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
03/20/03                (H)        -- Meeting Canceled --                                                                       
03/27/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
03/27/03                (H)        Scheduled But Not Heard                                                                      
04/01/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE CHERYLL HEINZE                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As sponsor of HB 142, testified on the bill                                                                
and answered questions from the members.                                                                                        
                                                                                                                                
CARL ROSEN, M.D., President                                                                                                     
Alaska Academy of Ophthalmology                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 142 and answered                                                                
questions from the committee.                                                                                                   
                                                                                                                                
CARLOS BUZNEGO, M.D.                                                                                                            
Center for Excellence in Eye Care;                                                                                              
American Academy of Ophthalmology                                                                                               
Miami, Florida                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 142 and answered                                                                
questions from the committee.                                                                                                   
                                                                                                                                
GARY JACKSON                                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified via teleconference  in support of                                                               
HB 142.                                                                                                                         
                                                                                                                                
KEVIN SWEENEY, Special Assistant                                                                                                
Office of the Commissioner                                                                                                      
Department of Education and Early Development                                                                                   
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:    Testified  on HB  171  and  responded  to                                                               
questions from the committee.                                                                                                   
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
TAPE 03-31, SIDE A                                                                                                            
Number 0001                                                                                                                     
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:02  p.m.                                                               
Representatives Wilson,  Gatto, Coghill, Seaton, and  Cissna were                                                               
present at  the call  to order.   Representative Wolf  arrived as                                                               
the meeting was in progress.                                                                                                    
                                                                                                                                
HB 142-RESPONSIBILITY FOR CARE AFTER EYE SURGERY                                                                              
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE BILL NO.  142, "An Act relating  to provider responsibility                                                               
for  ocular postoperative  care; and  providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
Number 0050                                                                                                                     
                                                                                                                                
REPRESENTATIVE CHERYLL HEINZE,  Alaska State Legislature, sponsor                                                               
of  HB 142,  said the  purpose of  the bill  is to  ensure proper                                                               
ocular  postoperative care,  primarily with  respect to  cataract                                                               
surgery.  The bill allows  for postoperative care to be delegated                                                               
by  a surgeon  only  to another  ophthalmologist  and only  under                                                               
certain conditions.  It requires  that the physician be available                                                               
to the patient for up to  120 hours after surgery.  She explained                                                               
that    currently   comanagement    agreements   exist    between                                                               
optometrists  and  ophthalmologists.   Optometrists  provide  the                                                               
patients  to ophthalmologists  who perform  the surgery,  but the                                                               
ophthalmologist  does  not  follow the  patient  postoperatively.                                                               
Potential risks  to patients  exist with  this arrangement.   The                                                               
bill  is  intended   to  protect  the  patient   to  ensure  good                                                               
postoperative  care by  a qualified  physician, in  this case  an                                                               
ophthalmologist.                                                                                                                
                                                                                                                                
Number 0243                                                                                                                     
                                                                                                                                
REPRESENTATIVE GATTO  told the committee  he contacted  Dr. Rosen                                                               
this morning to talk about the bill.   He asked if in the case of                                                               
noncompliance, for  instance, if  the physician leaves  town, who                                                               
would investigate the case.  Who funds the investigation?                                                                       
                                                                                                                                
Number 0320                                                                                                                     
                                                                                                                                
CARL  ROSEN, M.D.,  President, Alaska  Academy of  Ophthalmology,                                                               
testified in  support of HB  142 and answered questions  from the                                                               
committee.  He told the  committee that he is an ophthalmologist,                                                               
is  fellowship-trained,  and  board-certified; and  is  a  neuro-                                                               
ophthalmolgist,  orbital  surgeon, and  oculaplastic  specialist.                                                               
In  response  to Representative  Gatto's  question,  he told  the                                                               
committee the  Alaska State  Medical Board  has the  authority to                                                               
investigate physicians in cases of negligence or malpractice.                                                                   
                                                                                                                                
Number 0395                                                                                                                     
                                                                                                                                
CARLOS  BUZNEGO, M.D.,  Center for  Excellence in  Eye Care;  and                                                               
American Academy  of Ophthalmology, testified  via teleconference                                                               
from Miami, Florida, in support  of HB 142 and answered questions                                                               
from  the committee.   He  told the  committee Congress  has been                                                               
talking about patient protection, and  it is important that state                                                               
legislators debate  the merits and  act upon state  health policy                                                               
to  improve the  system  and quality  of  care.   He  said he  is                                                               
representing the  American Academy of Ophthalmology,  which has a                                                               
membership  of   approximately  27,000  ophthalmologists.     Dr.                                                               
Buznego  told the  committee  he  serves as  a  volunteer on  the                                                               
academy's  governing  committee  for   state  affairs  and  is  a                                                               
practicing ophthalmologist.                                                                                                     
                                                                                                                                
Number 0459                                                                                                                     
                                                                                                                                
DR. BUZNEGO  provided a  brief overview  of health  policy issues                                                               
with respect  to HB 142.   He said  this bill addresses  abuse of                                                               
surgical practice of  a surgeon.  Ocular care is  one of the rare                                                               
areas where non-physicians  inappropriately perform postoperative                                                               
care after  eye surgery.   He explained that comanagement  is the                                                               
sharing of  postoperative responsibilities between  the operating                                                               
surgeon  and  another health  care  provider.   In  theory,  this                                                               
arrangement is  to be entered  into only in  cases when it  is in                                                               
the best  interests of the patient,  for example, when it  is too                                                               
far for  the patient  to safely  travel.  If  this were  the only                                                               
kind of  comanagement around,  he said he  would not  be speaking                                                               
today.   In practice, there  is abuse,  and there are  times when                                                               
this behavior is unethical.                                                                                                     
                                                                                                                                
Number 0542                                                                                                                     
                                                                                                                                
DR. BUZNEGO  said in the  interest of patient safety  he believes                                                               
the enactment of  HB 142 will eliminate the  pressure that allied                                                               
health  professionals  place  on  surgeons  to  enter  into  such                                                               
unethical   agreements.      Blatant   unethical   behaviors   in                                                               
comanagement  occur when  a surgeon  enters  into a  comanagement                                                               
agreement  with  an  allied health  care  provider  for  economic                                                               
considerations,  specifically,  as  an  inducement  for  surgical                                                               
referrals  or   as  a  result   of  coercion  by   the  referring                                                               
practitioner.   This bill would eliminate  the unethical behavior                                                               
by carefully  regulating when surgical  referrals can  include an                                                               
agreement to comanage only when it  will be in the patient's best                                                               
interest.   In such cases,  the surgeon in consultation  with the                                                               
patient  will   use  his/her  judgment  to   determine  the  most                                                               
appropriate  postoperative   care.     The  bill  does   not  ban                                                               
comanagement of  patients, but it ensures  that such arrangements                                                               
are  truly in  the best  interests  of patients.   It  recognizes                                                               
unique  challenges  of delivering  health  care  services to  the                                                               
citizens of  Alaska.  In  addition, the bill  permits flexibility                                                               
in  cases  of  emergencies  and unexpected  circumstances.    Dr.                                                               
Buznego told  the committee this  bill would  improve responsible                                                               
surgical practice in  Alaska.  Finally, it would  not raise costs                                                               
to the patients,  since all providers are reimbursed  at the same                                                               
rate  for their  services.   He said  this is  a patient-friendly                                                               
bill, and he urged the committee's support of this legislation.                                                                 
                                                                                                                                
Number 0616                                                                                                                     
                                                                                                                                
CHAIR WILSON  shared a  concern about her  mother, who  will have                                                               
cataract  surgery tomorrow.    She explained  that  there are  no                                                               
surgeons where she lives, so  someone is driving her mother about                                                               
an hour away from her home  to have the procedure done.  However,                                                               
she has  lung problems and she  coughs a lot.   Chair Wilson said                                                               
she is  concerned about who  is doing the follow-up  care because                                                               
of the  coughing.  Chair Wilson  asked if this might  be the kind                                                               
of special circumstances Dr. Buznego has been talking about.                                                                    
                                                                                                                                
Number 0679                                                                                                                     
                                                                                                                                
DR. BUZNEGO responded  that Chair Wilson is correct.   One of the                                                               
important issues of  cataract surgery is not  solely what happens                                                               
during  the  surgery,  although   that  is  obviously  critically                                                               
important, but there are certain  complications that can arise in                                                               
the first several weeks following  cataract surgery.  Often these                                                               
complications  have  very  subtle  signs;  in  the  situation  of                                                               
comanagement, oftentimes the practitioner  seeing that patient on                                                               
the first  postoperative day  may not  recognized early  signs of                                                               
difficulty.   For example, a  significant amount  of inflammation                                                               
in the  eye, which  is often very  subtle and can  be one  of the                                                               
earliest sign  of an eye  infection after cataract surgery,  is a                                                               
potentially  blinding complication.    Dr. Buznego  said that  in                                                               
cases like Chair  Wilson's mother, where the  patient is coughing                                                               
a  lot, the  coughing could  raise the  pressure in  the eye  and                                                               
cause the wound  to open and the implant could  be displaced.  He                                                               
said he  is sure  the surgeon  who is taking  care of  her mother                                                               
will  provide some  medications that  will decrease  coughing and                                                               
make sure that the incision is nice and tight.                                                                                  
                                                                                                                                
DR. BUZNEGO  said it is  critically important during  those first                                                               
several   postoperative  visits   that  the   surgeon  identifies                                                               
complications  and fixes  them.    Dr. Buznego  said  one of  the                                                               
current  problems of  postoperative care  being provided  by non-                                                               
ophthalmologists is the possibility that  they may not be able to                                                               
recognize complications.   He said in the case  of Chair Wilson's                                                               
mother, even if  a problem is identified and she  needs to be re-                                                               
operated on  or she might  need intravenous medications,  none of                                                               
those  things could  be done  by  a comanaging  optometrist.   It                                                               
would be hard to find someone to fix the problem.                                                                               
                                                                                                                                
Number 0790                                                                                                                     
                                                                                                                                
REPRESENTATIVE  GATTO asked  if  there is  a  Florida academy  of                                                               
ophthalmology.                                                                                                                  
                                                                                                                                
DR.   BUZNEGO   replied  there   is   the   Florida  Society   of                                                               
Ophthalmology.                                                                                                                  
                                                                                                                                
REPRESENTATIVE GATTO  responded that the president  of the Alaska                                                               
Academy of  Ophthalmology provided information to  the committee.                                                               
That information said that HB  142 provides that unless a surgeon                                                               
enters into  a written comanagement  agreement with  the patient,                                                               
the  bill requires  a surgeon  to  be physically  available to  a                                                               
patient  for postoperative  care in  the community  in which  the                                                               
operation  was  performed  for   120  hours  after  the  surgery.                                                               
Representative Gatto said that when  most people go into surgery,                                                               
they  have a  stack  of  papers that  they  sign before  surgery.                                                               
There usually  is very  small print and  multiple pages,  and the                                                               
patient  just signs  the bottom.    He pointed  out that  usually                                                               
patients  do not  take  an  attorney with  them  to the  doctor's                                                               
office; it is  usually a spouse or  child.  He said  his guess is                                                               
that there is going  to be a form in there  that says the surgeon                                                               
is  associated  with a  licensed  optometrist  who will  see  the                                                               
patient after surgery.  People will  look at that and say, "Okay,                                                               
why not?"  He said he  is curious about what Florida's experience                                                               
has been  and what has been  done when this kind  of practice has                                                               
been discovered.                                                                                                                
                                                                                                                                
Number 0872                                                                                                                     
                                                                                                                                
DR. BUZNEGO replied that it is  a critically important point.  It                                                               
is  possible that  kind of  agreement could  be slipped  into the                                                               
paperwork  given to  patients, since  the surgeon  would have  to                                                               
have consent.  The  spirit of the law is not  just having a paper                                                               
signed.    When the  surgeon  talks  to patients  about  cataract                                                               
surgery  and the  risks, he/she  should talk  about complications                                                               
and  postoperative  care.   Theoretically,  even  if the  patient                                                               
signs  something, if  the  doctor  does not  talk  about it,  the                                                               
doctor could be held to a higher standard in court.                                                                             
                                                                                                                                
REPRESENTATIVE GATTO asked if in  Florida there is a paper signed                                                               
by patients  that has dialog that  says when a person  signs this                                                               
paper that person  is giving up the right to  insist upon his/her                                                               
ophthalmologist's care.  He asked if  there is a form that Alaska                                                               
could use as a guide.                                                                                                           
                                                                                                                                
DR. BUZNEGO  responded that  Florida nearly  passed this  kind of                                                               
legislation.   He said it  passed the House  and the Senate  by a                                                               
simple  majority,  but  because  of  confusion  in  parliamentary                                                               
procedure, it  is not currently law.   The bill is  being brought                                                               
up again this year.   At this time, there is not  a form he could                                                               
provide.  He  pointed out that it is an  important national issue                                                               
and that  both the  American Academy  of Ophthalmology,  which is                                                               
the largest  association, and another  organization that  is just                                                               
cataract   surgeons   provided   national  position   papers   on                                                               
postoperative care because they felt it is that important.                                                                      
                                                                                                                                
Number 1036                                                                                                                     
                                                                                                                                
REPRESENTATIVE   SEATON  asked   if  in   Florida  HMOs   [health                                                               
maintenance organizations]  typically use a surgeon,  but not for                                                               
postoperative care  [as in a  comanagement agreement].   He asked                                                               
if that is the reason this legislation was proposed in Florida.                                                                 
                                                                                                                                
Number 1076                                                                                                                     
                                                                                                                                
DR.  BUZNEGO responded  that is  not the  reason.   He said  this                                                               
legislation actually predates the  time when HMOs actually became                                                               
popular.  He said the reason  that this is a significant issue is                                                               
that many  optometrists will talk  to an ophthalmologist  and say                                                               
they will send  the surgeon patients for cataract  surgery if the                                                               
surgeon will then send the  patient back to them for comanagement                                                               
[postoperative care].  For example,  in Florida there is a doctor                                                               
who will send  his patients in Key West to  Boca Raton because he                                                               
gets comanagement  rates.   This doctor sends  his patients  on a                                                               
four-hour  drive, when  he  could send  the  patients across  the                                                               
street  to a  doctor who  does  not believe  in comanagement  and                                                               
takes good care of his patients.                                                                                                
                                                                                                                                
Number 1138                                                                                                                     
                                                                                                                                
REPRESENTATIVE  CISSNA said  she recalls  reading about  "surgery                                                               
mills" where there is an  unusually aggressive person without the                                                               
proper credentials  doing surgery  and where  the emphasis  is on                                                               
making  money.   She asked  if Dr.  Rosen would  comment on  that                                                               
issue.                                                                                                                          
                                                                                                                                
Number 1183                                                                                                                     
                                                                                                                                
DR.  ROSEN said  he  knows  of two  good  examples in  Anchorage.                                                               
There is  a group from Washington  state that comes up  to Alaska                                                               
and  has  a  comanagement  arrangement.    Specifically,  Pacific                                                               
Cataract  and Laser  Institute has  a surgeon  come to  Anchorage                                                               
twice a month  and operates on anywhere from 10  to 30 people per                                                               
month.   An  optometrist  follows  the patients  postoperatively.                                                               
The surgeon  leaves the state after  the surgery.  Not  only does                                                               
the   surgeon  leave,   but  he   also  has   not  accepted   the                                                               
responsibility  that every  other ophthalmologist  in Alaska  has                                                               
accepted, which  is to  respond to  calls.  He  said he  does not                                                               
like to get called into  the hospital, but if Providence Hospital                                                               
calls him at  3:00 a.m., he responds.  This  doctor has said that                                                               
he  is such  an expert  and so  specialized and  patients are  so                                                               
privileged that he does not have  to do that.  Another example is                                                               
an  outfit that  not  only  does cataract  surgery,  but also  is                                                               
primarily  a refractive  surgery  outfit, which  is called  Laser                                                               
Vision of  Canada.  They  had plenty of patients,  and advertised                                                               
$1,000 for two  eyes and 20-20 vision without glasses.   Not only                                                               
is that  not true,  but these  guys are no  longer around.   They                                                               
went out  of business and now  there are abandoned patients.   He                                                               
said he and his partners have to  take care of these people.  Dr.                                                               
Rosen said  these are two good  examples of mills that  have gone                                                               
awry.                                                                                                                           
                                                                                                                                
Number 1281                                                                                                                     
                                                                                                                                
GARY JACKSON testified  via teleconference in support  of HB 142.                                                               
He shared his experience when  he was referred by his optometrist                                                               
to the PCLI  [Pacific Cataract and Laser  Institute] for cataract                                                               
surgery.   Following the procedure,  he was referred back  to the                                                               
optometrist for follow-up  the next day.  He said  he did not see                                                               
the actual surgeon for two  weeks.  An infection developed, which                                                               
was treated  by the  optometrist.  Finally,  the surgeon  saw him                                                               
two weeks later  when he returned to Alaska  and additional laser                                                               
repair was done.  For this reason,  he urged passage of HB 142 to                                                               
ensure  that proper  follow-up by  the  surgeon is  given to  the                                                               
patient.                                                                                                                        
                                                                                                                                
Number 1444                                                                                                                     
                                                                                                                                
CHAIR  WILSON commented  that  Mr. Jackson  ended  up having  two                                                               
surgeries instead of one.                                                                                                       
                                                                                                                                
MR. JACKSON said that  is correct.  He said he  does not know the                                                               
reason for  the infection,  but he required  laser repair  to the                                                               
original surgery.   In response to Chair  Wilson's question about                                                               
further surgery, he responded that  since that experience, he has                                                               
had unrelated  surgery done by  Dr. Rosen.   Mr. Jackson  said he                                                               
wanted to  make one further point  and that is that  he never met                                                               
the surgeon who  did his cataract surgery.  He  said he was given                                                               
a video to watch.  In contrast,  the surgery he had done with Dr.                                                               
Rosen was preceded by a meeting;  Dr. Rosen stayed with him after                                                               
the surgery  was finished, and called  him at home that  night to                                                               
make  sure everything  was  okay.   Mr. Jackson  said  he had  an                                                               
appointment  with him  the  following day  when  the bandage  was                                                               
taken off.   Dr.  Rosen has  been totally accessible.   It  was a                                                               
very different experience.                                                                                                      
                                                                                                                                
Number 1450                                                                                                                     
                                                                                                                                
DR. ROSEN reiterated previous points made  about HB 142.  He said                                                               
that  while the  option of  comanagement was  originally designed                                                               
with good intentions, patients' safety  has been compromised.  He                                                               
told the  committee patients really  entrust surgeons  with their                                                               
best  interests.   There is  nothing more  noble or  coveted than                                                               
this  bond,  and  this  is what  medical  schools  teach  budding                                                               
surgeons and  physicians.  A  surgeon must ensure  that following                                                               
surgery any  problems and complications  be recognized  and dealt                                                               
with in a timely fashion.                                                                                                       
                                                                                                                                
Number 1599                                                                                                                     
                                                                                                                                
DR. ROSEN  told the  committee there  are legitimate  reasons for                                                               
comanagement in  distant or rural  places, for example,  where it                                                               
is too inconvenient  or inaccessible due to weather.   He said it                                                               
is important  that an  equally trained  and competent  surgeon be                                                               
responsible  for the  patient's  postoperative care.   There  are                                                               
some  wonderful optometrists  who do  their job  brilliantly, but                                                               
surgery is  not part of the  optometric training.  He  said it is                                                               
not  possible for  someone  to know  all  the complications,  let                                                               
alone the simple nuances that can  occur after surgery.  It takes                                                               
an  ophthalmology residency,  which is  a surgical  residency for                                                               
three years,  an internship  for one year,  and a  fellowship [in                                                               
Dr. Rosen's  case] for  14 months to  understand what  can happen                                                               
from  surgical  manipulation and  instrumentation  of  an eye  or                                                               
orbit.   A weekend course, a  book, or pictures simply  do not do                                                               
it.   It  is  necessary  to do  surgery  to  understand what  can                                                               
happen.                                                                                                                         
                                                                                                                                
DR. ROSEN pointed out an  unscrupulous arrangement that can occur                                                               
between  an optometrist  and an  ophthalmologist as  a result  of                                                               
financial gain.   He said  that his  practice is not  affected by                                                               
this  kind  of  arrangement  because his  patients  come  to  him                                                               
largely because  the patient has  been injured or has  cancer and                                                               
needs  reconstruction of  the patient's  bone  or eyelid  tissue.                                                               
However,   as  the   president   of  the   [Alaska  Academy   of]                                                               
Ophthalmology,  it  is  his  job   to  point  out  this  kind  of                                                               
unscrupulous arrangement.   When  financial gain is  involved, it                                                               
is really  a kickback for every  patient sent to a  surgeon by an                                                               
optometrist.    There are  some  wonderful  public relations  and                                                               
marketing deals  that have  come about  and that  have mesmerized                                                               
some optometrists into  bringing this about.   When patients find                                                               
out, they wonder why no one told  them.  Dr. Rosen said a patient                                                               
does not have to go to a mill  to get better care.  He said he is                                                               
a Harvard graduate  and his colleague graduated from  Yale.  They                                                               
will provide better  postoperative care because they  live in the                                                               
community.                                                                                                                      
                                                                                                                                
Number 1700                                                                                                                     
                                                                                                                                
DR. ROSEN summarized that the crux  of the problem is that when a                                                               
surgeon leaves  town, the patient  is being  left in the  care of                                                               
someone less  qualified.  If  a complication occurs, the  hope is                                                               
that the  optometrist can recognize  it and  deal with it  so the                                                               
patient does not end up in the  emergency room late at night.  In                                                               
these instances,  the patient and  family are  inconvenienced and                                                               
the  local ophthalmologist  ends up  being responsible  for these                                                               
problems  and must  take  care  of the  patient.    He asked  the                                                               
committee  to pass  the bill  to protect  unwitting patients  for                                                               
five days  [after surgery].   He noted that there  are exclusions                                                               
for  emergencies.   However,  it  is  important that  an  equally                                                               
qualified surgeon be available for the patient.                                                                                 
                                                                                                                                
Number 1734                                                                                                                     
                                                                                                                                
REPRESENTATIVE  HEINZE  summarized that  this  bill  will send  a                                                               
message to physicians  outside of Alaska that the  state does not                                                               
abide  these kinds  of practices.    She said  that Alaskans  are                                                               
proud  of  their  ophthalmologists,   and  this  is  a  dangerous                                                               
practice that may  affect something very precious  to all people,                                                               
their  eyesight.   Representative Heinze  asked the  committee to                                                               
vote to move this bill out of committee.                                                                                        
                                                                                                                                
Number 1765                                                                                                                     
                                                                                                                                
CHAIR WILSON commented on her  experience in assisting doctors in                                                               
doing eye  surgery, which  is so  delicate that  it must  be done                                                               
using  a microscope.   The  sutures used  are so  tiny that  they                                                               
float and are even finer than hair.                                                                                             
                                                                                                                                
Number 1796                                                                                                                     
                                                                                                                                
REPRESENTATIVE COGHILL questioned whether  the bill would provide                                                               
for more civil  and criminal liability.  He noted  that there are                                                               
a lot  of exceptions.  He  suggested this will create  a lot more                                                               
room  for litigation  if not  followed closely.   He  said he  is                                                               
wondering  what the  medical board  sees  as a  way of  enforcing                                                               
complaints  coming before  them  and what  they might  anticipate                                                               
with  respect to  regulation.   He asked  if there  has been  any                                                               
testimony  from  the  state  medical  board  on  how  they  might                                                               
implement this statute in regulation.                                                                                           
                                                                                                                                
REPRESENTATIVE  HEINZE  responded that  there  has  not been  any                                                               
testimony by  the medical  board on how  they would  regulate the                                                               
law.                                                                                                                            
                                                                                                                                
REPRESENTATIVE COGHILL said  it appears that in  Sections 5-7 the                                                               
effective dates are awaiting the  development of the regulations.                                                               
He asked  if Representative Heinze  could explain how  that might                                                               
work.   He  said  it looks  as though  Sections  1-4 take  effect                                                               
differently than Section 5.  Is  that to allow for regulations to                                                               
be implemented?                                                                                                                 
                                                                                                                                
Number 1912                                                                                                                     
                                                                                                                                
REPRESENTATIVE HEINZE responded that she does not know.                                                                         
                                                                                                                                
Number 1919                                                                                                                     
                                                                                                                                
REPRESENTATIVE  CISSNA  referred  to the  Legislative  Legal  and                                                               
Research Services sectional  analysis on Sections 5  and 7, where                                                               
it  says that  it allows  the state  medical board  to begin  the                                                               
regulations process  before the  rest of  the bill  takes effect.                                                               
She  said she  believes that  would take  care of  Representative                                                               
Coghill's concerns.                                                                                                             
                                                                                                                                
REPRESENTATIVE COGHILL responded that he  would like to know what                                                               
the   state  medical   board  anticipates   and  what   part  the                                                               
legislature plays in that discussion.   He said he is not sure it                                                               
is  wise to  pass the  bill before  knowing what  that discussion                                                               
will be.                                                                                                                        
                                                                                                                                
Number 1946                                                                                                                     
                                                                                                                                
DR. ROSEN responded  that he does not  see that as an  issue.  He                                                               
said the medical board can easily  take care of that question and                                                               
it  falls within  the realm  of  their capability  by looking  at                                                               
other examples of what they do now.                                                                                             
                                                                                                                                
REPRESENTATIVE COGHILL said  he believes the policy  call is good                                                               
and  does not  plan on  holding up  the bill.   He  expressed his                                                               
concern about what may come from this legislation.                                                                              
                                                                                                                                
CHAIR WILSON told Representative Heinze  that it would be wise to                                                               
have  the answers  to these  questions prior  to hearings  in the                                                               
next committee of referral.                                                                                                     
                                                                                                                                
REPRESENTATIVE HEINZE  said she would be  providing the committee                                                               
with any information requested.                                                                                                 
                                                                                                                                
Number 2013                                                                                                                     
                                                                                                                                
REPRESENTATIVE COGHILL  moved to report  HB 142 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.  There being no objection,  HB 142 was reported out of the                                                               
House Health, Education and Social Services Standing Committee.                                                                 
                                                                                                                                
HB 171-REPEAL CHARTER SCHOOL GRANTS                                                                                           
                                                                                                                                
Number 2053                                                                                                                     
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 171, "An  Act repealing the charter  school grant                                                               
program; and providing for an effective date."                                                                                  
                                                                                                                                
Number 2061                                                                                                                     
                                                                                                                                
KEVIN  SWEENEY, Special  Assistant, Office  of the  Commissioner,                                                               
Department of  Education and Early  Development, testified  on HB                                                               
171 and responded  to questions from the committee.   Mr. Sweeney                                                               
explained that  this bill eliminates the  state-funded grants for                                                               
charter  school startup.   He  explained that  the Department  of                                                               
Education and  Early Development has  been working with  the U.S.                                                               
Department  of  Education  to secure  funds  that  will  actually                                                               
increase  the level  of startup  grants provided  by the  federal                                                               
government.   He  said the  money that  will be  coming from  the                                                               
federal government  exceeds the  amount provided  in the  past by                                                               
state and  federal money  combined.  The  new federal  money that                                                               
will be allocated to a new  school, in the amount of $150,000 for                                                               
the  first  three   years  and  $45,000  for   the  fourth  year,                                                               
eliminates the need for the state's supplemental grant.                                                                         
                                                                                                                                
Number 2105                                                                                                                     
                                                                                                                                
CHAIR WILSON  asked Mr. Sweeney  if he is  sure no funds  will be                                                               
lost to new charter schools if this bill is passed.                                                                             
                                                                                                                                
MR. SWEENEY replied this is correct.   He explained that what has                                                               
happened in  the past is  that a new  charter school was  given a                                                               
federal grant  and then the  state supplemented that grant  for a                                                               
total grant for  startup purposes.  For the  charter schools that                                                               
have come  on board, the  total amount  of funding for  a charter                                                               
school  has ranged  anywhere from  $164,000 to  $478,000 for  the                                                               
state  and  federal  combined  funds.    In  comparison,  charter                                                               
schools coming on  board in 2003 will get $450,000  for the first                                                               
three  years and  $45,000 for  the fourth  year, for  a total  of                                                               
$495,000,  so, in  fact,  the  funds would  be  increased to  new                                                               
charter schools.                                                                                                                
                                                                                                                                
Number 2146                                                                                                                     
                                                                                                                                
MR. SWEENEY  asked the  committee to  note that  this legislation                                                               
does  not take  effect  until next  July.   He  said the  delayed                                                               
effective date  in the bill  is so the state  can live up  to its                                                               
commitment to  two charter schools  that will be  receiving funds                                                               
from the  department in  their final  year of  funding.   He also                                                               
added the department believes that  the delay will allow them the                                                               
time to  make certain the  funding will  come in and  the state's                                                               
application will  be approved hopefully  by June or July  of this                                                               
year.   Mr.  Sweeney  said  the state  is  saving  money and  the                                                               
charter schools are getting more money than in the past.                                                                        
                                                                                                                                
Number 2170                                                                                                                     
                                                                                                                                
REPRESENTATIVE GATTO asked if any  charter schools will be caught                                                               
in the  middle, for example, too  late for state funding  and too                                                               
early for federal funding.                                                                                                      
                                                                                                                                
MR. SWEENEY said  no schools will be caught in  the middle.  Only                                                               
two schools  are currently  owed one more  year in  funding under                                                               
the  old  regulations  whereby  they will  get  their  state  and                                                               
federal funding combined.                                                                                                       
                                                                                                                                
REPRESENTATIVE GATTO asked the name of the two schools.                                                                         
                                                                                                                                
MR. SWEENEY said the schools  are Soldotna Montessori and Chinook                                                               
Montessori.    He  commented  that  four  new  schools  that  are                                                               
proposed to start are Frontier,  Highland Technical, Horizon, and                                                               
Tongass,  and their  grants  will  fall under  the  new level  of                                                               
funding.   The  department  expects  that there  will  be 17  new                                                               
schools  in the  near future,  based on  what the  department has                                                               
heard from school  districts.  That is the number  of schools the                                                               
state  has applied  for  under  the new  funding  by the  federal                                                               
government and for which the  department expects to hear approval                                                               
by this July.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  GATTO commented  that  he had  heard Horizon  was                                                               
trying to start up  over a year ago.  The  school board told them                                                               
they were a  little premature; normally it takes a  year, and now                                                               
the  year is  over.   He  asked Mr.  Sweeney if  this means  that                                                               
Horizon will now have to wait another year.                                                                                     
                                                                                                                                
MR. SWEENEY responded that he  is not certain, but thinks Horizon                                                               
will be starting in 2003.   He explained that the way the process                                                               
works  is that  a charter  school goes  through the  local school                                                               
district, and  then the  application comes  to the  Department of                                                               
Education and Early  Development for approval.   The local school                                                               
district is  where a lot of  the investigation and review  of the                                                               
charter  school's plan  is done.    By the  time the  application                                                               
comes to the  state, the local district has  already approved it.                                                               
He commented  that Horizon  may have had  some challenges  at the                                                               
local district that he would be unaware of.                                                                                     
                                                                                                                                
Number 2228                                                                                                                     
                                                                                                                                
REPRESENTATIVE  GATTO responded  that Mr.  Sweeney had  mentioned                                                               
Horizon as  one of the four  schools that would be  covered under                                                               
the new federal money.                                                                                                          
                                                                                                                                
MR. SWEENEY replied  that is correct.  He  believes Horizon opens                                                               
next fall;  however, he is not  sure when it opens,  but he knows                                                               
that Horizon is  identified as one of the new  schools.  In fact,                                                               
he believes  Horizon was  just approved at  the last  state board                                                               
meeting,  so it  will get  the  new funding  through the  federal                                                               
government.                                                                                                                     
                                                                                                                                
CHAIR WILSON asked  in what school districts  the charter schools                                                               
are located.                                                                                                                    
                                                                                                                                
MR. SWEENEY responded that he does not know.                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  asked Mr. Sweeney  if the state  can expect                                                               
many more  charter schools,  to the  point where  charter schools                                                               
would  take a  significant  number of  students from  traditional                                                               
public schools.                                                                                                                 
                                                                                                                                
MR. SWEENEY replied  that in the past, federal  grant funding for                                                               
15  charter  schools was  $2.5  million,  and  now the  state  is                                                               
looking at  getting $10.5 million  for upcoming  charter schools.                                                               
It is something the U.S.  Department of Education is pushing, and                                                               
the state  anticipates that there  will be a lot  of applications                                                               
statewide.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  GATTO  asked if  he  knows  the failure  rate  of                                                               
charter schools.                                                                                                                
                                                                                                                                
MR. SWEENEY responded that he does not know.                                                                                    
                                                                                                                                
Number 2325                                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON  moved to  report HB  171 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.   There being no objection,  HB 171 was reported  from the                                                               
House Health, Education and Social Services Standing Committee.                                                                 
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
TAPE 03-31, SIDE B                                                                                                            
Number 2306                                                                                                                     
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 3:50 p.m.                                                                                                      

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