Legislature(2001 - 2002)
04/24/2001 03:08 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ 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
emergency."
- 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 -
REFERRALS
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 -
REFERRALS
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 -
REFERRALS
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 -
REFERRALS
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
MINUTE(HES)
04/19/01 (H) HES AT 3:00 PM CAPITOL 106
04/19/01 (H) Heard & Held
MINUTE(HES)
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
197.
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
implementation.
Number 1001
REPRESENTATIVE JOULE remarked that he would like to thank
Representative Porter for bringing this legislation forward. He
stated:
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
fixed.
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
adopted.
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
Committee.
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
need.
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
injections.
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
medications.
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
stated:
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
Alaska.
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
it.
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
loss.
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
give.
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
states.
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
optometrists.
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
diagnosis."
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
optometrist.
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
vote.
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
concern.
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
note.
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
logic.
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.
ADJOURNMENT
The House Health, Education and Social Services Standing
Committee meeting was recessed to the call of the chair at 5:05
p.m.
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