Legislature(2017 - 2018)CAPITOL 106

03/18/2017 03:00 PM HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 159 OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+ SB 91 EXTEND DISASTER EMERGENCY:OPIOID EPIDEMIC TELECONFERENCED
Moved CSSB 91(HSS) Out of Committee
Uniform Rule 23 Waived
+= HB 103 OPTOMETRY & OPTOMETRISTS TELECONFERENCED
Moved CSHB 103(HSS) Out of Committee
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 18, 2017                                                                                         
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Bryce Edgmon, Vice Chair                                                                                         
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 159                                                                                                              
"An  Act relating  to the  prescription of  opioids; establishing                                                               
the   Voluntary  Nonopioid   Directive  Act;   relating  to   the                                                               
controlled  substance  prescription  database;  relating  to  the                                                               
practice  of dentistry;  relating  to the  practice of  medicine;                                                               
relating to  the practice of  podiatry; relating to  the practice                                                               
of osteopathy; relating  to the practice of  nursing; relating to                                                               
the  practice   of  optometry;  relating   to  the   practice  of                                                               
veterinary  medicine;  related to  the  duties  of the  Board  of                                                               
Pharmacy; and providing for an effective date."                                                                                 
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
CS FOR SENATE BILL NO. 91(HSS)                                                                                                  
"An Act  relating to the  opioid epidemic; authorizing  the chief                                                               
medical officer of  the Department of Health  and Social Services                                                               
to  issue a  standing order  for  the prescription  of an  opioid                                                               
overdose drug; and providing for an effective date."                                                                            
                                                                                                                                
     - MOVED CSSB 91(HSS) OUT OF COMMITTEE                                                                                      
                                                                                                                                
HOUSE BILL NO. 103                                                                                                              
"An Act relating to the practice of optometry."                                                                                 
                                                                                                                                
     - MOVED CSHB 103(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 159                                                                                                                  
SHORT TITLE: OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES                                                                            
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/06/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/06/17       (H)       HSS, FIN                                                                                               
03/18/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: SB 91                                                                                                                   
SHORT TITLE: DISASTER EMERGENCY: OPIOID EPIDEMIC                                                                                
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/10/17       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/10/17       (S)       HSS                                                                                                    
03/13/17       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/13/17       (S)       Heard & Held                                                                                           
03/13/17       (S)       MINUTE(HSS)                                                                                            
03/15/17       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/15/17       (S)       Moved  CSSB 91(HSS) Out of Committee                                                                   
03/15/17       (S)       MINUTE(HSS)                                                                                            
03/16/17       (S)       HSS RPT CS  5DP    NEW TITLE                                                                           
03/16/17       (S)       DP: WILSON, VON IMHOF, BEGICH, GIESSEL,                                                                
                         MICCICHE                                                                                               
03/16/17       (S)       TRANSMITTED TO (H)                                                                                     
03/16/17       (S)       VERSION: CSSB 91(HSS)                                                                                  
03/17/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/17/17       (H)       HSS                                                                                                    
03/17/17       (H)       HSS WAIVED PUBLIC HEARING NOTICE, RULE                                                                 
                         23                                                                                                     
03/18/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 103                                                                                                                  
SHORT TITLE: OPTOMETRY & OPTOMETRISTS                                                                                           
SPONSOR(s): SPOHNHOLZ                                                                                                           
                                                                                                                                
02/03/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/03/17       (H)       HSS, L&C                                                                                               
03/14/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/14/17       (H)       Heard & Held                                                                                           
03/14/17       (H)       MINUTE(HSS)                                                                                            
03/16/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/16/17       (H)       Scheduled but Not Heard                                                                                
03/18/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JAY BUTLER, MD, Chief Medical Officer/ DPH Director                                                                             
Central Office                                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during discussions of HB                                                              
159 and SB 91.                                                                                                                  
                                                                                                                                
BERNICE NISBETT, Staff                                                                                                          
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions about HB 103 on behalf                                                                
of the bill sponsor, Representative Spohnholz.                                                                                  
                                                                                                                                
JILL GEERING MATHESON, OD                                                                                                       
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 103.                                                                          
                                                                                                                                
HARRIET MILKS, Assistant Attorney General                                                                                       
Commercial and Fair Business Section                                                                                            
Civil Division (Juneau)                                                                                                         
Department of Law                                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
103.                                                                                                                            
                                                                                                                                
RACHEL REINHARDT, MD                                                                                                            
American Academy of Ophthalmology                                                                                               
Seattle, WA                                                                                                                     
POSITION STATEMENT:  Testified in opposition to HB 103.                                                                       
                                                                                                                                
VICTORIA BLOWER, OD                                                                                                             
Optometrist                                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 103.                                                                          
                                                                                                                                
KARL ROSEN, MD                                                                                                                  
Ophthalmologist                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 103.                                                                       
                                                                                                                                
ALFRED DERAMUS, MD                                                                                                              
Ophthalmologist                                                                                                                 
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 103.                                                                       
                                                                                                                                
DAVID ZUMBRO, MD                                                                                                                
Ophthalmologist                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 103.                                                                       
                                                                                                                                
PAUL BARNEY, OD                                                                                                                 
Chair                                                                                                                           
Board of Optometry                                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 103.                                                                          
                                                                                                                                
ELIZABETH MORGAN, MD                                                                                                            
Ophthalmologist                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 103.                                                                   
                                                                                                                                
DAVID KARPIK, OD                                                                                                                
Kenai, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of HB 103.                                                                          
                                                                                                                                
ERIC COULTER, MD                                                                                                                
Ophthalmologist                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 103.                                                                       
                                                                                                                                
ERIK CHRISTIANSON, OD                                                                                                           
Optometrist                                                                                                                     
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 103.                                                                          
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:19 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing Committee meeting to order  at 3:03 p.m. Representatives                                                               
Spohnholz,  Sullivan-Leonard,   Eastman,  Kito,  and   Tarr  were                                                               
present at  the call to  order.  Representative  Johnston arrived                                                               
as the meeting was in progress.                                                                                                 
                                                                                                                                
         HB 159-OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES                                                                     
                                                                                                                                
3:03:59 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be HOUSE  BILL NO. 159, "An  Act relating to the  prescription of                                                               
opioids;  establishing  the  Voluntary Nonopioid  Directive  Act;                                                               
relating  to  the  controlled  substance  prescription  database;                                                               
relating to the  practice of dentistry; relating  to the practice                                                               
of medicine;  relating to the  practice of podiatry;  relating to                                                               
the practice of osteopathy; relating  to the practice of nursing;                                                               
relating to the  practice of optometry; relating  to the practice                                                               
of veterinary  medicine; related  to the duties  of the  Board of                                                               
Pharmacy; and providing for an effective date."                                                                                 
                                                                                                                                
3:04:59 PM                                                                                                                    
                                                                                                                                
JAY  BUTLER, MD,  Chief Medical  Officer/  DPH Director,  Central                                                               
Office,  Division  of Public  Health,  Department  of Health  and                                                               
Social Services, stated  that there had been  a fourfold increase                                                               
in the number  of opioid associated deaths in the  past 20 years.                                                               
He declared that  this was an opioid epidemic,  pointing out that                                                               
no other cause  of death had increased so remarkably  over such a                                                               
short  period of  time.    He reported  that  there  was also  an                                                               
increase in  the rates of Hepatitis  C, as well as  other burdens                                                               
on  the  health care  system  associated  with increased  use  of                                                               
opioids, both  legal and illicit.   He said that there  were many                                                               
things that had  to be done, which would  require a multi-faceted                                                               
approach.   He  declared that  it  was necessary  to address  the                                                               
needs  of people  who were  currently struggling  with addiction,                                                               
and to prevent addiction through  more evidence based prescribing                                                               
practices,  control  the flood  of  prescription  opioids in  the                                                               
community,  and  address the  access  to  treatment and  the  de-                                                               
stigmatization  by improving  provider  knowledge.   He  reported                                                               
that there had been an  increase in illicit opioid use, beginning                                                               
with  heroin in  the  past  five years,  and  more recently  with                                                               
fentanyl and other  synthetic opioids.  He noted  that 80 percent                                                               
of   heroin   users   started  opioid   use   with   prescription                                                               
painkillers.     He  said  that   HB  [159]  aligned   with  many                                                               
prescribing  guidelines delivered  to  the  legislature from  the                                                               
health care  boards through Senate  Bill 74  in 2016, as  well as                                                               
the Centers  for Disease Control  and Prevention  pain management                                                               
guidelines, and  the Surgeon General's report  on alcohol, drugs,                                                               
and health.   He added  that recent statements from  the American                                                               
Medical Association and the American  Dental Association, as well                                                               
as   recommendations   for   evidence   based   improvement   and                                                               
prescription drug  monitoring from the PEW  Charitable Trust also                                                               
supported these guidelines.                                                                                                     
                                                                                                                                
DR.  BUTLER  offered  to  outline the  proposed  bill  for  three                                                               
particular areas: patients, providers,  and the prescription drug                                                               
monitoring program.   He  said that  proposed HB  [159] empowered                                                               
patients in  two ways, it  provided an  option for those  who did                                                               
not wish to be prescribed  opioids to communicate that preference                                                               
to the providers by way  of a voluntary revocable opioid advanced                                                               
directive  which could  be  placed  on the  medical  record.   He                                                               
shared that this had been  a request from the recovery community,                                                               
describing  the challenges  they faced  in interactions  with the                                                               
health care system  when a provider was unaware  that the patient                                                               
was  in recovery.   He  shared that  the second  way was  that it                                                               
allowed  patients to  request that  the pharmacist  dispense less                                                               
than the  total prescribed amount.   He said that a  partial fill                                                               
was  authorized under  federal law,  with  a goal  to affirm  the                                                               
rights of  the patient and the  authority of the pharmacist.   He                                                               
said  that a  portion  of the  continuing professional  education                                                               
that health care  providers must receive would  include a section                                                               
of  at least  two hours  designated  on pain  management and  the                                                               
basics of addiction  medicine.  He explained that  the renewal of                                                               
a  medical  license required  at  least  40 hours  of  continuing                                                               
medical education credit.  He  said that the second component for                                                               
providers  was a  setting of  dispensing limits  for the  initial                                                               
opioid prescription  to no more than  7 days.  He  added that the                                                               
proposed  bill did  allow exceptions,  when  in the  professional                                                               
judgment of  the provider, a  longer supply was necessary  due to                                                               
chronic  pain,  severe acute  pain,  cancer  pain, or  palliative                                                               
care, or  when a  longer supply  was necessary  due to  travel or                                                               
other logistical barriers.   The third component  was for changes                                                               
to  the  prescription  drug  monitoring   program,  a  data  base                                                               
accessible  to  prescribers and  dispensers,  in  order to  share                                                               
information about  controlled substances.   He declared  that the                                                               
data base was  secure and confidential, and  met the requirements                                                               
of  the  Health  Insurance  Portability  and  Accountability  Act                                                               
(HIPAA).   He added that  this database was not  openly available                                                               
to law enforcement without appropriate search warrant authority.                                                                
                                                                                                                                
DR. BUTLER  said that the  proposed bill authorized  the pharmacy                                                               
board  to   issue  routine   periodic  confidential   reports  to                                                               
prescribers to  provide feedback  on their  prescribing practices                                                               
relative to  those of their peers.   These "report cards"  were a                                                               
good  way  to  provide  feedback  for  providers  for  their  own                                                               
prescribing habits.  He said  that this had been proven effective                                                               
in   other  states   for  reducing   the   number  of   excessive                                                               
prescriptions with other  substances.  He stated  that the second                                                               
component  of the  changes to  the  prescription drug  monitoring                                                               
program  (PDMP) was  for clarification  to include  veterinarians                                                               
who  prescribe  opioids  to  register   and  use  the  monitoring                                                               
program.   He referenced recent media  reports regarding attempts                                                               
to get opioid medications from  veterinarians.  He explained that                                                               
the third  component was to make  the PDMP a more  useful tool by                                                               
providing that  pharmacists update  the data  on a  daily, rather                                                               
than  weekly, basis.   He  stated that  the proposed  bill had  a                                                               
zero-fiscal  note  from  the  Department  of  Health  and  Social                                                               
Services and the  Department of Corrections, and  a one-time cost                                                               
of $27,500 from the Department  of Commerce, Community & Economic                                                               
Development to  cover legal  costs to  amend the  regulations and                                                               
for printing.  He directed attention  to a letter of support from                                                               
the Alaska Dental Society.                                                                                                      
                                                                                                                                
REPRESENTATIVE  TARR asked  if  there had  been  a response  from                                                               
pharmacists regarding the more frequent updating of PDMP.                                                                       
                                                                                                                                
DR.  BUTLER said  that there  had been  this discussion  with the                                                               
pharmacists  and  that  DHSS shared  concern  for  any  increased                                                               
burden on the  smaller pharmacies. He explained  that there could                                                               
be a delay  for this requirement to take effect.   He pointed out                                                               
that  some  of  the  larger, more  automated  pharmacies  already                                                               
updated more frequently than currently required by law.                                                                         
                                                                                                                                
3:16:58 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  asked about the  option for patients  to decline                                                               
the full prescription  amount, as it seemed  counter intuitive to                                                               
ask  permission to  accept less  medicine than  prescribed.   She                                                               
asked if that was not currently possible.                                                                                       
                                                                                                                                
DR. BUTLER  offered his belief that  "it depends on who  you ask"                                                               
and that federal  law had recently changed,  which clarified that                                                               
pharmacists  could  do a  partial  fill  at  the request  of  the                                                               
patient.                                                                                                                        
                                                                                                                                
REPRESENTATIVE  KITO   pointed  out   that  there   were  certain                                                               
medications  which required  the  full regimen  to be  effective,                                                               
which could lead to some confusion.                                                                                             
                                                                                                                                
DR. BUTLER  acknowledged and  stated that  the law  specified for                                                               
federally designated  Schedule 2 controlled substances.   He said                                                               
that this  use for  full regimen may  have inadvertently  lead to                                                               
patient confusion with opioid prescriptions.                                                                                    
                                                                                                                                
3:19:16 PM                                                                                                                    
                                                                                                                                
DR. BUTLER paraphrased from the Sectional Analysis [Included in                                                                 
members' packets], which read:                                                                                                  
                                                                                                                                
     Sec.  1  Adds a  new  Chapter  55, Voluntary  Nonopioid                                                                    
     Directive   Act,   to   AS  13,   Decedents'   estates,                                                                    
     guardianships,  transfers,  trusts,   and  health  care                                                                    
     decisions,  that provides  an  option  for patients  to                                                                    
     execute  a  Voluntary  Nonopioid Directive  that  would                                                                    
     allow a  person in recovery  (or for other  reasons) to                                                                    
     make clear  the person's desire not  to be administered                                                                    
     an  opioid. A  person, guardian,  conservator or  other                                                                    
     appointed person  may revoke  a directive at  any time.                                                                    
     The person would  provide this confidential information                                                                    
     to  a  health  care  provider or  hospital  on  a  form                                                                    
     provided  by   the  Department  of  Health   of  Social                                                                    
     Services. The  department would  promulgate regulations                                                                    
     on  procedures,  confidentiality,  and  exemptions  for                                                                    
     emergency or substance  misuse treatment. Providers are                                                                    
     not  liable for  following  a directive.  Prescriptions                                                                    
     are  assumed to  be valid;  pharmacists are  not liable                                                                    
     for dispensing a  controlled substance in contradiction                                                                    
     to  a  directive.  The  directive  does  not  alter  an                                                                    
     advance  health care  directive, limit  opioid overdose                                                                    
     drugs,  or  limit  treatment  for  substance  abuse  or                                                                    
     opioid dependence.                                                                                                         
                                                                                                                                
     Sec. 2-25  Amend AS 08,  Business and  Professions, for                                                                    
     the  Boards   of  Dentistry,  Medicine,   Nursing,  and                                                                    
     Optometry to                                                                                                               
     • Require two  (2) hours of pain  management and opioid                                                                    
     misuse and addiction instruction;                                                                                          
     •  Disciplinary actions  for prescribing  or dispensing                                                                    
     an opioid  in excess of  the maximum dosage  allowed by                                                                    
     law or violated  a law related to  drugs, regardless of                                                                    
     any criminal action;                                                                                                       
     •   Set  the   maximum   dosage   for  initial   opioid                                                                    
     prescriptions  at a  seven-day  supply  unless, in  the                                                                    
     practitioner's professional  judgment, it  is necessary                                                                    
     for chronic pain  management or a patient  is unable to                                                                    
     access   a  practitioner   in   time   to  refill   the                                                                    
     prescription; and                                                                                                          
     •  Require, for  a minor  under  18 years  of age,  the                                                                    
     practitioner discuss  with the  parent or  guardian why                                                                    
     the prescription is necessary  and the risks associated                                                                    
     with opioid use.                                                                                                           
                                                                                                                                
     Sec. 26-27 Amend AS 08.80 for the Board of Pharmacy to                                                                     
     •  Register  with   the  Prescription  Drug  Monitoring                                                                    
     Database  (PDMP)   with  or  without  a   federal  Drug                                                                    
     Enforcement Administration registration number; and                                                                        
     •  Allow   pharmacists  to   dispense  less   than  the                                                                    
     prescribed amount  of a schedule  II or  III controlled                                                                    
     substance at a person's  request; the pharmacists would                                                                    
     inform   the    prescribing   practitioner    and   the                                                                    
     Prescription Drug Monitoring Database.                                                                                     
                                                                                                                                
     Sec. 28  Amends AS  08.98 for  the Board  of Veterinary                                                                    
     Medicine  to  •  Register with  the  Prescription  Drug                                                                    
     Monitoring Database  if the veterinarian has  a federal                                                                    
     Drug Enforcement Administration number; and                                                                                
     •  Identify  resources  and educational  materials  for                                                                    
     veterinarians to  identify clients  at risk  for opioid                                                                    
     misuse or diversion of prescribed opioids.                                                                                 
                                                                                                                                
     Sec. 29-36  Amend AS  17.30, Controlled  Substances, to                                                                    
     change   the  frequency   pharmacists  report   to  the                                                                    
     Prescription  Drug Monitoring  Database from  weekly to                                                                    
     daily;  remove the  prohibition on  sharing information                                                                    
     with  the federal  government. The  pharmacy board  may                                                                    
     provide  a  confidential  unsolicited  notification  in                                                                    
     summary form to a  practitioner's licensing board which                                                                    
     includes   the   basis   for  the   notification.   The                                                                    
     notification must  be provided  to the  practitioner as                                                                    
     well.                                                                                                                      
                                                                                                                                
     Sec.  37 Directs  the Department  of Health  and Social                                                                    
     Services   to  draft   regulations  to   implement  the                                                                    
     Voluntary Nonopioid Directive Act.                                                                                         
                                                                                                                                
     Sec. 38 Repeals  sunset dates in sections 52  and 73 of                                                                    
     Ch. 25, SLA 2016 (SB 74).                                                                                                  
                                                                                                                                
     Sec. 39-40 Set an  immediate effective date and provide                                                                    
     an effective date for regulations.                                                                                         
                                                                                                                                
3:28:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN asked for the type of information on the                                                                 
report cards and whether the confidentiality was discoverable in                                                                
any legal action.                                                                                                               
                                                                                                                                
DR. BUTLER explained that the report cards, as used in other                                                                    
states, would compare the usage over the previous 12 months with                                                                
other providers.   He replied  that he did  not know if  this was                                                               
discoverable in a legal situation.                                                                                              
                                                                                                                                
REPRESENTATIVE EASTMAN directed  attention to page 7,  [lines 8 -                                                               
9] of the  proposed bill, and questioned whether  there should be                                                               
sanctions  "regardless  of  whether  there has  been  a  criminal                                                               
action or patient harm."  He  expressed his concern, as there was                                                               
the possibility  of easily breaking one  of many, many laws.   He                                                               
asked  if  this  was  opening  up  the  providers  to  liability.                                                               
Although he  was unsure  of the  implications, he  suggested this                                                               
might require  the hiring of  extra staff to deal  with potential                                                               
technical violations,  or the  increasing of  insurance coverage.                                                               
He asked for the reason behind this language.                                                                                   
                                                                                                                                
DR. BUTLER offered  his understanding that this  language was not                                                               
new in this bill.                                                                                                               
                                                                                                                                
REPRESENTATIVE TARR  directed attention  to page 28,  Section 36,                                                               
of the proposed  bill, and stated that she was  supportive of the                                                               
idea  that providers  be  responsible,  benchmark their  practice                                                               
against  others,  and  adjust  their  own  prescribing  practices                                                               
accordingly.   She pointed out  that the language  was permissive                                                               
and not  required, and  asked if  this should  be required.   She                                                               
declared  that  providers were  part  of  the solution,  as  they                                                               
recognized  that   there  were  alternative  options   for  their                                                               
patients to address health care needs.                                                                                          
                                                                                                                                
DR. BUTLER explained  that the primary goal of Section  36 of the                                                               
proposed bill was  to provide authority to the  Board of Pharmacy                                                               
to issue  the report cards, and  whether or not it  was a mandate                                                               
was  a matter  of ideology.   He  said that,  as the  issuance of                                                               
these  types of  report  cards was  not  currently allowed  under                                                               
Alaska law, the desire was to establish the authority to do so.                                                                 
                                                                                                                                
REPRESENTATIVE   TARR   asked  if   the   board   had  a   better                                                               
understanding for whether this would  be voluntary.  She asked if                                                               
these were the recommendations from the task force.                                                                             
                                                                                                                                
DR. BUTLER, in reference to  the Alaska Opioid Policy Task Force,                                                               
said that a number of its recommendations were used in the bill.                                                                
                                                                                                                                
3:35:28 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ said that the bill would be held over.                                                                          
                                                                                                                                
           SB 91-DISASTER EMERGENCY: OPIOID EPIDEMIC                                                                        
                                                                                                                                
3:35:50 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be  CS FOR  SENATE  BILL NO.  91(HSS), "An  Act  relating to  the                                                               
opioid  epidemic; authorizing  the chief  medical officer  of the                                                               
Department  of Health  and Social  Services to  issue a  standing                                                               
order  for  the prescription  of  an  opioid overdose  drug;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
JAY  BUTLER, MD,  Chief Medical  Officer/  DPH Director,  Central                                                               
Office,  Division  of Public  Health,  Department  of Health  and                                                               
Social  Services,  reported  that  in late  2016,  Department  of                                                               
Health and Social Services was  awarded a five-year federal grant                                                               
to support  an opioid overdose prevention  program which included                                                               
the   distribution   of   naloxone,  a   lifesaving   drug   when                                                               
administered during  an opioid overdose.   He explained  that the                                                               
grant funds  had been used to  acquire a nasal spray  form of the                                                               
drug which  was part of  the rescue kit, and  distributed through                                                               
Project HOPE,  Harm reduction Overdose Prevention  and Education.                                                               
He  added that  Project  HOPE had  prioritized partnerships  with                                                               
staff of organizations which did  not have medical direction, and                                                               
whose  staff were  most likely  to  be present  when an  overdose                                                               
occurred,  including first  responders and  recover support.   In                                                               
order to provide the kits  statewide under a standing order, with                                                               
a prescription that  was present, DHSS had  explored some options                                                               
and decided that  the best way to move  forward expeditiously was                                                               
for the state medical officer to  issue a standing order, under a                                                               
disaster declaration.   He reported that the  governor had issued                                                               
the  disaster declaration  on February  14,  with an  anticipated                                                               
legislative resolution  to extend  this declaration.   He pointed                                                               
out  that no  state funds  were requested,  and that  14 provider                                                               
organizations  had received  over 1200  kits.   He reported  that                                                               
Legislative Legal  Services had offered  the opinion that  a bill                                                               
was  required to  extend the  disaster declaration  for continued                                                               
distribution  of the  kits.    He reported  that  SB 91  included                                                               
further  improvements  to HB  174,  as  it authorized  the  Chief                                                               
Medical Officer of DHSS to issue  a state wide standing order for                                                               
prescription  of an  opioid overdose  drug.   This  authorization                                                               
would mean that the disaster  declaration was no longer necessary                                                               
to conduct  the program, and would  be allowed to lapse  after 30                                                               
days,  as prescribed  under Alaska  statute.   He added  that, as                                                               
stated in AS  44.62.270, emergencies were held to a  minimum.  He                                                               
pointed out  that the proposed bill  had a zero fiscal  note, and                                                               
was supported by the federal grant.                                                                                             
                                                                                                                                
3:40:20 PM                                                                                                                    
                                                                                                                                
DR. BUTLER  paraphrased from Senate  Bill 91  Sectional Analysis,                                                               
version J, [Included in members' packets] which read:                                                                           
                                                                                                                                
     Sec. 1  amends AS 17.20.085, Opioid  overdose drugs, to                                                                    
     authorize  the   Chief  Medical  Officer  to   issue  a                                                                    
     standing order,  including a statewide  standing order,                                                                    
     for  the  prescription  of   an  opioid  overdose  drug                                                                    
     through June  30, 2021. The  department is  required to                                                                    
     report  annually  to  the  Legislature  on  the  opioid                                                                    
     epidemic's SAMHSA grant activities and expenditures.                                                                       
                                                                                                                                
     Sec. 2 repeals section 1 on June 30, 2021.                                                                                 
                                                                                                                                
     Sec. 3  makes the  effective date retroactive  to March                                                                    
     15, 2017, when the disaster declaration expires.                                                                           
                                                                                                                                
     Sec. 4 provides for an immediate effective date.                                                                           
                                                                                                                                
REPRESENTATIVE  EASTMAN said  that the  committee substitute  was                                                               
cleaner  than  the  original  and   he  asked  if  the  emergency                                                               
[declaration] had expired and was not being extended.                                                                           
                                                                                                                                
DR. BUTLER replied, "that is correct."                                                                                          
                                                                                                                                
REPRESENTATIVE EASTMAN voiced his support  for not making a habit                                                               
of declaring emergencies for one year.                                                                                          
                                                                                                                                
3:42:18 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
3:43:38 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
3:43:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   moved  to  report  CSSB   91(HSS)  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
zero fiscal  notes.  There  being no objection, CSSB  91(HSS) was                                                               
moved  from  the  House  Health   and  Social  Services  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
3:44:10 PM                                                                                                                    
                                                                                                                                
The committee took an at ease from 3:44 p.m. to 3:49 p.m.                                                                       
                                                                                                                                
                HB 103-OPTOMETRY & OPTOMETRISTS                                                                             
                                                                                                                                
3:49:32 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the final order of business would                                                                
be HOUSE BILL NO. 103, "An Act relating to the practice of                                                                      
optometry."                                                                                                                     
                                                                                                                                
[In front of the committee was the proposed committee substitute                                                                
for HB 103, Version D.]                                                                                                         
                                                                                                                                
3:49:57 PM                                                                                                                    
                                                                                                                                
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska                                                                    
State Legislature, paraphrased from the sponsor statement                                                                       
[Included in members' packets] which read:                                                                                      
                                                                                                                                
     HB  103 modernizes  and  updates  the Alaska  Optometry                                                                    
     Statute,  as  many parts  are  over  50 years  old.  It                                                                    
     allows the  optometry board  the authority  to regulate                                                                    
     its  practice  the  same as  other  prescribing  health                                                                    
     professions  such as  dentistry, medicine  and nursing.                                                                    
     This bill  also allows the  board to continue  to adopt                                                                    
     regulations, updated to current  practice and moves the                                                                    
     continuing  education   (CE)  requirements   back  into                                                                    
     regulations. Continuing education  is still required by                                                                    
     current  statute, but  the hours  and subjects  will be                                                                    
     determined  by the  board  as  with other  professions.                                                                    
     This change allows the board  flexibility to control CE                                                                    
     requirements and  is recommended  by the  Department of                                                                    
     Commerce,  Community  and   Economic  Development.  The                                                                    
     current  regulations require  more  CE  hours than  the                                                                    
     statute subsection deleted by  this bill. HB 103 allows                                                                    
     the  optometry  board   to  determine  prescribed  drug                                                                    
     schedules,  including  standards   and  limitations  on                                                                    
     practice  determined by  the  board.  The bill  ensures                                                                    
     that no  licensee may perform any  procedure beyond the                                                                    
     scope  of  the   licensee's  education,  training,  and                                                                    
     experience  as established  by the  board. This  allows                                                                    
     for future new and  improved diagnostic and therapeutic                                                                    
     procedures  as  determined  by  the  board,  while  not                                                                    
     having  to  return to  the  legislature  for every  new                                                                    
     technological advance, which is  currently the case and                                                                    
     unnecessarily burdensome.  The optometry  definition in                                                                    
     this bill is updated  to reflect current and modern-day                                                                    
     practice.                                                                                                                  
                                                                                                                                
MS. NISBETT paraphrased from the Sectional Analysis [Included in                                                                
members' packets], which read:                                                                                                  
                                                                                                                                
     Section   1  AS.08.72.050   (4)(6)  updates   very  old                                                                    
     statutes to indicate that  regulations shall be adopted                                                                    
     to  govern   the  current   prescription  and   use  of                                                                    
     pharmaceutical  agents; and  develop uniform  standards                                                                    
     for the practice of optometry.                                                                                             
                                                                                                                                
     Section 2  AS.08.72.060 (c)(4) the board  shall publish                                                                    
     advisory opinions regarding  standards for the practice                                                                    
     of optometry.                                                                                                              
                                                                                                                                
     Section   3  AS   08.72.181(d)  moves   the  continuing                                                                    
     education  (CE) requirements  back into  regulation, as                                                                    
     desired by  the Department  of Commerce,  Community and                                                                    
     Economic  Development.  Continuing education  is  still                                                                    
     required  by   current  statute,  but  the   hours  and                                                                    
     subjects will be determined by the board.                                                                                  
                                                                                                                                
     Section  4   AS  08.72.272(a)  clarifies   the  current                                                                    
     statute for the board  to regulate pharmaceutical agent                                                                    
     prescription  including  standards and  limitations  on                                                                    
     practice determined by the board.                                                                                          
                                                                                                                                
     Section 5  AS 08.72.278  Limitation on practice  adds a                                                                    
     new   section  that   sets  limitations   on  services,                                                                    
     ensuring  that   the  board   may  not   authorize  any                                                                    
     procedure beyond the scope  of the licensee's education                                                                    
     and experience.                                                                                                            
                                                                                                                                
     Section  6   AS  08.72.300(3)  updates   the  optometry                                                                    
     definition to reflect current practice.                                                                                    
                                                                                                                                
     Section  7  Effective  date  for  Section  2.  This  is                                                                    
     because (3) of  Section 2 was added to  statute in 2016                                                                    
     via Senate  Bill 74, the  Medicaid Reform bill,  and it                                                                    
     had the effective date of  July 2017, so (4) is written                                                                    
     to  comply with  that  date as  well. (per  Legislative                                                                    
     Drafting)                                                                                                                  
                                                                                                                                
3:52:17 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
3:52:44 PM                                                                                                                    
                                                                                                                                
JILL GEERING  MATHESON, OD,  reported that  she was  a practicing                                                               
doctor of  optometry and  that she  had testified  numerous times                                                               
before  legislative  committees  in  support of  changes  to  the                                                               
optometry statute  over the  last 25 years.   She  explained that                                                               
those  statutes  had  allowed  doctors  of  optometry  to  safely                                                               
practice  to the  level of  their  training and  education.   She                                                               
asked for support  to proposed HB 103, explaining  that the state                                                               
boards  and  commissions  were appointed  and  confirmed  by  the                                                               
Alaska State  Legislature to  represent the  people of  Alaska in                                                               
these areas of expertise.  She  explained that the state chose to                                                               
set up separate  boards for each medical  profession because each                                                               
profession was unique  and the oversight needed to  be handled by                                                               
the  members of  that profession.   She  noted that  the approved                                                               
statutes were  very broad  for the  medical board,  the dentistry                                                               
board, and the Board of  Advanced Practice Nurses, and that these                                                               
boards  could autonomously  manage  their respective  professions                                                               
within the  law in an honest,  safe and responsible manner.   She                                                               
pointed  out  that  the  optometry   statute,  however,  was  too                                                               
complicated and  restrictive.   Proposed HB  103 would  allow the                                                               
State Board of  Examiners in Optometry to have  the same autonomy                                                               
as the other  boards.  She assured the committee  that, as a past                                                               
president of the state optometry  board, the board acted with the                                                               
same level  of professionalism and  safety as  the aforementioned                                                               
boards.  She reiterated that the  proposed bill was not about eye                                                               
surgery,  even though  doctors of  optometry had  performed minor                                                               
eye  surgery for  many years.   They  were trained  in depth  for                                                               
these  procedures,  which  were   routine  within  the  scope  of                                                               
practice.   She declared that  she would  no more perform  an eye                                                               
surgery that she  was not trained for than  any other profession.                                                               
She   offered  her   belief  that   all  professions,   including                                                               
optometry,  must evolve  and there  was  no way  to predict  what                                                               
tools and  options a doctor of  optometry would need in  20 years                                                               
to protect or cure the vision of  a patient.  She stated that the                                                               
proposed  bill allowed  the  profession to  evolve  and make  the                                                               
necessary  changes.   HB  103  allowed  doctors of  optometry  in                                                               
Alaska to  operate with the  same autonomy,  respect, efficiency,                                                               
and   oversight   as   the   other   professional   health   care                                                               
practitioners were granted.                                                                                                     
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked about the  minor surgeries                                                               
performed by optometrists.                                                                                                      
                                                                                                                                
DR.  MATHESON explained  that  the most  common  surgery was  for                                                               
removal of a  foreign body, and that these had  been approved and                                                               
authorized for almost 25 years.                                                                                                 
                                                                                                                                
REPRESENTATIVE TARR offered her  belief that practitioners should                                                               
be authorized  to practice to  their full scope and  be regulated                                                               
by peer professionals.   She stated her support  for the proposed                                                               
bill.   She said that  regulations would be drafted,  which would                                                               
be followed by  a public comment period  when professionals could                                                               
speak out,  and if there  was anything questionable,  the process                                                               
would reveal any problems.                                                                                                      
                                                                                                                                
DR. MATHESON  expressed her agreement that  any complaint brought                                                               
to the board would be investigated,  and there could be a vote to                                                               
see if  there should be a  sanction on an optometrist.   She said                                                               
that the  legal process would also  be started.  She  stated that                                                               
there had not been any  sanctions against optometrists during her                                                               
8 years on the board.                                                                                                           
                                                                                                                                
REPRESENTATIVE TARR  asked if the regulations  were available for                                                               
public comment.                                                                                                                 
                                                                                                                                
DR. MATHESON  expressed her agreement,  and explained  that after                                                               
the  regulations were  set, they  went  to Department  of Law  to                                                               
ensure they  met the law, went  out for public comment,  and were                                                               
again voted on by the board.                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN  stated  that the  investigation  process                                                               
could be very  costly, even if they did not  result in sanctions.                                                               
He asked if  there was any hesitation due to  the potential of an                                                               
increase to liability cost.                                                                                                     
                                                                                                                                
DR. MATHESON  replied that  she was not  aware of  any opposition                                                               
from optometrists  for that reason,  and she explained  that this                                                               
could lead  to an  increase in  licensing fees  at a  later time.                                                               
She offered her  belief that optometrists and the  board were all                                                               
"a pretty conservative bunch."                                                                                                  
                                                                                                                                
CHAIR SPOHNHOLZ  pointed out that  Dr. Matheson was  a practicing                                                               
optometrist and  not necessarily an  expert on the  operations of                                                               
the board.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  why  the optometry  board was  not                                                               
currently treated like the other boards.                                                                                        
                                                                                                                                
DR. MATHESON offered her belief that  this had just been a matter                                                               
of time, and, as other parts  of the statute had been cleaned up,                                                               
this was now the final stage.                                                                                                   
                                                                                                                                
4:04:01 PM                                                                                                                    
                                                                                                                                
HARRIET MILKS,  Assistant Attorney  General, Commercial  and Fair                                                               
Business  Section, Civil  Division (Juneau),  Department of  Law,                                                               
said that she represented professional licensing boards.                                                                        
                                                                                                                                
REPRESENTATIVE TARR asked about the process.                                                                                    
                                                                                                                                
MS. MILKS,  in response,  said that  the board  typically drafted                                                               
the proposed regulation, and it  often took time to determine the                                                               
language which represented  the inclination of the  board.  Then,                                                               
the proposed  regulation went out  for public comment.   It could                                                               
go out  more than once  for public comment  and for more  than 30                                                               
days.  She  noted that, based on public comment,  the board could                                                               
revisit the  regulation, and if  there were  substantial changes,                                                               
it would again go out for  public comment.  She acknowledged that                                                               
the transparency  of this process  could sometimes  frustrate the                                                               
public for  the amount of  time necessary to adopt  a regulation.                                                               
She added that the board did  discuss the scope of practice.  She                                                               
said that typically  the health care related boards  met at least                                                               
two or  three times  each year,  and that  the public  was always                                                               
advised.                                                                                                                        
                                                                                                                                
4:08:09 PM                                                                                                                    
                                                                                                                                
RACHEL   REINHARDT,  MD,   American  Academy   of  Ophthalmology,                                                               
reported  that she  was a  board-certified ophthalmologist.   She                                                               
stated her  opposition to  proposed HB  103.   She said  that the                                                               
primary goal  of any legislation  involving medical care  was for                                                               
patient  safety.   She stated  that HB  103 removed  the existing                                                               
surgery restrictions,  and would redefine  the field.   She asked                                                               
that it be clearly specified in  the law that surgery was outside                                                               
the  scope of  practice for  optometry.   She  said that  without                                                               
specific language to restrict surgery,  Alaska would be the first                                                               
state  to  adopt  such  broad  unprecedented  legislation.    She                                                               
suggested  that  the  definition  of  surgery  be  added  to  the                                                               
proposed bill,  and that  surgery be  expressly prohibited.   She                                                               
noted  that the  Board of  Optometry could  still govern  its own                                                               
profession, even though  surgery was prohibited.   She offered an                                                               
example of the lack of restrictions  under the Oklahoma law.  She                                                               
said that  a major  study released  in July  2016 had  data which                                                               
concluded that optometrists doing  laser surgery in Oklahoma were                                                               
causing  patient harm  and  increasing health  care  costs.   She                                                               
stated  that  the proposed  bill  would  result in  unprecedented                                                               
sweeping  change  in the  practice  of  optometry, with  profound                                                               
implications  for patient  safety.   She said  that, at  the very                                                               
least the proposed bill needed  a definition of surgery to ensure                                                               
public safety.   She made  the distinction that  optometry school                                                               
was  not a  medical education  or  a surgical  education, as  the                                                               
students received approximately one  tenth of the clinical hours.                                                               
She  concluded by  stating that  prescription narcotic  death was                                                               
the leading  cause of unintended  death in the country,  and that                                                               
HB  103 would  allow optometrists  to prescribe  these narcotics.                                                               
She  declared that  this was  not the  time to  expand who  could                                                               
prescribe these medications.                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  said that  there  was  a challenge  from  a                                                               
shortage of  providers in  every area of  health care  in Alaska.                                                               
She suggested that  the proposed bill offered  an opportunity for                                                               
trained professionals  to meet  this need for  health care.   She                                                               
relayed that the optometrists wanted  to continue with the things                                                               
they had already done for the past decade.                                                                                      
                                                                                                                                
DR. REINHARDT relayed that there  were 26 ophthalmologists in the                                                               
State of  Alaska and that the  State of Washington had  a similar                                                               
ratio of  ophthalmologists to the  population.   She acknowledged                                                               
that the Alaska  population was spread over  remote areas, though                                                               
she stated  that the State  of Washington had patients  in remote                                                               
areas, as  well.   She said  that it was  important to  note that                                                               
ophthalmologists had  a responsibility for  patient safety.   She                                                               
suggested  that  there was  a  nationwide  trend of  optometrists                                                               
introducing  vague  bills with  the  intention  of expanding  the                                                               
scope to include surgery.                                                                                                       
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  about the  committee  substitute                                                               
which had removed the reference to surgery.                                                                                     
                                                                                                                                
DR.  REINHARDT explained  that the  committee substitute  did not                                                               
change  Sections  5 and  6,  which  offered new  definitions  for                                                               
optometry, which  inserted language for treatment  or performance                                                               
of  preventive procedures.    She stated  that  the inclusion  of                                                               
treatment opened  the door  for any  treatment modality  to treat                                                               
any and  all eye diseases, and  it included surgery.   She deemed                                                               
that  the crux  of  the  issue was  that  the  new definition  of                                                               
optometry could be interpreted to include all surgeries.                                                                        
                                                                                                                                
4:17:41 PM                                                                                                                    
                                                                                                                                
VICTORIA BLOWER,  OD, Optometrist,  shared that  she had  been in                                                               
optometric practice  in Anchorage for  32 years.  She  stated her                                                               
support  for HB  103.    She reported  that  technology and  best                                                               
practices had advanced to allow  for superior medical care, which                                                               
included eye  care.  She  pointed out that the  statute governing                                                               
the optometry board was more than  40 years old and did not allow                                                               
for  reaction   to  the  rapidly  changing   environment  without                                                               
repeatedly  going to  the Alaska  State  Legislature for  action.                                                               
She noted  that the  protocols had been  extended to  protect the                                                               
public.  She shared her respect  for the Board of Optometry.  She                                                               
said  it  was  unfair  and   a  waste  of  resources  to  prevent                                                               
optometrists from  providing care at  the highest level  of their                                                               
education and training,  as this did include  knowledge about the                                                               
entire body.   She  pointed out  that, as so  much of  Alaska was                                                               
rural, most  of the eye  care was  administered by the  more than                                                               
150  optometrists  serving  in  80  communities.    She  directed                                                               
attention  to   a  letter  of   support  from  the  CEO   of  the                                                               
Southcentral  Foundation.   She  expressed her  objection to  the                                                               
argument that  optometrists could  not be  trusted to  have sound                                                               
judgement about their skills and  training, thereby not acting in                                                               
the public's  best interest.   She  offered examples  about other                                                               
medical professions working within  their education and training.                                                               
She  stated that  HB 103  would modernize  the statute  and allow                                                               
detailed legislation to be determined  by the optometry board, as                                                               
was the current standard in  all other prescribing professions in                                                               
Alaska.    It would  also  streamline  the legislative  governing                                                               
process  and bring  the best  practices to  the residents  of the                                                               
state in a cost-effective manner.                                                                                               
                                                                                                                                
4:21:43 PM                                                                                                                    
                                                                                                                                
KARL ROSEN, MD, Ophthalmologist, voiced  his strong opposition to                                                               
the proposed bill.  He reported  that he had been in practice for                                                               
23 years  in Anchorage.   He  shared his  educational background.                                                               
He declared that  the proposed bill was the  most expansive scope                                                               
of  practice  bill  in  the  country.   He  said  that  the  bill                                                               
dismissed  the  rigorous  training  of an  ophthalmologist.    He                                                               
offered  his belief  that the  optometry board,  a group  of non-                                                               
surgeons,   was  going   to  decide   which  potential   surgical                                                               
privileges  would  be  allowed.   He  suggested  to  correct  the                                                               
proposed  bill by  providing an  amendment with  a definition  of                                                               
surgery.   He declared that  the optometry board already  had the                                                               
ability to regulate  its profession.  He shared  an article which                                                               
refuted  the statement  that more  optometrists doing  procedures                                                               
would  cut costs,  and he  directed  attention to  a study  which                                                               
determined  that more  than twice  the  number of  eyes were  re-                                                               
treated    after   laser    surgery   by    optometrists   versus                                                               
ophthalmologists.  He stated that  health policy makers should be                                                               
cautious about  approving laser privileges for  optometrists.  He                                                               
pointed out  that optometrists  did not  take hospital  calls and                                                               
did  not   have  hospital  privileges,  and   if  a  complication                                                               
occurred,  there would  be the  need  to transfer  patients to  a                                                               
hospital.   He declared  "you can't  get good  doing a  couple of                                                               
procedures a  year."  He  said that insurance carriers  would not                                                               
accept CPT codes  by optometrists.  He declared  that, should all                                                               
privileges be  made similar, then  there needed to be  an equally                                                               
strong legislative effort  to ensure that all  aspects of school,                                                               
training,  and  continued competency  were  also  similar, or  it                                                               
would become a two-tiered system  for patients.  He declared that                                                               
the  proposed  bill  would  make  it  difficult  to  recruit  new                                                               
ophthalmologists to Alaska.                                                                                                     
                                                                                                                                
REPRESENTATIVE KITO asked  how much of his  educational study and                                                               
experience provided  for vision and eye,  or was most of  it just                                                               
medical.                                                                                                                        
                                                                                                                                
DR. ROSEN explained his education  and background, which included                                                               
three years  of ophthalmology  residency of  more than  110 hours                                                               
each week.  He stated that it was  not a job, it was a lifestyle,                                                               
a culture.   He shared  that studying  at a major  medical center                                                               
included  interaction with  the  other colleges  and allowed  for                                                               
better communication with the other areas of medicine.                                                                          
                                                                                                                                
REPRESENTATIVE  TARR  said  that   she  shared  the  concern  for                                                               
surgeries by properly  trained individuals.   She  mused that, if                                                               
the  Board of  Optometry wanted  to propose  regulations allowing                                                               
performance of  Lasik surgery, those regulations  would be opened                                                               
for a public  comment period.  She offered her  belief that those                                                               
with views  similar to Dr.  Rosen would speak out  in opposition.                                                               
She said  that she did not  see the circumstance to  which he was                                                               
worried actually happening, as it  would not make its way through                                                               
the public process.                                                                                                             
                                                                                                                                
DR. ROSEN  replied that this  was an ideological question  and he                                                               
asked if optometry  was being redefined.  He said  that there had                                                               
been a change in the past  10 years, and that optometry wanted to                                                               
be something else.   He stated that there had  been a process for                                                               
standardization in the American Medical System since 1910.                                                                      
                                                                                                                                
REPRESENTATIVE  TARR   reiterated  that  she  could   not  see  a                                                               
circumstance where this would happen.                                                                                           
                                                                                                                                
DR. ROSEN  said most providers  followed their oath,  although he                                                               
was there to  protect the public from the outliers.   He reminded                                                               
that there was method in place for licensing.                                                                                   
                                                                                                                                
4:33:23 PM                                                                                                                    
                                                                                                                                
ALFRED   DERAMUS,   MD,   Ophthalmologist,  stated   his   gentle                                                               
opposition  to the  proposed bill.   He  said that  this was  the                                                               
latest legislation  on which he  had been testifying  since 1982.                                                               
He said  that the ophthalmologist  purview for the  definition of                                                               
surgery  was   different  than  the  definition   of  surgery  by                                                               
optometry.    His problem was that the  proposed legislation left                                                               
an opening for interpretation that  treatment for all eye disease                                                               
could  include surgery.   He  declared that  "we should  be very,                                                               
very   careful   about   this  bill."      He   emphasized   that                                                               
ophthalmologists were  concerned that optometrists  would perform                                                               
ophthalmic surgeries and be protected by the definition.                                                                        
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked what  type  of  surgery would  be                                                               
performed by optometrists.                                                                                                      
                                                                                                                                
DR. DERAMUS  replied that the  definition was open ended,  and he                                                               
offered an example for the  removal of a superficial foreign body                                                               
versus a deeply imbedded foreign body in the cornea.                                                                            
                                                                                                                                
CHAIR SPOHNHOLZ  referenced the  earlier testimony  regarding the                                                               
regulatory process  for changing regulations around  the practice                                                               
of optometry and  asked if he was concerned that  there would not                                                               
be the  opportunity to testify and  for those concerns to  be put                                                               
on the record.                                                                                                                  
                                                                                                                                
DR. DERAMUS expressed  his agreement that he would  be allowed to                                                               
testify, and, in  response to Chair Spohnholz, that  he was aware                                                               
that the meetings of the Board  of Optometry were all public.  He                                                               
replied  that he  had only  testified on  one occasion  regarding                                                               
various optometric bills,  and that he had  found that, regarding                                                               
the experience,  he had been  able to  present his point  of view                                                               
and have it  weighed by the board.  In  further response to Chair                                                               
Spohnholz, he said  that he had always  been treated respectfully                                                               
by the board.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  TARR  reiterated  that  she  could  not  see  the                                                               
circumstance  whereby optometrists  were given  the authority  to                                                               
perform procedures that offered  concern to ophthalmologist.  She                                                               
stated  that there  were "bad  actors  that are  in the  provider                                                               
community whether  it be for  dental care or physical  therapy or                                                               
other areas."                                                                                                                   
                                                                                                                                
DR. DERAMUS  said that the  reality of  life goes far  beyond the                                                               
written or  spoken word.   He  said that  the pain  of experience                                                               
from a surprise was "where you  really find out where you stand."                                                               
He offered an example for a seemingly minor accident.                                                                           
                                                                                                                                
CHAIR SPOHNHOLZ  asked if he  was suggesting that  an optometrist                                                               
might try to treat this incident in an emergency room.                                                                          
                                                                                                                                
DR. DERAMUS replied  that he did not believe  that an optometrist                                                               
would  be  in  the  operating  room because  they  did  not  have                                                               
admitting privileges.                                                                                                           
                                                                                                                                
4:45:43 PM                                                                                                                    
                                                                                                                                
DAVID  ZUMBRO, MD,  Ophthalmologist, shared  his background  as a                                                               
retina surgeon.   He  offered his belief  that the  proposed bill                                                               
"radically  redefines optometry"  as optometry  did not  have any                                                               
procedural background  in its  training or  practice.   He stated                                                               
that the proposed bill removed  the prohibition against lasers in                                                               
surgery.    He  declared  that there  was  a  difference  between                                                               
optometry and ophthalmology.   He offered an example  of some co-                                                               
workers who  were optometrists  and had gone  back to  school for                                                               
ophthalmology.  He stated that they  were not given any credit by                                                               
the  medical school  for their  doctor of  optometry degree.   He                                                               
offered his belief that the  regulations had changed in 2008 when                                                               
prescriptive  authority  advanced  the  scope  of  the  optometry                                                               
practice.  The proposed bill was  too vague and open ended, as it                                                               
removed the  specific prohibition  against lasers in  surgery and                                                               
allowed non-physicians to  regulate the practice of  surgery.  He                                                               
declared  that the  focus  of  any health  care  issue should  be                                                               
patient safety.                                                                                                                 
                                                                                                                                
CHAIR SPOHNHOLZ asked where the  legislation changed the scope of                                                               
practice.                                                                                                                       
                                                                                                                                
DR. ZUMBRO explained that the  removal of the prohibition against                                                               
lasers  in surgery  and the  allowance for  the treatment  of eye                                                               
conditions  were worrisome,  as  it would  allow optometrists  to                                                               
expand the scope of practice.                                                                                                   
                                                                                                                                
CHAIR SPOHNHOLZ stated that the  proposed bill did not remove any                                                               
limitations, but only  added language for the  opportunity to use                                                               
pharmaceutical  agents  for  the  treatment of  eye  disease  and                                                               
develop uniform  standards for  the practice  of optometry.   She                                                               
said  that  it  rescinded  the   limitations  on  the  amount  of                                                               
education, as  the continuing education requirements  had already                                                               
been expanded.                                                                                                                  
                                                                                                                                
DR.  ZUMBRO  suggested that  an  amendment  defining eye  surgery                                                               
would offer clarity for all the parties.                                                                                        
                                                                                                                                
4:50:30 PM                                                                                                                    
                                                                                                                                
PAUL  BARNEY,  OD,  Chair,  Board  of  Optometry,  reassured  the                                                               
committee  that the  board did  not have  the authority  to write                                                               
regulations  for  anything that  optometrists  did  not have  the                                                               
education  to do,  and  that  the purpose  of  the  board was  to                                                               
protect the public.  In  response to Representative Tarr, he said                                                               
that he supported the bill.                                                                                                     
                                                                                                                                
4:52:17 PM                                                                                                                    
                                                                                                                                
ELIZABETH  MORGAN,   MD,  Ophthalmologist,  said  that   she  had                                                               
practiced in Anchorage  for almost 14 years, and  that she worked                                                               
closely with  optometrists, especially  in working  with glaucoma                                                               
patients.    She lauded  the  relationship  and stated  that  the                                                               
proposed  bill   created  a  divisive   force  between   the  two                                                               
practices.   She  said  that ophthalmologists  took  eye care  of                                                               
individuals very  seriously and  they were  adamant if  there was                                                               
something  that  threatened the  patient's  best  interest.   She                                                               
offered her  belief that the problem  with the bill was  that the                                                               
language was  "a bit  open ended."   She  suggested that  the two                                                               
groups of providers  arrive at a common  definition for treatment                                                               
that was in the best interest of the patient.                                                                                   
                                                                                                                                
REPRESENTATIVE JOHNSTON asked for that definition for treatment.                                                                
                                                                                                                                
DR. MORGAN offered her belief that  both sides needed to agree on                                                               
the definition of surgery.                                                                                                      
                                                                                                                                
4:56:01 PM                                                                                                                    
                                                                                                                                
DAVID  KARPIK, OD,  stated that  he  was an  optometrist and  his                                                               
group provided the  majority of eye care on  the Kenai Peninsula.                                                               
He reported that  he was also the medical  director [indisc], and                                                               
that  these  practices  offered similar  comprehensive  eye  care                                                               
services  and  worked  in conjunction  with  other  primary  care                                                               
providers.   He declared that  this model was cost  effective and                                                               
in  the patient's  best interest.   He  stated that  optometrists                                                               
practiced in small  communities throughout Alaska and  had a long                                                               
history  of compassionate  conservative  care.   He referenced  a                                                               
recent study  which reported  that Alaska was  last in  access to                                                               
health  care, and  that this  was an  opportunity to  help change                                                               
that alarming statistic.  He  said that all health care providers                                                               
practiced  to the  extent of  their ever-evolving  training.   He                                                               
declared that  optometrists have had full  prescribing privileges                                                               
for 10 years.   He pointed out that optometrists  had been safely                                                               
performing procedures for decades,  noting that they had training                                                               
on the entire body.  He  said that some schools duplicate medical                                                               
and dental courses for the first few years of the program.                                                                      
                                                                                                                                
4:59:26 PM                                                                                                                    
                                                                                                                                
ERIC COULTER,  MD, Ophthalmologist,  referenced a letter  that he                                                               
had  sent  to  the  committee,   and  shared  that  he  had  good                                                               
relationships with optometrists.   He stated that privileges were                                                               
delineated  through  hospitals  and   surgery  centers  and  were                                                               
outlined by  law.  He  expressed his concern that  the optometric                                                               
community  would  not let  the  public  know the  differences  in                                                               
medical training.   He declared  that the proposed bill  needed a                                                               
definition of surgery.                                                                                                          
                                                                                                                                
5:02:17 PM                                                                                                                    
                                                                                                                                
ERIK CHRISTIANSON,  OD, Optometrist,  said that  he was  the only                                                               
full-time eye care provider in  the community.  He suggested that                                                               
the  proposed   bill  was  modernizing  language   to  allow  the                                                               
profession to move  forward and regulate similar  to other health                                                               
care  providers.    He  said  that   the  goal  was  to  work  as                                                               
effectively as possible, and that  there were a variety of little                                                               
procedures  that could  be  done often  enough to  be  good.   He                                                               
expressed his concern for the  rural communities to get qualified                                                               
health  care providers,  and,  unless there  was  the ability  to                                                               
practice  to the  level of  training,  it would  be difficult  to                                                               
attract them.                                                                                                                   
                                                                                                                                
5:04:28 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
5:04:51 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ stated  that the proposed bill  was introduced to                                                               
modernize the way optometry was managed  in Alaska, as it was the                                                               
only health  profession in  the state where  it was  necessary to                                                               
visit in statute every time a  small change was made to education                                                               
or scope of  practice.  She pointed out that  things changed more                                                               
rapidly than the legislature could  move.  She offered her belief                                                               
that there were  enough tools in the regulatory  process to allow                                                               
for robust  public participation  and opportunities  for concerns                                                               
to be expressed  and to ensure that the Board  of Optometry would                                                               
not "go rogue."   She added that the proposed  bill would get the                                                               
legislature out  of the  business of  micromanaging optometrists.                                                               
She shared  a personal  story of  an eye  surgery performed  by a                                                               
local optometrist.   She offered her  belief that it was  best to                                                               
not define  "surgery" in statute  as it  was a complex  and broad                                                               
term.   She  shared that  it was  very difficult  to arrive  at a                                                               
definition  of  "surgery"  which  met  all  the  criteria.    She                                                               
suggested that  it was best  to let the regulatory  process work.                                                               
She  said  that  best  management   practices  were  to  delegate                                                               
authority  to   the  lowest  possible  level,   and  allow  those                                                               
professionals the opportunity to perform  their work.  She lauded                                                               
the  "robust regulatory  process as  it related  to the  way that                                                               
board regulations were adopted."                                                                                                
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked  how the  board for  chiropractors                                                               
regulated in Alaska.                                                                                                            
                                                                                                                                
MS. MILKS, in response, explained  that the Board of Chiropractic                                                               
Examiners  was  managed  with  the same  legal  advice  from  the                                                               
Department  of Law  as  the other  boards.   She  stated that  an                                                               
Assistant Attorney General  was assigned to advise  in both board                                                               
procedure   and   procedure   for   constructing   and   adopting                                                               
regulations, and  that sometimes  the Assistant  Attorney General                                                               
would attend the board meetings.                                                                                                
                                                                                                                                
REPRESENTATIVE JOHNSTON asked if there  was a similar process for                                                               
change  which required  bringing proposed  changes to  the Alaska                                                               
State Legislature.                                                                                                              
                                                                                                                                
MS.  MILKS   replied  that   all  the   boards  were   under  the                                                               
Administrative Procedure Act  (APA).  She explained  that the APA                                                               
set  out  the  procedures  for adopting  regulations  and  having                                                               
hearings,  and  that  all  the  boards were  under  the  APA  and                                                               
followed the same rules with respect to adoption of regulations.                                                                
                                                                                                                                
REPRESENTATIVE  EASTMAN shared  that the  board of  chiropractors                                                               
were  very proud  of  their  process, as  they  had pursued  some                                                               
unique approaches  to their  profession.   He expressed  his hope                                                               
that the Board of Optometry would  review this example.  He asked                                                               
whether an expanded scope for  optometrists would result in fewer                                                               
ophthalmologists.                                                                                                               
                                                                                                                                
CHAIR SPOHNHOLZ  emphasized that she  did not, as the  sponsor of                                                               
the  proposed bill,  introduce  the bill  because  of the  unique                                                               
nature of  the state.   She said  that this was  a response  to a                                                               
comparison of the  State of Alaska to the State  of Washington by                                                               
an  earlier testifier.    She  declared that  the  intent of  the                                                               
proposed  bill was  not  to  expand the  scope  of  the Board  of                                                               
Optometry,  but instead  to  delegate  discussions regarding  the                                                               
practice  of optometry  to the  Board of  Optometry, rather  than                                                               
having it done in statute on an annual basis.                                                                                   
                                                                                                                                
REPRESENTATIVE  TARR said  that she  would have  concerns if  the                                                               
regulations  allowed for  optometrists  to  perform eye  surgery.                                                               
She offered her  understanding that this was beyond  the scope of                                                               
practice,  and she  could not  see a  circumstance in  which this                                                               
would be the result.  She  declared that there were many barriers                                                               
to expansion  of specialties.   She opined that with  the limited                                                               
number of providers  it was necessary to take  the opportunity to                                                               
allow practice  to the full  scope of  training.  She  added that                                                               
the health care  fields were always evolving, and  she stated her                                                               
support of HB 103.                                                                                                              
                                                                                                                                
5:15:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  moved  to  report  CSHB  103,  Version  30-                                                               
LS0459\D,  Bruce,  2/21/17,  out  of  committee  with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB 103 (HSS) was  moved from the House Health and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
5:17:04 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:17 p.m.                                                                                                          

Document Name Date/Time Subjects
HB0159 ver A 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB159 Sponsor Statement 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB 159 Sectional Analysis ver A 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB159 Fiscal Note DHSS-PHAS 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
SB 91 ver A.pdf HHSS 3/18/2017 3:00:00 PM
SB 91
SB091 Sponsor Statement 3.16.17.pdf HHSS 3/18/2017 3:00:00 PM
SB 91
SB091 ver J 3.16.17.pdf HHSS 3/18/2017 3:00:00 PM
SB 91
SB091 Sectional Analysis ver J 3.16.17.pdf HHSS 3/18/2017 3:00:00 PM
SB 91
SB091 Additional Documents-Explanation of Changes, ver J 3.17.17.pdf HHSS 3/18/2017 3:00:00 PM
SB 91
SB091 Fiscal Note DHSS-PHAS ver J 3.16.17.pdf HHSS 3/18/2017 3:00:00 PM
SB 91
SB 36 Opposition Letter Coulter MD vs. SB36 HB103.pdf HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
SFIN 3/14/2017 9:00:00 AM
HB 103
SB 36
HB 103 Draft Proposed Blank CS ver D 3.13.2017.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Explanation of Changes (CS) 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Letters of Support 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Fiscal Note DCCED--DCBPL 3.13.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Sectional Analysis (CS) 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Sponsor Statement 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Supporting Document Ohio State Optometry Curriculum 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Supporting Document Medical Liability Premiums Fact Sheet 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Supporting Document Regulation Flow Chart 3-10-17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Supporting Document-Board of the Examiners in Optometry.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Supporting Document-Optometrists Practicing in AK 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Supporting Documents Optometry Education Flyer 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB103 Career Guide Optometry 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB103 Letters of Opposition-Support.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Opposing Document--Letters 3.15.17.pdf HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103