Legislature(2017 - 2018)SENATE FINANCE 532
03/14/2017 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB80 | |
| SB36 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 80 | TELECONFERENCED | |
| + | SB 36 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
March 14, 2017
9:03 a.m.
9:03:43 AM
CALL TO ORDER
Co-Chair MacKinnon called the Senate Finance Committee
meeting to order at 9:03 a.m.
MEMBERS PRESENT
Senator Lyman Hoffman, Co-Chair
Senator Anna MacKinnon, Co-Chair
Senator Mike Dunleavy
Senator Peter Micciche
Senator Donny Olson
Senator Natasha von Imhof
MEMBERS ABSENT
Senator Click Bishop, Vice-Chair
ALSO PRESENT
Juli Lucky, Staff, Representative Anna MacKinnon; Rob Earl,
Staff, Representative Adam Wool; Senator Cathy Giessel,
Sponsor; Jane Conway, Staff, Senator Cathy Giessel; Doctor
Paul Barney, Chair, Board of Optometry; Doctor Jeff
Gonnason, President, Alaska Optometric Association; Harriet
Milks, Assistant Attorney General, Department of Law; Janey
Hovenden, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community
and Economic Development.
PRESENT VIA TELECONFERENCE
Doctor David Zumbro, Ophthalmologist, Anchorage; Doctor
Rachel Reinhardt, Member, American Academy of
Ophthalmology, Seattle.
SUMMARY
SB 36 OPTOMETRY & OPTOMETRISTS
SB 36 was HEARD and HELD in committee for further
consideration.
CSHB 80(ENE)
MUNI ENERGY IMPROVEMNT:ASSESSMNTS/BONDS
SCS CSHB 36(FIN) was REPORTED out of committee
with no recommendation and with one previously
published zero fiscal note: FN1 (CED).
9:04:12 AM
Co-Chair Hoffman announced that the Unalaska crab feed
would be at 5:30pm at the Baranof Hotel.
9:04:28 AM
AT EASE
9:04:52 AM
RECONVENED
CS FOR HOUSE BILL NO. 80(ENE)
"An Act adopting the Municipal Property Assessed Clean
Energy Act; authorizing municipalities to establish
programs to impose assessments for energy improvements
in regions designated by municipalities; imposing
fees; and providing for an effective date."
9:05:40 AM
Co-Chair Hoffman MOVED to ADOPT the committee substitute
for CSHB 80 (ENE), Work Draft 30-LS0337\N (Shutts,
3/13/17).
Co-Chair MacKinnon OBJECTED for discussion.
9:06:04 AM
JULI LUCKY, STAFF, REPRESENTATIVE ANNA MACKINNON, discussed
the "Explanation of Changes" (copy on file):
Page 6, lines 4-7: Amends §29.55.105(d)(3) to only
prohibit utilities from using C-PACE if the
electricity or energy is used outside of the assessed
property.
Page 6, lines 20-21: Amends §29.55.105 (h) to limit
the amount of assessment to 50% of the assessed value
of the property at time of application.
Page 8, lines 16-18: Amends §29.55.110 (a) (14) to
require the municipality, as part of the quality
assurance and antifraud measures in the ordinance, to
specify the consequence of not completing the project
as proposed.
Page 8, lines 19-21: Adds a new section - §29.55.110
(a) (15) which requires the improvements financed
through C-PACE to be insured for the life of the
assessment.
9:10:10 AM
ROB EARL, STAFF, REPRESENTATIVE ADAM WOOL, testified that
the bill sponsor was in support of the committee substitute
version N.
Co-Chair MacKinnon REMOVED her OBJECTION. There being NO
further OBJECTION, the proposed committee substitute was
adopted.
9:10:40 AM
Senator von Imhof Spoke to Page 6, and the new upper limit
of 50 percent of the assessed value at the time of the
application. She queried whether the change would be
prohibitive of the program.
Mr. Earl replied that the sponsor did not predict that
there would be any problem due to the change.
9:11:55 AM
Co-Chair Hoffman MOVED to REPORT SCS CSHB 80 (FIN) from
committee with individual recommendations and accompanying
fiscal note. There being NO OBJECTION, it was so ordered.
SCS CSHB 36(FIN) was REPORTED out of committee with no
recommendation and with one previously published zero
fiscal note: FN1 (CED).
9:12:24 AM
AT EASE
9:15:39 AM
RECONVENED
SENATE BILL NO. 36
"An Act relating to the practice of optometry."
9:15:55 AM
Co-Chair Hoffman MOVED to ADOPT the committee substitute
for SB 36, Work Draft 30-LS0328\J (Bruce, 2/13/17).
Co-Chair MacKinnon OBJECTED for discussion.
9:16:25 AM
SENATOR CATHY GIESSEL, SPONSOR, discussed the committee
substitute and the root version of the bill. She stated
that the regulations pertaining to medicine, dentistry, and
nursing were regularly updated to comply with new
technology and education. She noted that the bill had been
offered multiple times in the past. She read from the
sponsor statement:
Senate Bill 36 modernizes and updates the Alaska
Optometry Statute, as many sections are over 50 years
old. It authorizes the optometry board to regulate its
practice as do the other prescribing health
professions such as dentistry, medicine and nursing.
Under SB 36 the board will continue to adopt
regulations, updating them to current education,
certification and practice.
Continuing education, required by current statute,
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
Dept. of Commerce, Community and Economic Development.
The current regulations require more CE hours than the
statute subsection deleted by this bill.
SB 36 authorizes the optometry board to continue to
regulate prescription pharmaceutical agents, including
standards and limitations on practice determined by
the board.
SB 36 ensures that the optometry board, with the
oversight of the Department of Law, may not authorize
any procedure beyond the scope of the licensee's
education, training, and experience.
The optometry definition in this bill is updated to
reflect current education, certification and modern-
day practice. This allows for future new and improved
diagnostic and therapeutic procedures, while not
having to return to the legislature for every new
technological advance.
Senator Giessel reported that the bill had been offered
several times in the past and had faced significant
opposition. She stressed that the malpractice insurance for
optometrists was low.
9:21:16 AM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, provided an
explanation of changes (copy on file):
The language in the committee substitute gives the
Board of Optometry authority to regulate its practice,
reflecting the same regulatory authority given to the
other prescribing practices such as medicine, nursing
and dentistry.
In this new version J we have removed the reference to
ophthalmic surgery from the bill (version A, page 1,
lines 12-13, and also on page 2, lines 21-23).
It is unnecessary for this language to be placed in
statute; optometric procedures, within optometry's
scope of practice, can be regulated by the board, all
requiring robust public comment from stakeholders and
rigorous Department of Law oversight.
This is the current process for the Medical Board. The
Board of Nursing. The Board of Dentistry. And so
should it be for the Board of Optometry. The new CS
reflects that intent in version J.
9:22:49 AM
Co-Chair MacKinnon REMOVED her OBJECTION. There being NO
further OBJECTION, the proposed committee substitute was
adopted.
9:23:04 AM
Ms. Conway discussed the Sectional Analysis (copy on file):
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)
9:25:18 AM
Co-Chair MacKinnon queried any additional comments.
Senator Giessel replied in the negative.
9:25:33 AM
Senator Olson wondered how many other states had similar
legislation to SB 36.
Senator Giessel corrected the assumption that the bill
would expand the scope of practice for optometrists. She
deferred the question to the current chair of the Alaska
State Board of Optometry.
9:26:18 AM
Senator Olson clarified that the bill would allow
optometrists the authority to prescribe additional
medications, as well as perform additional procedures.
Senator Giessel replied that optometrists had the authority
to write prescriptions for a "very long time." She said
that the bill offered no expansion of the procedures that
optometrists could perform.
9:27:34 AM
Senator Olson wondered how many other states had visited
the issue of the limitations of optometry practices.
Senator Giessel deferred the question to the board.
9:28:30 AM
DOCTOR PAUL BARNEY, CHAIR, BOARD OF OPTOMETRY, spoke in
support of the legislation. He read from a prepared
statement (copy on file).:
My name is Paul Barney, I am an optometrist and the
current chair of the Alaska Board of Examiners in
Optometry. I am also a past president of the Alaska
Optometric Association. I'm here today in support SB
36.
I have practiced in Anchorage for 17 years where I am
the Center Director of Pacific Cataract and Laser
Institute in Anchorage. Pacific Cataract and Laser
Institute (also known as PCLI) is a referral center
limited to medical and surgical eye care. I practice
with an Ophthalmic Surgeon and a Certified Registered
Nurse Anesthetist. PCLI's approach to eye care is to
work collaboratively as a team and optimize each
practitioner's education and skills. Together we are
able to provide quality, affordable, surgical eye care
to Alaskans. We in fact are the largest provider of
cataract care in the state of Alaska.
I support SB 36 because it will allow the Board of
Optometry to regulate the details of the practice of
Optometry. This is already the case with Advanced
Practice Nurses, Dentists, and Medical Doctors. This
legislation will not set a new precedence in health
care, since this is already the way other health care
providers are regulated in the state of Alaska.
SB 36 will give Optometrists a better opportunity to
practice to the highest level of their education by
allowing the Board of Optometry to write regulations
that are commensurate with educational advances that
occur with new technology and medications. The current
Optometry statute was written over 40 years ago and
requires Optometry to pursue a statute change whenever
there are advances in education and technology. As you
know, statute changes are costly and time consuming.
Like all other professional regulatory boards, the
Board of Optometry cannot promulgate regulations for
practices or procedures that are beyond the education
of Optometrists. The Board of Optometry is overseen by
the AK Department of Law, just like other health care
boards. And the AK Department of Law would ensure that
the Board of Optometry's regulations were within the
scope of Optometric education.
Other safeguards are our medical legal system and
insurance system. Any healthcare provider who provides
care outside of their education is subject to
disciplinary action by their respective board, as well
as serious medical legal ramifications. Additionally,
insurance carriers do not pay providers for care they
provide outside of their scope of education. With that
said, there is no incentive for any healthcare
provider to provide care outside of their education,
and, there are very serious consequences, both
financially and to their licensure, to practitioners
who do provide care outside of their education.
As chair of the Alaska Board of Optometry, I can
assure you that the primary concern of the Board is
the safety of the public. In the six years that I have
served on the Board we have had no complaints from the
public that were serious enough to even consider
disciplinary action. Optometrists are conservative and
cautious practitioners and the passage of SB 36 would
not change their conservative nature.
SB 36 would be good for the state of Alaska. The bill
puts the regulatory details regarding the practice of
Optometry in the authority of the Alaska Board of
Optometry. These changes are important to allow the
profession and practice of Optometry to incorporate
new technologies and advances in eye care as they
occur. Optometry provides over 70% of the eye care in
the U.S. In some rural areas, especially in Alaska,
Optometrists are the only eye care provider in the
community. The citizens of Alaska deserve to be served
by a profession that is allowed to stay current with
advances in education and new technologies in eye
care.
I respectfully urge you to support SB 36.
9:32:41 AM
Senator Olson wondered whether Dr. Barney had practiced in
rural Alaska.
Dr. Barney replied that he had not practiced in rural or
bush Alaska. He relayed that he had worked with patients
from rural Alaska that had been referred to him, and he was
familiar with the eye health needs of rural Alaska.
9:33:31 AM
Senator Olson wondered how the legislations would affect
the optometrists working in rural Alaska.
Dr. Barney replied that the bill would allow the board to
write regulations that were more commensurate with
education. He said that the current practice of optometry
in rural Alaska was a bit below the education that was
provided in most schools of optometry. The bill would allow
the board to consider regulations that would expand the
scope of practice. He relayed that the bill would allow
optometrists to provide more expansive care to rural
Alaskans.
9:34:42 AM
Senator Olson asked how many other states had legislation
similar to SB 36.
Dr. Barney replied that Kentucky, Oklahoma, and Louisiana
had passed legislation allowing for greater scope of
practice for optometrists. The bill would allow for the
board to make the scope of practice in Alaska equal to
those states.
9:35:25 AM
Senator Olson asked how many complaints the board received
within the past 5 years concerning scope of practice.
Dr. Barney responded that he had received no complaints in
the past 6 years that he had served on the board.
9:35:48 AM
Senator Olson surmised that the board had no taken
disciplinary action on any optometrists in the state.
Dr. Barney replied in the affirmative.
9:36:06 AM
Senator Micciche wondered why the state had not allowed the
Board of Optometry to regulate itself.
Dr. Barney replied that he did not know why the state had
not allowed the Board of Optometry to regulate itself.
9:36:39 AM
Co-Chair Hoffman queried the position of the Alaska Native
Health Corporation on the bill.
Dr. Barney understood that the Southcentral Foundation was
in support of the legislation. He cited a support letter
(copy on file).
9:37:07 AM
Co-Chair Hoffman rebuffed that he was more interested in
the opinion of corporations providing services in rural
Alaska.
Dr. Barney replied that he was unaware of a position either
for or against from corporations serving rural Alaskans.
9:37:45 AM
Co-Chair Hoffman felt that the position of corporations
providing health care to rural Alaskans should be entered
into the record.
9:37:54 AM
Senator Olson announced that it was normally the position
of practicing physician's in rural areas, that optometrists
had more training in the field of eye health than medical
doctors and were usually in favor of legislation like SB
36.
9:39:20 AM
Co-Chair MacKinnon said that she would reach out to native
health organizations for an opinion.
9:39:24 AM
Senator von Imhof thought that both sides of the issue
brought up valid points but wondered why the issue was so
contentious. She spoke of other states that had defined
ophthalmic surgery in statute. She felt that a compromise
could be reached.
9:42:27 AM
DOCTOR JEFF GONNASON, PRESIDENT, ALASKA OPTOMETRIC
ASSOCIATION, testified in support of the bill. He read from
a prepared statement (copy on file):
My name is Jeff Gonnason, OD. I was born and raised in
Ketchikan & Craig and I was the first Alaska Native
optometrist. I have served on the State Optometry
Board under two different governors, and as Past
President of the Alaska Optometric Association. I have
volunteered at the ANMC and SCF. I practice in
Anchorage and performed Bush clinics in my younger
days.
A brief history for those new to this issue:
Optometry's doctor's degree was brought up to the same
level of education as medicine and dentistry over 45
years ago - 4 years of undergraduate Bachelors degree
followed by a 4 year graduate professional doctoral
program, plus often 1-2 year residencies for advanced
education.
This exactly follows the dental school model. Looking
at 8-10 years of university education.
By the way, currently 2/3 of optometry students are
women.
The 4 learned professions of medicine, dentistry,
optometry, and advanced practice nurses - are all
independent, all have their own regulatory boards, and
are all currently authorized by Alaska law to
prescribe drugs including controlled narcotics with
DEA numbers. Alaska optometrists have prescribed drugs
for the past 25 years with no issues of harm or abuse.
Optometrists are defined as PHYSICIANS by the federal
Center for Medicare, and are held to the same standard
of care as other medical professions as we treat
Medicare & 1 Medicaid patients, and are on preferred
provider insurance panels.
The optometry malpractice insurance fee is extremely
low - about $485 per year for $4M in coverage.
Approximately 150 optometrists practice all over the
state and provide the vast majority of eye care in
Alaska, servicing over 80 remote locations. Local
optometrists are called upon at rural hospitals and
clinics for their expertise. We are the primary care
physicians for eyecare in Alaska.
Treatment and travel costs from rural areas greatly
increases when routine eye care is instead provided by
urban specialists.
Alaska needs the best new doctors of optometry, and
antiquated state statutes are a barrier to attracting
the best and brightest to our state.
To be absolutely clear, SB 36 does NOT authorize any
optometrist to do ANYTHING. It only updates antiquated
statutes and gives the State Optometry Board authority
to regulate the profession with their sworn duty to
protect the public, the same as Alaska medical
physicians, dentists and advanced practice nurses - so
that optometry does not have to return for legislation
for every new advance in education or technology.
The legislature creates professional boards to
regulate the specific details of practice, that allows
for flexibility with advances in health care delivery.
Licensing includes 2 professional judgment of when to
refer patients for specialty care.
This bill has nothing to do with comparing the
advanced subspecialty ophthalmology training with
optometry. The clinical education of an optometrist
does not have to parallel that of an ophthalmologist
any more than the education of a family physician
needs to parallel a heart surgeon or a neurosurgeon.
The family doctor has no restrictions, but does not
perform heart or brain surgery, as they refer to those
specialties. Optometry does the same. The state
optometry board would NEVER authorize any optometrist
to perform any treatment they were not educated and
qualified to do. Risk of harm to the public has NEVER
been an issue, and all these claims of harm are
patently untrue.
Of the 4 main prescribing professions, only optometry
still contains outdated statutes. The Alaska Optometry
Board deserves the same level of respect as these
other professions.
I respectfully ask for your support of SB 36 to allow
the optometry board to better regulate for the future,
to benefit Alaska citizens by providing better access
to eye care and lower costs.
Dr. Gonnason offered a brief history as to the contention
between optometry and ophthalmology. He lamented that the
fight had been brewing over the past 40 years. He felt that
the issue was one of professional judgement. He contended
that no optometrist would perform surgery on the eye that
was outside their scope of training.
Senator Olson spoke to the concern voiced by an
ophthalmologist regarding the overly expansive scope
allowed to optometrists.
Dr. Gonnason responded that the legislation would not
expand the scope of practice but would allow the board the
authority to authorize new procedures, taught in nationally
accredited optometry schools. He said that several states
offered more authority in statute, some offered less. He
believed that doctors should be able to practice to the
full extent of their training.
9:51:39 AM
Senator Olson wondered how many optometrists had DEA
numbers.
Dr. Barney believed that the number was more than 50
percent of the 150 optometrists practicing in Alaska.
9:52:01 AM
Senator Olson wondered about the additional yearly training
hours required for optometrists.
Dr. Barney responded that 36 hours were required every two
years.
9:52:15 AM
Senator Olson asked how those numbers compared to the
requirements for ophthalmologists.
Dr. Barney replied that he did not know.
9:52:24 AM
Co-Chair MacKinnon shared that representatives from the
ophthalmologist community would testify later in the
meeting.
9:52:28 AM
Senator Micciche wondered what would occur if the Alaska
Board of Dentistry decided to pas regulation that said that
dentists could perform reconstructive surgery on the jaw.
Dr. Barney replied that the board would write regulations,
which would be given to the Department of Law for
meticulous scrutiny. He said that regulation would require
appropriate educational requirements. He added that if the
board of optometry wrote regulations for practices or
procedures that did not have an educational basis, the
regulations would never be approved.
9:53:41 AM
Senator Micciche understood that if the board decided to
give ophthalmologists broader reach in terms of practices
that could be performed, the educational criteria would be
very clear.
Dr. Barney replied that the board would have to provide
proof, through the Department of Law, that education had
been provided through credited schools of optometry.
9:55:49 AM
DOCTOR DAVID ZUMBRO, OPHTHALMOLOGIST, ANCHORAGE (via
teleconference), testified against the legislation:
I am concerned that Senate Bill 36 is moving forward.
This bill is special interest legislation purposefully
crafted in ambiguity that potentially allows optometry
professionals to regulate and perform eye surgery for
which they have received no training. Where is the
public outcry for the necessity of this bill? How does
the current statute prohibit Optometry Professionals
from regulating their profession? This bill
incorrectly redefines optometry as a surgical
profession.
It has been stated that my profession, ophthalmology,
opposes optometric scope of practice expansion because
of fear of competition. This is wholly incorrect. It
is absolutely about patient safety. Currently, it
takes 8 years after college and 20,000 hours of
supervised training to create a safe and competent eye
physician and surgeon. There is a rigorous board
certification process involving both written and oral
examinations that must be renewed every 10 years.
Surgical privileges at hospitals and surgicenters are
limited to 2 years and renewed by a committee of other
physicians and surgeons only after proof of currency
and competency. As an eye physician and surgeon, I
have to directly request permission from the
credentials committee to perform specific surgical
procedures such as laser each 2 year cycle. In the
case of Senate Bill 36, the state legislature is the
credentials committee and the optometry lobby has
asked for surgical privileges.
The fact that this bill permits access to all
schedules of controlled medications for optometrists
should be enough to give you pause about supporting
this bill. In my eye surgery practice, I deal with
procedures and conditions associated with severe eye
pain on a daily basis. I hardly ever prescribe a
controlled medicine and when I do, it is usually just
hydrocodone, which the optometrists already can
legally prescribe.
I have absolutely no problem with optometry
professionals regulating themselves in the practice of
optometry. However, Senate Bill 36 allows the
optometry profession to define and regulate
optometrists in the performance of ophthalmic surgery.
Consequently, it is imperative that the current eye
physicians and surgeons in the state of Alaska have a
voice in this legislative process. If ophthalmic
surgery is to be defined and regulated in statute, it
makes perfect sense that ophthalmologists should be
involved. If it is imperative to Alaskans that Senate
Bill 1 36 be passed, please consider adding a
definition of eye surgery addendum. This will put
everybody on the same page regarding the definition of
ophthalmic surgery, reduce the unnecessary rhetoric,
protect patients and satisfy all concerned parties.
10:00:17 AM
DOCTOR RACHEL REINHARDT, MEMBER, AMERICAN ACADEMY OF
OPHTHALMOLOGY, SEATTLE (via teleconference), spoke against
the legislation. She expressed concern that the legislation
would interfere with patient safety. She stated that
without specific language to restrict surgery, Alaska would
be the first state in the country to adopt such broad and
unprecedented legislation. She noted that similar
legislation had been introduced in Washington State several
years ago, which contained language that specifically
prohibited optometrists from performing surgery. She shared
that only 3 states in the country have passed similar
bills. She concluded that SB 36 would result in
unprecedented sweeping change in optometry's scope of
practice and would have profound implications for patient
safety.
Co-Chair MacKinnon CLOSED public testimony.
10:05:08 AM
HARRIET MILKS, ASSISTANT ATTORNEY GENERAL, DEPARTMENT OF
LAW, shared that she represented 25 professional licensing
boards, including all medical care boards. She provided a
description the relationship between the boards and the
department. She related that the department did not dictate
what the regulations boards chose to draft, or how to
regulate their professions. She explained that the
department worked with the boards to make sure that the
regulations were consistent with the constitution, the
Administrative Procedure Act, and the scope of authority
given in statute. She said that the department made sure
that the regulations were adopted, consistent with the
Administrative Procedure Act. She clarified that the boards
did not devise and adopt regulations without public input.
She explained that the Administrative Procedure Act
required that proposed regulation go out for public comment
for a minimum of 30 days. She emphasized that the public
comment period for every regulation involved every state
resident. She said that adoption of new regulations by a
board required the consideration of public comment. She
said that once the regulations were adopted by a board,
they were sent back to the department for careful analysis.
10:10:25 AM
Senator Micciche hypothesized about optometrists performing
eye transplant and wondered whether there were criteria
that the department would review to evaluate whether
optometrists could perform eye transplants.
Ms. Milks replied that the department would review the
scope of practice as defined by the statute. If the scope
of practice included eye transplants, there would be no
legal problem with optometrists performing eye transplants.
10:12:00 AM
Senator Micciche wondered whether the department could deny
a new regulation if it fell outside of the scope of
training.
Ms. Milks replied in the affirmative.
10:13:01 AM
Senator von Imhof wondered what other states had done in
terms of defining ophthalmic surgery.
Ms. Milks replied that she had not researched the issue.
10:13:15 AM
Senator von Imhof wondered how the department would vet
amendments to the legislation.
Ms. Milks responded that the department was not taking a
position on the legislation but would wait and see what the
boards reaction was on the bill.
10:13:41 AM
Senator von Imhof understood that the department would not
offer a legal opinion on an amendment.
Ms. Milks clarified that the department would not be
silent, but that she was not currently prepared to speak on
the bill.
10:13:56 AM
Senator Olson hoped that the public understood that the
legislature was not trying to pass legislation that harmed
people.
Ms. Milks thought that public opinion would stay favorable
as long as the process, particularly public input, was
respected.
10:14:55 AM
Co-Chair MacKinnon noted the attached fiscal note #1, from
Department of Commerce, Community and Economic Development
(DCCED).
10:15:56 AM
JANEY HOVENDEN, DIRECTOR, DIVISION OF CORPORATIONS,
BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF
COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, stated that
the fiscal note had been doubled from the previous year in
order to account for legal costs to amend regulation,
printing, and postage in the first year.
10:17:43 AM
Senator Olson asked about the removal of the surgical
restriction to using laser equipment and wondered how
lasers were used in eye care for diagnostics and treatment.
Dr. Gonnason replied that ophthalmologists were concerned
about the use of lasers. He relayed that much of the
equipment he currently used employed lasers. He detailed
that there were both diagnostic and therapeutic lasers.
Diagnostic lasers were used for measurement. He related
that currently optometrists were not supposed to use lasers
and wondered how that would be possible when the most up-
to-date equipment used lasers. He said that therapeutic
lasers were used in limited procedures in his practice to
combat glaucoma. He spoke to the misinformation offered by
a previous testifier concerning a study in Oklahoma.
10:21:15 AM
Dr. Gonnason contended that in the Oklahoma case some
patients had to return to their optometrists more
frequently was not due to questionable practices but was a
result of optometrists working more conservatively.
10:21:48 AM
Dr. Gonnason continued to discuss an anecdote concerning
laser surgery procedures done on veterans. He asserted that
the only thing that would change under the bill was that
optometrists would be trained in smaller laser procedures.
10:23:08 AM
Co-Chair MacKinnon wondered whether the malpractice costs
for optometrists differed from family practice doctors or
surgeons.
Dr. Barney replied that malpractice insurance premiums were
lower for optometrists.
Co-Chair MacKinnon asked that whether the malpractice
coverage would increase if the board increased the scope of
practice for optometrists.
Dr. Barney replied that procedures that were safe still
held the risk of complication. He shared that malpractice
rates had not increased significantly in Oklahoma.
10:24:54 AM
Dr. Gonnason furthered that there was no correlation
between scope of practice and malpractice insurance.
10:25:24 AM
Co-Chair MacKinnon remarked that Alaska had some of the
highest medical costs in the nation. She spoke of similar
arguments in other medical fields. She lamented the myriad
of issues that the legislature worked to balance in
providing for public safety.
10:28:21 AM
Co-Chair Hoffman stressed that the fees for medical
services were markedly higher in Alaska than in the rest of
the country.
10:29:51 AM
Co-Chair MacKinnon agreed. She noted that there were cost
drivers in ever facet of the medical field, but that
industry had to consider risk factors and rates of return.
SB 36 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
10:31:18 AM
The meeting was adjourned at 10:31 a.m.