03/18/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB23 | |
| SB55 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 23 | TELECONFERENCED | |
| *+ | SB 55 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 18, 2015
1:32 p.m.
MEMBERS PRESENT
Senator Bert Stedman, Chair
Senator Cathy Giessel, Vice Chair
Senator Bill Stoltze
Senator Johnny Ellis
Senator Pete Kelly
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 23
"An Act relating to immunity for prescribing, providing, or
administering opioid overdose drugs."
- HEARD & HELD
SENATE BILL NO. 55
"An Act relating to the practice of optometry."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 23
SHORT TITLE: IMMUNITY FOR PROVIDING OPIOID OD DRUG
SPONSOR(s): SENATOR(s) ELLIS
01/21/15 (S) READ THE FIRST TIME - REFERRALS
01/21/15 (S) HSS, JUD
03/18/15 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 55
SHORT TITLE: OPTOMETRY & OPTOMETRISTS
SPONSOR(s): SENATOR(s) GIESSEL BY REQUEST
02/18/15 (S) READ THE FIRST TIME - REFERRALS
02/18/15 (S) HSS, L&C
03/18/15 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
AMORY LELAKE, Staff
Senator Johnny Ellis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided the sectional analysis of SB 23.
DR. PAULA COLESCOTT, Addiction Specialist
Providence Breakthrough
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 23.
KATE BURKHART, Executive Director
Advisory Board on Alcohol and
Drug Abuse and Alaska Mental Health Board
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 23.
KARA NELSON, Member
Juneau Recovery Community and
Director
Haven House
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 23.
JANE CONWAY, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis of SB 55 on
behalf of the sponsor.
RACHEL REINHARDT, Ophthalmologist
American Academy of Ophthalmology
Seattle, Washington
POSITION STATEMENT: Testified in opposition to SB 55.
JEFF GONNASON, Optometrist
Alaska Optometric Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 55.
SCOTT LIMSTROM, Ophthalmologist
Alaska Academy of Eye Physicians
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to SB 55.
PAUL BARNEY, Chairman
Alaska Board of Examiners in Optometry
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 55.
JILL MATHESON, Optometrist
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 55.
FORREST MESSERSCHMIDT, Optometrist
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 55.
ACTION NARRATIVE
1:32:36 PM
CHAIR BERT STEDMAN called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Ellis, Stoltz, Giessel, and Chair
Stedman. He said it is the first hearing of two bills, SB 23 and
SB 55, and he plans to hold them in committee today.
SB 23-IMMUNITY FOR PROVIDING OPIOID OD DRUG
1:33:07 PM
CHAIR STEDMAN announced the consideration of SB 23.
SENATOR JOHNNY ELLIS, Alaska State Legislature, sponsor of SB
23, introduced the bill. He said fatal drug overdoses have
increased more than six-fold in the past three decades and now
claim the lives of over 36,000 Americans every year. Specific to
this bill is heroin use and, in Alaska, heroin use is here in
force. Heroin-related overdoses are claiming more young lives
than traffic fatalities, according to the Anchorage Police
Department. The 2014 Alaska Troopers' Drug Report identified an
increase in heroin abuse and the continued use of other opiates
as significant concerns. He noted he and former-Senator Dyson
have brought this issue before the legislature over the years;
the need for more Methadone clinic funding, the appearance of
new drugs, and the rise in drug-related burglaries.
SENATOR ELLIS maintained that the abuse and overdose epidemic is
largely driven by addiction to prescription opioids, such as
OxyContin, Oxycodone, and Vicodin. These drugs have grown more
expensive over time so the abusers and addicts seek out a
cheaper alternative, such as black tar heroin imported to Alaska
by the Mexican drug cartel.
He said the face of heroin is also changing; heroin abuse is
across all economic levels, is at an epidemic level, and has
reached every corner of the state. No community is left
unscathed. These highly addictive drugs are extremely deadly.
This trend is troubling because prescription opioids are popular
among young Alaskans.
He pointed out that opioid overdose is reversible through the
timely administration of the medication naloxone, but that
medication is often not available when needed. Friends and
family members are often the ones who are best situated to save
the life of the person having the overdose. Currently, medical
professionals are wary of prescribing naloxone and lay persons
are wary of administering them due to potential civil liability.
1:37:37 PM
He summarized that the bill is a simple Good Samaritan bill that
removes the civil liability from doctors and trained bystanders.
He concluded that SB 23 is an attempt to help reverse the opioid
overdose epidemic and he hopes that Alaska becomes the 29th
state to have this provision. It is a life and death situation.
1:38:30 PM
AMORY LELAKE, Staff, Senator Johnny Ellis, Alaska State
Legislature, provided the sectional analysis of SB 23:
Section 1. Amends AS 09.65 by adding a new section
(09.65.340) to give immunity for prescribing,
providing, or administering an opioid overdose drug
Subsection (a) exempts a person from civil liability
if providing or prescribing an opioid overdose drug if
the prescriber or provider is a health care provider
or an employee of an opioid overdose program and the
person has been educated and trained in the proper
emergency use and administration of the opioid
overdose drug
Subsection (b) except as provided in (c) exempts a
person who administers an opioid overdose drug to
another person who the person reasonably believes is
experiencing an opioid overdose emergency if the
person
1. Was prescribed or provided the drug by a health
care provider or opioid overdose program and
2. Received education and training in the proper
emergency use and administration
Subsection (c) does not preclude liability for civil
damages that are a result of gross negligence or
reckless or intentional misconduct
Subsection (d) defines
1. "health care provider" as a licensed physician,
advanced nurse practitioner, physician assistant,
village health aide, or pharmacist operating within
the scope of the health care provider's authority;
2. "opioid" includes the opium and opiate substances
and opium and opiate derivatives listed in AS
11.71.140
3. "opioid overdose drug" means a drug that reverses
in whole or part the pharmacological effects of an
opioid overdose
4. "opioid overdose program" means a program operated
or otherwise funded by the federal government, the
state, or a municipality that provides opioid overdose
drugs to persons at risk of experiencing an opioid
overdose or to a family member, friend, or other
person in a position to assist a person at risk of
experiencing an overdose.
1:42:28 PM
CHAIR STEDMAN asked if the committee had any questions.
MS. LELAKE read from the sponsor statement:
States across the country have enacted laws to
increase access to treatment for opioid overdose as a
way to combat increasing opioid overdose rates. Senate
Bill 23 provides immunity from civil liability to
health care providers who prescribe and bystanders who
administer opioid overdose drugs like naloxone in
cases of opioid overdose.
Naloxone (also known by the brand name Narcan) is a
medication called an opioid antagonist and is used to
counter the effects of opioid overdose, from drugs
like OxyContin, morphine, or heroin. Naloxone is
extremely safe and effective at reversing opioid
overdose.
Specifically, naloxone is used in opioid overdose to
counteract life-threatening depression of the central
nervous system, allowing an overdose victim to breathe
normally. Naloxone is not a controlled substance, has
NO abuse potential, and has zero effect if
administered to someone with no opiates in their
system.
Naloxone, much like an epi pen for severe allergic
emergencies, comes in the form of a nasal spray or is
injected in a muscle or vein. The efficacy of naloxone
is fundamentally time dependent.
Death from overdose typically occurs within 1 to 3
hours, although earlier in some cases, leaving a brief
window of opportunity for intervention. Naloxone takes
effect immediately and can last between 30 and 90
minutes.
Naloxone is both safe and effective. For more than
three decades, naloxone has been used by emergency
medical personnel to reverse overdoses. It is
regularly carried by medical first responders and can
be administered by ordinary citizens with little or no
formal training.
Data from recent pilot programs demonstrate that lay
persons are consistently successful in safely
administering naloxone and reversing opioid overdose.
The problem is, friends or family members of overdose
victims, not emergency medical personnel, are most
often the actual first responders and are best
positioned to intervene within an hour of the onset of
overdose symptoms.
As a result of rising opioid abuse and overdose, in
2001, New Mexico became the first state to amend its
laws to make it easier for medical professionals to
prescribe and dispense naloxone without liability
concerns, and for lay administrators to use it without
fear of legal repercussions.
At the urging of organizations including the US
Conference of Mayors, the American Medical Association
and the American Public Health Organization, a number
of states have addressed the epidemic by removing
legal barriers to the timely administration of
naloxone.
These changes come in two general varieties: The first
is the approach in SB23 - which encourages the wider
prescription and use of naloxone by removing the
possibility of negative legal action against
prescribers and lay administrators who prescribe the
drugs to those who may be able to use to reverse
overdose.
So far, 27 states and the District of Columbia have
made this important change.
The second change encourages bystanders to become Good
Samaritans by summoning emergency responders without
fear of arrest or other negative legal consequences.
Thankfully, the legislature wisely took that critical
step last year by passing Representative Lance
Pruitt's "Make the Call" Good Samaritan bill, House
Bill 369. Alaska is among 21 states to have passed
similar legislation in recent years. Based partly on
these changes to state law, at least 188 community-
based overdose prevention programs now distribute
naloxone.
As of 2010, those programs had provided training and
naloxone to over 50,000 people, resulting in over
10,000 overdose reversals. A recent evaluation of one
such program in Massachusetts, which trained over
2,900 potential overdose bystanders, reported that
opioid overdose death rates were significantly reduced
in communities in which the program was implemented
compared to those in which it was not.
Given the safety and effectiveness of naloxone, many
public health advocates question why naloxone is not
available over the counter. I point this out because
its status as a prescription medication does not mean
it is dangerous or difficult to use. Italy, for
example, has had naloxone available over the counter
since the 1980s without any reported negative
consequences.
It is understandable that regulators did not foresee
the utility of naloxone as a public health
intervention carried out by people who are not medical
professionals. But, in the midst of our current
epidemic of accidental deaths related to illicit and
prescription opioids, these restrictions are
untenable.
One very important thing to point out, Mister
Chairman, is that Senate Bill 23 is not the result of
a rash of lawsuits over providing or administering
lawsuits. I spoke with national experts who told me I
would be hard pressed to find any case law related to
this issue. SB23 simply removes an unintended barrier
to this life-saving drug.
Finally, Mister Chairman, Senate Bill 23 is not a
replacement for substance abuse treatment. Drug
enforcement and rehabilitation are also critical
components of this war on addiction. SB23 simply gives
doctors and bystanders to overdoses the peace of mind
that they will not be held civilly liable for doing
the right thing, and perhaps more importantly, Mister
Chairman, gives families and loved ones of addicts a
life-saving tool against the heartbreak caused by
opioid overdose.
SB23 is supported by The Alaska State Medical
Association, The Alaska Police Department Employees
Association, the Alaska Mental Health Trust Authority,
the Alaska Mental Health Board and Advisory Board on
Alcoholism and Drug Abuse, the Narcotic Drug Treatment
Center, and countless families and addicts who could
not be here today.
1:49:32 PM
SENATOR STOLTZE objected to the idea that the bill is a "Good
Samaritan" effort. He noted SB 23 is related to civil immunity
and asked if there was any relationship to criminal immunity.
MS. LAKE stated that the bill is only related to civil liability
and relates to the Good Samaritan Act in that it is about
accessing medical personnel for fast treatment.
CHAIR STEDMAN opened public testimony.
1:51:31 PM
DR. PAULA COLESCOTT, Addiction Specialist, Providence
Breakthrough, testified in support of SB 23. She said she has
been involved with the overdose population for over eight years.
She agreed that there is an avalanche of opioid use and
overdose. Patients report that their friends try to resuscitate
overdoses by putting them in a tub of cold water and it doesn't
work. She spoke of the brain damage as a result of overdose.
She opined the bill gives a green light to first responders and
physicians who are trained to save the life of someone who is
experiencing an accidental overdose. She described cases of
overdose.
She said naloxone is a safe method of preventing overdoses. She
highly encouraged approval of the bill. She concluded that the
American Society of Addiction Medicine has published a public
policy statement which agrees with the rescue of overdoses.
1:56:38 PM
KATE BURKHART, Executive Director, Advisory Board on Alcohol and
Drug Abuse and Alaska Mental Health Board, testified in support
of SB 23. She said she agrees with the previous testimony. She
said she has received numerous letters of support for this bill.
She described how SB 23 provides protection and policy guides to
physicians and family members.
1:59:05 PM
KARA NELSON, Member, Juneau Recovery Community, and Director,
Haven House, testified in support of SB 23. She described her
personal history with drug addiction and overdose. She related
how important the drug naloxone is. She shared a personal story
of overdoses. She pointed out that addiction does not
discriminate. She testified how important one saved life is. She
said the bill will keep people from being afraid of going to
jail when saving a life. She concluded that it is a public
issue, not a criminal issue.
She described her work with Haven House and the fears people
have. She noted that Narcan is so important to recovery.
2:04:29 PM
CHAIR STEDMAN closed public testimony.
SENATOR STOLTZE named supporters of the bill and wished to hear
from the criminal division. He supported the direction of the
bill away from criminal ramifications.
CHAIR STEDMAN held SB 31 in committee.
SB 55-OPTOMETRY & OPTOMETRISTS
2:07:08 PM
CHAIR STEDMAN announced the consideration of SB 55.
SENATOR CATHY GIESSEL, Alaska State Legislature, sponsor of SB
55, read the sponsor statement:
SB 55 modernizes and updates the Alaska Optometry
Statute. This bill 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 of Optometry, as with other
professions. The current regulations require more CE
hours than the statute subsection deleted by this
bill.
SB 55 allows the board to determine prescribed drug
schedules anticipating federal regulations that may
change again in the future as they did in 2014; that
regulation required another statute change, and this
bill would allow the board to move in step with its
industry.
This bill updates the optometry definition to reflect
current education and training, but specifically
prohibits invasive surgery. 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.
It also defines that optometrists must be qualified
for any procedure that they perform.
SENATOR GIESSEL noted that there are letters in the packet that
say the bill would allow optometrists to perform surgery around
or on the eye and that is not true. The bill also further
defines and clarifies the prohibited surgical procedures under
an "invasive surgery" definition. Alaska optometrists already do
superficial surgical procedures such as removal of corneal
foreign bodies under current statute, but nothing invasive would
be allowed.
She said the vast majority of Alaskans visit an optometrist for
their health care. Nationally, 75 percent of citizens see an
optometrist first. Optometrists refer more complicated issues to
an ophthalmologist. She stated that the bill updates the scope
of practice and statutes pertaining to optometry.
2:11:09 PM
SENATOR STOLTZE asked whether any ocular surgery is non-
invasive.
SENATOR GIESSEL reiterated that removing a corneal foreign body
is an example.
JANE CONWAY, Staff, Senator Cathy Giessel, presented the
sectional analysis of SB 55 on behalf of the sponsor. She read:
Section 1 requires the Board of Examiners in Optometry to adopt
regulations governing prescription and use of pharmaceutical
agents.
Section 2 amends AS 08.72.181(d) by removing specified hours and
period of continuing education requirements for the renewal of
an optometrist's license but retains delegation of those
requirements to the board in regulation.
Section 3 repeals and reenacts AS 08.72.272(a) to provide that
pharmaceutical agents, including controlled substances, may be
used by a licensed optometrist if consistent with standards
adopted by the board and any limitations on practice under
section 5 of the bill.
Section 4 reenacts and modifies the prohibition by a licensee to
perform an intravitreal injection.
Section 5 provides that a licensee may perform only services
within the licensee's training and experience as provided by
board regulation.
Section 6 revises the definition of optometry.
Section 7 adds a definition of "invasive surgery."
2:13:54 PM
CHAIR STEDMAN asked for the change of the definition in Section
6, line 23, page 2.
MS. CONWAY offered to get back to the committee.
SENATOR STOLTZE asked what the difference is between OD and MD.
SENATOR GIESSEL explained that a doctor of optometry has an
extensive degree, but a doctor of ophthalmologist is a medical
physician who has had specialized training in surgery of the eye
and more complex procedures. An optometrist performs basic eye
exams, diagnostic procedures, and some treatment, but not
invasive surgery.
CHAIR STEDMAN opened public testimony.
RACHEL REINHARDT, Ophthalmologist, American Academy of
Ophthalmology, testified in opposition to SB 55. She explained
her concern with how the bill relates to surgery. The language
is misleading and would allow optometrists to do all procedures
not mentioned in the bill. The bill does not list all surgical
procedures needed; there are more procedures not listed, such as
laser surgery. The bill removes existing safeguards about
injections. She stressed the importance of understanding that
the bill creates loopholes. She described the education needed
to become an ophthalmologist; four years of medical school and
four years of surgical residency. She concluded by recalling
testimony from last year about the prescribing of narcotics,
which she said would be allowed this year.
2:24:53 PM
SENATOR GIESSEL asked if Ms. Reinhardt has practiced in Alaska
and how many ophthalmologists there are in Alaska.
DR. REINHARDT replied that she has not, and there are 27
ophthalmologists in Alaska.
SENATOR GIESSEL noted there are 179 optometrists in Alaska.
JEFF GONNASON, Optometrist, Alaska Optometric Association,
testified in support of SB 55. He shared his professional
background. He shared the history of Alaska's optometrist
journey and the opposition by the American Academy of
Ophthalmology the whole way. He described how optometrists work,
their limitations on practice, and that they use their
professional judgement as to when to refer patients. He thought
there were about 160 optometrists in Alaska.
2:29:30 PM
SCOTT LIMSTROM, Ophthalmologist, Alaska Academy of Eye
Physicians, testified in opposition to SB 55. He maintained that
the bill is misleading and allows optometrists to perform many
surgical procedures. He provided examples of patients who lost
their eyes and the procedures that were needed. He stressed the
importance of those who perform the procedures to be trained.
The bill would allow optometrists to perform laser and Lasik
procedures. He concluded that the Alaska State Medical
Association, the American Academy of Ophthalmology, and the
Alaska Academy of Eye Physicians, and the Interior Independent
Practice Association are opposed to the bill.
2:34:34 PM
SENATOR STOLTZE asked if his concern is that medical doctors
should also be limited regarding eye procedures.
DR. LIMSTROM said his main point was these procedures require
careful analysis of the patient and extensive training.
SENATOR STOLTZE asked if any medical doctor can perform these
types of retinal procedures.
DR. LIMSTROM explained that medical doctors limit their practice
to their specialties and surgical procedures are highly
regulated. He said he is not aware of regulations applying to
the procedures done in private offices.
SENATOR STOLTZE asked if there is a legal prohibition to
practices by individual hospitals.
2:39:00 PM
SENATOR GIESSEL said medical statutes do not limit, in general,
the practice of physicians to specific specialties. The
ophthalmologist was describing hospital privileges and the
inappropriate diagnosis was made in an outpatient setting.
Physicians are not limited in any way.
2:39:44 PM
PAUL BARNEY, Chairman, Alaska Board of Examiners in Optometry,
testified in support of SB 55. He shared his professional
background. He described his role as the director of, and
optometrist with, the Pacific Cataract and Laser Institute, a
referral center limited to surgical and medical eye care. He
said his involvement concerns medical eye care and pre-surgical
and post-surgical care. PCLI's approach is to work
collaboratively as a team. The ophthalmologist performs the
surgery.
He said the arguments against SB 55 are that only an
ophthalmologist is trained to do specific procedures, some of
which he and the nurse anesthetist at PCLI are qualified to
perform. The bill prohibits injections into the eye globe and
prohibits optometrists to do surgery. The bill allows the Board
of Examiners in Optometry to set the details of the practice of
optometry. He assured that the primary concern of the board is
the safety of the public.
He maintained that in the four years he has served on the board,
there have been no public complaints that were serious enough
for disciplinary action. He concluded that SB 55 would be good
for Alaska. It modernizes the definition of optometry and allows
the board to determine the details of pharmaceutical
prescribing. Optometry provides about 70 percent of eye care in
the U.S. In rural Alaska optometrists are sometimes the only
provider of eye care.
2:44:04 PM
JILL MATHESON, Optometrist, testified in support of SB 55. She
shared her background and professional experience. She related
that the four times there have bills related to optometrists,
there has been opposition by ophthalmologists. All four times
the legislature listened to optometrists and passed bills that
allow them to practice as they currently do. Optometrists treat
patients promptly, safely, and effectively. The optometrist
profession is a safe profession and the malpractice rate is very
low.
She said SB 55 allows the Optometry Board to regulate the
profession, puts continuing education requirements back into
regulation, and it modernizes definitions of optometry and
invasive surgery for optometrists. She opined that the bill
would allow the board to update regulations in the future. She
concluded that the bill allows the board to react as technology
advances and it opens the door for expansion in the future. It
allows optometrists to practice at the highest level of training
which equals protection of the public because it ensures that
optometrists, who are the first line of eye care in Alaska, can
treat Alaskans with the most modern methods available to them.
She clarified that the opposition's statement that the bill
lowers surgical standards is not true. The Optometry Board is
very conservative and would not allow optometrists to do
anything without proper training. Optometrists currently have
authority to do injections around the eye.
2:49:35 PM
FORREST MESSERSCHMIDT, Optometrist, testified in support of SB
55. He said he is serving his third year on the State Board of
Optometry. He opined that SB 55 puts the regulation of optometry
where it belongs, with the board. He said the profession has
changed and more than 50 percent of his practice is medical
care. He listed several of the procedures he deals with, such as
complex eye diseases, diabetic retinopathy, glaucoma, macular
degeneration, and others. These issues involve relationships
with ophthalmologists that are based on mutual trust. He
described how the care optometrists provide has changed over the
years. He provided an example of why the bill is needed. There
are not enough skilled ophthalmologists to serve the rapidly
aging population. He stated that optometrists will continue to
provide quality care and the board is capable of providing
oversight. SB 55 is good for Alaska.
2:53:24 PM
SENATOR GIESSEL inquired how many ophthalmologists are in
Juneau.
DR. MESSERSCHMIDT said one.
SENATOR GIESSEL said if that individual goes on vacation there
are none.
CHAIR STEDMAN doubted there were any in Sitka.
DR. MESSERSCHMIDT said some ophthalmologists travel through
Sitka to provide services.
REPRESENTATIVE KELLY asked if he was confirmed by the
legislature to serve on the Board.
DR. MESSERSCHMIDT did not know.
REPRESENTATIVE KELLY requested that the ophthalmologists who
oppose the bill submit a list of why the bill is wrong regarding
surgical procedures and injections.
2:55:36 PM
SENATOR STOLTZE requested a list of where the ophthalmologists
are located in Alaska. He requested assurance that insurance
providers are not opposed to the bill.
CHAIR STEDMAN held SB 55 in committee.
2:57:03 PM
There being nothing further to come before the committee,
Chair Stedman adjourned the Senate Health and Social Services
Standing Committee at 2:57 p.m.