HOUSE BILL NO. 103 "An Act relating to the practice of optometry." 3:37:42 PM Co-Chair Foster MOVED to ADOPT Amendment 1: Page 2, line 27, following "practice.": Insert "(a)" 3 Page 2, following line 30: Insert new subsections to read: "(b) A licensee may not perform ophthalmic surgery unless the procedure is (1) within the scope of the licensee's education and training from an accredited school of optometry; and (2) authorized by regulations adopted by the board. (c) In this section, "ophthalmic surgery" means an invasive procedure in which human tissue is cut, ablated, or otherwise penetrated by incision, laser, or other means to treat diseases of the human eye, alter or correct refractive error, or alter or enhance cosmetic appearance; "ophthalmic surgery" does not include the procedure described under AS 08.72.273." Representative Wilson OBJECTED. REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, explained the amendment. She decided to advance an amendment in response to some of the concerns expressed about the potential that optometrists might work outside of their scope of practice. The amendment would do two things to clarify and further codify the restrictions the original bill stated. She read directly from the amendment (See above). She conveyed that the definition of surgery provided in the amendment was borrowed from Washington state law and preferred by the ophthalmologists. They would not practice any of the items unless they were clearly trained in them by an accredited school of optometry. It would ensure that there would not be fly-by-night optometry trainings offered in hotel conference rooms that could result in unsafe care. Vice-Chair Gara wanted it on record that if either amendment passed there was an ophthalmic surgery definition. The amendments were different. His understanding was that, regardless of her definition, it would allow optometrists to continue doing things they were doing presently. He did not want to limit their ability to perform procedures they were currently allowed to do. He asked her to comment. Representative Spohnholz responded that there were two amendments. Amendment 1 would continue to allow optometrists to practice as they did currently. It was her understanding Amendment 2 would not. The second amendment would roll back some of the authorization that optometrists had to practice. She thought a member of the Board of Optometry was available online. Vice-Chair Gara did not want the amendment to stop optometrists from doing the procedures they had already been authorized to perform. He asked if the amendment was aimed at future things that optometrists were thinking about doing. Representative Spohnholz responded that the language in Amendment 1 stipulated clearly that a licensee could not perform ophthalmic surgery unless the procedure was within their scope of education and training. Anything that they were currently practicing were items they had already received training in at an optometry school. The amendment allowed them to continue with their practices. Vice-Chair Gara wanted to get on record that the amendment should not be interpreted in a way that would somehow erase their ability to practice what they were already practicing. Co-Chair Foster relayed the list of testifiers available. 3:43:05 PM Representative Kawasaki asked about removing foreign bodies. He wanted to make sure they would be able to continue to perform the surgery. Representative Spohnholz responded in the affirmative because it was within the scope of their training and licensure. Representative Kawasaki mentioned the 40 schools of optometry and asked if any of them taught Lasik surgery. Representative Spohnholz thought Lasik surgery was not within the scope of practice for optometrists. She deferred to the doctor online for clarification. DR. BARNEY, BOARD OF OPTOMETRY, responded that Lasik was not taught at any optometry school in the US. Representative Wilson commented that the definitions were the same. She was concerned that optometrists wanted to do surgery. She was unclear of the purpose of the amendment. She wondered what the amendment would do to change what optometrists could do without the amendment. Representative Spohnholz responded that the amendment codified some things that had been verbally expressed on the record but not explicitly stated in statute and the original bill. She felt the amendment might give people more comfort and clarity that there would not be a dramatic scope of practice change. She emphasized the importance of specifying that education and training needed to come from an accredited school of optometry. The amendment clarified that drive-by-night trainings in Lasik surgery offered at hotels by non-accredited institutions and rammed through a board of optometry was not possible. Representative Wilson asked what procedure optometrists could currently perform that fit within the definition provided in the amendment. Representative Spohnholz deferred to Dr. Barney. Dr. Barney provided a list of procedures optometrists could currently perform that met the definition of surgery as written in the amendment. The list included corneal foreign body removal, rust ring removal, epithelial debridement, removal of corneal filament, and draining a hidrocystoma. Representative Wilson wondered if all of the procedures he mentioned had been taught at an accredited school. Dr. Barney responded affirmatively. 3:48:41 PM Representative Wilson was trying to address concerns that were brought to her attention via email. She understood there was a difference between the two groups concerning surgery. She wanted to make sure people remained safe. She had heard in testimony that they [optometrists] did not want to do surgery. However, they were already doing what was considered surgery based on the definition in the amendment. She did not understand the purpose of the amendment. Representative Spohnholz clarified that accreditation was done by a separate nationally recognized body which was true for all accredited universities. The Alaska board was not in charge of accrediting universities that offered optometric education. Representative Wilson thought that the board could require all training to be from an accredited university. Under regulation, they [optometrists] could already perform defined services. She believed the legislation allowed providers to go beyond the scope of their training. She would be voting based on the testimony she heard and received. Co-Chair Seaton thought that regulations required training to be obtained by an accredited institution. He added that the board could implement the same requirement. However, he believed the amendment clarified that the training would have to be obtained by an accredited school of optometry. He thought the definition of surgery was too broad, based on feedback from the entire medical field. He provided an example of an optometrist removing a fishhook from a person's eyes and it being considered a surgical procedure. He indicated he was comfortable with the amendment. Representative Wilson WITHDREW her OBJECTION. There being NO OBJECTION, Amendment 1 was ADOPTED. 3:52:35 PM Representative Wilson WITHDREW Amendment 2. Vice-Chair Gara commented that he thought the bill should be decided with a floor vote. Therefore, he would not object to moving the bill from committee. Vice-Chair Gara reviewed that there was one fiscal note: Office of Management and Budget (OMB) component number 2360 in the amount of $5,100 for the drafting and implementation of regulations. Representative Wilson clarified that the amount would be paid for with program receipts rather than general fund dollars. Co-Chair Seaton MOVED to report CSHB 103 (FIN) out of Committee with individual recommendations and the accompanying fiscal note. There being NO OBJECTION, it was so ordered. CSHB 103 (FIN) was REPORTED out of committee with a "do pass" recommendation and with a previously published fiscal impact note: FN2 (CED). 3:54:48 PM At EASE 3:55:31 PM RECONVENED