Legislature(2017 - 2018)HOUSE FINANCE 519
04/12/2017 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB166 | |
| HB103 | |
| HB151 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 166 | TELECONFERENCED | |
| + | HB 151 | TELECONFERENCED | |
| += | HB 144 | TELECONFERENCED | |
| + | SB 51 | TELECONFERENCED | |
| + | HB 103 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 103
"An Act relating to the practice of optometry."
3:27:21 PM
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, read a prepared
statement:
HB 103 gives authority to the Board of Optometry to
regulate the practice of optometrists, much as is done
by doctors, nurses, midwives, chiropractors and
dentists. It ensures that the Board of Optometry will
have the opportunity to update their current and
continuing standards and scope of practice based on
the best evidence available.
The bill will not allow optometrists to provide
services outside of their scope of practice like
performing invasive surgeries which will continue to
be illegal.
What it will allow is for optometrists to utilize the
State of Alaska's rigorous regulatory process to
manage themselves just as doctors, nurses, midwives,
chiropractors and dentists do.
HB 103 allows our robust regulatory process to work.
The process for developing new regulations is public
and transparent, ensuring that any new regulations
will be fully vetted by the board, the public and the
Department of Law before it becomes regulation.
The Board of Optometry has a strong track record of
regulating itself. In fact, the Board has implemented
higher continuing education standards on the
profession than the Legislature has required in
statute which makes a strong case for why this board
is more than capable of regulating its own education
and practice. (Statute: 15 hours of continuing
education while optometrists have required themselves
to have 36 hours of continuing education.)
It is my hope that this bill will get the Legislature
out of the business of managing optometrists, so we
can focus on our efforts and energy on issues which do
require our attention and optometrists can get on with
the business of caring for Alaskan's eye health.
Co-Chair Foster invited Dr. Barney to the table. He
reviewed a list of other available testifiers.
DR. PAUL BARNEY, DOCTOR OF OPTOMETRY, introduced himself.
Representative Wilson had been asked for a definition of
surgery. She wondered if the doctor would have any issues
if a definition was added to the bill for further
clarification.
Representative Spohnholz responded that she had strongly
resisted adding a definition of surgery to the bill. She
was intentionally trying to move the discussion out of the
legislature's hands. She asserted that adding a definition
of surgery would keep the discussion in the hands of the
legislature. An invasive surgery was already not allowed in
statute. It was unclear what the scope of practice would be
for optometrists in 20 years, 30 years, or 40 years. She
provided an analogous situation. She suggested that when a
person went to the dentist 20 years previously the things a
hygienist did versus what a dentist did were very different
from what they did presently. For instance, currently, she
visited the dentist's office twice per year. She saw the
dentist at one visit and the hygienist at both. A hygienist
provided almost all her oral health needs with very little
consultation from her dentist, which 20 years ago would not
have been imaginable. She did not think the legislature
needed to be a part of such a conversation. She believed
that the conversation should be had between the health care
professionals and providers who were keeping on pace with
the standards of practice and educational standards. She
made the case that the definition did not belong in the
bill.
3:32:25 PM
Representative Wilson asked for the reference to the
definition of invasive surgery in statute. Representative
Spohnholz read the statute:
AS 08.72.273 Removal of foreign bodies.
A licensee may remove superficial foreign bodies from
the eye and its appendages. This section is not
intended to permit a licensee to perform invasive
surgery.
Representative Kawasaki referred to Section 3. He asked
about the removal of language regarding the applicant and
continuing education including eight hours for
pharmaceuticals and 7 hours for non-topical therapeutic
pharmaceutical agents. The language would be replaced with
language that required continuing education requirements as
prescribed by the board. He asked her to clarify whether
the goal was to reduce the number of hours or to allow the
board to determine the requirements. Dr. Barney replied
that 8 hours of pharmaceutical requirements were written
into statute a couple of decades prior. At the time the law
was written, most of the education did not deal with
pharmaceuticals. The legislature wanted to make certain
that pharmaceutical education was required. Currently, the
education available had changed dramatically. Most
encompassed pharmaceuticals and their applications. He
stated that the board was more likely to increase the
number of required hours of education rather than reduce
them.
Representative Kawasaki mentioned concerns about the board
overseeing the establishment of regulations for licensed
optometrists, as they could permit them to do things
outside of their scope of practice. He asked Dr. Barney to
address the issue. Representative Spohnholz relayed that
the primary concern of the opposition to the bill was that
the board would start authorizing practices well outside of
practitioners' education and expertise. There were similar
professional distinctions such as those between dentists
and oral surgeons. Dentists did not perform oral surgery,
and there was no major concern or outcry that they were
expanding their authority to do so. It was not within the
scope of their training and practice. She highlighted that
there was a rigorous process for drafting new regulations;
they were required to be drafted in partnership with the
Department of Law. The goal of the process was to to
reconcile any proposed regulations with existing statute.
The regulations were also thoroughly vetted and included
public input. She was confident that the Ophthalmologists
would be happy to participate in the same process. The
Department of Law would go through a more rigorous review
of the process following public comment. She was confident
that the Department of Law and the attorney general would
not allow for an expansion of the scope of practice beyond
that which optometrists were trained and had the necessary
expertise.
3:36:52 PM
Representative Kawasaki asked how a licensed optometrist
was regulated versus a hygienist. He wondered how
optometrists were qualified. Representative Spohnholz
deferred to Dr. Barney.
Dr. Barney responded that to be eligible for licensure, an
optometrist or student of optometry had to take a board
examination. The board process started when optometry
students were in school. A person had to take national
boards and pass all sections to be eligible to take the
state license test. For someone who graduated in 1980, for
example, the statutes had not changed significantly. There
had been a couple of scope-related bills that passed. Each
time there was a scope expansion in which continuing
education was required everyone had to get the training.
The credits were offered in accredited colleges of
optometry and had to be taken and successfully completed
before optometrists could conduct the expanded procedures.
The board would do something similar if HB 166 passed.
Representative Kawasaki spoke to the comment about a person
being licensed in 1970 versus presently. He mentioned
driver's licenses. His mom got her license in 1950 and did
not have to requalify for a license or take another test.
He wanted to ensure strict confines of performance. Dr.
Barney conveyed that continuing education was required on a
yearly basis. If anyone were to fall behind on that
requirement their license would be in jeopardy.
Representative Spohnholz added that in contrast with
Representative Kawasaki's mother's driver's license, which
she believed required a periodic update to maintain it, an
optometrist or another healthcare professional was required
to do continuing education to demonstrate that they were
keeping pace with the changing profession over time.
3:40:11 PM
Representative Wilson thought that the statute AS.08.72.273
did not define invasive surgery, rather, it discussed
foreign bodies. She was looking for the definition of
invasive surgery. Representative Spohnholz understood there
to be a definition. She had talked with the Department of
Law recently looking for the definition of invasive
surgery. The department indicated it would get the
definition of invasive surgery from the medical board. If
the medical board's standard was used, the invasive surgery
standard would be the same for dentistry, optometry,
podiatry, across professions for anyone wanting to use a
laser or knife to cut someone open. Representative Wilson
wanted to hear from the Department of Law.
JOAN WILSON, ASSISTANT ATTORNEY GENERAL, DEPARTMENT OF LAW,
saw no definition for invasive surgery in statute. She
furthered the board would likely proceed to define
standards and practices, including eye surgery, in
regulations. A three-fold review process: the board would
draft regulations and a public notice stating that the
board was considering new regulations. The Department of
Law would then review the public notice to ensure the
adopting agency was identified, the statutory authority and
the statutes being implemented were identified, and
deadlines were set for comments. The department also made
sure that if an oral hearing was held, it was laid out
properly. The point was for due process and public input.
Co-Chair Seaton asked Representative Wilson to repeat her
questions. Representative Wilson wanted to know where the
definition could be found in statute. Representative
Spohnholz relayed that the definition was not in statute
but it was in regulations. She relayed that she had been
working on the bill with Harriette Milks, Assistant
Attorney General. Joan Wilson was pinch hitting while Ms.
Milks was unavailable.
Ms. Wilson would look up the medical regulation.
Co-Chair Seaton indicated there would be time to find the
definition, as there would be additional hearings on the
bill.
3:45:21 PM
Vice-Chair Gara liked the provision of the law that stated
that an optometrist could remove a foreign object from
someone's eye in case of an emergency. He asked what was in
Alaska law that prevented someone from doing Lasik surgery
compared to the laws of other states where optometrists
were able to conduct the procedure. Mr. Barney replied that
optometrists did not perform Lasik surgery in other states.
Co-Chair Seaton asked if Dr. Barney had a statement he
wanted to put on the record.
Mr. Barney read a prepared statement:
My name is Dr. 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 live and practice in
Anchorage and have done so for the past 17 years. I'm
here today in support of HB-103.
I support HB-103 because it will allow the Board of
Optometry to regulate the details of the practice of
Optometry, which is how Advanced Practice Nurses,
Dentists, and Medical Doctors are regulated in Alaska.
This legislation will not set a new precedence in
health ca re, nor will it be a risk to Alaskans since
this is already the way other health care providers
are successfully regulated in Alaska.
HB-103 will give Optometrists 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. 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.
You'll hear arguments against this legislation stating
that it will be dangerous to allow Optometrists to
regulate themselves. But 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 that
they provide outside of their scope of education. As a
result, 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 HB-103 would not
change their conservative nature.
I would also like to share with you how I practice.
I'm the Center Director of Pacific Cataract and Laser
Institute in Anchorage. Our practice is a referral
only practice and we specialize• in cataract care,
laser vision correction, and medical consultative
services. I work with an ophthalmologist and a nurse
anesthetist. We all practice to the highest level that
statutes will allow and by doing so, as a team we ca n
provide high quality, more affordable care to Alaska
ns. I have a very good relationship with the
ophthalmologist that I work with, but if I were to
provide ca re that is outside of my education it would
not only jeopardize my relationship with the
ophthalmologist but it would also undermine a n
already very successful practice.
Optometry provides over 70% of the eye care in the
U.S. In some rural areas of Alaska, Optometrists are
the only eye care provider in the community. HB-103
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. 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 HB-103.
3:50:52 PM
DAVID ZUMBRO, SELF, ANCHORAGE (via teleconference), was an
eye physician and surgeon in Anchorage and was a partner
with Alaska Retina Consultants. He strongly opposed the
legislation. He indicated that the legislation was not a
simple house cleaning bill. Rather, it radically redefined
a profession. Although the bill seemed innocent and safe
and, as written, would allow non-physicians and non-
surgeons to determine what medical and surgical treatments
could be done to an eye. He believed it was special
interest legislation. It was not safe for patients. He
wondered where the public outcry was for the legislation.
He asked for proof that current practice regulations
adversely affected Alaska patients and the Alaska
optometrists. It had been stated that the bill was not
about surgery and that no surgeries would be done for which
optometrists were not trained. He was worried about
surgery. He relayed that a local optometrist told him that
when the bill was first crafted that optometrists wanted to
perform intraocular injections of medications currently
performed by retina physicians. The current bill removed
all previous regulations preventing injections. He wondered
why regulations would be removed that prevented injections.
He suggested that there were many bills in many states that
would allow optometrists to advance their scope of practice
into lasers and surgery. As a result, several states had
adopted definition of surgery language in their statutes.
Alaska could do the same thing. He opined that the bill was
about advancing the optometric scope of practice into the
practice of medicine for which they did not have training.
He used to teach ophthalmology residents when he was active
duty in the US military. One of the most difficult things
to impart to young physicians in training was when to take
a step back and not do something. He spoke of the
Hippocratic Oath which all medical physicians took
requiring them to do no harm. The surgical maturity to sit
back and observe a patient did not happen overnight. It
took many months of direct supervision and guidance by
qualified and experienced physicians. The field of
optometry did not have such a type of training background
when it came to procedures and lasers. They were not
trained in any ophthalmic procedures, lasers, or surgeries.
He had no problem with the Board of Optometry regulating
the Optometry profession in the practice of optometry.
However, if the bill became law optometrists would be
regulating themselves in the practice of ophthalmology. As
an ophthalmologist he felt he had a say in the issue. The
regulation would be without any physician or surgeon
oversight, without any training or experience or
background, and he had concerns about patient safety and
its dangers. He thanked the committee.
Co-Chair Seaton asked how many ophthalmologists were in
Alaska. Dr. Zumbro responded that there were approximately
26.
Vice-Chair Gara agreed with not wanting optometrists to
perform surgery. The doctor prior had indicated there was
no intention of optometrists doing surgery. He asked Dr.
Zumbo if he agreed that in other states optometrists did
not perform Lasik surgery. Dr. Zumbro agreed that
optometrists did not do Lasik surgery in the United States.
3:55:32 PM
DR. JANEY CARL ROSEN, SELF, ANCHORAGE (via teleconference),
was a Doctor of Ophthalmology, specifically an
oculoplastics surgeon and neuro-ophthalmologist which meant
he was an eyelid surgeon and worked with neurology and
neuro surgery. He took care of bumps and cysts on eyelids.
He provided more information on his professional
background. He had heard repeatedly the bill was not about
surgery, optometry had no business doing surgery, and
optometrists did not want to do surgery. The sponsor had
said the bill was not about surgery and her aide had stated
that all surgery language was removed from the bill. He had
heard that as time changed the scope of practice should be
modernized by the optometry board and should a surgical
procedure be deemed within the scope of practice by the
board they did not want to come back to the legislature.
The assistant attorney general previously stated that
public testimony would help decide if a surgery was
appropriate for an optometrist. He wondered if members were
bothered by those statements. He suggested that not only
would no one have actual surgical experience on the board
and the legislature would ask the public for help. He
thought asking an expert with actual experience was more
appropriate. He reviewed several examples of problems from
botched surgeries. Dental boards and nurse practitioner
boards policed themselves because they learned procedures
in graduate school. Optometry students did not perform
surgery, lasers, or injections on real people. He did not
believe an 8-hour class was enough training. He was asking
folks to wake up and consider what was being proposed. He
read from the Journal of the American Medical Association
about a study done in Oklahoma where they performed laser
surgeries. He believed the legislation was racing towards a
slippery slope. He thought there should be more public
outcry.
3:59:06 PM
DR. KELLY LORENZ, SELF, ANCHORAGE (via teleconference), was
a board-certified Ophthalmologist and strongly opposed HB
103. She believed the bill was an unprecedented expansion
of practice. The legislation would allow for limitless
surgical procedures without any defined training in
surgical techniques. She indicated that she had met
patients that had been told by their optometrist that there
was only one cataract surgeon that came to Alaska. The bill
did not have the best interest of Alaskans in mind and
there was no public outcry for it. She spoke of the
importance of having a skilled professional with years of
training under the supervision of an experienced preceptor.
She read statistics from a medical journal about a recent
study regarding laser procedures in Oklahoma and the fact
that optometrists had repeated the laser more than twice as
much as ophthalmologists. She thought it was also essential
to have the ability to manage the inevitable complications
that arose from laser and traditional surgery. She brought
up other serious issues members should consider before
signing what she considered to be a blank slate. She
advised members to be cautious and to demand specifics. She
urged members to oppose the bill in its current form.
4:01:41 PM
DR. ANDREW PETER, SELF, HOMER (via teleconference), was an
optometrist from Homer and asked members to support HB 103.
He relayed a list of services he provided. He mentioned
that the clinic's daily schedule could accommodate 4 to 6
urgent care patients. It was common for the appointments to
be fully utilized. He spoke to the challenges of living in
rural Alaska. He quoted some statistics concerning the
number of optometrists and ophthalmologists in the state.
He encouraged members to help optometrists be more nimble
and accessible. He thanked the committee and made himself
available for questions.
Representative Wilson thought the definition of surgery was
the key issue. She wondered if it would be something that
could be discussed. Dr. Peter responded that one of the
ophthalmologists had defined surgery as cutting, blading,
or altering tissue. Under that definition, tattoo artists
and tattoo removal specialists performed surgery. He
relayed that if a patient came in with a piece of metal in
their eye and he removed it, it would be considered
surgery. He provided other examples of potential surgeries.
He hoped the legislature could take itself out of the
business of managing optometry eyecare.
4:06:16 PM
DR. JILL MATHESON, SELF, JUNEAU (via teleconference), was
an optometrist in Juneau. She spoke of her previous
experience on the Board of Optometry. Over the previous 25
years she had testified numerous times before several
legislative committees in support of changes to the Alaska
optometry statute. Efforts had been successful due to the
level of trust legislators had given optometrists over time
and after sifting through testimony. She asked for member's
support in having the optometry board regulate
optometrists. The bill did not give any expansion of
privilege to optometrists. It allowed the optometry board
to decide what optometrists were trained and qualified to
do via the regulatory process of the board and within their
scope and training. She assumed that the members of the
state board were appointed and confirmed by the legislature
to do the same. There were separate boards because each
profession was unique. She suggested that only optometrists
knew what doctors of optometry were trained and qualified
to do. She was aware members were trying to figure out what
"fiscally responsible" looked like. The bill had been heard
by four committees multiple times. She suggested that if
the optometry board could regulate optometrists there would
still be a very public process via open public testimony.
Also, boards had to be self-sufficient. The bill allowed
the profession of optometry to evolve. She trusted the
appointed optometry board members to make any necessary
changes.
4:09:15 PM
DR. KURT HEITMAN, AMERICAN ACADEMY OF OPHTHALMOLOGY, SOUTH
CAROLINA (via teleconference), strongly opposed HB 103. He
remarked that the bill was a surgery bill. The bill made
two crucial changes to existing Alaska law. First, it
removed surgery restrictions already in existing law. It
also inserted a new definition of the word optometry in
Section 6 that included the words "treatment" and
"procedures". The insertion of the word treatment put no
limitations on the type of treatment. In other words, all
surgeries in the eye would be allowed under the law because
the Board of Optometry could define invasive surgery any
way they wanted. HB 103 allowed the board cart blanch
authority to redefine their field into a surgical field. He
had seen an example in North Carolina where optometrists
defined laser as non-invasive. He wondered why proponents
of the bill opposed the inclusion of language that clearly
specified that surgery was outside the scope of practice of
optometrists avoiding patient harm. Without specific
language restricting surgery, Alaska would be the first
state in the country to adopt such broad, unprecedented
legislation. There would be no restrictions of optometrists
being able to obtain surgical privilege. Optometrists
provided a valuable service to communities and were an
integral part of the eyecare team. However, they were not
medical doctors and did not graduate from a comprehensive
surgical residency. There were only three states that
allowed optometrists restricted surgical authority. The
first was Oklahoma. In Oklahoma, optometrists expanded
scope to include surgeries because of language in a bill
similar to HB 103. He continued to provide background
regarding Oklahoma law. He had reminded the board of an
incident at the Palo Alto VA hospital where veterans were
hardened because of poor glaucoma follow-up. Because of the
incident the VA strengthened its directives prohibiting
optometrists from performing laser procedures - the same
procedures that would be allowed by the current language in
HB 103. He disagreed that the bill was similar to other
bills governing professional boards such as nursing,
dentistry, or engineers. Unlike nursing and dentistry,
optometry school was not a medical or surgical education.
Optometrists received about 1900 hours of clinical
education in their 4-year training compared to 20,000 hours
that ophthalmologists received, about one-tenth the medical
education. He disagreed that the bill was about governing
boards. He continued to provide a comparison between
education received by optometrists and ophthalmologists. He
thanked committee members.
4:13:47 PM
DAVID KARPIK, SELF, KENAI (via teleconference), was a
Doctor of Optometry. He spoke in support of HB 103. He
provided information on his professional background. He
suggested that the optometrist might be the only doctor
that a patient had access to because of Alaska's wide
geographic distribution. He reported that a recent
publication ranked Alaska 50th in access to health care.
All health care providers should practice within the scope
of their training. He supported the legislation due to its
simplicity. It would replace the aging current optometry
law that needed updating. He asserted the delay in updating
the old optometry statute hindered access to eyecare and
increased Medicaid travel costs in the state. Other
prescribing professions such as dentistry and advanced
practice nurses were regulated by their state board. The
Board of Optometry ensured protection of the public and
timely updates of practice. He thanked members for their
support of the bill. He brought up the procedures that had
been performed for decades by optometrists in their offices
legally and safely in Alaska. He suggested that opposition
had not familiarized themselves with current law. Treatment
was an integral part of the profession. He thanked him for
his time.
Co-Chair Seaton asked if there was opposition to removing
laser surgery from the scope of practice. Dr. Karpik
responded that training and technology changed all the
time. He thought the purpose of the bill was a durable
statute that would stand the test of time like the state
constitution. He was in favor of the current statute
language in the bill.
4:18:44 PM
JEFF GONNASON, CHAIR, ALASKA OPTOMETRY ASSOCIATION,
ANCHORAGE (via teleconference), spoke in favor of HB 103.
He was born and raised in Ketchikan and Craig and was the
first Alaska Native optometrist. He practiced in Anchorage
and performed clinics in the villages when he was a young
man. He suggested that HB 103 did not authorize any
optometrist to do anything. He relayed that of the four
independent prescribing professions only optometry had been
treated unfairly for several years. The Alaska Optometry
Board deserved to receive the same level of trust as other
health care professions. He opined that the optometry board
would never authorize any practice outside the scope of
education and training. Doctors of Optometry were held to
the same standard of care as any medical provider treating
patients. Section 5 of HB 103 was clear on the topic. The
optometry practice definition in Section 6 was modeled
after the exact wording from the Alaska dental statutes.
Dr. Gonnason continued that two opposition arguments had
prevailed over the course of the previous 40 years. The
first argument was that optometrists were a danger to the
public. The second argument was that optometry education
was not adequate. He thought both arguments had been proven
to be untrue. Optometry education and training was
identical to the dentist model requiring 8 years to 10
years of university level education and residencies.
Optometrists were real doctors. He relayed that optometrist
had been prescribing medications for 25 years including
prescribing scheduled narcotics for the past 10 years with
no issues of harm. Alaska optometry supported limiting
opioid use. Optometrists were defined as physicians under
federal Medicare. There had never been a case of patient
harm before the state optometry board involving
prescriptions of treatment. Yet, over the past 40 years,
the opposition had testified predicting terrible harm that
never occurred.
Dr. Gonnason argued that the clinical education of
optometrists did not have to parallel that of an
ophthalmologist any more than the education of a family
physician having to parallel that of a neuro surgeon. He
commented that optometrists and ophthalmologists did very
little of the same things. Optometrists did not do any of
the advanced specialty surgeries done by subspecialists.
Rather, they did minor procedures in which they were
competent. He suggested that surgery would be difficult to
define in statute because technically anything that touched
human tissue was surgery. He provided examples of surgery.
He thought the definition should be in regulations rather
than in statute to avoid having to come back to the
legislature for changes. He pointed to a letter in member
packets from a VA hospital where an optometrist did laser
procedures with zero incidents of harm. He referred to an
Oklahoma study which he thought was flawed. He was
available for questions.
4:23:20 PM
DR. GRIFF STEINER, SELF, ANCHORAGE (via teleconference),
was an ophthalmologist in Anchorage. He read from a
prepared statement:
The ophthalmologists and others that oppose this bill
(HB103) in no way want to prevent optometrists from
practicing to the full extent of their specialty and
training. This boils down to whether they intend to do
surgery, which would truly be inappropriate.
The bill should not pass as it currently written.
If the optometrists want an autonomous board, but no
surgery, then a concise definition of surgery can
easily be added. If they oppose a definition of
surgery, it can only mean they want to perform
surgery. More than one optometrist has approached you
indicating a desire to do a type of laser called YAG
laser capsulotomy. They have not used these words,
because capsulotomy means to cut a hole in the
capsule. They instead have described this as "shining
a light in the eye to clear up some clouding." But,
the laser does not shine as it is invisible. The
invisible light needs a second laser "HeNe" beam
(Helium-neon) to focus the primary cutting laser. This
laser cuts a hole in the membrane that holds the lens
implant in place following cataract surgery (the
removal of the natural lens when is has become
cloudy). This is not a benign procedure, particularly
in those without proper surgical training. This laser
cuts a hole in a critical tissue in the eye and there
is no shining involved.
This is just one example, but is the first surgery
they intend to approve.
Ask them if they want to do surgery. It was not
appropriate.
Dr. Steiner was available for questions.
Representative Wilson clarified that optometrists did the
procedure currently. Dr. Steiner indicated that they did
not do the procedure in Alaska. He thought only one or two
states allowed it, Oklahoma and maybe Kentucky. He believed
that it would be the first procedure approved by the Board
of Optometrists. It was the type of procedure optometrists
would advance into - something they have not been trained
to do or have ever done.
Representative Wilson asked if additional training had been
offered in the two states he mentioned. Dr. Steiner was
aware that a weekend course was offered on how to do a
laser procedure. Following the training, optometrists were
approved by their boards.
4:27:57 PM
AT EASE
4:28:10 PM
RECONVENED
Co-Chair Foster CLOSED Public Testimony.
Co-Chair Foster relayed that amendments were due by Monday,
at 5:00 PM.
HB 103 was HEARD and HELD in committee for further
consideration.
4:28:35 PM
AT EASE
4:31:48 PM
RECONVENED
Co-Chair Foster indicated that he was going to change the
deadline for the amendments to HB 103. He relayed that they
were now due by Friday, April 14th by noon.