Legislature(2017 - 2018)SENATE FINANCE 532
05/10/2017 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB222 | |
| HB103 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 222 | TELECONFERENCED | |
| + | HB 103 | TELECONFERENCED | |
| += | HB 111 | TELECONFERENCED | |
| + | SB 79 | TELECONFERENCED | |
| + | TELECONFERENCED |
CS FOR HOUSE BILL NO. 103(FIN)
"An Act relating to the practice of optometry; and
providing for an effective date."
10:22:52 AM
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, introduced the bill.
She relayed that HB 103, as amended in the house, would not
allow optometrists to perform services outside of their
scope of practice; performing invasive surgery would
continue to be illegal. She said that if optometrists
wanted to perform procedures beyond what was currently
allowed in statute and regulation, they would only be
allowed to do so if the licensee had been educated and
trained in the procedure at one of the accredited schools
of optometry. Additionally, procedures would need to be
authorized by regulations adopted by the board. She stated
that there should be room for innovation in the healthcare
sector, but that optometrists should only practice
procedures that had been taught by a credited school of
optometry. She noted that the ophthalmologist definition of
"surgery" was used in the bill, which expressly stated that
optometrists would not practice any of the listed
surgeries, with narrow exceptions. She relayed that the
definition of "surgery" was broad and that some of the
things that optometrists currently practiced met the
definition of surgery. She added that there had to be an
allowance for narrow exceptions, which would change over
time as the skills and training of optometrists continued.
She offered a personal anecdote pertaining to the nebulous
definition of surgery under the current law. She concluded
that the bill would allow for the board of optometry to
regulate itself in an ongoing and iterative fashion that
would allow for evolution in best practices.
10:27:29 AM
BERNICE NISBETT, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,
discussed the sectional analysis for HB 103:
Notes differences between HB 103 v. U and SB 36 v. J
Section 1 - The Board of Examiners of Optometry will
regulate prescriptive authority and develop standards
for the practice of optometry. No difference.
Section 2 - The board will publish advisory opinions
regarding standards for the practice of optometry.
Language was changed by the House Labor & Commerce
committee: expanded to state that the Board of
Examiners of Optometry will be allowed to publish
advisory opinions to the public regarding whether the
standards of practice of optometry comply with what is
currently written in statute.
Section 3 - The licensee must provide evidence that
they have completed their continuing education hours
during the preceding licensing period. No difference.
Section 4 - A licensee can prescribe pharmaceuticals
in a manner that is consistent with board regulations
and complies with the limitation on practice in
section 5. No difference.
Section 5 - Limits an individual licensee to
performing services that are within the scope of the
licensee's education, training, and experience. No
difference in subsection (a). Subsections (b) and (c)
were added in the House Finance committee: (b) added
setting a limitation on performing ophthalmic surgery
unless a licensee has received education and training
from an accredited school of optometry and the
procedure is authorized in regulations set by the
Board of Examiners of Optometry. Subsection (c) has
been added to define ophthalmic surgery.
Section 6 - The definition of optometry has been
updated. No difference.
Section 7 - Section 2 is effective July 17, 2017. No
difference.
10:29:11 AM
Representative Spohnholz stressed the importance that the
board have the flexibility to evolve, while also addressing
the issue of access to healthcare. She said that there were
26 ophthalmologists, verses 160 optometrists, providing the
majority of eye healthcare throughout the state. She
thought that allowing the board to manage itself would help
to increase access to high quality eye healthcare in rural
Alaska.
10:30:40 AM
Senator Hughes asked about Page 2, line 29. She asked about
the word "experience" and wondered how it applied to
someone fresh out of school. She wondered how experience
would be measured.
Representative Spohnholz explained that there were
optometrists practicing in the state that had been trained
in procedures that they had not had the opportunity to
provide in 20 years. She said that before those doctors
could practice those procedures they would be expected to
be retrained in updated methods.
Senator Hughes remained confused about how the experience
levels would be measured.
Representative Spohnholz referred the question to the board
of optometry.
Co-Chair MacKinnon OPENED public testimony.
10:33:41 AM
DAVID ZUMBRO, OPHTHALMOLOGIST, ANCHORAGE (via
teleconference), spoke in opposition to HB 103. He spoke to
the assertion that the statutes pertaining to optometry had
not been updated in 40 years; he countered that multiple
times in the past 25 years legislation had been passed and
signed into law that expanded the scope of practice. He
contended that optometry and ophthalmology educations were
not equivalent or similar. He encouraged members to further
study the accreditation requirements for completing an
ophthalmology residency. He said that his opposition to the
bill had nothing to do with economics. He contended that
the reason behind standards and board certification was
patient safety, and that the only way to expand medical and
surgical scope of practice was proper education and not
legislation.
10:36:58 AM
JEFF GONNASON, CHAIR, ALASKA OPTOMETRY ASSOCIATION,
ANCHORAGE (via teleconference), spoke in support of the
bill. He believed that the bill was innocuous and would do
very little to the practice of optometry in the state. He
noted that he had sent a letter to the committee (copy on
file).
10:38:34 AM
GRIFF STEINER, OPHTHALMOLOGIST, ANCHORAGE, testified in
opposition to the bill. He asserted that the bill pertained
to surgical procedures. He stated that optometrists were
not qualified to perform surgery. He relayed that the cost
for care would increase under the legislation.
10:40:47 AM
ANDREW PETER, SELF, HOMER (via teleconference), spoke in
support of HB 103. He believed that the bill would create
board autonomy, which would remove the legislature from the
position of managing optometry. He noted that optometrists
catered to a diverse section of the state's population. He
offered some details as to how his practice worked on a
day-to-day basis. He contended that emergency cases in
rural areas of the state posed the need for immediate
attention, which occasionally called for optometrists to
perform services like ophthalmologists.
10:44:07 AM
CARL ROSEN, OPHTHALMOLOGIST, ANCHORAGE (via
teleconference), testified in strong opposition to the
bill. He highlighted that the optometry board should not
have the authority to decide which surgical procedures,
laser procedures, and injections were possible. He argued
that optometrists were not qualified to perform the same
medical procedures as ophthalmologists because they did not
have the same rigorous medical training. He believed that
the bill would work if the word "unless" was removed from
the language pertaining to surgery and optometry.
10:46:43 AM
REBEKAH SAWERS, SELF, HOONAH (via teleconference), spoke in
opposition to the bill.
10:47:08 AM
LUCRETIA DENNIS, SELF, ANCHORAGE (via teleconference),
testified in opposition to the bill. She provided a
comparison between armed and unarmed security officers, and
ophthalmologists versus optometrists.
10:50:13 AM
DAVID KARPIK, SELF, KENAI (via teleconference), spoke in
support of HB 103. He testified that optometrists were
sometimes the only eyecare providers in rural Alaska. He
said that as an optometrist he supported practices that
provided comprehensive eyecare services and referred to
sub-special services, which enhanced patient care and
lowered costs by allowing primary eyecare to be provided
locally. He referred to a U.S News and World report study
published in early 2017, that ranked Alaska as last in
access to healthcare. He believed that the delays to
healthcare that were currently written into statute
hindered access to eyecare. He believed that the
legislation would create an optometry statute that would be
durable and would allow for the incorporation of new
technology in the field.
10:52:38 AM
DAVID KATZEEK, SELF, JUNEAU (via teleconference), spoke in
opposition to HB 103. He testified of the delicate nature
and importance of the human eye. He asserted that eyes
"speak" in a way understood by optometrists and
ophthalmologists. He worried that the bill was being used
as a political tool at the expense of the eye health of
Alaskans. He warned that the legislation passed by the
committee should protect the eyes of current and future
Alaskans. He stressed the importance of teaching young
people to maintain a health whole body, which included
their eyes.
10:57:28 AM
STANLEY FULLER MD, SELF, FAIRBANKS (via teleconference),
testified in opposition to the bill. He noted that the
expansion of the scope of practice for optometrists was an
issue that was being discussed on the national level, and
what more than just a housekeeping issue. He believed that
the legislation would allow optometrists to perform
surgery, which would result in dangerous and unsafe
practices. He stressed that optometrists were not trained
in surgical procedures, and that optometry schools did not
offer training in surgical procedures. He agreed that
access to healthcare in Alaska was a problem, but he felt
that access to providers that were appropriately trained to
safely perform procedures should be germane to the
conversation.
11:00:35 AM
MARY NANUWAK, SELF, BETHEL (via teleconference), spoke in
opposition to the bill. She provided remarks in Yup'ik. She
thanked the committee for allowing her to testify. She
believed that optometrists should not be performing eye
surgery.
11:03:22 AM
JILL GEERING MATHESON, OPTOMETRY, JUNEAU, spoke in support
of the bill. She believed that the intent of the
legislation was to allow the Alaska State Board of
Optometry to regulate optometrists in the state. She
asserted that the bill would not expand the privileges
allowed to optometrists, but would give the optometry board
the ability to decide what optometrists were trained and
qualified to perform and then provide for regulation. She
believed that the opposition was employing fear tactics
concerning surgery to sway public opinion on the bill. She
argued that the board needed to be able to act quickly, via
the regulatory process, to make changes as technology
advanced.
11:07:00 AM
PAUL BARNEY, BOARD OF OPTOMETRY, JUNEAU, testified in
support of the bill. He discussed his experience in the
field. He believed that the bill would allow for the board
of optometry to regulate the details of the practice of
optometry, and would allow optometrists to practice to
their highest education level. He felt that the bill
clearly defined "surgery".
11:10:31 AM
Senator Olson asked what kind of complaints the board
received from licensees.
Dr. Barney relayed that he had been on the board for the
past 6 years and in that time the board had received zero
complaints.
Senator Olson asked whether Dr. Barney was familiar with
the Oklahoma study that had been referenced earlier in the
meeting.
Dr. Barney replied that he was familiar with the study. He
said that the study was regarding a laser trabeculoplasty,
which was a surgery used to lower pressure in glaucoma. He
said that the study examined billing codes. He spoke to the
details of the study and concluded that it had not
accurately examined outcomes of different surgery
procedures.
11:12:52 AM
Senator von Imhof stated that she had researched an
optometry school in Ohio. She felt that an accredited
school of optometry could license a person to perform
ophthalmic surgery non-invasively.
Dr. Barney stated that he performed procedures daily that
were considered surgery. He added that there were different
levels to ophthalmic surgery.
11:14:35 AM
Co-Chair MacKinnon CLOSED public testimony.
11:14:57 AM
RECESSED
2:37:40 PM
RECONVENED
Co-Chair MacKinnon discussed housekeeping.
Senator Olson asked whether the Alaska Native Tribal Health
Consortium (ANTHC) supported the legislation.
Ms. Nisbett responded that ANTHC had not provided any
comments regarding HB 103.
Senator Olson understood that the Southcentral Foundation
had provided an opinion on the legislation.
Ms. Nisbett relayed that the bill carried with it a letter
of support from the Southcentral Foundation, in addition to
one from the Alaska Native Health Board.
Senator Olson commented that healthcare was primarily
handled by tribal health corporations in Western and
Southern Alaska. He asked whether the sponsor had been in
contact with tribal health corporations regarding HB 103.
Ms. Nisbett stated that the sponsor's office had not
reached out to those organizations, but would be willing to
do so.
2:40:06 PM
Senator Hughes referred to her earlier question about how
experience would be quantified for new optometrists. She
wondered whether Dr. Barney could speak to the issue.
Dr. Barney provided that as part of their clinical training
optometrists would experience any procedures that needed to
be done, which would provide them with the necessary
experience upon graduation.
Senator Hughes asked what procedures a newly graduated
optometrist in the state was trained to do, but could not
currently execute due to current statutes.
Dr. Barney provided the example of removal of minor eye lid
lesions. He said that optometrists would receive education
and training for the procedure during optometry school, but
that state statute currently did not allow for optometrists
to perform the procedure.
Senator Hughes understood that the bill would give the
board the authority through regulation to allow for
practices within the scope of the licensee's education and
training from an accredited school of optometry. She asked
how, as a board member, Dr. Barney would make decisions as
to whether a procedure could be performed by an
optometrist.
Dr. Barney explained that the federal accreditation process
for optometry schools within the state was overseen by the
U.S. Department of Education. He said that there would be
federal oversight into the curricula to assure that it was
complete and thorough. He stated that an optometrist that
had been practicing for 20 years that wanted to perform a
board approved procedure would be required by the board to
acquire the proper updated training.
2:44:48 PM
Vice-Chair Bishop discussed FN2(CED) for the bill.
2:46:15 PM
Co-Chair MacKinnon noted that Senator Giessel had sponsored
the Senate companion bill for HB 103.
SENATOR CATHY GIESSEL, remarked that she supported the
changes that had been made in the house version of the
legislation.
2:46:58 PM
Vice-Chair Bishop 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 "no
recommendation" and with one previously published fiscal
impact note: FN2(CED).
2:47:30 PM
AT EASE
2:49:40 PM
RECONVENED
Co-Chair MacKinnon discussed housekeeping for SB 79 and HB
111. She stated that each member's office had received a
Senate Finance Committee Resolution that pertained to the
Real ID Act and the handling of Alaskan's private data.