Legislature(2017 - 2018)BUTROVICH 205
02/15/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB36 | |
| SB32 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 36 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 32 | TELECONFERENCED | |
SB 36-OPTOMETRY & OPTOMETRISTS
1:33:22 PM
CHAIR WILSON announced the consideration of SB 36. He welcomed
invited testimony to address SB 36.
1:34:05 PM
DR. PAUL BARNEY, Chairman; Board of Examiners in Optometry,
Corporations, Business & Professional Licensing; Alaska
Department of Commerce, Community, and Economic Development;
Juneau, Alaska; testified in support of SB 36. He noted that he
has served on the board for five years and was also the director
for Pacific Cataract and Laser Institute in Anchorage, Alaska.
He detailed that his practice specializes in cataract care,
laser vision correction, and medical eye-care. He pointed out
that he works with an ophthalmic surgeon and an advanced-
practice nurse; together they work as a team and use their
training to provide care more efficiently and affordably.
He emphasized that SB 36 would not allow optometrists to do
anything more than what they have already been trained to do. He
specified that there is a limitation that would prevent
optometrists from writing regulations beyond the scope of their
training. He revealed that the Alaska the Department of Law
oversees all health-care boards; consequently, the Board of
Examiners in Optometry has to prove that optometrists are
trained for the regulations that they write. He asserted that
the Alaska Department of Law oversight acts as a fail-safe to
prevent optometrists from doing something outside of their scope
of training. He added that as a provider, if he were to do
something outside of his scope of training, his medical
malpractice insurance would be immediately negated. He
summarized that there really is no incentive for optometrists to
provide care that they are not trained to do because they would
not get paid and more importantly, optometrists could end their
careers by doing something outside of their scope of training.
1:37:11 PM
DR. JEFF GONNASON, Legislative Chairman, Alaska Optometric
Association, Anchorage, Alaska, testified in support of SB 36.
He disclosed that he has been licensed as an optometrist in
Alaska for 40 years, the past chairman of the Board of Examiners
in Optometry, and served twice on the state board in the past
under two different governors. He added that he was also a 22-
year volunteer for the American Optometric Association.
He pointed out that optometrists' education is exactly the same
as a dentistry-model with 8 to 10 years of university-level
education. He addressed testimony from an ophthalmologist during
an earlier committee meeting and noted that he had the same
professor for pharmacology as the ophthalmologist.
DR. GONNASON disclosed that optometrists are defined as
physicians under federal Medicare and that has been the case for
approximately 18 years. He divulged that 160-plus optometrists
serve over 80 communities in the state. He set forth that
optometrists work together very well with general-family doctors
and ophthalmologists.
He opined that optometrist training cannot be compared to
ophthalmologist training because it would be like comparing a
family physician with a neurosurgeon. He summarized as follows:
We need ophthalmologists, we love having their
abilities to do their surgeries, we only overlap in a
small area; but, we do very few of the things that
they do and we are not trying to do things that are
outside of our scope of training. Of the four-
prescribing professions, only optometry has to always
come back to, "Ask daddy for permission" to change
something as technology goes along. We are very
skilled in using our professional judgement to know
when to refer patients.
1:39:56 PM
SENATOR BEGICH revealed that Dr. Barney did his Lasik eye
surgery.
DR. BARNEY clarified that Dr. Ford from Seattle did Senator
Begich's surgery. He specified that he did the preoperative
evaluation and the postoperative care.
SENATOR BEGICH disclosed that he had talked earlier with Dr.
Barney and Dr. Gonnason to express his concerns about the
Legislature's responsibility to public safety. He said he asked
both doctors about the importance in clarifying surgery in a way
that would meet the American Medical Association's health
concerns as well as meet some of the needs and interests of what
optometrists in Alaska are doing. He said he suggested to Dr.
Barney that language around surgery might be required and noted
that Dr. Barney appeared to respond that his suggestion made
sense. He asked Dr. Barney to comment on the idea of a tighter
surgery definition to help committee members understand what the
optometrists are seeking in statute.
1:42:06 PM
DR. BARNEY replied that if necessary, he is not opposed to
language that further defines surgery.
SENATOR BEGICH set forth that his hope is the committee can come
to a conclusion that further defines surgery.
1:44:03 PM
DR. GONNASON remarked that part of the difficulty is that
"forces" have tried to suppress the optometrist profession for a
long time. He said to answer Senator Begich's question on
surgery, the problem is everyone knows what surgery is, but
trying to define surgery can get murky. He pointed out that
clipping a finger nail alters tissue and can be considered
surgery. He noted that some states have defined surgery for
physicians and dentists. He remarked that putting a surgery
definition in SB 36 would apply to other fields too, unless
exempted. He opined that details should be left to the medical,
dental, and nursing boards. He pointed out that there in nothing
in the nursing statute that says, "You will not do brain
surgery" because nurses do not do that. He asserted that there's
no need for defining surgery in the optometry law that says,
"You will not do these 16 things." He noted that a proposal came
out to put 110 procedures that could not be done in statute, a
proposal that made no sense. He emphasized that optometrists
perform procedures that do not "penetrate." He added that
optometrists do not do the things that ophthalmologists claim
optometrists will be trying to do.
1:46:26 PM
SENATOR BEGICH stated that Dr. Gonnason's reply is more
difficult for him to understand. He said he thought Dr. Gonnason
provided a clear answer that surgery as a definition might be
something that he would entertain. He continued as follows:
You understood that concern and we do have a
definition of surgery in statute and admittedly part
of why we have a legislative-affairs agency here that
drafts bills is that they look at other statutes where
those definitions will conflict, and they identify in
those statutes where they do and they allow us to know
that in the process because all of us are generally
generalists here. With that understanding, a
definition of surgery is a norm in many states and
I've provided to some members of the committee some of
those definitions that I've researched some myself. I
am now confused whether you are or are not willing to
look at a definition of surgery in statute because
I've heard you now say "no," and I heard Dr. Barney
say "yes." So which is it, I'm confused.
DR. GONNASON clarified that he did not mean he would not look at
a definition of surgery. He specified that he was trying to
explain why defining surgery is difficult and pointed out that
most states address through regulation. He remarked that laws
are different in all 50 states due to legislative compromise
that results in optometrists having to go back and ask for
permission when new technology comes along rather than having
the board be able to say "yes" when an optometrist is trained
for a procedure.
1:48:29 PM
SENATOR VON IMHOF addressed Dr. Gonnason's remarks as follows:
Trying to create a bill, any bill, so open ended that
it precludes having to go back and change statute as
technology changes, as circumstances changes, is
probably too difficult in any industry. I'm already
noticing that we are tweaking things now in this
legislature for all sorts of different things as new
chemicals come about, as new technology comes about,
as new laws come about, that's just the nature of the
beast, I think.
That being said, what I'm understanding is that this
particular conflict has been around for quite some
time and I understand the challenge of optometrists
having to come legislatively every single time, it's
not cost effective for any stakeholder. So the key is
to stop this nonsense and to move forward that while
we may find a solution that not everyone is happy
with, everyone can live with.
I think what's important is Senator Begich and I and a
few others have looked at what other states have done,
some are more onerous than others, but some have tried
to thread-the-needle to make it make sense for all
parties. I think what Senator Begich was asking you
today for a deliverable is to perhaps, could you take
a first crack at what you think based on other states'
legislation, what might make sense.
1:50:28 PM
At ease.
1:50:38 PM
CHAIR WILSON called the committee back to order.
SENATOR GIESSEL said she was thrilled that Senator Begich has
done research on the definition of surgery, but noted that she
was one of the committee members that did not receive his
information.
She asked Dr. Barney to address the number of patient complaints
that the Board of Examiners in Optometry has received in the
last decade.
DR. BARNEY answered that there have been some complaints, but no
complaints that required disciplinary action over the past ten
years.
SENATOR GIESSEL asked Dr. Barney if the Board of Examiners in
Optometry was in good standing financially with regards to
licensing fees covering their costs.
DR. BARNEY replied that the board is currently in good standing.
He noted that the last scope-of-practice bill passed 10 years
ago and the board had to address legal expenses implemented from
the scope-of-practice change.
SENATOR GIESSEL asked Dr. Barney to clarify the legal issues
that he referenced.
1:52:57 PM
DR. BARNEY specified that the Alaska Department of Law billed
the board for their investigative work involved with the scope-
of-practice change. He detailed that license fees were not
increased, and the board fell behind, but noted that the board
will be caught up in the next cycle.
SENATOR GIESSEL asked him to verify that the board pays the cost
in implementing regulatory changes and the funding ultimately
comes from licensees.
DR. BARNEY answered correct.
CHAIR WILSON asked for final comments from the bill's sponsor.
1:54:15 PM
SENATOR GIESSEL summarized intent and issues of SB 36 as
follows:
I think Senator von Imhof really encapsulated it, this
has been an issue that has been discussed multiple
times over at least a decade, it continues to take
time in this legislature; in that time optometrists
have been practicing safely. You've heard testimony
that professional complaints against their practice
are zero. I think it is time to allow this board to
function as other boards do.
I have the definitions of the scope-of-practice for
the four boards that currently have authority over
their regulation, over their regulatory authority and
that is: nursing, physicians, dentistry, and pharmacy.
All are extremely broad, I will speak only of my own
advanced nurse practitioner scope-of-practice, it
means that, "A registered nurse authorized to practice
in the state, who because of specialized education and
experience, is certified to perform acts of medical
diagnosis and the prescription and dispensing of
medical, therapeutic or corrective measures under
regulations adopted by the board."
One of the really interesting ones is for the scope-
of-practice for medicine and osteopathy. Osteopaths
are not medical doctors, they are doctors of
osteopathy, this is a subspecialty so to speak that
believes that adjustment of the spine is often an
answer to medical problems, they however fall into the
same definition and says, "For a fee, donation or
other consideration, to diagnose, treat, operate on or
prescribe for or administer to any human ailment,
blemish, deformity, disease, disfigurement, disorder,
injury or other mental or physical condition, or to
attempt to perform or represent that a person is
authorized to perform any of the acts set out in the
subparagraph;" I think listening to that you can hear
that the practice of medicine is all encompassing of
everything possible that could happen to a human
being. We don't worry that a family practice doctor is
going to attempt heart surgery, we don't worry about
that. I suggest that the same reasonable outlook could
be applied to optometry.
1:56:39 PM
CHAIR WILSON announced that hearing no call for amendments,
asked for a motion to move SB 36 out of committee.
1:56:51 PM
SENATOR VON IMHOF moved to report SB 36, [30-LS0328\A], from
committee with individual recommendations and attached fiscal
note(s).
1:57:02 PM
CHAIR WILSON announced that seeing no objection SB 36 moved from
the Senate Health and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| ASPS Comments - Scope Optometric - AK SB36 - 02-13-2017.pdf |
SHSS 2/15/2017 1:30:00 PM |
SB 36 |
| Carmen Moore - oppose.pdf |
SHSS 2/15/2017 1:30:00 PM |
SB 36 |
| Drug schedules - Giessel.pdf |
SHSS 2/15/2017 1:30:00 PM |
SB 36 |
| New Mexico House Business & Industry Committee Letter 2007.pdf |
SHSS 2/15/2017 1:30:00 PM |
SB 36 |
| SB 32 Legislation - Version J.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB 36 ASMA oppose.pdf |
SHSS 2/15/2017 1:30:00 PM |
SB 36 |
| Alaska Biosimilars Arth Fdn oppose amendment sb 32.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB32 - Clarification on Questions Asked in the Committee (Sen Hughes).doc |
HHSS 4/13/2017 3:00:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB32_ASMA.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB 32 Am No. 1.PDF |
SHSS 2/15/2017 1:30:00 PM |
SB 32 |