Legislature(2015 - 2016)BUTROVICH 205
03/18/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB23 | |
| SB55 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 23 | TELECONFERENCED | |
| *+ | SB 55 | TELECONFERENCED | |
| + | TELECONFERENCED |
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.