Legislature(2015 - 2016)BELTZ 105 (TSBldg)
03/10/2016 01:30 PM Senate LABOR & COMMERCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB168 | |
| SB55 | |
| SB197 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 55 | TELECONFERENCED | |
| *+ | SB 197 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 168 | TELECONFERENCED | |
SB 55-OPTOMETRY & OPTOMETRISTS
1:32:55 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SB 55.
SENATOR CATHY GIESSEL, Alaska State Legislature, sponsor of SB
55, introduced the legislation, speaking to the following
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 detractors will say the bill would
allow optometrists to perform surgery on the eye, and that is
not true. That authority is specifically prohibited in the bill.
Current statute already authorizes Alaska optometrists to do
superficial surgical procedures such as removal of corneal
foreign bodies, but nothing invasive would be allowed.
She said the vast majority of Alaskans visit one of Alaska's
[195] optometrists for their eye care needs. By contrast, there
are approximately 20 ophthalmologists in Alaska. They are eye
surgeons. It's these 20 ophthalmologists who are opposing this
bill, she said. She discussed the history of the credible, safe
healthcare providers that were routinely opposed by physician
groups to regulate themselves and highlighted that safe,
affordable healthcare was expanded when the legislature listened
to the facts. She also point out that optometrists have one of
the lowest malpractice insurance rates in the nation.
SENATOR GIESSEL summarized that SB 55 gives the Board of
Examiners in Optometry the authority to oversee and regulate its
own profession, just as other professional boards are trusted to
do.
1:39:27 PM
JANE CONWAY, Staff, Senator Cathy Giessel, presented the
following sectional analysis for SB 55 on behalf of the sponsor:
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."
1:41:34 PM
CHAIR COSTELLO asked what pharmaceutical agents optometrists are
currently allowed to prescribe and how the bill expands that
authority.
SENATOR GIESSEL said optometrists can prescribe simple
antibiotics as well as schedule II and schedule III opioids.
Responding to a further question, she said the bill would allow
any updates to be regulated by the board. For example, it could
adjust to federal regulation changes without coming before the
legislature.
CHAIR COSTELLO asked the statutory definition of "optometry" and
if the bill changes that.
MS. CONWAY read the definition of "optometry" in AS 08.72.300(3)
found on page 2, lines 24-27. The bill repeals and reenacts that
section of statute.
CHAIR COSTELLO asked how the definition changed when the
definition was repealed and reenacted.
1:44:53 PM
MS. CONWAY said it's very similar but the new definition removed
specific reference to x-rays and scans. They were removed
because those things are already being practiced within the
scope of optometrists' education.
CHAIR COSTELLO asked if including the term "preventive
procedures" within the definition is intentional.
SENATOR GIESSEL deferred the question to optometrists online.
CHAIR COSTELLO asked if the bill makes Alaska unique compared to
other states.
MS. CONWAY said it's unique in that other states allow more use
of lasers and other techniques that will continue to be
prohibited in Alaska.
1:46:59 PM
SENATOR STEVENS asked who makes up the board, its powers, and if
it is limited to regulating optometrists.
SENATOR GIESSEL said ophthalmologists are eye surgeons and are
regulated by the State Medical Board. Optometrists are regulated
by the Board of Optometry, which is a five-member board
consisting of one public member and four practicing
optometrists.
SENATOR STEVENS asked if the Board of Optometry has the power to
authorize the increased use of lasers.
SENATOR GIESSEL clarified that laser technology currently is
used in diagnostic procedures, and the board only authorizes
practices for which the person is educated.
SENATOR STEVENS asked for information on injections in the eye.
SENATOR GIESSEL explained that optometrists are prohibited from
performing an intravitreal injection.
SENATOR STEVENS asked what modifications were made to [AS
08.72.272].
1:51:30 PM
MS. CONWAY explained that subsection (e) was added to
specifically state that a licensee cannot perform an
intravitreal injection.
SENATOR MEYER asked what the educational requirements are for
optometrists.
SENATOR GIESSEL read the qualifications in AS 08.72.140; the
education is doctoral level and has a residency option.
MS. CONWAY added that it's 4 years for a bachelor's degree, an
additional 4 years in optometry school, and an optional
residency.
SENATOR MEYER asked if optometrists would be prohibited from
treating conditions of the eyelid.
SENATOR GIESSEL replied optometrist currently are qualified to
remove fish hooks, metal fragments from the cornea, debris from
the eye, and treat maladies of the eyelid such as a stye.
SENATOR MEYER asked if the bill expands what optometrists can do
to the eyelid.
SENATOR GIESSEL answered no.
CHAIR COSTELLO asked if she said that ophthalmologists do not
have a separate board; they are regulated by the State Medical
Board so they.
SENATOR GIESSEL replied ophthalmologists are specialty surgeons
regulated by the State Medical Board. An ophthalmologist may or
may not sit on that board, but they do not have their own board.
CHAIR COSTELLO mentioned the list in the packets and asked if
the bill will shift work away from ophthalmologists toward
optometrists.
SENATOR GIESSEL indicated that optometrists will continue to
practice within the scope of their education and refer patients
to ophthalmologists when appropriate.
1:56:38 PM
CHAIR COSTELLO asked Ms. Hovenden to address the fiscal note and
tell the committee whether or not the administration has a
position on the bill.
1:57:11 PM
JANEY HOVENDEN, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), said the division doesn't have a
position on SB 55 because of the situation that two boards have
opposing views. She explained that the fiscal note reflects a
$2,500 regulations project. This is a receipt supported service
so the costs would be paid for by licensing fees.
CHAIR COSTELLO opened public testimony.
1:58:19 PM
FORREST MESSERSCHMIDT, Optometrist, said he is representing
himself and the Alaska Optometric Association testifying in
support of SB 55. He has been practicing for 27 years and just
completed a four-year term on the Board of Examiners in
Optometry. He described SB 55 as good legislation. It puts the
regulation of optometry where it belongs, modernizes the
statutes, allows details of regulation to be determined by the
board, and is the current standard with other professions in
Alaska. Optometrists should be held to the same high standard of
care as other medical professionals, but it defies logic to
suggest that the profession cannot regulate standards through
its own board.
He talked about how eye care has changed in the last 27 years;
now more than 70 percent of his patient business is medically
oriented. A few years ago many of the cases he manages would
have required referrals. Consultations and close work with eye
surgeons and other medical providers is done on a daily basis.
DR. MESSERSCHMIDT said there will be claims that harm will come
if SB 55 passes, but the past 40 years of optometry scope
expansion law has not shown that to be the case. Optometry
malpractice insurance rates are among the lowest of all
providers for a reason. He said the people that don't like the
bill miss the point that this is all about patients' best
interest. There are not enough skilled ophthalmologists to serve
the population, so all eye care physicians need to be able to
practice to their full level of training and expertise.
DR. MESSERSCHMIDT said his practice won't change with the
passage of SB 55, and it probably won't change for other
optometric physicians practicing in Alaska. He concluded saying
that SB 55 is good for optometry and it's good for Alaskans.
2:02:26 PM
SENATOR STEVENS asked if the responsibilities of the board will
increase if SB 55 were to pass.
DR. MESSERSCHMIDT replied it will be a bigger job for the board
but it won't change the mindset.
2:03:36 PM
JILL MATHESON, Optometrist, said she is representing herself and
the Alaska Optometric Association testifying in support of SB
55. She has served two terms on the board, once as chair. As a
practicing optometrist for over 24 years she has testified on
four different optometry bills. Each time the legislature has
carefully considered the information put forth and passed bills
to get the optometry profession where it is today. SB 55 is the
next step. It gives the board the autonomy to run the optometric
profession in the state. The legislature continues to have
oversight by approving members of the board. The malpractice
insurance rates are under $500 per year, which is an indication
that the profession is run safely and conservatively. She opined
that the bill protects the public by keeping optometrists at the
highest level of training.
2:06:42 PM
SENATOR STEVENS asked how she gets training.
DR MATHESON replied continuing education is offered in different
locations throughout the state and approved classes are also
offered at the numerous optometry conferences. Optometry schools
also offer continuing education classes. She discussed what
qualifies as continuing education and noted that when
optometrists were approved to do injections, a class was offered
in the state to ensure that optometrists received the training
if they hadn't gotten it in school.
CHAIR COSTELLO asked if optometrists charge by the hour or
procedure.
DR. MATHESON replied charges are based on the procedure.
CHAIR COSTELLO asked how optometrist charges compare to
ophthalmologist charges.
DR. MATHESON said she doesn't know but the reimbursement rate
from insurance companies is the same because it's based on the
procedure.
2:09:24 PM
OLIVER JORSHIN, Ophthalmologist, testified in opposition to SB
55. He has been in private practice since 1985 and before that
was chief of ophthalmology at the Alaska Native Medical Center.
He related that he has had four years of medical school, a year
internship in internal medicine, and an obligatory three-year
residency in ophthalmology. He has worked alongside optometrists
and is well acquainted with their skills in diagnosing and
treating eye conditions. His respect for the profession is
great, but optometrists are not medical doctors.
DR. JORSHIN maintained that the broad language in SB 55
substitutes the judgement of the members of the board of
optometry for the years of training and experience
ophthalmologists must go through before they can practice. The
bill defines what surgery an optometrist cannot perform, but
leaves open what they can perform. Invasive surgery is
prohibited but is defined in such narrow terms that optometrists
could legally perform complex procedures that involve the
eyeball, eyelid, eye socket, and surrounding tissues. He
questioned why the bill permits optometrists to use controlled
substances when they are used so infrequently in ophthalmology.
He related his experience is to write such a prescription every
couple of years. Also, adding a new class of subscribers won't
help alleviate the epidemic of misuse of prescription narcotics.
He urged the committee to vote against the bill in the interest
of patient safety.
2:13:28 PM
RACHEL REINHARDT, Ophthalmologist, American Academy of
Ophthalmology, testified in opposition to SB 55. She explained
her concern with how the bill relates to surgery. She noted only
four other states allow lasers. 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 expressed concern that the bill allows the use of
prescription narcotics, which undermines state and federal
efforts to stem the epidemic of prescription narcotic abuse. She
said the claim that Alaskan's have limited access to
ophthalmologists isn't a valid argument. The ratio of
ophthalmologists to residents is about one in 24,000 in
Washington state and about one in 27,000 in Alaska. She
concluded that if the proponents of the bill say it's not a
surgery bill, it either needs to be rejected or redrafted.
CHAIR COSTELLO asked how the malpractice rates were affected in
the four states that allow lasers.
DR. REINHARDT said it's too early to have any data.
SENATOR STEVENS asked how often she prescribes a prescription
narcotics to a patient.
DR. REINHARDT said it's rare and generally for a surgical
patient.
2:23:32 PM
JEFF GONNASON, Optometrist and Legislative Chair, Alaska
Optometry Association, testified in support of SB 55. He shared
his professional background. He shared the history of Alaska's
optometric journey and the opposition by the American Academy of
Ophthalmology. He described how optometrists work, their
limitations on practice, and that they use their professional
judgement as to when to refer patients to specialists.
Optometrists have been defined as physicians under Medicare for
many years and have had the authority to prescribe narcotics for
nine years. SB 55 updates the statutes and gives the state board
better autonomy to regulate itself. The board would never
authorize optometrists to do anything they are not trained to
do.
2:27:56 PM
CHAIR COSTELLO held SB 55 in committee with public testimony
open.