04/15/1999 01:40 PM Senate L&C

                                                                                                                                
               SB 78-USE OF DRUGS BY OPTOMETRISTS                                                                               
CHAIRMAN MACKIE called the Senate Labor and Commerce Committee                                                                  
meeting to order at 1:40 p.m. and announced SB 78 to be up for                                                                  
consideration.                                                                                                                  
                                                                                                                                
MR. DAVE GRAY, Staff to Senate Labor and Commerce Committee, said                                                               
that optometry is a primary health care profession that examines,                                                               
diagnoses, and treats disorders of the human eye and its appendages                                                             
utilizing diagnostic and therapeutic medications, methods, and                                                                  
procedures in accordance with professional training in competency.                                                              
Historically, medical doctors have enjoyed unlimited legislative                                                                
trust in their scope of practice.  However, the methods and                                                                     
procedures used by other limited license health care professionals,                                                             
such as optometrists, dentists, podiatrists, nurse practitioners,                                                               
and others, are determined in regulation by their respective state                                                              
boards.  In the past, Alaska's doctors of optometry have had their                                                              
scope of practice unduly restricted by outdated state statutes.                                                                 
For every new advance in technology, optometry has had to return to                                                             
the legislature to revise these statutes in order to practice at                                                                
the highest standard of care.  In 1988, the statutes were updated                                                               
to allow optometrists to use diagnostic drugs.  The Alaska                                                                      
Legislature was the last of the 50 states to pass this law.  In                                                                 
1992, the prescribing of therapeutic drugs to treat eye diseases                                                                
was authorized and Alaska was the 32nd state to pass such                                                                       
legislation.  However, due to a compromise, only topical                                                                        
medications were included at that time.  Currently, all 50 states                                                               
authorize optometrists to prescribe drugs; 34 allow oral systemic                                                               
drugs and 16 states, including Alaska, further restrict to topical                                                              
drugs only.  One state authorizes the use of lasers by                                                                          
optometrists.                                                                                                                   
                                                                                                                                
Last session, a bill was introduced and heard that would expand the                                                             
scope of optometry to include all medications for the eye, as well                                                              
as the use of lasers and limited surgical procedures for qualified                                                              
optometrists.  This bill, SB 78, only allows qualified optometrists                                                             
to prescribe and use medications related to the eye and for                                                                     
emergency anaphylaxis.  This change will allow optometrists to                                                                  
practice at the currently accepted standard of care.  It will                                                                   
provide Alaskans with improved access to quality, cost effective                                                                
eye care.                                                                                                                       
                                                                                                                                
CATHERINE REARDON, Director of the Division of Occupational                                                                     
Licensing, Department of Commerce and Economic Development, stated                                                              
the Division has not taken a position on SB 78 at this time.  She                                                               
noted after the Alaska Medical Board meeting tomorrow, she may have                                                             
a position to relay to future committees.  However she is concerned                                                             
that the Optometry Board and Alaska Medical Board may have                                                                      
conflicting opinions.  Therefore, she prefers to delay taking a                                                                 
position on the legislation until both boards make their positions                                                              
known.                                                                                                                          
                                                                                                                                
Number 92                                                                                                                       
                                                                                                                                
DR. JEFF GONNASON made the following comments via teleconference.                                                               
He has been a licensed optometrist in the State of Alaska since                                                                 
1976 and was the president of the Alaska State Board of Examiners                                                               
and Optometry during a previous Administration.  The professions of                                                             
dentistry and optometry have expanded their scopes of practice over                                                             
the years as technology and methods of treatment became available.                                                              
Aside from 35 states, Guam and Washington, D.C. also allow                                                                      
optometrists to prescribe oral or systemic drugs. MR. GONESON said                                                              
SB 78 allows optometrists to work to the full extent of their                                                                   
training.                                                                                                                       
                                                                                                                                
MR. GONNASON said optometrists are trained in the same manner as                                                                
dentists and, like a dentist, he would like to be able to                                                                       
administer necessary drugs including antibiotics, pain medication                                                               
and other oral drugs. He noted this bill does not include a request                                                             
to allow the use of lasers or do limited surgery.                                                                               
                                                                                                                                
Number 159                                                                                                                      
                                                                                                                                
SENATOR LEMAN asked if this bill would allow optometrists to                                                                    
prescribe or recommend marijuana. He asked what position the Board                                                              
of Optometrists has taken on the use of marijuana to treat                                                                      
glaucoma. MR. GONNASON replied that studies have shown marijuana                                                                
does lower pressure in glaucoma patients, but only when taken in                                                                
high doses. Since other modern drugs do not cause side effects and                                                              
are more effective, the Board has resolved that the use of                                                                      
marijuana is unnecessary. MR. GONESON assured SENATOR LEMAN that,                                                               
"No one is interested in prescribing marijuana for the treatment of                                                             
glaucoma . . . "                                                                                                                
                                                                                                                                
MR. BARRY CHRISTENSEN, a pharmacist from Ketchikan and the                                                                      
Legislative Chair of the Alaska Pharmaceutical Association (APA),                                                               
said the APA has not taken a stand on this bill, but does have two                                                              
concerns about the bill. First, they are concerned that there is                                                                
currently no listing of optometrists who can prescribe drugs, which                                                             
makes it difficult for pharmacists to process prescriptions.                                                                    
Second, pharmacists are not familiar with the training and                                                                      
education optometrists receive on drugs and drug interactions. The                                                              
addition of oral drugs prescribed by optometrists makes this an                                                                 
issue of concern to the APA.                                                                                                    
                                                                                                                                
SENATOR MACKIE clarified that the APA is concerned that pharmacists                                                             
may be put in the position of issuing drugs prescribed by                                                                       
optometrists without the regulations in place allowing them to do                                                               
so. MR. CHRISTENSEN affirmed that was one concern, the other being                                                              
the necessity of a list of optometrists able to prescribe drugs.                                                                
                                                                                                                                
SENATOR MACKIE asked MS. CATHERINE REARDON how regulations might                                                                
alleviate MR. CHRISTENSEN'S concerns. MS. REARDON replied the Board                                                             
gives particular endorsements for those optometrists with the                                                                   
training and ability to prescribe drugs. She said the division has                                                              
this information and can provide it to whomever requests it.                                                                    
                                                                                                                                
Number 290                                                                                                                      
                                                                                                                                
SENATOR LEMAN moved to report SB 78 from committee with individual                                                              
recommendations. Without objection, SB 78 moved from committee with                                                             
individual recommendations.