Legislature(2017 - 2018)BARNES 124

03/27/2017 03:15 PM House LABOR & COMMERCE

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03:19:25 PM Start
03:20:12 PM Confirmation Hearings
03:52:04 PM HB170
03:56:34 PM HB103
05:09:04 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearings: TELECONFERENCED
AK State Board of Public Accountancy;
Alcoholic Beverage Control Board; State Board of
Registration for Architects, Engineers & Land
Surveyors; Board of Barbers & Hairdressers;
Board of Chiropractic Examiners; Board of Dental
Examiners; AK Labor Relations Agency; Marijuana
Control Board; Board of Marine Pilots; Board of
Marital & Family Therapy; Board of Massage
Therapists; Board of Certified Direct-Entry
Midwives; Board of Nursing; Occupational Safety
& Health Review Board; Board of Examiners in
Optometry; Board of Pharmacy; State Physical
Therapy & Occupational Therapy Board; Board of
Professional Counselors; Board of Psychologists
& Psychological Associate Examiners; Board of
Certified Real Estate Appraisers; Real Estate
Commission; Workers' Compensation Appeals
Commission; AK Workers' Compensation Board; AK
Gasline Development Corporation Board of
Directors; AK Oil & Gas Conservation Commission
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved HB 170 Out of Committee
-- Public Testimony --
                HB 103-OPTOMETRY & OPTOMETRISTS                                                                             
[Contains mention of SB 36]                                                                                                     
3:56:34 PM                                                                                                                    
CHAIR KITO  announced that the  final order of business  would be                                                               
HOUSE  BILL  NO.  103,  "An  Act  relating  to  the  practice  of                                                               
optometry."  [Before the committee was CSHB 103(HSS).]                                                                          
3:57:01 PM                                                                                                                    
REPRESENTATIVE IVY SPOHNHOLZ, Alaska  State Legislature, as prime                                                               
sponsor, presented HB 103.   She explained that the proposed bill                                                               
would give  authority to the  Board of Examiners in  Optometry to                                                               
regulate  the practice  of optometry;  it would  ensure that  the                                                               
board  has   the  opportunity   to  update   current,  continuing                                                               
education  which is  more  expansive than  those  in policy,  the                                                               
scope of  best practices, and  would allow  the board to  use the                                                               
regulatory process  to manage  itself.   Representative Spohnholz                                                               
would  allow  a  transparent   regulatory  process  ensuring  the                                                               
vetting  of  any  new  board  regulations  with  public  and  the                                                               
Department  of   Law.    The   proposed  bill  would   not  allow                                                               
optometrists  to  provide  services  outside of  their  scope  of                                                               
practice.   Representative  Spohnholz  stated, "My  hope is  this                                                               
will  get  the  legislature  out  of  the  business  of  managing                                                               
3:58:39 PM                                                                                                                    
BERNICE  NISBETT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State  Legislature,  presented  a  sectional  analysis  for  CSHB
103(HSS), on  behalf of Representative Spohnholz,  prime sponsor.                                                               
She drew  attention to the  beginning of the  sectional analysis,                                                               
which read  as follows [original punctuation  provided, with some                                                               
formatting changes]:                                                                                                            
     Section  one  AS.08.72.050   (4)(6)  updates  very  old                                                                    
     statutes to indicate that  regulations shall be adopted                                                                    
     to  govern   the  current   prescription  and   use  of                                                                    
     Pharmaceutical  agents; and  develop uniform  standards                                                                    
     for the practice of optometry.                                                                                             
MS. NISBETT added  that the most significant change  in Section 1                                                               
is  that  the  language  regarding ophthalmic  surgery  and  non-                                                               
invasive  procedures has  been removed  [from  the original  bill                                                               
version].    She  continued  to   Section  2,  described  in  the                                                               
sectional  analysis, as  follows [original  punctuation provided,                                                               
with some formatting changes]:                                                                                                  
     Section  two   AS.08.72.060  (c)(4)  the   board  shall                                                                    
     publish advisory  opinions regarding standards  for the                                                                    
     practice of optometry.                                                                                                     
MS. NISBETT included  that the sponsor of the bill  would like to                                                               
add an amendment  to tighten up the language  and would introduce                                                               
the amendment at a  later date.  She pointed to  page 1, line 13,                                                               
and explained  that "sec.11, ch.25,  SLA" refers to  the Medicaid                                                               
Reform  Bill  that was  passed  in  2016.    She noted  that  "AS                                                               
17.30.200(o)" also refers to the Medicaid Reform Bill.                                                                          
MS. NISBETT  highlighted the remaining  portion of  the sectional                                                               
analysis, which  read as follows [original  punctuation provided,                                                               
with some formatting changes]:                                                                                                  
     Section  three  AS  08.72.181(d) moves  the  continuing                                                                    
     education  (CE) requirements  back into  regulation, as                                                                    
     desired  by the  Department  of  Commerce, Community  &                                                                    
     Economic  Development.   Continuing education  is still                                                                    
     required  by   current  statute,  but  the   hours  and                                                                    
     subjects will be determined by the board.                                                                                  
     Section  four  AS  08.72.272(a) clarifies  the  current                                                                    
     statute for the board  to regulate pharmaceutical agent                                                                    
     prescription  including  standards and  limitations  on                                                                    
     practice determined by the board.                                                                                          
     Section five  AS 08.72.278 Limitation on  practice adds                                                                    
     a  new  section  that  sets  limitations  on  services,                                                                    
     ensuring  that   the  board   may  not   authorize  any                                                                    
     procedure beyond the scope  of the licensee's education                                                                    
     and experience.                                                                                                            
     Section  six  AS  08.72.300(3)  updates  the  optometry                                                                    
     definition to reflect current practice.                                                                                    
     Section  seven Effective  date for  Section 2.  This is                                                                    
     because  (3) of  Section two  was added  to statute  in                                                                    
     2016 via Senate Bill 74,  the Medicaid Reform bill, and                                                                    
     it  had the  effective date  of  July 2017,  so (4)  is                                                                    
     written  to  comply  with  that   date  as  well.  (per                                                                    
     Legislative Drafting)                                                                                                      
4:01:58 PM                                                                                                                    
REPRESENTATIVE  WOOL requested  the  information  on the  omitted                                                               
procedures in Section 1.                                                                                                        
MS.  NISBETT  stated  that  the language  in  the  original  bill                                                               
version that  was removed  under the  CS pertained  to ophthalmic                                                               
4:02:44 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ emphasized  that  to define  ophthalmic                                                               
surgery in a  way that made a clear statute  is challenging; this                                                               
resulted in the  language being taken out in the  bill.  She said                                                               
that  the word  "surgery"  has  a very  specific  meaning to  the                                                               
average person but  is a broadly used term in  the medical field.                                                               
She shared  that she had  had a  small foreign body  removed from                                                               
her  left eye  and how  that meets  the definition  of ophthalmic                                                               
surgery.   She  said she  doesn't want  to "split  hairs" in  the                                                               
statute but instead  leave the authority to the  board to develop                                                               
uniform  standards of  practice  for  optometry.   Representative                                                               
Spohnholz  stated this  won't  give the  board  the authority  to                                                               
allow for surgeries  that are outside of [a  licensee's] scope of                                                               
practice.   She stated  that [the board]  needs to  find language                                                               
that will be relevant after a few  years.  She gave an example of                                                               
the language that isn't durable on  page 2, section 3, which is a                                                               
whole  section describing  a timeframe  for continuing  education                                                               
that  is  not  as  aggressive  as  the  board's  regulations  for                                                               
continuing  education.     Representative   Spohnholz  encouraged                                                               
allowing the  board to regulate  itself as regularly as  it would                                                               
like, without having  to bring requests for minor  changes to the                                                               
4:05:02 PM                                                                                                                    
REPRESENTATIVE  JOSEPHSON  asked  who determines  the  background                                                               
requirements  for  optometry  practices regarding  education  and                                                               
REPRESENTATIVE SPOHNHOLZ  responded both  the Board  of Examiners                                                               
in Optometry and the Department of Law.                                                                                         
4:05:46 PM                                                                                                                    
MS.  NESBITT,  in  response to  a  question  from  Representative                                                               
Knopp, explained that the sponsor  intends to change the language                                                               
on page 2, line 6, of CSHB 103(HSS), which read as follows:                                                                     
     (4) publish advisory opinions regarding standards for                                                                  
     the practice seven of optometry as provided under this                                                                 
MS. NESBITT  said [the  bill sponsor] would  like to  change that                                                               
language  to read  as  in the  statute for  the  Alaska Board  of                                                               
Nursing, AS 08.68.100(a)(9), which read as follows:                                                                             
     (9)   publish  advisory   opinions  regarding   whether                                                                    
     nursing  practice procedures  or  policies comply  with                                                                    
     acceptable  standards of  nursing  practice as  defined                                                                    
     under this chapter;                                                                                                        
MS. NESBITT noted that "optometric" would replace "nursing".                                                                    
REPRESENTATIVE  KNOPP expressed  his approval  of the  bill.   He                                                               
said  Ms.  Nesbitt, in  presenting  the  sectional analysis,  had                                                               
addressed any  concerns he  had regarding  optometrists operating                                                               
"within the limits of their training."                                                                                          
4:08:29 PM                                                                                                                    
HARRIET MILKS,  Assistant Attorney  General, Commercial  and Fair                                                               
Business  Section,  Civil  Division, Juneau,  Department  of  Law                                                               
(DOL), said that she represented professional licensing boards.                                                                 
4:08:42 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON  related that  Ms. Nesbitt had  told him                                                               
that [the bill  sponsor's] office would not  "intervene on policy                                                               
or comment on  how the board regulates itself."   He asked if the                                                               
Department  of  Law  has  the   authority  to  determine  whether                                                               
optometrists have the necessary training to "do 'X'."                                                                           
MS. MILKS responded,  "Absolutely, that is our role,  and the way                                                               
we  do  that is  we  look  very carefully  at  the  scope of  the                                                               
statutory authority  that you  would give  the board,  and that's                                                               
our  starting point."    She  explained that  at  that point  the                                                               
Department  of  Law   would  advise  the  board   if  a  proposed                                                               
regulation goes beyond the scope of the statutory authority.                                                                    
REPRESENTATIVE   JOSEPHSON   shared    his   understanding   that                                                               
ophthalmologists  have concerns  that  under  the proposed  bill,                                                               
optometrists would  be able to  define what treatment means.   He                                                               
asked whether the  department has any authority  over the board's                                                               
decisions regarding treatment being within  the scope of field of                                                               
4:10:57 PM                                                                                                                    
MS. MILKS  responded that it  "can be  a delicate balance."   She                                                               
said the Department of Law  doesn't make judgements or substitute                                                               
its  vision  of what  the  policy  should  be;  it looks  at  the                                                               
language of the statute.                                                                                                        
4:12:15 PM                                                                                                                    
REPRESENTATIVE BIRCH  asked how the  Good Samaritan Law  would be                                                               
affected by  CSHB 103 (HSS).   He related that in  rural areas of                                                               
the  state, dentists,  veterinarians, and  physicians often  help                                                               
outside their field of practice.   Representative Birch offered a                                                               
hypothetical example of  an individual getting a  fish hook stuck                                                               
in his/her  eye, and the only  person in town that  could help is                                                               
an optometrist.                                                                                                                 
MS.  MILKS  responded  she  would   have  to  research  the  Good                                                               
Samaritan Law  and get  back to  the committee.   She  added that                                                               
optometrists have authority to remove fish hooks.                                                                               
REPRESENTATIVE  BIRCH  stated many  rural  areas  in Alaska  have                                                               
incidences that  would be affected  by the  proposal legislation,                                                               
and he stated that he is interested in the topic.                                                                               
4:14:38 PM                                                                                                                    
REPRESENTATIVE SULLIVAN-LEONARD asked Ms.  Milks if she was aware                                                               
of a  court case where there  had been a challenge  regarding the                                                               
prescribed duties of optometrists versus ophthalmologists.                                                                      
MS. MILKS replied that she was not familiar with any.                                                                           
4:15:23 PM                                                                                                                    
REPRESENTATIVE  WOOL   referred  to   Representative  Spohnholz's                                                               
example that  having a small  foreign body  taken out of  her eye                                                               
would constitute surgery.  He  implied that the definition "would                                                               
make a lot of layman surgeons."   He questioned if the definition                                                               
for surgery  would need to be  in statute, how the  Department of                                                               
Law  defined the  terms,  and  if the  Department  of Law  needed                                                               
direction through statute over words like surgery.                                                                              
MS. MILKS  stated the Department  of Law refers to  sources, such                                                               
as statute  and the  board, and the  board seeks  public comment.                                                               
She said, "What we don't do is make it up."                                                                                     
4:17:08 PM                                                                                                                    
REPRESENTATIVE KNOPP asked for Ms.  Milks' thoughts on whether an                                                               
optometrist is  equally qualified  to do what  an ophthalmologist                                                               
MS. MILKS stated she did not have an opinion on that question.                                                                  
4:17:47 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ cited  current  statute, AS  08.72.273,                                                               
which reads as follows:                                                                                                         
     Removal  of  foreign  bodies.  A  licensee  may  remove                                                                    
     superficial  foreign  bodies  from   the  eye  and  its                                                                    
     appendages. This  section is  not intended to  permit a                                                                    
     licensee to perform invasive surgery.                                                                                      
She explained that she had  read this statutory language to avoid                                                               
[the committee discussion] "going down the rabbit hole."                                                                        
4:18:48 PM                                                                                                                    
REPRESENTATIVE  JOSEPHSON  expressed  his concern  regarding  the                                                               
ongoing dispute  between the two  professions, and he  stated his                                                               
presumption that the debate will shift to the board.                                                                            
4:20:02 PM                                                                                                                    
MS.  MILKS answered  that the  Department of  Law provides  legal                                                               
advice  at  every  public  meeting   if  the  board  requests  an                                                               
attorney.   She stated that  she can't predict what  would happen                                                               
between the two professions.                                                                                                    
REPRESENTATIVE JOSEPHSON stated the  previous version of the bill                                                               
that suggested  an interest  in optometrists  performing surgery.                                                               
He opined that  there would have to be "a  day of reckoning where                                                               
some surgeries  will be allowed,  and some  won't."  He  asked if                                                               
the proposed bill  would resolve this or if it  would be resolved                                                               
at a different date.                                                                                                            
MS. MILKS deferred to the bill sponsor.                                                                                         
4:21:48 PM                                                                                                                    
CHAIR KITO opened public testimony on HB 103.                                                                                   
4:22:08 PM                                                                                                                    
PAUL  BARNEY,  MD,  Chair,  Board   of  Examiners  on  Optometry,                                                               
Division of  Corporations, Business, and  Professional Licensing,                                                               
Department   of  Commerce,   Community  &   Economic  Development                                                               
(DCCED), testified in support of HB 103.   He noted that he is an                                                               
optometrist  and   past  president   of  the   Alaska  Optometric                                                               
Association,  who has  practiced for  the  last 17  years as  the                                                               
center  director  of the  Pacific  Cataract  and Laser  Institute                                                               
(PCLI),  which  is  a  referral center  limited  to  medical  and                                                               
surgical eye care.  He continued as follows:                                                                                    
     I  practice with  an  ophthalmologist  and a  certified                                                                    
     registered  nurse anesthetist.    Our  approach to  eye                                                                    
     care  is to  approach it  as a  team and  optimize each                                                                    
     practitioner's  education and  skills.   I bring  up my                                                                    
     mode  of practice  with other  eye care  professionals,                                                                    
     because by  practicing to our fullest  potential, we're                                                                    
     able to provide quality,  more affordable, surgical eye                                                                    
     care for  Alaskans.  In  fact, we are  largest provider                                                                    
     of cataract care in the state of Alaska.                                                                                   
     I  support HB  103, because  it'll allow  the Board  of                                                                    
     [Examiners  on] Optometry  to regulate  the details  of                                                                    
     the  practice  of  optometry.    This  is  how  advance                                                                    
     practice  nurses,  dentists,  and medical  doctors  are                                                                    
     regulated in Alaska.  With  that said, this legislation                                                                    
     will not  set a new  [precedent] in healthcare  ... and                                                                    
     will not  be a risk  to Alaskans since this  is already                                                                    
     the way  other health  care providers are  regulated in                                                                    
     Alaska.     HB  103   will  give   optometrists  better                                                                    
     opportunity to  practice at the highest  level of their                                                                    
     education  by  allowing  the Board  of  [Examiners  on]                                                                    
     Optometry  to write  regulations that  are commensurate                                                                    
     with   educational  advances   that   occur  with   new                                                                    
     technology.  The current  optometry statute was written                                                                    
     over 40  years ago and  requires optometry to  pursue a                                                                    
     statute   change  whenever   there   are  advances   in                                                                    
     education  and  technology.     As  you  know,  statute                                                                    
     changes are costly and time consuming.                                                                                     
     Like  other professional  regulatory boards,  the Board                                                                    
     of   [Examiners   on]   Optometry   cannot   promulgate                                                                    
     regulations  for  practices   or  procedures  that  are                                                                    
     beyond  the education  of optometrists.   The  Board of                                                                    
     [Examiners on] Optometry is  overseen by the Department                                                                    
     of  Law, just  like  other healthcare  boards, and  the                                                                    
     Alaska Department  of Law would  ensure that  the Board                                                                    
     of [Examiners  on] Optometry's regulations  were within                                                                    
     the scope of optometric education.                                                                                         
     Other  safeguards  are  our medical  legal  system  and                                                                    
     insurance   system.     Any  healthcare   provider  who                                                                    
     provides care outside of their  education is subject to                                                                    
     disciplinary action by their  respective board, as well                                                                    
     as serious medical  legal ramifications.  Additionally,                                                                    
     insurance carriers  do not pay providers  for care that                                                                    
     they provide  outside their scope  of education.   As a                                                                    
     result,  there's   no  incentive  for   any  healthcare                                                                    
     provider to  provide care  outside of  their education,                                                                    
     and   there  are   very   serious  consequences,   both                                                                    
     financially  and to  their licensure,  to practitioners                                                                    
     that do provide care outside of their education.                                                                           
     As  chair  of  the   Alaska  Board  of  [Examiners  on]                                                                    
     Optometry, I  can assure you  that the  primary concern                                                                    
     of the board  is the safety of the public.   In the six                                                                    
     years  that I've  served  on the  board,  we've had  no                                                                    
     complaints  from the  public that  were serious  enough                                                                    
     that   they   even  considered   disciplinary   action.                                                                    
     Optometrists,   in   general,  are   conservative   and                                                                    
     cautious  practitioners,  and  the passage  of  HB  103                                                                    
     would not change their conservative nature.                                                                                
     HB 103  would be  good for  the state  of Alaska.   The                                                                    
     bill   puts  the   regulatory  details   regarding  the                                                                    
     practice of optometry in the  authority of the Board of                                                                    
     [Examiners on] Optometry.   These changes are important                                                                    
     to allow  the profession  and practice of  optometry to                                                                    
     incorporate  new technologies  and advances  in eyecare                                                                    
     as  they occur.   Optometry  provides approximately  70                                                                    
     percent  of the  eye care  in  the U.S.,  and in  rural                                                                    
     areas, especially  in Alaska,  they often are  the only                                                                    
     eye care  provider in the  community.  The  citizens of                                                                    
     Alaska deserve  to be  served by  a profession  that is                                                                    
     allowed to stay current  with advances in education and                                                                    
     new technology.                                                                                                            
DR. BARNEY  concluded his  testimony by  urging the  committee to                                                               
support HB 103.                                                                                                                 
4:26:31 PM                                                                                                                    
REPRESENTATIVE BIRCH asked  how optometrists and ophthalmologists                                                               
"do a hand-off" with their patients.                                                                                            
MR. BARNEY  answered that optometrists and  ophthalmologists work                                                               
well together.   He  stated that  the two  professions understand                                                               
each other's  potential and know  what statutory authority  is in                                                               
each profession.                                                                                                                
4:27:56 PM                                                                                                                    
JILL  GEERING  MATHESON,  OD, Alaskan  Vision  Center  Optometry,                                                               
testified  in support  of HB  103.   She related  that she  was a                                                               
former  chair  of the  Board  of  Examiners  in Optometry.    She                                                               
continued, as follows:                                                                                                          
     Over 25  years, I have testified  numerous times before                                                                    
     this  committee and  many other  legislative committees                                                                    
     in  support   of  changes   to  the   Alaska  Optometry                                                                    
     statutes,  and  these  have been  successful  over  the                                                                    
     years.  This is due to  the level of trust that the ...                                                                    
     legislators  have   given  optometrists  in   spite  of                                                                    
     rhetoric saying that we were going to harm people.                                                                         
     Now I  come before you not  to argue safety or  get the                                                                    
     efficacy  of  treatment  options  that need  to  be  in                                                                    
     statute but to  ask for your support for  HB 103, which                                                                    
     gives  the  Board  [of   Examiners  in  Optometry]  the                                                                    
     authority  to  regulate  optometrists.    Just  as  the                                                                    
     people of  Alaska elect  all of  you to  represent them                                                                    
     honestly, safely,  and responsibly, the members  of the                                                                    
     state   boards  and   commissions  are   appointed  and                                                                    
     confirmed  by  the legislature  to  do  the same  under                                                                    
     their  various areas  of expertise.   The  days of  the                                                                    
     medical  board's being  the  holy  grail of  overseeing                                                                    
     every health profession are long gone.                                                                                     
     Alaska  chose  to  set  up  separate  boards  for  each                                                                    
     profession  because  each  profession  is  unique,  and                                                                    
     Alaska  saw that  the  oversite  for those  professions                                                                    
     needed to be handled by  those members.  So, the people                                                                    
     of  Alaska -  through the  legislature -  have approved                                                                    
     statutes  that are  very  broad to  many  of the  other                                                                    
     health  boards,  and  these  boards  are  now  able  to                                                                    
     autonomously  manage their  respected profession  in an                                                                    
     honest, safe,  and responsible  manner.   The optometry                                                                    
     statute,   on  the   other  hand,   is  currently   too                                                                    
     complicated and restrictive.  All  HB 103 does is allow                                                                    
     the state Board  of Examiners in Optometry  to have the                                                                    
     same autonomy.                                                                                                             
DR.  GEERING MATHESON  said HB  103 is  not about  "eye surgery,"                                                               
which she said is  a buzz term used by the  opposition as a scare                                                               
tactic.  She  said she was licensed 25 years  ago, and Doctors of                                                               
Optometry  are trained  to  do minor  surgeries  that are  within                                                               
their scope of  practice.  She said she would  no more conduct an                                                               
eye surgery  she was  not qualified  to do  than would  a dentist                                                               
perform jaw reconstruction, a nurse  perform spinal surgery, or a                                                               
physician perform  neural surgery.   She  stated her  belief that                                                               
the world must  evolve and that professions change.   She stated,                                                               
"There is  no way to  predict what  tools or treatment  options a                                                               
Doctor of  Optometry will need  twenty years from now  to protect                                                               
or cure  the eyes and vision  of a patient."   She explained this                                                               
is why  HB 103 is  written with such  broad language -  "to allow                                                               
for  updates  as  things advance"  and  encompass  "unforeseeable                                                               
changes  in technology."   She  said  she trusts  members of  the                                                               
Board  of  Examiners  of  Optometry to  make  and  oversee  those                                                               
4:31:22 PM                                                                                                                    
REPRESENTATIVE SULLIVAN-LEONARD asked  for examples of continuing                                                               
education units (CEUs)  that would broaden the  scope of practice                                                               
[within the field of optometry].                                                                                                
DR.  MATHESON answered  that CEUs  are unforeseen.   She  gave an                                                               
example  from  other states  of  minor  surgical procedures  that                                                               
Alaska doesn't do, like laser procedures.                                                                                       
4:32:22 PM                                                                                                                    
REPRESENTATIVE KNOPP  said the state  and board mandates  are for                                                               
the timeline for completion of CEUs for an optometrist.                                                                         
DR.  MATHESON answered  that under  regulation, optometrists  are                                                               
required  to  complete  18  hours  every  year.    She  said  the                                                               
licensing period  is two  years, so the  total requirement  is 36                                                               
hours  during each  licensing period.    The 36-hour  requirement                                                               
under regulation is more than  the current statutory requirement,                                                               
which is eight hours.                                                                                                           
REPRESENTATIVE KNOPP asked what  credentials optometrists need to                                                               
get and how many years it takes them to get certified.                                                                          
DR.  MATHESON  answered  four  years  undergraduate,  four  years                                                               
optometry school, and then optional residencies.                                                                                
REPRESENTATIVE  KNOPP mentioned  that  some ophthalmologists  are                                                               
certified in laser procedures while  others are not, and he asked                                                               
if there have been recent changes with that issue.                                                                              
DR. MATHESON indicated she did not know.                                                                                        
4:34:17 PM                                                                                                                    
REPRESENTATIVE WOOL referenced feedback  his office received that                                                               
highlights a  difference of opinion between  ophthalmologists and                                                               
optometrists  as to  what optometrist  are qualified  to do.   He                                                               
then asked if continuing education counts as "basic training."                                                                  
4:36:01 PM                                                                                                                    
DR. MATHESON answered that if  the board allowed a new procedure,                                                               
then there  would be required  training that would go  along with                                                               
that new  procedure.  She gave  an example of what  has been done                                                               
in  the  past  with  new  procedures  and  the  number  of  hours                                                               
optometrists have  had to  complete before  they were  allowed to                                                               
perform that procedure.                                                                                                         
4:37:06 PM                                                                                                                    
REPRESENTATIVE  WOOL  gave an  example  of  dental hygienists  in                                                               
other states  administering Novocain  injections, which  20 years                                                               
ago may  not have happened.   He asked what the  process would be                                                               
for the board to allow changes.                                                                                                 
DR. MATHESON answered that all  medical professionals must meet a                                                               
standard  of care  and all  are  held to  high standards  through                                                               
their education.                                                                                                                
4:38:41 PM                                                                                                                    
SCOTT LIMSTROM,  MD, President, Alaska Society  of Eye Physicians                                                               
and Surgeons (ASEPS),  stated that HB 103 and  its companion bill                                                               
SB 36  are opposed by  the Alaska  Society of Eye  Physicians and                                                               
Surgeons, the  State of  Alaska Board  of Medical  Examiners, the                                                               
Alaska  State Medical  Association, and  the American  Academy of                                                               
Ophthalmology.  He stated that  the controversy with the proposed                                                               
legislation  is that  it  would  allow non-medical  professionals                                                               
unrestricted ability to prescribe all  scheduled drugs.  He said,                                                               
as an  ophthalmologist, he rarely  prescribes narcotics  for pain                                                               
control.  He spoke of the  epidemic in Alaska resulting in deaths                                                               
from overdoses of narcotics.                                                                                                    
4:40:38 PM                                                                                                                    
DR. LIMSTROM  opined that HB 103  and SB 36, as  written, are the                                                               
most expansive scope of practice bills  in the nation.  He stated                                                               
that  the   proposed  legislation  would  give   the  board  full                                                               
authority to  determine which invasive, diagnostic,  and surgical                                                               
procedures ophthalmologists  may perform  on patient's eyes.   He                                                               
noted that  there are no  doctors or surgeons  on the board.   In                                                               
response  to a  previous  remark  by the  bill  sponsor that  the                                                               
attorney  general would  be scrutinizing  the regulations  of the                                                               
board, he  questioned what the attorney  general's qualifications                                                               
are on  eye surgery.   He referenced  the State of  Washington as                                                               
having  very  clear  law  defining  eye  surgery.    In  the  law                                                               
optometrists  are  prohibited  from   performing  surgery.    Dr.                                                               
Limstrom  said ASEPS  requests clear  definition of  eye surgery.                                                               
He opined  that for the safety  of [Alaskans], HB 103  should not                                                               
move forward.                                                                                                                   
4:41:49 PM                                                                                                                    
REPRESENTATIVE KNOPP  asked if prescribing drugs  will be covered                                                               
under continuing education requirements.                                                                                        
DR.  LIMSTROM  stated  the bill  gives  unrestricted  ability  to                                                               
prescribe all scheduled drugs.                                                                                                  
REPRESENTATIVE  KNOPP noted  that  Dr. Limstrom  had requested  a                                                               
clear  definition of  eye  surgery.   He  questioned whether  Dr.                                                               
Limstrom  felt  description  of  the  educational  experience  of                                                               
optometrists was insufficient.                                                                                                  
DR.  LIMSTROM  answered  no,  he doesn't.    He  referenced  that                                                               
Washington  State  enacted  a  definition many  years  ago.    He                                                               
expressed concern that the current  bill could leave the board to                                                               
define what [optometrists] can and  can't do and dictate what the                                                               
education requirements are.                                                                                                     
4:44:03 PM                                                                                                                    
REPRESENTATIVE BIRCH asked  if dentists and nurses  have the same                                                               
authority as ophthalmologists for prescribing narcotics.                                                                        
DR. LIMSTROM stated he isn't  familiar with what authority nurses                                                               
and   dentists  have.     The   requirements   for  becoming   an                                                               
ophthalmologist, as  a medical doctor,  include going  to medical                                                               
school, serving internships,  and undergoing fellowship training.                                                               
He   explained  his   ability   subscribe   all  five   scheduled                                                               
medications but  said the strongest medication  he prescribes, as                                                               
a  physician,  is hydrocodone  and  rarely  his prescriptions  go                                                               
beyond three  to four days  post operation.  Dr.  Limstrom stated                                                               
that  the reason  these medications  are restricted  is that  the                                                               
more prescriptions are written, the  more abuse will occur in the                                                               
general public.  So, when  the Food and Drug Administration (FDA)                                                               
and   the  Drug   Enforcement  Administration   (DEA)  restricted                                                               
[prescribing ability],  it caused  a reduction  in the  number of                                                               
prescriptions being written.                                                                                                    
4:45:18 PM                                                                                                                    
REPRESENTATIVE  JOSEPHSON  asked  what ophthalmic  surgeries  are                                                               
acceptable for optometrists to get trained on and perform.                                                                      
DR.  LIMSTROM stated  that Representative  Josephson would  get a                                                               
different answer  regarding what is acceptable  and unacceptable,                                                               
depending  on  whom  he  asks.     He  affirmed  that  there  are                                                               
procedures  that optometrists  are  allowed to  perform and  that                                                               
there are more  procedures that optometrists are  capable of with                                                               
the proper  training.  He questioned  if it is necessary  or safe                                                               
for the public.  He said a  person who wants to perform a surgery                                                               
with  general  anesthesia  has  to  go to  medical  school.    He                                                               
asserted that as  an ophthalmologist, the procedures  he does are                                                               
complicated, and many require generalized  anesthesia.  He warned                                                               
that the danger  of HB 103 is that the  optometrists have not had                                                               
[the same level of] training.                                                                                                   
4:47:31 PM                                                                                                                    
EVAN WOLF,  MD, Wolf  Eye Center, testified  in opposition  to HB
103.  He  said he has been  in practice for 15 years.   He opined                                                               
that the  proposed bill is  the most expansive scope  of practice                                                               
bill  in   the  country.     He  referenced   Washington  State's                                                               
legislation,  which  established a  definition  on  the scope  of                                                               
practice for optometry, the definition  of surgery, and a list of                                                               
procedures  that aren't  considered  surgical and,  thus, can  be                                                               
done by  an optometrist  in the  clinic.   He cited  a Washington                                                               
State statute labeled  RCW 18.53.010, Section 8,  which he opined                                                               
would be a  good reference for Alaska lawmakers.   Dr. Wolf cited                                                               
Malcolm Gladwell's  book, Outliers.   The book theorizes  that it                                                             
takes  10,000  hours  to  become  an  expert  in  anything.    He                                                               
explained how  this theory relates  to surgical  knowledge, since                                                               
it took  him 26,000 hours  of training  to use laser  and perform                                                               
cataract  surgery safely.   He  stated that  the training  for an                                                               
optometrist would  be about  8,000 hours. Dr.  Wolf cited  a 2016                                                               
Journal  of America  Medical Association  (JAMA) study,  in which                                                             
Joshua  Dr.  Stein,  MD,  MS,   discovered  what  happens  if  an                                                               
optometrists and ophthalmologist perform  the same procedures, in                                                               
states like  Kentucky and Oklahoma  where optometrists  are doing                                                               
basic laser procedures.  The  study asked what the outcomes would                                                               
be if  they compared optometrists  or ophthalmologists  doing the                                                               
same procedures.  Dr. Wolf  said the study showed that worst-case                                                               
scenario is that  the procedure needs to be repeated.   The study                                                               
found that  procedures performed  by optometrists were  2.3 times                                                               
more likely  to need to  be repeated compared to  those performed                                                               
by ophthalmologists.                                                                                                            
4:52:42 PM                                                                                                                    
REPRESENTATIVE  WOOL  asked  if  Dr. Wolf  did  26,000  hours  of                                                               
training before performing an unaccompanied surgery.                                                                            
DR.  WOLF  answered  by  stating his  26,000  hours  of  training                                                               
included medical school and residency.   Residency is a four-year                                                               
process of  learning, including  basic surgeries  and development                                                               
of knowledge and vocabulary.                                                                                                    
REPRESENTATIVE  WOOL   asked  if   Dr.  Wolf's   overall  medical                                                               
education of eight years was not specifically surgery training.                                                                 
DR. WOLF  broke down the hours  of training he obtained:   12,000                                                               
hours  of  medical training  and  14,000  hours of  ophthalmology                                                               
4:53:54 PM                                                                                                                    
ERIK  CHRISTIANSON, OD,  testified  in  support of  HB  103.   He                                                               
stated  that   as  the  only   medically  based   optometrist  in                                                               
Ketchikan, he  sees how HB 103  could benefit his community.   He                                                               
already performs  minor surgeries  every day and  refers patients                                                               
to  ophthalmologists for  complex surgeries.   His  community and                                                               
the communities  around him only have  access to ophthalmologists                                                               
who rotate  through; it  can be tough  to get  an ophthalmologist                                                               
because of travel restraints.   Dr. Christianson said he knows of                                                               
patients  performing minor  procedures on  themselves because  of                                                               
the  lack  of  medically  trained  individuals  available.    Dr.                                                               
Christianson  is  asking  [the   legislature]  to  modernize  the                                                               
optometry statute  so that  optometrists are  "able to  do things                                                               
within our training."                                                                                                           
4:57:56 PM                                                                                                                    
MATTHEW  GUESS,  MD, testified  in  opposition  to  HB 103.    He                                                               
expressed concern  that under HB  103, the Board of  Examiners in                                                               
Optometry  could  self-regulate  its   scope  of  practice,  thus                                                               
allowing  invasive procedures  in or  around the  eye, for  which                                                               
optometrists  have received  no meaningful  formal training.   He                                                               
referenced  earlier  testimony  by  Dr.  Matheson,  in  which  he                                                               
indicated  that part  of  ophthalmologists' continuing  education                                                               
required   seven  hours   of   injection   training  for   eyelid                                                               
procedures.     He  said  he   spent  time  in   medical  school,                                                               
residencies, and  two extra  years of  training in  a fellowship,                                                               
and he  learned to both  diagnose and  treat diseases of  the eye                                                               
with  operative  procedures  and  operative  invasive  surgeries.                                                               
During that time,  he spent two years in a  fellowship, worked 55                                                               
to 65  hours per  week, examined tens  of thousands  of patients,                                                               
and  performed  thousands  of surgeries  under  the  guidance  of                                                               
experienced mentors.   He stated there is no  substitute for this                                                               
training; the training allows him  to provide diagnoses treatment                                                               
and  perform  procedures and  surgeries  in  the safest  possible                                                               
manner for  patients.  He stated  that seven hours of  training a                                                               
year  sounds  like  a  minimal   amount  of  work  to  learn  new                                                               
procedures or stay current on the procedures that are available.                                                                
5:00:24 PM                                                                                                                    
KELLY LORENZ, MD, testified in  opposition to 103.  She expressed                                                               
concern over the vague wording of  HB 103 and stated the proposed                                                               
bill would  support optometrists performing procedures  that they                                                               
are not  adequately trained to  do, including:  several  types of                                                               
laser  procedures; eyelid  surgery, including  eye lifts;  limbal                                                               
relaxing incisions;  and many other  procedures.  She  stated her                                                               
concern that  "a couple weekend  courses at  a local hotel  by an                                                               
optometrist will  not make up  for years of surgical  training by                                                               
an ophthalmologist."   She stated  that the bill would  lower the                                                               
standards  of surgical  care in  Alaska.   She shared  statistics                                                               
that 90 percent of people polled  stated they would rather have a                                                               
medical doctor performing a surgery.                                                                                            
5:03:30 PM                                                                                                                    
STEVE DOBSON,  OD, testified in  support of HB  103.  He  said he                                                               
has   answers  for   all  the   questions  he   heard  from   the                                                               
ophthalmologists that  had testified.   He said he  thinks either                                                               
there   is  intent   to   mislead  or,   perhaps,   there  is   a                                                               
misunderstanding of the  intent of the proposed  legislation.  He                                                               
stated that  HB 103 is  not about  surgery but, for  some reason,                                                               
organized  ophthalmology has  turned it  into "a  surgical bill."                                                               
He said  HB 103  is about board  autonomy and  about optometrists                                                               
practicing at the  highest level for which they are  trained.  He                                                               
indicated  that malpractice  is the  same in  those states  [that                                                               
allow optometrists]  to perform  minor procedures, such  as minor                                                               
laser  procedures, as  it is  in Alaska,  and he  emphasized that                                                               
"insurance  companies  understand  risk."    Dr.  Dobson  stated,                                                               
"Obviously optometrists  are doing  what they  trained to  do and                                                               
nothing more."   He continued, "Optometrists are  trained in very                                                               
few of the  procedures that ophthalmologists do.  I  think we all                                                               
agree with  that.  And  that's not what  we're trying to  do, and                                                               
it's actually  not what this  legislation is about."   Dr. Dobson                                                               
stressed  the  importance of  what  ophthalmologists  do, and  he                                                               
reiterated  that  there  is  little  crossover  between  the  two                                                               
professions.    He proffered  that  if  dentists and  nurses  can                                                               
maintain  their  own boards,  then  it's  time optometrists  were                                                               
given the respect  and consideration to regulate  themselves.  He                                                               
said [this  issue] has been  repeated before the  legislature for                                                               
years, with  the same arguments  given by  ophthalmologists, whom                                                               
he  said  vehemently  oppose  the  recognition  of  "any  of  the                                                               
advances in optometric care."                                                                                                   
5:08:25 PM                                                                                                                    
CHAIR KITO announced that HB 103 was held over.                                                                                 

Document Name Date/Time Subjects
HB 103 Fiscal Note DCCED-DCBPL 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Explanation of Changes 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB0103 ver J 3.22.17.PDF HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Sectional Analysis 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Sponsor Statement 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Board of Examiners in Optometry 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Career Guide Optometry 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Letters of Opposition 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Letters of Support 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Medical Liability Premiums Fact Sheet 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Ohio State Optometry Curriculum 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Optometrists Practicing in AK 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Optometry Education Flyer 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103
HB103 Supporting Documents-Regulation Flow Chart 3.20.17.pdf HL&C 3/27/2017 3:15:00 PM
HB 103