Legislature(2017 - 2018)BARNES 124

03/29/2017 03:15 PM House LABOR & COMMERCE

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03:19:11 PM Start
03:19:42 PM Confirmation Hearing(s)
03:25:14 PM HB126
03:42:27 PM HB142
04:34:22 PM HB103
05:16:10 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony --
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+ Confirmation Hearings: TELECONFERENCED
- Board of Certified Direct-Entry Midwives
- Board of Pharmacy
- Board of Professional Counselors
Heard & Held
-- Public Testimony --
                HB 103-OPTOMETRY & OPTOMETRISTS                                                                             
4:34:22 PM                                                                                                                    
CHAIR KITO  announced that the  final order of business  would be                                                               
HOUSE  BILL  NO.  103  "An   Act  relating  to  the  practice  of                                                               
4:35:03 PM                                                                                                                    
REPRESENTATIVE IVY  SPOHNHOLZ provided a brief  reintroduction of                                                               
HB 103.  She  said the bill would give authority  to the Board of                                                               
Optometry to  regulate the  practice of  optometrists.   It would                                                               
ensure that the Board of  Optometrists would have the opportunity                                                               
to  update the  current  and continuing  education standards  and                                                               
scope of  practice based  on best available  evidence.   The bill                                                               
would not  allow optometrists to  perform outside of  their scope                                                               
of practice,  for example as  in performing surgeries.   It would                                                               
allow  the board  to  utilize the  regulatory  process to  manage                                                               
itself, just as doctors, chiropractors,  nurses, and dentists are                                                               
REPRESENTATIVE  SPOHNHOLZ pointed  out that  current statute,  AS                                                               
08.72.273,  does  not  allow  optometrists  to  provide  invasive                                                               
surgeries.   She  further noted  that licensees  must submit  the                                                               
necessary   credentials,   including   the   proper   experience,                                                               
education,  and  training,  to perform  procedures  that  require                                                               
approval from the board.   Lastly, she pointed out that Assistant                                                               
Attorney  General  Harriet  Milks  had testified  that  a  robust                                                               
process for adopting new regulations  already exists and includes                                                               
board  meetings that  are open  to  the public,  a 30-day  public                                                               
comment period, a  Department of Law review period,  and a review                                                               
from the governor's office.  She  said that this final point gets                                                               
at  Representative Josephson's  question  about  "where the  buck                                                               
stops";  it  stops with  the  governor  when  it relates  to  the                                                               
adoption of any new regulations.                                                                                                
REPRESENTATIVE   SPOHNHOLZ   acknowledged   that   it   was   the                                                               
legislature that developed  the statute in question.   She stated                                                               
that it was  her hope that this bill will  remove the legislature                                                               
from the business of managing  optometrists, so they can focus on                                                               
other issues  they need to  resolve, rather than the  "eye wars."                                                               
She said that the intent of HB  103 is to delegate the "eye wars"                                                               
to  the Board  of  Optometry, which  is where  it  belongs.   She                                                               
pointed  out further  that  the  legislature is  not  a group  of                                                               
medical professionals, and yet they  have been discussing medical                                                               
procedures.   Such  discussions should  be held  at the  Board of                                                               
Optometry, just  as dental and chiropractic  issues are discussed                                                               
at their respective boards.                                                                                                     
4:39:12 PM                                                                                                                    
REPRESENTATIVE  WOOL asked  if there  was perhaps  an analogy  to                                                               
this issue in the world of  dentists and oral surgeons; such that                                                               
there might be one board for dentists and one for oral surgeons.                                                                
4:41:28 PM                                                                                                                    
BERNICE  NESBITT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State Legislature,  on behalf of Representative  Spohnholz, prime                                                               
sponsor of HB 103, said  that she thought Representative Wool was                                                               
correct:  because  oral surgeons are medical  doctors, they would                                                               
be regulated by a medical  board, whereas dentists, she believed,                                                               
would be regulated by a board of dentistry.                                                                                     
REPRESENTATIVE  WOOL said  that if  that  is the  case, then  the                                                               
situation   with  optometrists   and  ophthalmologists   is  very                                                               
similar.  He  said that he would assume that  a dentist would not                                                               
have to  come and  ask the  legislature if  say he/she  wanted to                                                               
pull a tooth.                                                                                                                   
4:42:22 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  said that Representative  Wool provided                                                               
a  good analogy;  if dentists  wanted to  introduce a  regulation                                                               
that would expand their scope, then  the process would occur at a                                                               
board of  dentistry.  She  also said  that in that  process, oral                                                               
surgeons,  like  any  member  of   the  public,  would  have  the                                                               
opportunity to  provide testimony and feedback.   Similarly, oral                                                               
surgeons could  attend any  board of  dentistry meetings  to stay                                                               
apprised of new developments.                                                                                                   
4:43:10 PM                                                                                                                    
CHAIR  KITO  stated   that  they  would  now   return  to  public                                                               
4:43:55 PM                                                                                                                    
RACHEL REINHARDT,  MD, stated that  she was testifying  on behalf                                                               
of The  American Academy of  Ophthalmologists and  its world-wide                                                               
membership of 32,000 eye physicians  and surgeons.  She said that                                                               
she was a board-certified  ophthalmologist from Washington state.                                                               
She stated, "We  are asking for your opposition to  HB 103."  She                                                               
stated that  the bill was "without  a shred of doubt"  a "surgery                                                               
bill" that  would make  two very  concerning changes  to existing                                                               
law:   removing from existing  law the surgery  restrictions that                                                               
currently  exist; and  inserting  a new  definition  of the  word                                                               
optometry in  Section 6 that  includes the words  "treatment" and                                                               
"procedures".   She  said the  addition of  the word  "treatment"                                                               
would  leave   "absolutely  no  limitations"   on  the   type  of                                                               
treatment; therefore, any  surgeries on the eye  would be allowed                                                               
under this new  law if the Board of Optometry  deemed them within                                                               
its scope.  She said the  new definition would allow the Board of                                                               
Optometry to  redefine itself  into a surgical  field.   She also                                                               
said that  if proponents of the  bill continue to insist  that it                                                               
is not  a surgery bill,  then she  thinks the bill  either cannot                                                               
pass  or  "it  needs  to  be put  in  writing,"  because  without                                                               
specific language Alaska would be  the first state in the country                                                               
to adopt such broad unprecedented legislation.                                                                                  
DR. REINHARDT  said that  a number  of years  ago a  similar bill                                                               
proposed in Washington  state added a definition  of surgery that                                                               
cleared  up the  issue, specifically  prohibiting an  optometrist                                                               
from performing  surgery.  She  stated that there are  only three                                                               
states in the  United States that have allowed  bills similar [to                                                               
HB  103] to  pass.   In  Oklahoma,  language in  a  bill did  not                                                               
specifically allow  surgery, including laser surgery,  but it was                                                               
never specifically restricted.   As such, the  Board of Optometry                                                               
in Oklahoma interpreted the law  to redefine its scope to include                                                               
surgery.   A study  now shows that  optometrists in  Oklahoma are                                                               
causing people harm and increasing healthcare costs.                                                                            
DR.   REINHARDT   stated   that    [the   American   Academy   of                                                               
Ophthalmologists] respectfully  but strongly disagrees  that [the                                                               
board addressed  under HB 103]  is similar to  other professional                                                               
boards,  such   as  those  for   nursing,  dentistry,   and  even                                                               
engineers.   She said  that unlike  nursing, dentistry,  and even                                                               
pharmacy, optometry education is  not medical education, and it's                                                               
not surgical  education, yet this  bill would allow the  Board of                                                               
Optometry, which  is made up  of nonmedical  nonsurgical doctors,                                                               
to  regulate a  profession  that is  nonmedical and  nonsurgical.                                                               
She said, "This  says everything."  The  statutes and regulations                                                               
for  the  boards  of  pharmacy,   nursing,  dentistry,  and  even                                                               
engineering  comprise 45-65  pages  of Alaska  Statutes, yet  the                                                               
optometry statutes and regulations comprise 12 pages.                                                                           
DR.  REINHARDT  said  two  days ago,  an  optometrist  was  heard                                                               
stating that insurance companies understand  risk.  She said that                                                               
while she agrees with that  100 percent, committee members should                                                               
bear  in  mind  that  the  Ophthalmic  Mutual  Insurance  Company                                                               
(OMIC),  the largest  insurance company  for ophthalmologists  in                                                               
the country,  has essentially come  out with a policy  stating it                                                               
will  refuse   to  insure  any  ophthalmologist   that  hires  an                                                               
optometrist  to perform  surgery, including  laser surgery.   She                                                               
said that  this is the  third consecutive year this  surgery bill                                                               
has  been heard,  the  first  time being  under  Senate Bill  55,                                                               
during the  Twenty-Ninth Alaska State  Legislature.   During that                                                               
time, she noted, the legislature  heard the concerns of scores of                                                               
MDs,  who  were  not  all ophthalmologists.    She  implored  the                                                               
committee to listen to the experts  in eye care and "not to leave                                                               
the safety of your constituents up  to a public comment period or                                                               
the assistant  attorney general after  the fact."  Those  are not                                                               
people  that  are  trained  medically.    If  MDs  are  having  a                                                               
difficult  time  voicing  their   concerns  now,  she  proffered,                                                               
imagine  how  futile  their  efforts will  be  to  protect  their                                                               
patients  after HB  103 is  passed.   She stated  there are  four                                                               
states  in the  country  that don't  even  allow optometrists  to                                                               
prescribe  oral medication,  yet here  we are  debating (indisc.)                                                               
surgery in Alaska.   She said HB 103 would  be unprecedented, and                                                               
it would  change the scope  for the  practice of optometry.   She                                                               
said  that  she  respectfully  asks the  committee  to  vote  no;                                                               
however, she stated  that if the proposed  legislation must pass,                                                               
then  at the  very  least  the definition  of  surgery should  be                                                               
added,  as it  was in  other  states like  Washington, to  ensure                                                               
public   safety.     She  said   that   the  committee   member's                                                               
constituents are counting on them.                                                                                              
DR.   REINHARDT  concluded   by  mentioning   amendment  language                                                               
regarding  the practice  and  procedures  of optometry  complying                                                               
with acceptable standards,  and she said such  language would not                                                               
resolve the core concern regarding board authority.                                                                             
4:49:19 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON  asked Dr. Reinhardt whether  she had an                                                               
opinion on  what he  described as  the apparent  conflict between                                                               
the two  following conditions:   passage of a bill  with language                                                               
stating an optometrist cannot perform  any invasive surgery other                                                               
than removal of  a foreign body; and the  elimination of existing                                                               
language that says [optometrists] can  do assorted things but not                                                               
4:50:32 PM                                                                                                                    
MS. REINHARDT said the concern  is that when there is conflicting                                                               
language  in  a  bill,  it  is   not  abnormal  for  laws  to  be                                                               
interpreted in  different ways.   The risk  is that  not defining                                                               
the  term "invasive  surgery"  creates  loopholes for  performing                                                               
surgeries.  She said she  takes issue with categorizing surgeries                                                               
as   "invasive"  versus   "noninvasive,"   because  "surgery   is                                                               
surgery."     She  explained   that  surgery   involves  cutting,                                                               
ablating, or  altering tissue somehow.   She also said  that it's                                                               
not  hard to  define surgery,  adding that  the American  Medical                                                               
Association has had  a definition for decades.   She concluded by                                                               
saying that  the problem  lies in not  defining the  word surgery                                                               
[in the proposed bill].                                                                                                         
4:51:37 PM                                                                                                                    
DAVID S.  ZUMBRO, MD, Ophthalmologist,  introduced himself  as an                                                               
eye  physician,  surgeon,  and retina  specialist  in  Anchorage,                                                               
Alaska.   He said that  he is also  a partner with  Alaska Retina                                                               
Consultants and a retired colonel from  the U.S. Army, and he has                                                               
had  the opportunity  to participate  in a  training program  for                                                               
ophthalmologists  for  five years  in  San  Antonio, Texas.    He                                                               
expressed his  hope that the  committee would  consider rejecting                                                               
or  modifying HB  103.   He  said that  while the  bill may  seem                                                               
"innocent and  safe," the vagueness  of the language  would allow                                                               
non-physicians  and non-surgeons  to  determine  the medical  and                                                               
surgical procedures they can perform on  the eye, which is a real                                                               
patient safety issue.  He proposed  the question of why he should                                                               
still be worried about procedures when  it has been said the bill                                                               
is not about surgery and  optometrists will not perform surgeries                                                               
they are  not trained to perform.   In response to  his question,                                                               
he stated  that an optometrist in  Alaska told him that  they are                                                               
planning  to help  with eye  injections.   He  said that  looking                                                               
around the country we see  multiple states which have similar and                                                               
current  legislation, some  of which  are  worded more  directly.                                                               
All of these are associated  with expanding the scope of practice                                                               
for optometry into surgery.                                                                                                     
DR.  ZUMBRO said  that the  reason  he is  worried about  patient                                                               
safety  is because  the "optometry  curriculum" does  not provide                                                               
the  training   for  optometrists   to  perform   surgery,  gives                                                               
injections,  and   operate  lasers,   let  alone   regulate  such                                                               
activity.    He  stated  that  with  any  procedure  there  is  a                                                               
difference between  knowing what to do  and how to do  it safely,                                                               
and the  hardest thing  for a  surgeon to learn  is when  to step                                                               
back and not do something.   As in any profession, where a person                                                               
is young  and eager to  serve, inexperience  sometimes interferes                                                               
with proper judgement.   He said that all one must  do is look at                                                               
the ophthalmology  curriculum to  understand the  "gold standard"                                                               
for  training eye  physicians and  surgeons.   He  asked for  the                                                               
evidence  optometry  has produced  to  show  their curriculum  is                                                               
equivalent to the gold standard.                                                                                                
DR.  ZUMBRO stated  that  he has  no problem  with  the Board  of                                                               
Optometry regulating  the optometry profession.   Notwithstanding                                                               
that, he  stated that while  it has been  said that the  Board of                                                               
Optometry will hold  public testimony for any  procedure, that is                                                               
what is  being done  now, and  he opined that  if eye  surgery is                                                               
being  discussed,  then it  would  make  sense that  the  current                                                               
board-certified   eye   surgeons   should  participate   in   the                                                               
discussion.   Dr. Zumbro questioned  how it could be  logical for                                                               
non-physicians  and non-surgeons  to  regulate eye  surgery.   He                                                               
stated that  the antidote  to this  argument is  simple:   if the                                                               
optometrists  wish to  practice medicine  and surgery,  then they                                                               
should  be  regulated  by  the  medical  board,  as  it  is  with                                                               
podiatry.   If  this is  unpalatable,  then Alaska  needs an  eye                                                               
surgery  amendment just  like Washington,  Arizona, and  Florida.                                                               
He said  HB 103 is  not a simple  housekeeping bill, as  it would                                                               
redefine  optometry into  a surgical  profession, and  this makes                                                               
for legitimate patient safety concerns.                                                                                         
4:54:34 PM                                                                                                                    
CARL  ELI ROSEN,  MD, Ophthalmologist,  specified that  he is  an                                                               
ocular plastic  surgeon and neuro-ophthalmologist.   He said that                                                               
he  interfaces with  neurology and  neurosurgery  with regard  to                                                               
patient diagnosis  and treatment.   He said  that he  "takes care                                                               
of"  bumps and  cysts on  eyelids and  has performed  over 15,000                                                               
surgeries   on  eyelids   for  folks   with  eyelid   and  cornea                                                               
abnormalities, cancers,  reconstructions, trauma, et cetera.   He                                                               
said  he  has been  in  practice  for  23 years  with  Ophthalmic                                                               
Associates   in  Anchorage   and   has   taken  emergency   calls                                                               
voluntarily.   He said  he is  a past  president with  the Alaska                                                               
State Medical Association.                                                                                                      
DR. ROSEN  indicated that he had  been confused by what  he heard                                                               
at the committee's  previous hearing on HB 103,  on Monday, March                                                               
27, 2017.   He pointed out  that at that meeting,  Dr. Dobson had                                                               
said that  the bill was  not about surgery and  that optometrists                                                               
have no  business performing surgery  and do not want  to perform                                                               
surgery.  He  said the prime sponsor  of HB 103 and  her aide had                                                               
stated  that the  proposed bill  is  not about  surgery, and  all                                                               
surgery language was removed from the  bill.  He went on to point                                                               
out that  during that  meeting, Dr.  Matheson had  testified that                                                               
she had  been doing  surgical procedures  for 30  years, removing                                                               
eyelashes and  foreign bodies from  the cornea.  He  reminded the                                                               
committee  that  Dr.  Christianson  said that  he  drains  sties.                                                               
Further,  he had  heard that  optometry removes  fish hooks  from                                                               
eyes.  He said that he also  heard that as times change, scope of                                                               
practice must be  modernized by the Board of  Optometry; should a                                                               
surgical procedure be deemed within  the scope of practice by the                                                               
board, it  won't want to come  back to the legislature.   He also                                                               
recollected  that the  attorney  general had  stated that  public                                                               
testimony would  help decide  if surgery  was appropriate  for an                                                               
DR.  ROSEN asked,  "Doesn't that  bother any  of you?   Not  only                                                               
would there  be no  one with actual  surgical experience  on this                                                               
board, but  you're going to  double down  and ask the  public for                                                               
help?"   He  answered his  own  question by  emphasizing that  an                                                               
expert -  someone with actual  experience - should  be consulted,                                                               
because "the  stakes are far  too high."   He said that  while it                                                               
seems  so innocent  for  someone  to say  that  they'll remove  a                                                               
foreign body or  drain/inject a sty or a cyst,  there are serious                                                               
situations   that   might   arise  under   those   circumstances,                                                               
including:  when a foreign body  is full thickness and results in                                                               
a  leaking,  open  globe;  when  a drained  sty  results  in  lid                                                               
retraction,  and  the  patient  can't  close  the  eye;  or  when                                                               
infection and necrosis  of the eyelid results,  requiring a full-                                                               
thickness skin graft.                                                                                                           
DR.  ROSEN stated  that (indisc.)  boards and  nurse practitioner                                                               
boards  police themselves  because of  the procedures  learned in                                                               
graduate school.  He said  that optometry students do not perform                                                               
surgery,   operate  lasers,   or  administer   injections.     He                                                               
questioned  why [someone  without sufficient  training] would  be                                                               
allowed to  put a needle  into an eye with  macular degeneration,                                                               
for example.   He  warned that  if something  is said  enough, it                                                               
becomes reality;  therefore, he  is asking folks  to wake  up and                                                               
think about what is being said here [in this process].                                                                          
DR. ROSEN  said an article,  dated July  2016, in the  Journal of                                                             
American  Medical Association  (JAMA) states  that health  policy                                                             
making  should be  cautious with  approving laser  privileges for                                                               
optometrists.   He said  that optometrists  do not  take hospital                                                               
emergency  calls or  (indisc. --  overlapping voices).   He  said                                                               
that  optometrists  cannot  transfer  or admit  patients  to  the                                                               
hospital as  bylaws do not allow  this.  He remarked  that people                                                               
like  to plan  for  the  unknown by  buying  fire and  earthquake                                                               
insurance, even though it is unlikely  they will ever use it.  He                                                               
then asked why  anyone would be willing to  risk patients' safety                                                               
based on  the words "trust  us."  He  emphasized the need  to set                                                               
boundaries and consequences.   He said, "Let's fix  this all with                                                               
a  definition of  surgery and  we can  all go  home."   Dr. Rosen                                                               
concluded,  "At  some  point  in  your lives  you  will  need  an                                                               
ophthalmologist.    Do  you  want to  continue  to  alienate  and                                                               
marginalize the  Alaskan ophthalmology  community?  As  it stands                                                               
it  is  difficult  enough  to  recruit  new  ophthalmologists  to                                                               
Alaska.  This bill only makes it more so."                                                                                      
4:58:28 PM                                                                                                                    
ERIC COULTER,  MD, Ophthalmologist; Medical Director,  Alaska Eye                                                               
Surgery  and Laser  Center,  stated that  the  last testimony  in                                                               
favor  of HB  103 expressed  nebulous reasons  why [optometrists]                                                               
require HB 103,  except "to modernize and be more  able to manage                                                               
themselves."   He mentioned  the testimony of  Dr. Rosen  and the                                                               
questions  of why  ophthalmologists  should get  into a  conflict                                                               
over a  nonsurgical issue.   Dr. Coulter  stated, "We  agree that                                                               
they are good  and great optometrists, but we  disagree that that                                                               
group is ready,  now or in the future, to  be great surgeons, and                                                               
despite  what they  say, this  is a  surgical bill.   ...  Unless                                                               
self-governance is dependent upon  expanded scope of practice and                                                               
surgical  privileges, this  really  doesn't have  anything to  do                                                               
with self-governance."                                                                                                          
DR.  COULTER said  there  is ample  evidence that  HB  103 is  "a                                                               
surgical-oriented  bill."    He  noted  that  the  original  bill                                                               
version would  have, under AS  08.72.050, required the  Board [of                                                               
Optometry]  to   adopt  regulations  "describing  the   scope  of                                                               
practice  for  a  licensee  to  perform  ophthalmic  surgery  and                                                               
noninvasive procedures"; however,  that language was subsequently                                                               
removed from [CSHB  103(HSS), the version that passed  out of the                                                               
previous  committee of  referral],  as a  result the  legislature                                                               
receiving  "overwhelming  concern about  optometrists  performing                                                               
surgery."   He said  this is  a moot  point, because  the current                                                               
version  would  define "optometry"  under  AS  08.72.300 as  "the                                                               
examination, evaluation, diagnosis,  treatment, or performance of                                                               
preventive   procedures  related   to  diseases,   disorders,  or                                                               
conditions  of   the  human  eyes  or   adjacent  and  associated                                                               
structures, consistent with this  chapter and regulations adopted                                                               
by  the  board".   He  said  this language  removes  restrictions                                                               
related to the  use of lasers or performing surgery.   He said he                                                               
does not  see how this change  in the definition of  optometry is                                                               
going to enhance the ability to self-regulate.                                                                                  
5:02:20 PM                                                                                                                    
DAVID KARPIK,  OD, introduced himself as  a residency-trained and                                                               
board-certified Doctor  of Optometry  testifying in  full support                                                               
of HB 103.  He said that he  and his wife are partners in a four-                                                               
doctor, two-location  practice that provides the  majority of eye                                                               
care  on the  Kenai  Peninsula.   He  said that  he  is also  the                                                               
medical  director  for  the  Vision  Source  Network  in  Alaska,                                                               
representing  18 private  optometry practice  locations scattered                                                               
throughout the  state, many of  which are  remote and rural.   He                                                               
said that some  of the opposing testimony has  indicated that all                                                               
optometrists'  training occurs  within  the statutorily  required                                                               
continuing  education but  neglects to  mention the  thousands of                                                               
hours  of  training on  the  human  body  for the  diagnosis  and                                                               
treatment of  eye disease that optometrists  receive during their                                                               
4  years  at  optometry  school,  post  graduate  residency,  and                                                               
additional  maintenance  requirements  for  board  certification,                                                               
which are well beyond the statutory requirements.                                                                               
DR. KARPIK said that Doctors of  Optometry have a long history of                                                               
providing quality,  conservative care  and practicing  within the                                                               
limits  of   what  they   are  highly  trained   to  do.     Non-                                                               
ophthalmologist   medical   doctors,    osteopaths,   and   nurse                                                               
practitioners are not statutorily  restricted from performing any                                                               
eye treatment or  surgery.  The average  medical student receives                                                               
about two  weeks in  an ophthalmology  rotation, yet  they safely                                                               
perform  eye treatment  within their  training and  comfort level                                                               
and  refer  the balance  often  to  optometrists in  their  small                                                               
communities, like himself.                                                                                                      
DR. KARPIK said  that a U.S. News & World  Report study published                                                             
this month  ranked Alaska last in  access to health care.   Today                                                               
[the  legislature] has  an opportunity  to  change that  alarming                                                               
statistic by  creating a statute  that will be durable  and allow                                                               
incorporation  of new  technology  as it  is developed,  provided                                                               
that training  is certified.   He  said all  healthcare providers                                                               
need to practice to the extent  of their training, which he added                                                               
is  provided  at great  cost  to  tax  payers whose  tax  dollars                                                               
support optometry  schools at state universities,  hospitals, and                                                               
VA hospitals.                                                                                                                   
DR. KARPIK said  that he supports the proposed  bill because it's                                                               
simple and  would replace the  rigid and aging  current optometry                                                               
law  with one  that would  match the  laws for  other prescribing                                                               
professions like  dentistry and advanced practice  nursing, which                                                               
are also regulated by state boards.   He said that as regulation,                                                               
technology,  and  research  continue to  change  best  practices,                                                               
regulation by  an optometry board  appointed by the  governor and                                                               
confirmed  by the  legislature ensures  protection of  the public                                                               
with  timely updates  in practice,  and that  allows for  optimum                                                               
access to eye care for Alaskans.                                                                                                
5:05:15 PM                                                                                                                    
ALFRED  DERAMUS,   MD,  Ophthalmologist,  stated,  "It   is  well                                                               
understood  by both  sides  that  the issue  of  surgery and  the                                                               
definition of surgery is the  lynchpin for the continued need for                                                               
us to go  back to the legislature and be  very specific about the                                                               
definition."   He said that both  sides have tried to  talk about                                                               
performing and  not performing  surgery, but  that this  does not                                                               
ring true to him.  He said  that the definition of surgery is the                                                               
incision  and  the   alteration  of  tissue.     He  opined  that                                                               
optometrists  are doing  a very  good job  in optometry,  and the                                                               
surgeons -  the ophthalmologists - are  doing a very good  job at                                                               
what  they  do.   He  emphasized  the  need  to provide  a  clear                                                               
definition of  surgery in statute,  because "... just  like water                                                               
goes through  small cracks,  we are  very concerned  that surgery                                                               
will be performed by the optometrists if there's a small crack."                                                                
5:07:21 PM                                                                                                                    
REPRESENTATIVE WOOL recollected that  the definition of surgery -                                                               
possibly  with   a  laser  -   that  he  had  heard   from  other                                                               
ophthalmologists  that  testified is  to  cut,  ablate, or  alter                                                               
tissue.  He asked Dr. Deramus if this is correct.                                                                               
DR.  DERAMUS answered  that the  definition  was "getting  close,                                                               
yes."  He  added that if laser energy is  applied to tissue, then                                                               
there would be no question that tissue would be altered.                                                                        
REPRESENTATIVE WOOL asked if that would qualify as surgery.                                                                     
DR. DERAMUS responded  that it would qualify  as surgery, because                                                               
laser  trabeculoplasty  affects  the  tissue in  a  fashion  that                                                               
causes  contraction and  movement of  the microstructures,  which                                                               
increases outflow; therefore, that is surgery.                                                                                  
REPRESENTATIVE  WOOL asked  if  having a  tattoo  removed with  a                                                               
laser would fall under the same definition.                                                                                     
DR. DERAMUS  said, "Yes,  I'm sorry, you  walked right  into that                                                               
one, it sure does."  He offered further details.                                                                                
5:09:28 PM                                                                                                                    
ELIZABETH MORGAN,  MD, Ophthalmologist,  introduced herself  as a                                                               
board-certified  ophthalmologist who  also  has  a fellowship  in                                                               
glaucoma.    She  said  that she  has  heard  repeated  testimony                                                               
regarding how  "self-legislation" by optometrists  could "easily"                                                               
result in  increased scope  of care for  optometrists.   She said                                                               
that  this  precedent  has  been  set in  Oklahoma.    She  cited                                                               
information from  JAMA, dated  October 2016,  which looks  at the                                                               
difference  in  outcomes  in  the  use  of  lasers  for  glaucoma                                                               
performed by  optometrists versus ophthalmologists.   She said it                                                               
was a very powerful study, as  there were 13,084 eyes included in                                                               
it.   She  said the  study discovered  there were  more than  two                                                               
times  the   number  of  repeat  laser   surgeries  performed  by                                                               
optometrists.   She said  the potential  explanation for  this is                                                               
ominous, because  it indicates that  either optometrists  are not                                                               
performing  laser surgery  correctly  or they  are repeating  the                                                               
laser surgeries as an effort  to increase reimbursement, which is                                                               
an issue with  cost containment in healthcare today.   Dr. Morgan                                                               
acknowledged that  she was  repeating a lot  of what  had already                                                               
been said,  but as  a glaucoma specialist  wanted to  bring these                                                               
details to light.  She said  she would like to work together with                                                               
optometrists and ophthalmologist but  thinks it is very important                                                               
to "come up with a definition  of surgery so that we may continue                                                               
to do that for the people of Alaska."                                                                                           
5:11:33 PM                                                                                                                    
JEFF   GONNASON,  OD,   Legislative   Chair,  Alaska   Optometric                                                               
Association, stated that he has  served under the state optometry                                                               
board under  two different governors  and has been  testifying on                                                               
this issue for over  40 years in Alaska.  He  said that every one                                                               
of  the  ophthalmologists  and medical  organizations  that  have                                                               
testified on this  issue for the past 40 years  have the same two                                                               
demeaning arguments:   optometrists are  a danger to  the public,                                                               
and  optometrists' education  is not  adequate.   He stated  that                                                               
both of these statements have been proven patently untrue.                                                                      
DR. GONNASON, regarding the claim  that optometrists are a danger                                                               
to the public, stated that public  safety has never been an issue                                                               
in over 40 years  of expanding scope of practice.   He said he is                                                               
not aware of  a single case before the board  involving harm from                                                               
any optometrist's treatment  or drug prescription, and  this is a                                                               
wonderful record for  Alaska.  He pointed out  that Dr. Lindstrom                                                               
commented  on  the  current  statute's   4-day  supply  limit  on                                                               
narcotics, as  described in Sections  4 and 5  of HB 103,  and he                                                               
stated that this  restriction would be kept in  regulation by the                                                               
board.   He said  that "optometry" strongly  agrees with  the new                                                               
push  to  limit narcotics  by  all  providers, and  optometry  in                                                               
Alaska  has a  10-year history  of prescribing  narcotics without                                                               
issue; therefore,  this part  of the  bill is not  an issue.   He                                                               
said that optometrists  began using eyedrop drugs in  the U.S. in                                                               
1972, but it was 16 more  years before Alaska became the fiftieth                                                               
and last  legislature to  approve this practice.   He  added that                                                               
this  was a  result  of the  same arguments  of  danger and  poor                                                               
training.  He said that he would  not be able to give eyedrops to                                                               
a child in Yakutat that had  pinkeye, even though the health aide                                                               
with only a  few weeks of training  could do this.   He said that                                                               
Alaskans  suffer  and pay  more  when  educated providers  cannot                                                               
utilize their skills.                                                                                                           
DR.  GONNASON,  regarding  inadequate education,  said  that  the                                                               
education  model is  identical to  dentistry with  8-10 years  of                                                               
university  study.    He  said that  optometrists  are  not  like                                                               
technicians; they are real doctors  receiving a bachelor's degree                                                               
followed by  a four-year doctoral  program, which  first includes                                                               
two years  of sciences,  then two  years of  clinical experience,                                                               
which is followed by the requirement  of having to pass state and                                                               
national  boards.    He  added that  many  optometrists  take  on                                                               
additional  residencies.   He said  that optometry  and dentistry                                                               
schools  are similar  to  medical schools  during  the first  two                                                               
years of  sciences, stating that  optometry and  medical students                                                               
often train together and have the  same professors.  He said that                                                               
the second two years of  clinical are different:  Because medical                                                               
students must cover  the entire range of the  body, more clinical                                                               
time is  spent on  the priorities of  heart disease,  cancer, and                                                               
stroke;   in  comparison,   optometry  students   cover  systemic                                                               
diseases, diabetes,  hypertension, and  brain tumors to  make the                                                               
appropriate referrals.                                                                                                          
DR. GONNASON  said that his  final comment pertains to  the scare                                                               
tactic regarding  surgery.  He  said optometrists do  very little                                                               
of  the work  of ophthalmologists  and that  optometrists perform                                                               
none of  the advanced specialty surgeries  of the subspecialists,                                                               
who have testified.   He said that optometrists  perform only the                                                               
minor procedures for which they are  fully competent.  He went on                                                               
to say that the reason surgery  cannot be well defined in statute                                                               
is  because,  technically,  anything  touching  human  tissue  is                                                               
surgery;  including clipping  fingernails, tattooing  of eyelids,                                                               
and piercing  metal through parts of  the body.  He  said that if                                                               
the legislature tries  to define surgery in statute,  it will end                                                               
up with the problem that exists  in other states, where they have                                                               
long lists  of everything that can  and cannot be performed.   He                                                               
stated  that having  to return  to  the legislature  is the  main                                                               
problem.     He  indicated  there   is  always   opposition  from                                                               
"organized  medicine."   For  example,  there  was opposition  to                                                               
Alaska's  advanced  practice  nurses, whom  Dr.  Gonnason  opined                                                               
provide  a  "magnificent" service  to  Alaskans.   He  asked  the                                                               
committee to  please note the  support letters  from Southcentral                                                               
Foundation,   other   native   health  organizations,   and   Dr.                                                               
Castillo's letter,  which "aren't,  you know,  on either  side of                                                               
this."   He said optometrists  in Alaska provide the  majority of                                                               
eye care at  lower cost; therefore, he would  thank the committee                                                               
for [supporting] better eyecare access for Alaskans.                                                                            
5:15:50 PM                                                                                                                    
CHAIR KITO,  after ascertaining  that there was  no one  else who                                                               
wished to testify, closed public testimony on HB 103.                                                                           
CHAIR KITO announced that HB 103 was held over.                                                                                 

Document Name Date/Time Subjects
HB142 Fiscal Note DOLWD-UI 3.1.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Sponsor Statement 3.8.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Supporting Document-Letter of Opposition Agosti 3.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Supporting Document-Letter of Opposition NFIB 3.7.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Supporting Document-Letter of Support Miller 3.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Supporting Document-MWBA Analysis 3.8.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Supporting Document-Resolution AWIB 3.8.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Supporting Document-Unemployment Insurance Handbook 3.8.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB142 Supporting Document-WBA charts 3.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 142
HB126 Fiscal Note DOA-DRM 2.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 126
HB126 Fiscal Note DOLWD-WC 2.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 126
HB126 Fiscal Note MVA-COM 2.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 126
HB126 Memo of Changes L&C 2.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 126
HB126 Sponsor Statement 2.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 126
HB126 Supporting Document-Letter Adjutant General Hummel 2.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 126
HB103 Supporting Documents-AS 08.72.273 Removal of foreign bodies 3.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 103
HB103 Amendment 1 3.28.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 103
HB103 Amendment 3 3.29.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 103
HB103 Amendment 2 3.29.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 103
HB103 Amendment 4 3.29.17.pdf HL&C 3/29/2017 3:15:00 PM
HB 103