Legislature(2017 - 2018)SENATE FINANCE 532

03/14/2017 09:00 AM Senate FINANCE

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SENATE BILL NO. 36                                                                                                            
     "An Act relating to the practice of optometry."                                                                            
9:15:55 AM                                                                                                                    
Co-Chair  Hoffman MOVED  to ADOPT  the committee  substitute                                                                    
for SB 36, Work Draft 30-LS0328\J (Bruce, 2/13/17).                                                                             
Co-Chair MacKinnon OBJECTED for discussion.                                                                                     
9:16:25 AM                                                                                                                    
SENATOR  CATHY  GIESSEL,  SPONSOR, discussed  the  committee                                                                    
substitute  and the  root version  of the  bill. She  stated                                                                    
that the regulations pertaining  to medicine, dentistry, and                                                                    
nursing   were  regularly   updated  to   comply  with   new                                                                    
technology and education.  She noted that the  bill had been                                                                    
offered  multiple  times in  the  past.  She read  from  the                                                                    
sponsor statement:                                                                                                              
     Senate  Bill  36  modernizes  and  updates  the  Alaska                                                                    
     Optometry Statute,  as many sections are  over 50 years                                                                    
     old. It authorizes the optometry  board to regulate its                                                                    
     practice   as   do   the   other   prescribing   health                                                                    
     professions such as dentistry, medicine and nursing.                                                                       
     Under  SB   36  the   board  will  continue   to  adopt                                                                    
     regulations,  updating   them  to   current  education,                                                                    
     certification and practice.                                                                                                
     Continuing  education,  required  by  current  statute,                                                                    
     will  be   determined  by  the  board   as  with  other                                                                    
     professions. This  change allows the  board flexibility                                                                    
     to control  CE requirements  and is recommended  by the                                                                    
     Dept. of Commerce,  Community and Economic Development.                                                                    
     The current regulations require  more CE hours than the                                                                    
     statute subsection deleted by this bill.                                                                                   
     SB  36 authorizes  the optometry  board to  continue to                                                                    
     regulate prescription  pharmaceutical agents, including                                                                    
     standards  and limitations  on  practice determined  by                                                                    
     the board.                                                                                                                 
     SB  36  ensures  that  the optometry  board,  with  the                                                                    
     oversight of  the Department of Law,  may not authorize                                                                    
     any  procedure  beyond  the  scope  of  the  licensee's                                                                    
     education, training, and experience.                                                                                       
     The  optometry definition  in this  bill is  updated to                                                                    
     reflect  current education,  certification and  modern-                                                                    
     day practice.  This allows for future  new and improved                                                                    
     diagnostic  and   therapeutic  procedures,   while  not                                                                    
     having  to  return to  the  legislature  for every  new                                                                    
     technological advance.                                                                                                     
Senator  Giessel reported  that  the bill  had been  offered                                                                    
several  times  in  the  past   and  had  faced  significant                                                                    
opposition. She stressed that  the malpractice insurance for                                                                    
optometrists was low.                                                                                                           
9:21:16 AM                                                                                                                    
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, provided an                                                                          
explanation of changes (copy on file):                                                                                          
     The  language in  the  committee  substitute gives  the                                                                    
     Board of Optometry authority  to regulate its practice,                                                                    
     reflecting the  same regulatory authority given  to the                                                                    
     other prescribing  practices such as  medicine, nursing                                                                    
     and dentistry.                                                                                                             
     In this new version J  we have removed the reference to                                                                    
     ophthalmic surgery  from the  bill (version A,  page 1,                                                                    
     lines 12-13, and also on page 2, lines 21-23).                                                                             
     It is  unnecessary for  this language  to be  placed in                                                                    
     statute;  optometric   procedures,  within  optometry's                                                                    
     scope of practice,  can be regulated by  the board, all                                                                    
     requiring robust  public comment from  stakeholders and                                                                    
     rigorous Department of Law oversight.                                                                                      
     This is the current process  for the Medical Board. The                                                                    
     Board  of  Nursing.  The Board  of  Dentistry.  And  so                                                                    
     should it  be for  the Board of  Optometry. The  new CS                                                                    
     reflects that intent in version J.                                                                                         
9:22:49 AM                                                                                                                    
Co-Chair MacKinnon REMOVED her OBJECTION. There being NO                                                                        
further OBJECTION, the proposed committee substitute was                                                                        
9:23:04 AM                                                                                                                    
Ms. Conway discussed the Sectional Analysis (copy on file):                                                                     
     Section 1                                                                                                              
     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.                                                                                                              
     Section 2                                                                                                              
     AS.08.72.060  (c)(4) the  board shall  publish advisory                                                                  
     opinions  regarding  standards   for  the  practice  of                                                                    
     Section 3                                                                                                              
     AS  08.72.181(d) moves  the  continuing education  (CE)                                                                  
     requirements back  into regulation,  as desired  by the                                                                    
     Department   of   Commerce,  Community   and   Economic                                                                    
     Development. Continuing education  is still required by                                                                    
     current  statute, but  the hours  and subjects  will be                                                                    
     determined by the board.                                                                                                   
     Section 4                                                                                                              
     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 5                                                                                                              
     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 6                                                                                                              
     AS  08.72.300(3) updates  the  optometry definition  to                                                                  
     reflect current practice.                                                                                                  
     Section 7                                                                                                              
     Effective date  for Section 2.  This is because  (3) of                                                                    
     Section 2 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)                                                                              
9:25:18 AM                                                                                                                    
Co-Chair MacKinnon queried any additional comments.                                                                             
Senator Giessel replied in the negative.                                                                                        
9:25:33 AM                                                                                                                    
Senator  Olson wondered  how many  other states  had similar                                                                    
legislation to SB 36.                                                                                                           
Senator  Giessel  corrected  the assumption  that  the  bill                                                                    
would  expand the  scope of  practice for  optometrists. She                                                                    
deferred the  question to  the current  chair of  the Alaska                                                                    
State Board of Optometry.                                                                                                       
9:26:18 AM                                                                                                                    
Senator   Olson  clarified   that  the   bill  would   allow                                                                    
optometrists   the   authority   to   prescribe   additional                                                                    
medications, as well as perform additional procedures.                                                                          
Senator Giessel replied that  optometrists had the authority                                                                    
to  write prescriptions  for a  "very long  time." She  said                                                                    
that the  bill offered no  expansion of the  procedures that                                                                    
optometrists could perform.                                                                                                     
9:27:34 AM                                                                                                                    
Senator  Olson wondered  how many  other states  had visited                                                                    
the issue of the limitations of optometry practices.                                                                            
Senator Giessel deferred the question to the board.                                                                             
9:28:30 AM                                                                                                                    
DOCTOR  PAUL BARNEY,  CHAIR, BOARD  OF  OPTOMETRY, spoke  in                                                                    
support  of  the  legislation.   He  read  from  a  prepared                                                                    
statement (copy on file).:                                                                                                      
     My name  is Paul  Barney, I am  an optometrist  and the                                                                    
     current  chair  of the  Alaska  Board  of Examiners  in                                                                    
     Optometry. I  am also  a past  president of  the Alaska                                                                    
     Optometric Association.  I'm here  today in  support SB
     I have practiced  in Anchorage for 17 years  where I am                                                                    
     the  Center  Director  of Pacific  Cataract  and  Laser                                                                    
     Institute  in  Anchorage.  Pacific Cataract  and  Laser                                                                    
     Institute  (also known  as PCLI)  is a  referral center                                                                    
     limited to  medical and surgical  eye care.  I practice                                                                    
     with an  Ophthalmic Surgeon and a  Certified Registered                                                                    
     Nurse Anesthetist.  PCLI's approach  to eye care  is to                                                                    
     work  collaboratively  as  a  team  and  optimize  each                                                                    
     practitioner's  education and  skills. Together  we are                                                                    
     able to provide quality,  affordable, surgical eye care                                                                    
     to Alaskans.  We in  fact are  the largest  provider of                                                                    
     cataract care in the state of Alaska.                                                                                      
     I  support SB  36 because  it will  allow the  Board of                                                                    
     Optometry to  regulate the details  of the  practice of                                                                    
     Optometry.  This  is  already the  case  with  Advanced                                                                    
     Practice  Nurses, Dentists,  and Medical  Doctors. This                                                                    
     legislation  will not  set a  new precedence  in health                                                                    
     care, since this  is already the way  other health care                                                                    
     providers are regulated in the state of Alaska.                                                                            
     SB 36  will give  Optometrists a better  opportunity to                                                                    
     practice  to the  highest level  of their  education by                                                                    
     allowing the  Board of  Optometry to  write regulations                                                                    
     that  are commensurate  with educational  advances that                                                                    
     occur with new technology  and medications. 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  all  other  professional regulatory  boards,  the                                                                    
     Board  of Optometry  cannot promulgate  regulations for                                                                    
     practices or  procedures that are beyond  the education                                                                    
     of Optometrists. The Board of  Optometry is overseen by                                                                    
     the AK Department  of Law, just like  other health care                                                                    
     boards. And the AK Department  of Law would ensure that                                                                    
     the Board  of 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 they                                                                    
     provide outside of their scope  of education. With that                                                                    
     said,  there   is  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                                                                    
     who do provide care outside of their education.                                                                            
     As  chair  of the  Alaska  Board  of Optometry,  I  can                                                                    
     assure you  that the  primary concern  of the  Board is                                                                    
     the safety of the public. In  the six years that I have                                                                    
     served on the Board we  have had no complaints from the                                                                    
     public  that  were  serious  enough  to  even  consider                                                                    
     disciplinary action. Optometrists  are conservative and                                                                    
     cautious practitioners  and the passage of  SB 36 would                                                                    
     not change their conservative nature.                                                                                      
     SB 36 would  be good for the state of  Alaska. The bill                                                                    
     puts the  regulatory details regarding the  practice of                                                                    
     Optometry  in  the authority  of  the  Alaska Board  of                                                                    
     Optometry.  These changes  are important  to allow  the                                                                    
     profession  and practice  of  Optometry to  incorporate                                                                    
     new  technologies  and advances  in  eye  care as  they                                                                    
     occur. Optometry provides  over 70% of the  eye care in                                                                    
     the  U.S. In  some rural  areas, especially  in Alaska,                                                                    
     Optometrists  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  technologies  in  eye                                                                    
     I respectfully urge you to support SB 36.                                                                                  
9:32:41 AM                                                                                                                    
Senator Olson wondered whether Dr. Barney had practiced in                                                                      
rural Alaska.                                                                                                                   
Dr. Barney  replied that  he had not  practiced in  rural or                                                                    
bush Alaska.  He relayed  that he  had worked  with patients                                                                    
from rural Alaska that had been  referred to him, and he was                                                                    
familiar with the eye health needs of rural Alaska.                                                                             
9:33:31 AM                                                                                                                    
Senator Olson wondered how the legislations would affect                                                                        
the optometrists working in rural Alaska.                                                                                       
Dr. Barney  replied that the  bill would allow the  board to                                                                    
write   regulations  that   were   more  commensurate   with                                                                    
education. He  said that the  current practice  of optometry                                                                    
in  rural Alaska  was a  bit  below the  education that  was                                                                    
provided in most schools of  optometry. The bill would allow                                                                    
the  board to  consider  regulations that  would expand  the                                                                    
scope  of practice.  He relayed  that the  bill would  allow                                                                    
optometrists  to  provide  more   expansive  care  to  rural                                                                    
9:34:42 AM                                                                                                                    
Senator Olson  asked how many  other states  had legislation                                                                    
similar to SB 36.                                                                                                               
Dr. Barney  replied that  Kentucky, Oklahoma,  and Louisiana                                                                    
had  passed  legislation  allowing   for  greater  scope  of                                                                    
practice  for optometrists.  The  bill would  allow for  the                                                                    
board  to make  the scope  of  practice in  Alaska equal  to                                                                    
those states.                                                                                                                   
9:35:25 AM                                                                                                                    
Senator Olson  asked how many complaints  the board received                                                                    
within the past 5 years concerning scope of practice.                                                                           
Dr. Barney responded  that he had received  no complaints in                                                                    
the past 6 years that he had served on the board.                                                                               
9:35:48 AM                                                                                                                    
Senator  Olson   surmised  that  the  board   had  no  taken                                                                    
disciplinary action on any optometrists in the state.                                                                           
Dr. Barney replied in the affirmative.                                                                                          
9:36:06 AM                                                                                                                    
Senator Micciche wondered why the  state had not allowed the                                                                    
Board of Optometry to regulate itself.                                                                                          
Dr. Barney  replied that he did  not know why the  state had                                                                    
not allowed the Board of Optometry to regulate itself.                                                                          
9:36:39 AM                                                                                                                    
Co-Chair Hoffman  queried the position of  the Alaska Native                                                                    
Health Corporation on the bill.                                                                                                 
Dr. Barney  understood that the Southcentral  Foundation was                                                                    
in support  of the  legislation. He  cited a  support letter                                                                    
(copy on file).                                                                                                                 
9:37:07 AM                                                                                                                    
Co-Chair  Hoffman rebuffed  that he  was more  interested in                                                                    
the  opinion of  corporations  providing  services in  rural                                                                    
Dr. Barney replied that he  was unaware of a position either                                                                    
for or against from corporations serving rural Alaskans.                                                                        
9:37:45 AM                                                                                                                    
Co-Chair  Hoffman felt  that  the  position of  corporations                                                                    
providing health  care to rural  Alaskans should  be entered                                                                    
into the record.                                                                                                                
9:37:54 AM                                                                                                                    
Senator Olson  announced that it  was normally  the position                                                                    
of practicing physician's in  rural areas, that optometrists                                                                    
had more  training in the  field of eye health  than medical                                                                    
doctors and  were usually  in favor  of legislation  like SB
9:39:20 AM                                                                                                                    
Co-Chair MacKinnon said  that she would reach  out to native                                                                    
health organizations for an opinion.                                                                                            
9:39:24 AM                                                                                                                    
Senator  von Imhof  thought  that both  sides  of the  issue                                                                    
brought up  valid points but  wondered why the issue  was so                                                                    
contentious.  She spoke  of other  states  that had  defined                                                                    
ophthalmic surgery  in statute.  She felt that  a compromise                                                                    
could be reached.                                                                                                               
9:42:27 AM                                                                                                                    
DOCTOR   JEFF   GONNASON,   PRESIDENT,   ALASKA   OPTOMETRIC                                                                    
ASSOCIATION, testified in support of the bill. He read from                                                                     
a prepared statement (copy on file):                                                                                            
     My name is Jeff Gonnason, OD.  I was born and raised in                                                                    
     Ketchikan &  Craig and  I was  the first  Alaska Native                                                                    
     optometrist.  I  have  served on  the  State  Optometry                                                                    
     Board  under  two  different  governors,  and  as  Past                                                                    
     President of the Alaska  Optometric Association. I have                                                                    
     volunteered  at  the  ANMC   and  SCF.  I  practice  in                                                                    
     Anchorage  and performed  Bush  clinics  in my  younger                                                                    
     A brief history for those new to this issue:                                                                               
     Optometry's doctor's degree was  brought up to the same                                                                    
     level of  education as medicine  and dentistry  over 45                                                                    
     years ago  - 4 years of  undergraduate Bachelors degree                                                                    
     followed  by a  4 year  graduate professional  doctoral                                                                    
     program, plus  often 1-2 year residencies  for advanced                                                                    
     This exactly  follows the dental school  model. Looking                                                                    
     at 8-10 years of university education.                                                                                     
     By  the way,  currently 2/3  of optometry  students are                                                                    
     The  4  learned  professions  of  medicine,  dentistry,                                                                    
     optometry,  and  advanced  practice nurses  -  are  all                                                                    
     independent, all have their  own regulatory boards, and                                                                    
     are  all   currently  authorized   by  Alaska   law  to                                                                    
     prescribe  drugs  including controlled  narcotics  with                                                                    
     DEA numbers. Alaska  optometrists have prescribed drugs                                                                    
     for the past 25 years with no issues of harm or abuse.                                                                     
     Optometrists are  defined as PHYSICIANS by  the federal                                                                    
     Center for Medicare, and are  held to the same standard                                                                    
     of  care  as  other  medical professions  as  we  treat                                                                    
     Medicare &  1 Medicaid  patients, and are  on preferred                                                                    
     provider insurance panels.                                                                                                 
     The  optometry malpractice  insurance fee  is extremely                                                                    
     low - about $485 per year for $4M in coverage.                                                                             
     Approximately  150 optometrists  practice all  over the                                                                    
     state  and provide  the vast  majority of  eye care  in                                                                    
     Alaska,  servicing  over  80  remote  locations.  Local                                                                    
     optometrists  are called  upon at  rural hospitals  and                                                                    
     clinics for  their expertise. We  are the  primary care                                                                    
     physicians for eyecare in Alaska.                                                                                          
     Treatment  and travel  costs from  rural areas  greatly                                                                    
     increases when routine eye care  is instead provided by                                                                    
     urban specialists.                                                                                                         
     Alaska  needs the  best new  doctors of  optometry, and                                                                    
     antiquated state  statutes are a barrier  to attracting                                                                    
     the best and brightest to our state.                                                                                       
     To be  absolutely clear, SB  36 does NOT  authorize any                                                                    
     optometrist to do ANYTHING.  It only updates antiquated                                                                    
     statutes and gives the  State Optometry Board authority                                                                    
     to  regulate the  profession with  their sworn  duty to                                                                    
     protect  the   public,  the  same  as   Alaska  medical                                                                    
     physicians, dentists and advanced  practice nurses - so                                                                    
     that optometry does not have  to return for legislation                                                                    
     for every new advance in education or technology.                                                                          
     The   legislature   creates  professional   boards   to                                                                    
     regulate the specific details  of practice, that allows                                                                    
     for flexibility with advances  in health care delivery.                                                                    
     Licensing includes  2 professional judgment of  when to                                                                    
     refer patients for specialty care.                                                                                         
     This  bill  has  nothing  to   do  with  comparing  the                                                                    
     advanced   subspecialty  ophthalmology   training  with                                                                    
     optometry.  The clinical  education  of an  optometrist                                                                    
     does not  have to  parallel that of  an ophthalmologist                                                                    
     any  more  than the  education  of  a family  physician                                                                    
     needs to parallel a heart surgeon or a neurosurgeon.                                                                       
     The  family doctor  has no  restrictions, but  does not                                                                    
     perform heart or brain surgery,  as they refer to those                                                                    
     specialties.  Optometry   does  the  same.   The  state                                                                    
     optometry board  would NEVER authorize  any optometrist                                                                    
     to  perform any  treatment they  were not  educated and                                                                    
     qualified to do.  Risk of harm to the  public has NEVER                                                                    
     been  an  issue,  and  all these  claims  of  harm  are                                                                    
     patently untrue.                                                                                                           
     Of the  4 main prescribing professions,  only optometry                                                                    
     still contains outdated  statutes. The Alaska Optometry                                                                    
     Board deserves the same level of respect as these                                                                          
     other professions.                                                                                                         
     I respectfully ask  for your support of SB  36 to allow                                                                    
     the optometry board to better  regulate for the future,                                                                    
     to benefit  Alaska citizens by providing  better access                                                                    
     to eye care and lower costs.                                                                                               
Dr. Gonnason  offered a brief  history as to  the contention                                                                    
between optometry  and ophthalmology.  He lamented  that the                                                                    
fight had been brewing over the  past 40 years. He felt that                                                                    
the issue  was one  of professional judgement.  He contended                                                                    
that no  optometrist would perform  surgery on the  eye that                                                                    
was outside their scope of training.                                                                                            
Senator   Olson  spoke   to   the  concern   voiced  by   an                                                                    
ophthalmologist   regarding  the   overly  expansive   scope                                                                    
allowed to optometrists.                                                                                                        
Dr.  Gonnason  responded  that  the  legislation  would  not                                                                    
expand the scope  of practice but would allow  the board the                                                                    
authority to authorize new  procedures, taught in nationally                                                                    
accredited optometry  schools. He  said that  several states                                                                    
offered  more authority  in statute,  some offered  less. He                                                                    
believed  that doctors  should be  able to  practice to  the                                                                    
full extent of their training.                                                                                                  
9:51:39 AM                                                                                                                    
Senator  Olson  wondered  how   many  optometrists  had  DEA                                                                    
Dr.  Barney  believed  that  the number  was  more  than  50                                                                    
percent of the 150 optometrists practicing in Alaska.                                                                           
9:52:01 AM                                                                                                                    
Senator Olson wondered about  the additional yearly training                                                                    
hours required for optometrists.                                                                                                
Dr. Barney responded  that 36 hours were  required every two                                                                    
9:52:15 AM                                                                                                                    
Senator  Olson  asked  how those  numbers  compared  to  the                                                                    
requirements for ophthalmologists.                                                                                              
Dr. Barney replied that he did not know.                                                                                        
9:52:24 AM                                                                                                                    
Co-Chair  MacKinnon  shared  that representatives  from  the                                                                    
ophthalmologist  community   would  testify  later   in  the                                                                    
9:52:28 AM                                                                                                                    
Senator  Micciche wondered  what would  occur if  the Alaska                                                                    
Board of Dentistry decided to  pas regulation that said that                                                                    
dentists could perform reconstructive surgery on the jaw.                                                                       
Dr. Barney  replied that the board  would write regulations,                                                                    
which  would  be   given  to  the  Department   of  Law  for                                                                    
meticulous scrutiny.  He said that regulation  would require                                                                    
appropriate educational  requirements. He added that  if the                                                                    
board  of  optometry  wrote  regulations  for  practices  or                                                                    
procedures  that  did not  have  an  educational basis,  the                                                                    
regulations would never be approved.                                                                                            
9:53:41 AM                                                                                                                    
Senator  Micciche understood  that if  the board  decided to                                                                    
give ophthalmologists  broader reach  in terms  of practices                                                                    
that could  be performed, the educational  criteria would be                                                                    
very clear.                                                                                                                     
Dr.  Barney replied  that the  board would  have to  provide                                                                    
proof,  through the  Department of  Law, that  education had                                                                    
been provided through credited schools of optometry.                                                                            
9:55:49 AM                                                                                                                    
DOCTOR   DAVID  ZUMBRO,   OPHTHALMOLOGIST,  ANCHORAGE   (via                                                                    
teleconference), testified against the legislation:                                                                             
     I am concerned  that Senate Bill 36  is moving forward.                                                                    
     This bill is  special interest legislation purposefully                                                                    
     crafted in ambiguity  that potentially allows optometry                                                                    
     professionals to  regulate and perform eye  surgery for                                                                    
     which  they have  received no  training.  Where is  the                                                                    
     public outcry for the necessity  of this bill? How does                                                                    
     the  current statute  prohibit Optometry  Professionals                                                                    
     from   regulating    their   profession?    This   bill                                                                    
     incorrectly   redefines   optometry   as   a   surgical                                                                    
     It has  been stated that my  profession, ophthalmology,                                                                    
     opposes optometric scope  of practice expansion because                                                                    
     of fear  of competition.  This is wholly  incorrect. It                                                                    
     is  absolutely  about  patient  safety.  Currently,  it                                                                    
     takes  8  years  after  college  and  20,000  hours  of                                                                    
     supervised training to create  a safe and competent eye                                                                    
     physician  and  surgeon.  There  is  a  rigorous  board                                                                    
     certification process  involving both written  and oral                                                                    
     examinations  that  must  be renewed  every  10  years.                                                                    
     Surgical privileges  at hospitals and  surgicenters are                                                                    
     limited to 2 years and  renewed by a committee of other                                                                    
     physicians and  surgeons only  after proof  of currency                                                                    
     and  competency. As  an eye  physician  and surgeon,  I                                                                    
     have   to   directly   request  permission   from   the                                                                    
     credentials  committee  to  perform  specific  surgical                                                                    
     procedures  such as  laser each  2 year  cycle. In  the                                                                    
     case of  Senate Bill 36,  the state legislature  is the                                                                    
     credentials  committee  and  the  optometry  lobby  has                                                                    
     asked for surgical privileges.                                                                                             
     The  fact   that  this  bill  permits   access  to  all                                                                    
     schedules  of controlled  medications for  optometrists                                                                    
     should  be enough  to give  you pause  about supporting                                                                    
     this  bill. In  my eye  surgery practice,  I deal  with                                                                    
     procedures  and conditions  associated with  severe eye                                                                    
     pain  on  a daily  basis.  I  hardly ever  prescribe  a                                                                    
     controlled medicine and  when I do, it  is usually just                                                                    
     hydrocodone,   which  the   optometrists  already   can                                                                    
     legally prescribe.                                                                                                         
     I   have   absolutely   no   problem   with   optometry                                                                    
     professionals regulating themselves  in the practice of                                                                    
     optometry.   However,  Senate   Bill   36  allows   the                                                                    
     optometry   profession    to   define    and   regulate                                                                    
     optometrists in the  performance of ophthalmic surgery.                                                                    
     Consequently,  it is  imperative that  the current  eye                                                                    
     physicians and surgeons  in the state of  Alaska have a                                                                    
     voice  in  this   legislative  process.  If  ophthalmic                                                                    
     surgery is to  be defined and regulated  in statute, it                                                                    
     makes  perfect sense  that  ophthalmologists should  be                                                                    
     involved. If  it is imperative to  Alaskans that Senate                                                                    
     Bill  1   36  be  passed,  please   consider  adding  a                                                                    
     definition  of  eye  surgery addendum.  This  will  put                                                                    
     everybody on the same page  regarding the definition of                                                                    
     ophthalmic surgery, reduce the unnecessary rhetoric,                                                                       
    protect patients and satisfy all concerned parties.                                                                         
10:00:17 AM                                                                                                                   
DOCTOR  RACHEL   REINHARDT,  MEMBER,  AMERICAN   ACADEMY  OF                                                                    
OPHTHALMOLOGY, SEATTLE  (via teleconference),  spoke against                                                                    
the legislation. She expressed  concern that the legislation                                                                    
would  interfere  with  patient   safety.  She  stated  that                                                                    
without specific language to  restrict surgery, Alaska would                                                                    
be the  first state in the  country to adopt such  broad and                                                                    
unprecedented   legislation.   She    noted   that   similar                                                                    
legislation had been introduced  in Washington State several                                                                    
years  ago,  which   contained  language  that  specifically                                                                    
prohibited optometrists from  performing surgery. She shared                                                                    
that  only  3 states  in  the  country have  passed  similar                                                                    
bills.   She  concluded   that   SB  36   would  result   in                                                                    
unprecedented  sweeping  change   in  optometry's  scope  of                                                                    
practice and  would have  profound implications  for patient                                                                    
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
10:05:08 AM                                                                                                                   
HARRIET  MILKS, ASSISTANT  ATTORNEY  GENERAL, DEPARTMENT  OF                                                                    
LAW, shared  that she represented 25  professional licensing                                                                    
boards, including  all medical  care boards. She  provided a                                                                    
description  the relationship  between  the  boards and  the                                                                    
department. She related that the  department did not dictate                                                                    
what  the  regulations boards  chose  to  draft, or  how  to                                                                    
regulate   their  professions.   She   explained  that   the                                                                    
department  worked with  the boards  to make  sure that  the                                                                    
regulations  were  consistent  with  the  constitution,  the                                                                    
Administrative  Procedure Act,  and the  scope of  authority                                                                    
given in  statute. She  said that  the department  made sure                                                                    
that  the  regulations  were adopted,  consistent  with  the                                                                    
Administrative Procedure Act. She  clarified that the boards                                                                    
did not  devise and adopt regulations  without public input.                                                                    
She   explained  that   the  Administrative   Procedure  Act                                                                    
required that proposed regulation  go out for public comment                                                                    
for a  minimum of  30 days. She  emphasized that  the public                                                                    
comment  period for  every regulation  involved every  state                                                                    
resident. She  said that  adoption of  new regulations  by a                                                                    
board  required the  consideration  of  public comment.  She                                                                    
said  that once  the regulations  were adopted  by a  board,                                                                    
they were sent back to the department for careful analysis.                                                                     
10:10:25 AM                                                                                                                   
Senator Micciche hypothesized  about optometrists performing                                                                    
eye  transplant and  wondered  whether  there were  criteria                                                                    
that  the  department  would   review  to  evaluate  whether                                                                    
optometrists could perform eye transplants.                                                                                     
Ms.  Milks  replied that  the  department  would review  the                                                                    
scope of  practice as defined  by the statute. If  the scope                                                                    
of  practice included  eye transplants,  there  would be  no                                                                    
legal problem with optometrists performing eye transplants.                                                                     
10:12:00 AM                                                                                                                   
Senator Micciche wondered whether  the department could deny                                                                    
a  new  regulation  if  it  fell outside  of  the  scope  of                                                                    
Ms. Milks replied in the affirmative.                                                                                           
10:13:01 AM                                                                                                                   
Senator von  Imhof wondered  what other  states had  done in                                                                    
terms of defining ophthalmic surgery.                                                                                           
Ms. Milks replied that she had not researched the issue.                                                                        
10:13:15 AM                                                                                                                   
Senator  von Imhof  wondered how  the  department would  vet                                                                    
amendments to the legislation.                                                                                                  
Ms. Milks  responded that  the department  was not  taking a                                                                    
position on the legislation but  would wait and see what the                                                                    
boards reaction was on the bill.                                                                                                
10:13:41 AM                                                                                                                   
Senator von  Imhof understood that the  department would not                                                                    
offer a legal opinion on an amendment.                                                                                          
Ms.  Milks  clarified  that  the  department  would  not  be                                                                    
silent, but that she was  not currently prepared to speak on                                                                    
the bill.                                                                                                                       
10:13:56 AM                                                                                                                   
Senator  Olson hoped  that the  public  understood that  the                                                                    
legislature was  not trying to pass  legislation that harmed                                                                    
Ms. Milks  thought that public opinion  would stay favorable                                                                    
as  long  as the  process,  particularly  public input,  was                                                                    
10:14:55 AM                                                                                                                   
Co-Chair MacKinnon  noted the attached fiscal  note #1, from                                                                    
Department of Commerce, Community and Economic Development                                                                      
10:15:56 AM                                                                                                                   
JANEY   HOVENDEN,   DIRECTOR,  DIVISION   OF   CORPORATIONS,                                                                    
BUSINESS   AND   PROFESSIONAL   LICENSING,   DEPARTMENT   OF                                                                    
COMMERCE,  COMMUNITY AND  ECONOMIC DEVELOPMENT,  stated that                                                                    
the fiscal note  had been doubled from the  previous year in                                                                    
order  to  account  for legal  costs  to  amend  regulation,                                                                    
printing, and postage in the first year.                                                                                        
10:17:43 AM                                                                                                                   
Senator  Olson  asked  about the  removal  of  the  surgical                                                                    
restriction  to  using  laser  equipment  and  wondered  how                                                                    
lasers were used in eye care for diagnostics and treatment.                                                                     
Dr.  Gonnason replied  that ophthalmologists  were concerned                                                                    
about  the  use of  lasers.  He  relayed  that much  of  the                                                                    
equipment  he currently  used employed  lasers. He  detailed                                                                    
that  there were  both  diagnostic  and therapeutic  lasers.                                                                    
Diagnostic  lasers were  used  for  measurement. He  related                                                                    
that currently optometrists were  not supposed to use lasers                                                                    
and wondered  how that would  be possible when the  most up-                                                                    
to-date  equipment used  lasers.  He  said that  therapeutic                                                                    
lasers were  used in limited  procedures in his  practice to                                                                    
combat glaucoma.  He spoke to the  misinformation offered by                                                                    
a previous testifier concerning a study in Oklahoma.                                                                            
10:21:15 AM                                                                                                                   
Dr.  Gonnason  contended  that in  the  Oklahoma  case  some                                                                    
patients   had  to   return  to   their  optometrists   more                                                                    
frequently was not  due to questionable practices  but was a                                                                    
result of optometrists working more conservatively.                                                                             
10:21:48 AM                                                                                                                   
Dr.  Gonnason continued  to discuss  an anecdote  concerning                                                                    
laser surgery procedures done on  veterans. He asserted that                                                                    
the only  thing that  would change under  the bill  was that                                                                    
optometrists would be trained in smaller laser procedures.                                                                      
10:23:08 AM                                                                                                                   
Co-Chair  MacKinnon wondered  whether the  malpractice costs                                                                    
for optometrists  differed from  family practice  doctors or                                                                    
Dr. Barney replied that  malpractice insurance premiums were                                                                    
lower for optometrists.                                                                                                         
Co-Chair  MacKinnon  asked   that  whether  the  malpractice                                                                    
coverage would increase if the  board increased the scope of                                                                    
practice for optometrists.                                                                                                      
Dr.  Barney replied  that procedures  that  were safe  still                                                                    
held the  risk of  complication. He shared  that malpractice                                                                    
rates had not increased significantly in Oklahoma.                                                                              
10:24:54 AM                                                                                                                   
Dr.  Gonnason  furthered  that   there  was  no  correlation                                                                    
between scope of practice and malpractice insurance.                                                                            
10:25:24 AM                                                                                                                   
Co-Chair  MacKinnon remarked  that  Alaska had  some of  the                                                                    
highest medical  costs in the  nation. She spoke  of similar                                                                    
arguments in  other medical fields. She  lamented the myriad                                                                    
of  issues  that  the  legislature   worked  to  balance  in                                                                    
providing for public safety.                                                                                                    
10:28:21 AM                                                                                                                   
Co-Chair  Hoffman   stressed  that  the  fees   for  medical                                                                    
services were markedly higher in  Alaska than in the rest of                                                                    
the country.                                                                                                                    
10:29:51 AM                                                                                                                   
Co-Chair MacKinnon agreed. She noted that there were cost                                                                       
drivers in ever facet of the medical field, but that                                                                            
industry had to consider risk factors and rates of return.                                                                      
SB 36 was HEARD and HELD in committee for further                                                                               

Document Name Date/Time Subjects
SB 36 Letters of Support Packet 1.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB 36 Opposition Letter Coulter MD vs. SB36 HB103.pdf HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
SFIN 3/14/2017 9:00:00 AM
HB 103
SB 36
SB 36 Opposition Letter Winkle.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB 36 Opposition Testimony Packet 1.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB36 Supporting Document Ohio State Optometry Curriculum.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB36 Supporting Document Malpractice Fact Sheet.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB36 Backup Accreditation in Optometry.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB36 Explanation of Changes vsn A to vsn J 2-22-17.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB36 Sponsor Statement 2-2-17.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
CS SB 36 Sponsor Statement 2-20-17.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
CS SB 36 Sectional Analysis.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
CS SB36 vsn J DRAFT Optometry 2-13-17.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
HB 80 SCS HB80 FIN Summary work draft v. N.pdf SFIN 3/14/2017 9:00:00 AM
HB 80
HB 80 SCS HB80 FIN work draft v. N.pdf SFIN 3/14/2017 9:00:00 AM
HB 80
SB 36 Testimony Jeff Gonnason.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB 36 ASMA Letter of Opposition.pdf SFIN 3/14/2017 9:00:00 AM
SB 36
SB 36 Testimony Barney.pdf SFIN 3/14/2017 9:00:00 AM
SB 36