Legislature(2017 - 2018)BUTROVICH 205

02/15/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SB 36 Out of Committee
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled: TELECONFERENCED
Moved SB 32 Out of Committee
                 SB 36-OPTOMETRY & OPTOMETRISTS                                                                             
1:33:22 PM                                                                                                                    
CHAIR WILSON  announced the consideration  of SB 36.  He welcomed                                                               
invited testimony to address SB 36.                                                                                             
1:34:05 PM                                                                                                                    
DR.  PAUL  BARNEY, Chairman;  Board  of  Examiners in  Optometry,                                                               
Corporations,   Business   &   Professional   Licensing;   Alaska                                                               
Department  of  Commerce,  Community, and  Economic  Development;                                                               
Juneau, Alaska; testified  in support of SB 36. He  noted that he                                                               
has served on the board for  five years and was also the director                                                               
for Pacific  Cataract and Laser  Institute in  Anchorage, Alaska.                                                               
He  detailed  that his  practice  specializes  in cataract  care,                                                               
laser  vision correction,  and medical  eye-care. He  pointed out                                                               
that  he  works  with  an ophthalmic  surgeon  and  an  advanced-                                                               
practice  nurse; together  they  work  as a  team  and use  their                                                               
training to provide care more efficiently and affordably.                                                                       
He  emphasized that  SB 36  would  not allow  optometrists to  do                                                               
anything more than what they have  already been trained to do. He                                                               
specified  that   there  is  a  limitation   that  would  prevent                                                               
optometrists from  writing regulations beyond the  scope of their                                                               
training.  He revealed  that  the Alaska  the  Department of  Law                                                               
oversees  all  health-care  boards; consequently,  the  Board  of                                                               
Examiners  in  Optometry  has  to  prove  that  optometrists  are                                                               
trained for  the regulations  that they  write. He  asserted that                                                               
the Alaska  Department of  Law oversight acts  as a  fail-safe to                                                               
prevent optometrists from doing  something outside of their scope                                                               
of  training. He  added that  as  a provider,  if he  were to  do                                                               
something  outside   of  his  scope  of   training,  his  medical                                                               
malpractice   insurance   would   be  immediately   negated.   He                                                               
summarized that there really is  no incentive for optometrists to                                                               
provide care that  they are not trained to do  because they would                                                               
not get paid  and more importantly, optometrists  could end their                                                               
careers by doing something outside of their scope of training.                                                                  
1:37:11 PM                                                                                                                    
DR.  JEFF  GONNASON,   Legislative  Chairman,  Alaska  Optometric                                                               
Association, Anchorage,  Alaska, testified  in support of  SB 36.                                                               
He  disclosed that  he has  been  licensed as  an optometrist  in                                                               
Alaska for 40 years, the past  chairman of the Board of Examiners                                                               
in Optometry,  and served twice  on the  state board in  the past                                                               
under two different governors. He added that he was also a 22-                                                                  
year volunteer for the American Optometric Association.                                                                         
He pointed out  that optometrists' education is  exactly the same                                                               
as  a dentistry-model  with  8 to  10  years of  university-level                                                               
education. He addressed testimony  from an ophthalmologist during                                                               
an  earlier committee  meeting and  noted  that he  had the  same                                                               
professor for pharmacology as the ophthalmologist.                                                                              
DR.  GONNASON   disclosed  that   optometrists  are   defined  as                                                               
physicians under federal Medicare and  that has been the case for                                                               
approximately 18  years. He  divulged that  160-plus optometrists                                                               
serve  over  80 communities  in  the  state.  He set  forth  that                                                               
optometrists work together very  well with general-family doctors                                                               
and ophthalmologists.                                                                                                           
He  opined  that  optometrist  training  cannot  be  compared  to                                                               
ophthalmologist  training because  it would  be like  comparing a                                                               
family physician with a neurosurgeon. He summarized as follows:                                                                 
     We   need  ophthalmologists,   we  love   having  their                                                                    
     abilities to do  their surgeries, we only  overlap in a                                                                    
     small  area; but,  we do  very few  of the  things that                                                                    
     they do  and we are  not trying  to do things  that are                                                                    
     outside  of  our  scope  of   training.  Of  the  four-                                                                    
     prescribing professions,  only optometry has  to always                                                                    
     come  back to,  "Ask  daddy for  permission" to  change                                                                    
     something  as  technology  goes   along.  We  are  very                                                                    
     skilled  in using  our professional  judgement to  know                                                                    
     when to refer patients.                                                                                                    
1:39:56 PM                                                                                                                    
SENATOR  BEGICH  revealed  that  Dr. Barney  did  his  Lasik  eye                                                               
DR.  BARNEY clarified  that  Dr. Ford  from  Seattle did  Senator                                                               
Begich's  surgery.  He specified  that  he  did the  preoperative                                                               
evaluation and the postoperative care.                                                                                          
SENATOR  BEGICH disclosed  that he  had talked  earlier with  Dr.                                                               
Barney  and  Dr.  Gonnason  to express  his  concerns  about  the                                                               
Legislature's responsibility  to public safety. He  said he asked                                                               
both doctors about the importance  in clarifying surgery in a way                                                               
that  would  meet  the   American  Medical  Association's  health                                                               
concerns as well as meet some  of the needs and interests of what                                                               
optometrists in  Alaska are  doing. He said  he suggested  to Dr.                                                               
Barney that language  around surgery might be  required and noted                                                               
that  Dr. Barney  appeared to  respond that  his suggestion  made                                                               
sense. He  asked Dr. Barney to  comment on the idea  of a tighter                                                               
surgery definition to help committee  members understand what the                                                               
optometrists are seeking in statute.                                                                                            
1:42:06 PM                                                                                                                    
DR.  BARNEY replied  that  if  necessary, he  is  not opposed  to                                                               
language that further defines surgery.                                                                                          
SENATOR BEGICH set forth that his  hope is the committee can come                                                               
to a conclusion that further defines surgery.                                                                                   
1:44:03 PM                                                                                                                    
DR.  GONNASON  remarked  that  part of  the  difficulty  is  that                                                               
"forces" have tried to suppress  the optometrist profession for a                                                               
long  time.  He  said  to answer  Senator  Begich's  question  on                                                               
surgery,  the problem  is  everyone knows  what  surgery is,  but                                                               
trying  to define  surgery can  get  murky. He  pointed out  that                                                               
clipping  a  finger nail  alters  tissue  and can  be  considered                                                               
surgery.  He noted  that  some states  have  defined surgery  for                                                               
physicians  and  dentists. He  remarked  that  putting a  surgery                                                               
definition  in SB  36 would  apply  to other  fields too,  unless                                                               
exempted. He opined  that details should be left  to the medical,                                                               
dental, and nursing boards. He  pointed out that there in nothing                                                               
in  the  nursing  statute  that  says, "You  will  not  do  brain                                                               
surgery" because nurses do not  do that. He asserted that there's                                                               
no  need for  defining surgery  in the  optometry law  that says,                                                               
"You will not do these 16  things." He noted that a proposal came                                                               
out to  put 110 procedures that  could not be done  in statute, a                                                               
proposal  that made  no sense.  He  emphasized that  optometrists                                                               
perform  procedures  that  do  not  "penetrate."  He  added  that                                                               
optometrists  do not  do the  things that  ophthalmologists claim                                                               
optometrists will be trying to do.                                                                                              
1:46:26 PM                                                                                                                    
SENATOR  BEGICH   stated  that  Dr.  Gonnason's   reply  is  more                                                               
difficult for him to understand.  He said he thought Dr. Gonnason                                                               
provided a  clear answer  that surgery as  a definition  might be                                                               
something that he would entertain. He continued as follows:                                                                     
     You  understood   that  concern   and  we  do   have  a                                                                    
     definition of  surgery in  statute and  admittedly part                                                                    
     of why  we have a legislative-affairs  agency here that                                                                    
     drafts bills is that they  look at other statutes where                                                                    
     those definitions  will conflict, and they  identify in                                                                    
     those statutes where they do  and they allow us to know                                                                    
     that in  the process  because all  of us  are generally                                                                    
     generalists   here.   With    that   understanding,   a                                                                    
     definition  of surgery  is a  norm in  many states  and                                                                    
     I've provided to some members  of the committee some of                                                                    
     those definitions  that I've researched some  myself. I                                                                    
     am now confused  whether you are or are  not willing to                                                                    
     look  at a  definition  of surgery  in statute  because                                                                    
     I've heard  you now  say "no," and  I heard  Dr. Barney                                                                    
     say "yes." So which is it, I'm confused.                                                                                   
DR. GONNASON clarified that he did  not mean he would not look at                                                               
a  definition of  surgery. He  specified  that he  was trying  to                                                               
explain why  defining surgery is  difficult and pointed  out that                                                               
most  states address  through regulation.  He remarked  that laws                                                               
are  different in  all 50  states due  to legislative  compromise                                                               
that  results in  optometrists  having  to go  back  and ask  for                                                               
permission  when new  technology comes  along rather  than having                                                               
the board  be able to  say "yes"  when an optometrist  is trained                                                               
for a procedure.                                                                                                                
1:48:29 PM                                                                                                                    
SENATOR VON IMHOF addressed Dr. Gonnason's remarks as follows:                                                                  
     Trying to create  a bill, any bill, so  open ended that                                                                    
     it precludes  having to go  back and change  statute as                                                                    
     technology  changes,   as  circumstances   changes,  is                                                                    
     probably  too difficult  in any  industry. I'm  already                                                                    
     noticing  that  we  are tweaking  things  now  in  this                                                                    
     legislature for  all sorts of  different things  as new                                                                    
     chemicals come  about, as  new technology  comes about,                                                                    
     as new laws  come about, that's just the  nature of the                                                                    
     beast, I think.                                                                                                            
     That being  said, what I'm  understanding is  that this                                                                    
     particular  conflict has  been  around  for quite  some                                                                    
     time  and I  understand the  challenge of  optometrists                                                                    
     having to  come legislatively  every single  time, it's                                                                    
     not cost effective  for any stakeholder. So  the key is                                                                    
     to stop  this nonsense and  to move forward  that while                                                                    
     we  may find  a  solution that  not  everyone is  happy                                                                    
     with, everyone can live with.                                                                                              
     I think what's important is  Senator Begich and I and a                                                                    
     few others have looked at  what other states have done,                                                                    
     some are more onerous than  others, but some have tried                                                                    
     to  thread-the-needle to  make  it make  sense for  all                                                                    
     parties.  I think  what Senator  Begich was  asking you                                                                    
     today for a  deliverable is to perhaps,  could you take                                                                    
     a first crack at what  you think based on other states'                                                                    
     legislation, what might make sense.                                                                                        
1:50:28 PM                                                                                                                    
At ease.                                                                                                                        
1:50:38 PM                                                                                                                    
CHAIR WILSON called the committee back to order.                                                                                
SENATOR GIESSEL  said she  was thrilled  that Senator  Begich has                                                               
done research  on the definition  of surgery, but noted  that she                                                               
was  one  of the  committee  members  that  did not  receive  his                                                               
She asked Dr. Barney to  address the number of patient complaints                                                               
that  the Board  of Examiners  in Optometry  has received  in the                                                               
last decade.                                                                                                                    
DR. BARNEY answered that there  have been some complaints, but no                                                               
complaints that  required disciplinary  action over the  past ten                                                               
SENATOR GIESSEL  asked Dr.  Barney if the  Board of  Examiners in                                                               
Optometry  was  in  good standing  financially  with  regards  to                                                               
licensing fees covering their costs.                                                                                            
DR. BARNEY replied that the  board is currently in good standing.                                                               
He noted  that the  last scope-of-practice  bill passed  10 years                                                               
ago and the board had  to address legal expenses implemented from                                                               
the scope-of-practice change.                                                                                                   
SENATOR  GIESSEL asked  Dr. Barney  to clarify  the legal  issues                                                               
that he referenced.                                                                                                             
1:52:57 PM                                                                                                                    
DR. BARNEY  specified that  the Alaska  Department of  Law billed                                                               
the board for  their investigative work involved  with the scope-                                                               
of-practice  change.  He  detailed  that license  fees  were  not                                                               
increased, and  the board fell  behind, but noted that  the board                                                               
will be caught up in the next cycle.                                                                                            
SENATOR GIESSEL asked him to verify  that the board pays the cost                                                               
in  implementing regulatory  changes and  the funding  ultimately                                                               
comes from licensees.                                                                                                           
DR. BARNEY answered correct.                                                                                                    
CHAIR WILSON asked for final comments from the bill's sponsor.                                                                  
1:54:15 PM                                                                                                                    
SENATOR  GIESSEL  summarized  intent  and  issues  of  SB  36  as                                                               
     I think Senator von  Imhof really encapsulated it, this                                                                    
     has  been an  issue  that has  been discussed  multiple                                                                    
     times  over at  least a  decade, it  continues to  take                                                                    
     time  in this  legislature; in  that time  optometrists                                                                    
     have  been practicing  safely.  You've heard  testimony                                                                    
     that  professional  complaints against  their  practice                                                                    
     are zero.  I think it  is time  to allow this  board to                                                                    
     function as other boards do.                                                                                               
     I  have the  definitions of  the scope-of-practice  for                                                                    
     the  four boards  that  currently  have authority  over                                                                    
     their regulation,  over their regulatory  authority and                                                                    
     that is: nursing,  physicians, dentistry, and pharmacy.                                                                    
     All are  extremely broad, I  will speak only of  my own                                                                    
     advanced   nurse  practitioner   scope-of-practice,  it                                                                    
     means that, "A registered  nurse authorized to practice                                                                    
     in the state, who  because of specialized education and                                                                    
     experience,  is certified  to perform  acts of  medical                                                                    
     diagnosis  and  the   prescription  and  dispensing  of                                                                    
     medical,  therapeutic  or   corrective  measures  under                                                                    
     regulations adopted by the board."                                                                                         
     One of  the really interesting  ones is for  the scope-                                                                    
     of-practice  for  medicine and  osteopathy.  Osteopaths                                                                    
     are   not  medical   doctors,  they   are  doctors   of                                                                    
     osteopathy,  this is  a subspecialty  so to  speak that                                                                    
     believes  that  adjustment of  the  spine  is often  an                                                                    
     answer to medical problems, they  however fall into the                                                                    
     same  definition  and says,  "For  a  fee, donation  or                                                                    
     other consideration, to diagnose,  treat, operate on or                                                                    
     prescribe  for  or  administer to  any  human  ailment,                                                                    
     blemish,  deformity, disease,  disfigurement, disorder,                                                                    
     injury  or other  mental or  physical condition,  or to                                                                    
     attempt  to  perform  or represent  that  a  person  is                                                                    
     authorized to  perform any of  the acts set out  in the                                                                    
     subparagraph;" I  think listening to that  you can hear                                                                    
     that the  practice of medicine  is all  encompassing of                                                                    
     everything  possible  that  could  happen  to  a  human                                                                    
     being. We don't worry that  a family practice doctor is                                                                    
     going to  attempt heart surgery,  we don't  worry about                                                                    
     that. I suggest that  the same reasonable outlook could                                                                    
     be applied to optometry.                                                                                                   
1:56:39 PM                                                                                                                    
CHAIR WILSON announced that hearing no call for amendments,                                                                     
asked for a motion to move SB 36 out of committee.                                                                              
1:56:51 PM                                                                                                                    
SENATOR  VON IMHOF  moved to  report SB  36, [30-LS0328\A],  from                                                               
committee  with individual  recommendations  and attached  fiscal                                                               
1:57:02 PM                                                                                                                    
CHAIR WILSON announced that seeing  no objection SB 36 moved from                                                               
the Senate Health and Social Services Standing Committee.                                                                       

Document Name Date/Time Subjects
ASPS Comments - Scope Optometric - AK SB36 - 02-13-2017.pdf SHSS 2/15/2017 1:30:00 PM
SB 36
Carmen Moore - oppose.pdf SHSS 2/15/2017 1:30:00 PM
SB 36
Drug schedules - Giessel.pdf SHSS 2/15/2017 1:30:00 PM
SB 36
New Mexico House Business & Industry Committee Letter 2007.pdf SHSS 2/15/2017 1:30:00 PM
SB 36
SB 32 Legislation - Version J.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB 36 ASMA oppose.pdf SHSS 2/15/2017 1:30:00 PM
SB 36
Alaska Biosimilars Arth Fdn oppose amendment sb 32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB32 - Clarification on Questions Asked in the Committee (Sen Hughes).doc HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB32_ASMA.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB 32 Am No. 1.PDF SHSS 2/15/2017 1:30:00 PM
SB 32