Legislature(1997 - 1998)
04/22/1997 03:03 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
April 22, 1997
3:03 p.m.
MEMBERS PRESENT
Representative Con Bunde, Chairman
Representative Joe Green, Vice Chairman
Representative Al Vezey
Representative Brian Porter
Representative Fred Dyson
Representative J. Allen Kemplen
MEMBERS ABSENT
Representative Tom Brice
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 13(RLS)
"An Act relating to taxes on cigarettes and tobacco products and to
the use of the proceeds of those taxes, and increasing by at least
35.5 mills the amount of excise tax levied on each cigarette
imported or acquired in the state; and providing for an effective
date."
- MOVED HCS CSSB 13(HES) OUT OF COMMITTEE
HOUSE BILL NO. 127
"An Act relating to the citizen review board and panels for
permanency planning for certain children in state custody; renaming
the Citizens' Review Panel For Permanency Planning as the Citizens'
Foster Care Review Board; extending the termination date of the
Citizens' Foster Care Review Board; and providing for an effective
date."
- MOVED CSHB 127(HES) OUT OF COMMITTEE
HOUSE BILL NO. 195
"An Act relating to licensure of optometrists; and providing for an
effective date."
- HEARD AND HELD
(* First public hearing)
PREVIOUS ACTION
BILL: SB 13
SHORT TITLE: INCREASE TOBACCO TAXES
SPONSOR(S): SENATOR(S) SHARP, Ellis
JRN-DATE JRN-DATE ACTION
01/03/97 17 (S) PREFILE RELEASED 1/3/97
01/13/97 17 (S) READ THE FIRST TIME - REFERRAL(S)
01/13/97 17 (S) HES, FIN
02/05/97 (S) HES AT 9:00 AM BUTROVICH ROOM 205
02/05/97 (S) MINUTE(HES)
02/10/97 (S) HES AT 9:00 AM BUTROVICH ROOM 205
02/10/97 (S) MINUTE(HES)
02/14/97 (S) HES AT 9:00 AM BUTROVICH ROOM 205
02/14/97 (S) MINUTE(HES)
02/14/97 355 (S) HES RPT CS 2DP 2NR NEW TITLE
02/14/97 355 (S) DP:WILKEN, ELLIS, NR: WARD, GREEN
02/14/97 355 (S) FISCAL NOTE TO SB (REV)
02/24/97 468 (S) FISCAL NOTE TO CS (REV)
02/24/97 468 (S) ZERO FISCAL NOTE TO CS (REV)
04/04/97 (S) FIN AT 10:00 AM SENATE FINANCE 532
04/04/97 (S) FIN AT 6:00 PM SENATE FINANCE 532
04/07/97 1024 (S) FIN RPT CS 4DP 2NR SAME TITLE
04/07/97 1024 (S) DP: PEARCE, SHARP, ADAMS, TORGERSON
04/07/97 1024 (S) NR: PHILLIPS, PARNELL
04/07/97 1024 (S) FN TO CS (REV)
04/10/97 1077 (S) RLS RPT CS CALENDAR AND 1DP
NEW TITLE
04/10/97 1078 (S) PREVIOUS FN APPLIES (REV-#4)
04/10/97 1080 (S) READ THE SECOND TIME
04/10/97 1080 (S) RLS CS ADOPTED UNAN CONSENT
04/10/97 1081 (S) AM NO 1 OFFERED BY ELLIS
04/10/97 1081 (S) AM NO 1 FAILED Y7 N12 A1
04/10/97 1082 (S) AM NO 2 OFFERED AND WITHDRAWN
04/10/97 1085 (S) ADVANCED TO THIRD READING
UNAN CONSENT
04/10/97 1085 (S) READ THE THIRD TIME CSSB 13(RLS)
04/10/97 1086 (S) PASSED Y16 N4
04/10/97 1086 (S) EFFECTIVE DATE(S) SAME AS PASSAGE
04/10/97 1086 (S) WARD NOTICE OF RECONSIDERATION
04/11/97 1106 (S) RECON TAKEN UP - IN THIRD READING
04/11/97 1106 (S) PASSED ON RECONSIDERATION Y15 N4 E1
04/11/97 1107 (S) EFFECTIVE DATE(S) SAME AS PASSAGE
04/11/97 1107 (S) TRANSMITTED TO (H)
04/14/97 1094 (H) READ THE FIRST TIME - REFERRAL(S)
04/14/97 1095 (H) HES, FINANCE
04/22/97 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 127
SHORT TITLE: FOSTER CARE REVIEW BOARD
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
JRN-DATE JRN-DATE ACTION
02/12/97 318 (H) READ THE FIRST TIME - REFERRAL(S)
02/12/97 318 (H) HES, FINANCE
03/27/97 (H) HES AT 3:00 PM CAPITOL 106
03/27/97 (H) MINUTE(HES)
04/10/97 (H) HES AT 3:00 PM CAPITOL 106
04/10/97 (H) MINUTE(HES)
04/22/97 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 195
SHORT TITLE: LICENSURE OF OPTOMETRISTS
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES BY REQUEST
JRN-DATE JRN-DATE ACTION
03/14/97 667 (H) READ THE FIRST TIME - REFERRAL(S)
03/14/97 667 (H) HES
04/22/97 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
SENATOR BERT SHARP
Alaska State Legislature
Capitol Building, Room 516
Juneau, Alaska 99801
Telephone: (907) 465-3004
POSITION STATEMENT: Sponsor of CSSB 13(RLS)
GLENN PRAX
1015 Meadow Rue
North Pole, Alaska 99705
Telephone: (907) 488-2400
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
WALTER GAUTHIER
P.O. Box 2246
Homer, Alaska 99603
Telephone: (907) 235-2809
POSITION STATEMENT: Testified against HCS CSSB 13(HES) and in
support of CSHB 127(HES)
DIANE BUFFINGTON
Kodiak, Alaska
Telephone: (907)
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
JOANNE LOVITZ-EDMISTON
347 Dailey Street
Anchorage, Alaska 995151
Telephone: (907) 349-8358
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
TESHA SANCHEZ
5630 South Tahiti
Anchorage, Alaska 99507
Telephone: (907) 561-6699
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
BOBBY SCOTT
521 Izembek
Anchorage, Alaska 99508
Telephone: (907) 338-8257
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
NICHOLAS ZERBINOS
P.O. Box 371
Glennallen, Alaska 99588
Telephone: (907) 822-3451
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
KEN JACOBUS
425 G Street, Number 920
Anchorage, Alaska 99501
Telephone: (907) 277-3333
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
SUZANNE FISHCHETTI
10336 Stewart Drive
Eagle River, Alaska 99577
Telephone: (907) 694-7944
POSITION STATEMENT: Testified against HCS CSSB 13(HES)
JODI OLMSTEAD, Founder
Concerned Parents for Reform
1995 Athena Drive
North Pole, Alaska 99705
Telephone: (907) 488-0334
POSITION STATEMENT: Testified against HCS CSSB 13(HES) and in
support of CSHB 127(HES)
JOHN CYR, President
National Education Association-Alaska (NEA-Alaska)
114 Second Street
Juneau, Alaska 99801
Telephone: (907) 586-3090
POSITION STATEMENT: Testified in support of HCS CSSB 13(HES)
RUPERT E. ANDREWS, Representative
American Association of Retired Persons (AARP)
9416 Long Run Drive
Juneau, Alaska 99801
Telephone: (907) 789-7422
POSITION STATEMENT: Testified in support of HCS CSSB 13(HES)
BLAIR McCUNE, Assistant Public Defender
Central Office
Public Defender Agency
Department of Administration
900 West Fifth Avenue, Suite 200
Anchorage, Alaska 99501-2090
Telephone: (907) 264-4400
POSITION STATEMENT: Testified on CSHB 127(HES)
PATTI SWENSON, Legislative Assistant
for Representative Bunde
Alaska State Legislature
Capitol Building, Room 104
Juneau, Alaska 99801
Telephone: (907) 465-4843
POSITION STATEMENT: Testified on CSHB 127(HES)
DR. JEFFREY A. GONNASON., O.D.
2211 East Northern Lights, Number 202
Anchorage, Alaska 99508
Telephone: (907) 276-2080
POSITION STATEMENT: Testified in support of HB 195
DR. SAM McCONKEY, M.D.
351 Gold Claim Avenue
Fairbanks, Alaska 99701
Telephone: (907) 456-7760
POSITION STATEMENT: Testified against HB 195
DR. PETER E. CANNAVA, M.D.
161 North Binkley Street
Soldotna, Alaska 99669
Telephone: (907) 262-4462
POSITION STATEMENT: Testified against HB 195
DR. RONALD ZAMBER, M.D.
3044 Riverview
Fairbanks, Alaska 99709
Telephone: (907) 479-4317
POSITION STATEMENT: Testified against HB 195
DR. ROBERT FORD, M.D.
1600 A Street, Suite 200
Anchorage, Alaska 99501-5146
Telephone: (907) 272-2423
POSITION STATEMENT: Testified in support of HB 195
DR. HANS KELL, O.D.
1600 A Street, Suite 200
Anchorage, Alaska 99501-5146
Telephone: (907) 272-2423
POSITION STATEMENT: Testified in support of HB 195
DR. GORDON PREECS, M.D.
15795 Glacier Highway
Juneau, Alaska 99801
Telephone: (907) 789-2290
POSITION STATEMENT: Testified on HB 195
TAPE 97-32, SIDE A
Number 0000
CHAIRMAN CON BUNDE called the House Health, Education and Social
Services Standing Committee meeting to order at 3:03 p.m. Members
present at the call to order were Representatives Bunde, Green,
Porter and Kemplen. Representative Vezey arrived at 3:12 p.m. and
Representative Dyson arrived at 3:15 p.m. Representative Brice was
absent. This meeting was teleconferenced to Anchorage, Fairbanks,
Glennallen, Homer and Kodiak.
SB 13 - INCREASE TOBACCO TAXES
Number 0040
CHAIRMAN BUNDE announced the first item on the agenda, CSSB
13(RLS), "An Act relating to taxes on cigarettes and tobacco
products and to the use of the proceeds of those taxes, and
increasing by at least 35.5 mills the amount of excise tax levied
on each cigarette imported or acquired in the state; and providing
for an effective date." He referred to an amendment located in the
committee file.
Number 0092
SENATOR BERT SHARP, Sponsor of CSSB 13(RLS), stated that the
amendment takes out the intent of using the tobacco tax for a
dedicated purpose.
Number 0186
CHAIRMAN BUNDE said the tobacco tax is separate from the cigarette
tax. The cigarette tax existed before statehood and is already a
dedicated tax. The tobacco tax refers to a tax on all tobacco,
except cigarettes. This tax was instituted after statehood and
therefore is not allowed to be a dedicated tax.
Number 0226
SENATOR SHARP explained that Section 1 details the legislative
intent. The dedicated school fund portion, otherwise known as the
cigarette tax, will derive the largest portion of the proposed
revenue. The school fund is one of three dedicated funds
established prior to statehood and is legitimately constituted as
a dedicated fund. This fund only allows for the rehabilitation,
construction or repair of state schools or facilities. The other
portion of the bill is the Senate version which is to use the
tobacco tax, constituting $2.5 million to $3 million according to
the Department of Revenue estimates, for anti-tobacco campaigns,
enforcement of present tobacco laws and things of that sort.
Grants would be given to municipalities to detect, apprehend and
prosecute adults who make tobacco products available to children.
The intent of these grants would be affected by the proposed
Amendment 1.
SENATOR SHARP stated that the tax in this bill is increased by 71
cents a pack to make the total tax equal $1.
Number 0354
CHAIRMAN BUNDE referred to the chart located in the committee file
regarding the existing tax, the tax if this bill passes with the
dedication and the final scenario of the bill passing with the
dedication found to be unconstitutional. He asked if this
indicated the 71 cents or the $1.
Number 0389
SENATOR SHARP indicated it was 71 cents, for a total tax of $1.
The fiscal note addresses the reduction down to a 71 cent total,
with a corresponding reduction in the tobacco product tax. The
tobacco tax has the same percentage increase as the cigarette tax.
SENATOR SHARP felt CSSB 13(RLS) was a bill addressing health care,
education and revenue. Up to 80 percent of the funds could be
dedicated to the schools. He said, "The other thing in the bill is
a case of a constitutional challenge that would negate the
dedication. There's a fail safe retroactive road block to make
sure the tax stayed in effect and would not be lost or have to be
refunded, that would only be subject to court decision, a negative
decision as far as the ability to dedicate the funds to the
dedicated account. That depending on who you talk to, there is
nothing that prohibits an increased funding on cigarettes to go
into that dedicated tax. We didn't want to entice a challenge to
avoid the tax, if they should challenge the constitutionality of
that. That was the purpose of the last few sections in the
retroactive section in the bill. It has nothing to do with
retroactive taxes."
Number 0592
CHAIRMAN BUNDE said the bill would increase the existing tobacco
taxes by 71 cents with those taxes on cigarettes dedicated to the
school construction and maintenance fund. Those taxes on other
forms of tobacco, if the committee adopts Amendment 1, would go to
the general fund and could be appropriated, by the legislature, for
the purposes discussed by Senator Sharp.
SENATOR SHARP answered that this money could also be used to close
the fiscal gap.
Number 0607
CHAIRMAN BUNDE mentioned the briefing by Grant Woods, the attorney
general from the state of Arizona, who began the lawsuit against
Liggett. Some members of the general public feel that raising the
fee would not serve as an economic barrier. Grant Woods referred
to discussions held with the Chief Executive Officer (CEO) of
Phillip Morris, who said that if the cost of cigarettes went up by
$1 a pack, nationwide, use would go down by 45 percent. He
commented that this information is vastly different from the
lobbying effort which claims that raising the tax would not have an
impact on use.
Number 0660
SENATOR SHARP was a firm believer in the price signal concept.
Most business people recognize that there is a definite price
signal in regards to any product.
Number 0670
CHAIRMAN BUNDE asked him if he had a problem with Amendment 1.
Number 0682
SENATOR SHARP answered that he didn't have a problem and he didn't
feel the Senate would object, as far as concurrence. The main
concern, of the Senate, regarded the dedication.
Number 0708
REPRESENTATIVE BRIAN PORTER made a motion to adopt Amendment 1,
dated April 22, 1997\T.7. Hearing no objection, Amendment 1 was
adopted.
Number 0770
GLENN PRAX testified next via teleconference from Fairbanks. He
was opposed to HCS CSSB 13(HES) and to the tax on cigarettes. He
did not feel the state should assume more responsibility for taking
care of citizens. Taking care of a person's health and well being
sets a dangerous precedent for the state and is not an appropriate
method for influencing public behavior. If the focus could be
limited to taxing tobacco and nothing else, then maybe it would be
okay. Often government gets some authority to do something and it
soon gets out of hand. He cited the income tax and prohibition as
examples where government tried to do something good, but it
backfired.
MR. PRAX did not feel the tax would have the desired effect, to
reduce consumption. He indicated that there are studies which
indicate both results. Tobacco was a product used to illustrate
inelastic demand when he studied economics as it isn't that
responsive to the influence of price. Once people get hooked, they
will pay whatever the amount needed to get the product. He said
some people might stop, but it won't be as significant as some
advertise.
MR. PRAX felt the tax would lead to smuggling. Kids would become
involved in the black market in order to save money to buy
cigarettes. He felt a sunset clause should be added to the bill.
If the reaction isn't what the proponents of this bill say it is,
then it should be repealed.
Number 0915
CHAIRMAN BUNDE stated that nothing this legislature does would bind
a future legislature. A future legislative body could chose to
amend, change or repeal this bill if they felt it was not working.
He appreciated the acknowledgement that there were different points
of view and different studies, but asked why he felt it wouldn't be
an economic deterrent for young people beginning to smoke. He
referred to his testimony that once people are addicted, it is
harder to change their behavior. He said the legislature hoped the
economic deterrent would affect people before they're addicted.
CHAIRMAN BUNDE explained that people who are addicted to tobacco
products cost the state a considerable sum of money every year in
health related expenses. He asked if he had a view on user fees.
Number 0968
MR. PRAX advocated getting out of the business of taking care of
people who are silly enough to smoke. It is obvious that the
health effects of cigarettes are detrimental. People chose to
smoke knowing the risks. The government cannot be so paternalistic
as to think that society must take care of them when they choose to
take foolish risks. He did not think this tax was an appropriate
solution to this problem.
Number 1011
CHAIRMAN BUNDE agreed, he would rather have people be responsible
for themselves. He used the example of people who get into car
accidents and are still taken to the hospital. He felt that on a
humanitarian level, it would be difficult to change this type of
assistance.
Number 1022
WALTER GAUTHIER testified next via teleconference from Homer. He
opposed any tobacco tax, no matter what shape or form in which it
was done. He contended that it is a shell game, that any money
dedicated to the Department of Education (DOE) will mean that less
money will be included in the DOE budget. This money will be
available to continue to fund a whole lot of state employees to
push paper from one desk to another. The Republicans were elected
to cut the budget. Any kind of tax is a revenue issue. He
believed that when you talk about it being a health issue, the
smokers costing the state of Alaska a certain amount of money then
you have to realize that fat people, people who drink too much
coffee, people who eat too many candy bars and get diabetes and
people who drink alcohol cost the state a certain amount of money.
People who are working for the DOE, the Department of Health and
Social Services (DHSS) and non-profit agencies see their budgets
shrinking. Those departments and agencies believe that by
targeting the evil smokers they can get enough money until a
Democratic legislature comes into power. He stated that this is a
revenue issue, not a health issue.
Number 1121
DIANE BUFFINGTON testified next via teleconference from Kodiak.
She stated that HCS CSSB 13(HES) was not a education, health nor a
revenue bill. This piece of legislation is a tax bill. This bill
purports to dedicate some of the funds to educate children on the
hazards of smoking. Over the past five years, the public service
announcements have not decreased any type of drug use in our youth.
Drug use is up 150 percent for cocaine and marijuana. An education
campaign is not going to work. Education needs to begin at the
family level. Taxing families is not going to decrease smoking.
Fourteen states, in the past two years, have increased their
cigarette tax. Most of those states have seen a rise in cigarette
usage by teenagers. The state of Washington, who currently has the
highest tax on cigarettes, is now attempting to lower their tax.
MS. BUFFINGTON referred to enforcement costs. She referred to
literature stating that it would cost more for enforcement, that
several more employees would need to be added to the budget. She
said 70 percent of the DHSS budget is slated for employees. The
tax revenue would not filter down to the local municipalities and
communities. This bill would violate the constitution. Taxes,
according to Mr. Chenoweth, would remain at the same "2.5 which it
is currently getting." The state should not enact any laws which
would automatically trigger a judicial challenge. The fiscal gap
needs to be closed through budget cuts.
Number 1282
JOANNE LOVITZ-EDMISTON testified next via teleconference from
Anchorage. She said it was an extraordinary abuse of governmental
power to propose stealing money from a small group of people via
taxation to provide for the education and the anti-smoking
sentiments of others. She questioned how the legislature could
justify having this small group of smokers pay for the education of
other people's children above what is already paid for in property
taxes dedicated to education. She did not have any children in the
school system. If all people benefited, then all people should
fund it. She questioned punishing smokers. She did not think that
Alaskans would pay more money to fund increased governmental
spending. As a member of Alaskans for Tax Reform she did not
approve of increased taxation.
MS. LOVITZ-EDMISTON described her upbringing where she learned that
it was wrong for a conscience to escape the parameters of personal
behavior and conduct. She said that Representatives Bunde and
Green have repeatedly expressed that routine smoking and tobacco
taxation are a matter of conscious. While she respected their
sense of conscious in this matter, she believed that it was her
responsibility to state that it is most inappropriate to use one's
power to subjugate other free thinking adults who do not share in
the same beliefs and values on taxes.
Number 1458
CHAIRMAN BUNDE respectfully disagreed with her testimony. He
stated that 71 percent of people support this issue according to
the Dittman Poll.
Number 1508
TESHA SANCHEZ testified next via teleconference from Anchorage.
She is in opposition to HCS CSSB 13(HES). She has heard both sides
of the tobacco issue. She felt putting a tax on people who smoke
because it will stop kids from smoking was wrong. Kids can afford
alcohol, drugs, Air Jordan tennis shoes. A dollar a pack won't
mean a thing to them. She felt it was her responsibility to teach
her children morals at home.
Number 1554
BOBBY SCOTT testified next via teleconference from Anchorage. He
did not condone the use of tobacco by minors. He stated that it
was illegal right now for minors to have tobacco products in their
possession. He has heard school principals, coaches and teachers
say that they have watched students walk out of school to take a
smoke break during school. He asked why these people weren't
stopping these students if they were truly concerned. He said when
you are a student you will get whatever you need to be popular no
matter what it costs. Students don't care about price. It was his
job to teach his kids respect, honesty and responsibility.
MR. SCOTT works for (Indisc.) Distributing. He feared for the
local retailer who would soon be out of business because of these
laws. He felt HB 159 should be promoted, rather than the tax bill.
The tax bill will not stop the kids, enforcement will.
Number 1686
CHAIRMAN BUNDE asked him if he would be willing to pay a cop to
watch every kid to ensure that children wouldn't smoke.
MR. SCOTT asked if the chair would be willing to pay a cop for
every kid to ensure that children didn't use drugs.
CHAIRMAN BUNDE answered that he was not willing.
MR. SCOTT said he would not be willing to do so either.
CHAIRMAN BUNDE then questioned him why he felt enforcement would
work.
MR. SCOTT referred to a police report located in the committee
file. He felt that HCS CSSB 13(HES) would cause people to break
into trucks.
CHAIRMAN BUNDE asked if young people, under the age of 19, should
smoke.
MR. SCOTT answered that he did not children should smoke.
CHAIRMAN BUNDE commented that the average Alaskan begins smoking at
age 14 and becomes addicted at that age.
Number 1746
NICHOLAS ZERBINOS testified next via teleconference from
Glennallen. He said this tax bill is the silliest thing he has
every heard. He talked with legislators who said that they knew
this bill was not going to stop kids from smoking, but money can be
made on the taxes which can be used for something else.
Legislators are not interested in the kids, they are interested in
the money. He said the name of the legislators were confidential.
He said tax money is not going to stop kids from smoking. Smoking
is something that if you take too much of it, it will hurt you. He
cited foods on the market that people can't eat including soft
drinks, tomatoes and oranges. He suggested taxing these products.
Taxes will not help anything, they will only allow the legislature
to spend money on things they want.
Number 1867
KEN JACOBUS testified next via teleconference from Anchorage. He
did not think you needed to increase the tax on tobacco to keep
children from smoking. He felt the tobacco companies were going to
have to increase their prices because of the settlements from the
nationwide lawsuits. He felt it would be possible to test the
legislative theory when this occurred. Alaska's lower income
group, including many Alaska Natives smoke in disproportionate
numbers. He did not think we should force the increased cost of
government onto Native Alaskans because they got hooked onto a bad
product when they were younger.
Number 1932
SUZANNE FISHCHETTI testified next via teleconference from
Anchorage. She opposed HCS CSSB 13(HES). "Last Tuesday over 61
percent of the Anchorage voters passed a ballot proposition that
required 60 percent majority vote to have a sales tax in Anchorage
and I think that's the poll that the legislators should be
listening to, not the Dittman Poll." She suggested that the state
should try to recover the $100 million in defaulted student loans
before they started raising tax revenue. Schools should be able to
teach our students about smoking. The Centers for Disease Control
have conducted studies, in Illinois, Nebraska and Hawaii where
taxes were raised, which showed kids smoking increased.
Number 1977
JODI OLMSTEAD testified next via teleconference from Fairbanks.
She was opposed to the tobacco tax. She stated that this tax is
against Alaskan Natives because a disproportionate high number of
them smoke. It has always been illegal for kids to smoke, drink
and do drugs. She questioned why the state's permanent fund monies
were invested in Phillip Morris. She has talked to many people and
has found no one who agrees with this bill. Kids say that the
price increase will not change whether or not they smoke. She
thought there were other things behind this tax, it did not have
anything to do with children. She asked why we are going to have
another law which will say that it is still against the law for
kids to smoke. She did not feel that money should be invested to
save people from themselves.
Number 2102
JOHN CYR, President, National Education Association-Alaska (NEA-
Alaska), said his organization supports the passage of HCS CSSB
13(HES). The increased cost of tobacco products will serve as a
deterrent to use by Alaskan students. He said the age when most
kids start to smoke is age 13 and 14 and this is the most price
sensitive age. Tobacco use is the leading cause of death in
Alaska. One out of five deaths are tobacco related. The United
States Centers for Disease Control estimates that 18,000 Alaskans,
currently under the age of 18, will die from tobacco related
diseases. He said this is absolutely a health bill and something
that is long overdue in this state.
MR. CYR stated that schools in Alaska have suffered under deferred
maintenance for years. There are schools with trash cans
collecting the spring runoff. The schools in this state need the
money that will be generated from this bill. His organization felt
that this bill will be one of the best pieces of legislation that
will be passed this year. It will positively affect the lives of
children into the foreseeable future and it will make schools
better places to be.
Number 2202
RUPERT E. ANDREWS, Representative, American Association of Retired
Persons (AARP), stated that the state legislative committee of AARP
was in favor of any increased taxes on tobacco products. Last fall
a survey was done in the membership. Currently there are 40,000
plus AARP members in Alaska, fifty years and older. A sample of
4,000 was chosen for the survey, 2,200 forms were returned. Some
of the questions had to do with the tobacco tax. About 79 percent
responded that they were in support of a tobacco tax as a health
issue. Alaska has an informed electorate that sees this tax as an
effective means to discourage children from starting to smoke. He
felt this 79 percent fit in well with the Dittman Poll.
Number 2268
REPRESENTATIVE JOE GREEN commented that none of the testimony given
against the bill cited where that money would go; children and
aggressive prosecution of those who sell tobacco products to
children. He said this bill prevents children from becoming
addicted to tobacco products.
TAPE 97-32, SIDE B
Number 0000
REPRESENTATIVE PORTER made a motion to move HCS CSSB 13(HES) out of
committee.
Number 0007
REPRESENTATIVE AL VEZEY objected to the motion. He then withdrew
his objection.
CHAIRMAN BUNDE stated that hearing no further objection, HCS CSSB
13(HES) was moved out of the House Health, Education and Social
Services Standing Committee.
HB 127 - FOSTER CARE REVIEW BOARD
Number 0130
CHAIRMAN BUNDE announced the next item on the agenda as HB 127, "An
Act relating to the citizen review board and panels for permanency
planning for certain children in state custody; renaming the
Citizens' Review Panel For Permanency Planning as the Citizens'
Foster Care Review Board; extending the termination date of the
Citizens' Foster Care Review Board; and providing for an effective
date." He referred to an amendment before the committee.
Number 0215
REPRESENTATIVE PORTER made a motion to adopt Amendment 1 to HB 127.
This amendment would remove two of the three attorney positions on
the board, limiting it to one position. Hearing no objection,
Amendment 1 was adopted.
BLAIR McCUNE, Assistant Public Defender, Central Office, Public
Defender Agency, Department of Administration, testified next via
teleconference from Anchorage.
Number 0362
CHAIRMAN BUNDE asked if a representative from the Public Defender
Agency attended the Title IV-E review with the Division of Family
and Youth Services (DFYS).
Number 0366
MR. McCUNE answered that this occurs sometimes. The agency does
not have the staffing to cover all Title IV-E reviews so their
attendance is rare.
Number 0391
CHAIRMAN BUNDE asked if the fiscal note included the cost of this
rare attendance.
Number 0400
MR. McCUNE stated that currently the Title IV-E review doesn't
generate a report used or submitted for a court disposition. The
court has to make a finding about reasonable efforts to provide
services. Under this bill, in Section 23, "the local panel shall
submit a final report to Anchorage Court and temporary custody
orders and dispositional hearings and reviews". He said this
language has changed from the current language. If the foster care
review panels are going to be set up as entities whose views are
considered in court hearings, then his agency ought to be there to
provide representation and input. If the review panels are not
used for that purpose and are done on a more internal procedures
basis, like the current Title IV-E procedures, then his agency
would not have to attend. This bill expands the scope of the
review.
Number 0529
REPRESENTATIVE PORTER asked if he was referring to the review
panel's consideration of their report in terms of the agency having
to be present or being present when this report is presented in
court.
Number 0546
MR. McCUNE answered that he was referring to attending the local
review panel hearings. Currently the review panels only review a
third of the cases in Anchorage. If this system was implemented
statewide for all out-of-home placement greater than 90 days, then
he thought the agency should be a participant.
Number 0608
REPRESENTATIVE PORTER observed that it was interesting that prior
to the adoption of Amendment 1, an agency staff would have been on
the Citizens' Foster Care Review Board, setting policy for the
review committee. He suggested that his agency would want to be a
advocate for their client, not as someone who sets policy for the
review committee and acts in the best interest of the child. The
attorney general's position and the public defender's position were
eliminated from the Citizens' Foster Care Review Board, leaving the
director or his designee from the Office of Public Advocacy.
Number 0675
JODI OLMSTEAD, Founder, Concerned Parents for Reform, testified
next via teleconference from Fairbanks. She referred to public law
96-272, the Child Welfare Assistance Act. This law says this
review system works as a tool to cut back on the abuses.
Nationally 28 percent of abuses happen within the foster care
system. Our nation has the highest number of allegations and
abuses of our children. These numbers play a role in overzealous
social workers. The review panels serve as a check and balance for
the foster care system. She referred to a case of her nephew who
suffered abuse while in foster care. Fairbanks has a big foster
care drift.
MS. OLMSTEAD stated that citizen oversight will decrease the amount
of cases which go through the foster care system. We need people
to be there through every single case plan of each child and the
programs they go through. No one has time to listen to the whole
thing in the judicial system. Citizens on these review panels need
to follow everything that goes on with the child, need to follow
them from the beginning to the end and they need to report what
they find. The Nebraska review panel tells what is done wrong and
how it could be made right.
MS. OLMSTEAD clarified that CSHB 127(HES) was extended to June 30,
2000. She asked to hear discussion on this point. There are a lot
of children in foster care in Fairbanks and something needs to be
done about it. Litigation does not have to be the answer. The
interior delegation have been inundated with complaints about this
situation.
Number 0917
WALTER GAUTHIER testified next via teleconference from Homer. He
was in support of CSHB 127(HES), but had some concerns. He
referred to page 3, "The board consists of five public members
appointed by the Governor". He suggested that part of the problem
with the whole social services system is that it is all under the
Department of Health and Social Services (DHSS) which is all under
the Governor. He cited an example of a program that was cut from
the budget last year which DHSS then funded out of another fund.
The legislature has no power over DHSS.
MR. GAUTHIER stated that for every Child in Need of Aid (CINA) case
there are probably nine agencies, public and private, whom are
concerned about the child. No one seems to be concerned about the
parents or the family as a whole. The last review panel on foster
care report stated that efforts were made to get the children into
foster care. Once the children were in foster care, they were
practically forgotten about and were in the system for an average
of 18 months to two years. He thought the problems stemmed from
the DHSS autonomy.
MR. GAUTHIER referred to page 10, "at the child's request, a child
who is ten years of age or older shall be allowed to be present at
interviews of the review panel, that concerns that child's case
unless the panel determines that for a good cause the child's
presence would be contrary to the best interests of the child or
there is other good cause for denying the child's request". He
felt confidentiality has been used to shield mistakes and creates
an overzealous approach. Any time these decisions are going to be
made, the child should be allowed to be there. A large percentage
of children recant previous testimony, a child will renounce things
that a social worker states. On a whole, he is in favor of CSHB
127(HES).
Number 1103
CHAIRMAN BUNDE assured him that the Citizens' Foster Care Review
Board will be created and administered by the Department of
Administration. The board will then recruit the volunteers, so
this process will be removed from the Governor and his influence.
Number 1149
CHAIRMAN BUNDE explained that current laws are inadequate, they
don't give enough power to local panels. The panels are a weak
duplication of DFYS. In many cases it is important that there be
an outside citizen review of government functions. He was not
saying that DFYS intentionally does things wrong, but it is
important to have an additional review. He said CSHB 127(HES)
amends the existing foster care review statutes and gives needed
power to local panels, stressing local oversight and local panels.
These local panels do not have the power to advocate for children
in a court of law. This legislation allows local review panels to
place their recommendations into the court record, this might
reduce the number of cases where children get lost in the system.
This provision gives the panels the power to be heard at the same
level as the case worker, public defender, guardian ad litem and
other parties who speak in court on the behalf of families. He
felt that you couldn't discuss the welfare of a child without also
acknowledging the importance of the family.
CHAIRMAN BUNDE commented that another problem with the existing
statutes is the duplication of services between DFYS and the local
review panels. The DFYS completes federally mandated Title IV-E
reviews for eligible children in out-of-home care every 180 days.
The review process allows DFYS to collect federal funds for
eligible children. The local review panels review the same
children with a more thorough process every 180 days. The two
separate reviews are seen as a duplication of effort, the
legislation will not fund a board that duplicates functions of an
existing department. This legislation gives the authority to the
local review panels to do the Title IV-E and take some of the
burden off DFYS.
Number 1270
REPRESENTATIVE FRED DYSON mentioned his concern over the fiscal
note. He though Alaska's social problems, including dysfunctional
families and dislocated children, would be assisted by the
citizens' review panels. The DFYS is in stress. Their credibility
and the credibility of all state government is in question. The
panels provide an objective outside review and oversight. It
builds confidence in what government is or should be doing. He
stated that his wife, who served on the Anchorage panel, found it
valuable.
Number 1379
REPRESENTATIVE GREEN asked someone to explain why the panel might
determine that the child's future shouldn't be witnessed by the
child.
Number 1409
PATTI SWENSON, Legislative Assistant for Representative Bunde,
stated that the panel doesn't really decide whether the child is
present or not. This decision is made in conjunction with advice
given by the Court Appointed Special Advocate (CASA) and the
Guardian ad litem. Some children don't want to come to these
reviews.
Number 1455
REPRESENTATIVE GREEN commented that the way in which CSHB 127(HES)
is written states that the child may be there unless the panel
determines that they should not be there. He clarified that she
was saying that the panel does not make this determination.
Number 1463
MS. SWENSON stated that the board works closely with all of the
people who are in contact with the children. A child would not be
invited if it would harm them in any way.
Number 1480
REPRESENTATIVE GREEN felt this language would create a restriction
if the child wanted to attend the review.
Number 1495
MS. SWENSON explained that some children feel they need to support
their parents no matter how abusive their parents have been. The
child might say that they want to go back to their parents, when in
actuality that isn't what they want. Children that age don't
necessarily tell the truth, no matter what their current situation
is. The board makes the determination of a child's attendance
based on those people who know the child best. A child might say
something that could be misconstrued.
Number 1524
REPRESENTATIVE GREEN verified that the court determined age 14 to
be the age of reason. He clarified that the reason why a child
wouldn't be invited to this review process is because their
psychological make-up wouldn't stand a review process.
Number 1553
CHAIRMAN BUNDE stated that first the Guardian ad litem, then the
social worker and finally the review panel would help the child
make the decision whether or not to attend the review. He shared
his concern that if a child wants to attend, there might be three
different entities describing why they shouldn't attend.
Number 1571
REPRESENTATIVE GREEN felt that the board had the ultimate decision
making power as contained in the language of CSHB 127(HES).
Number 1581
MS. SWENSON said she has not seen this happen.
Number 1583
CHAIRMAN BUNDE explained that the panel works on the advice of
professionals.
Number 1597
REPRESENTATIVE PORTER made a motion to move CSHB 127(HES) as
amended with individual recommendations and attached fiscal notes.
There being no objection, CSHB 127(HES) was moved from the House
Health, Education and Social Services Standing Committee.
HB 195 - LICENSURE OF OPTOMETRISTS
Number 1629
CHAIRMAN BUNDE announced the next item on the agenda was HB 195,
"An Act relating to licensure of optometrists; and providing for an
effective date."
Number 1634
JEFFREY A. GONNASON, O.D., stated that he has been licensed as a
optometrist since 1976. He has been in an Anchorage practice for
over 20 years. On behalf of Alaska Optometric Association he
wanted to thank the committee for hearing HB 195. The association
represents approximately 80 Alaskan doctors of optometry. He said
150 years ago dentistry progressed out of the barber shop and
optometry progressed out of the jewelry store. Both professions
have expanded their scope of practice over the years in accordance
with technological advances. Today optometry is a primary health
care profession that examines, diagnoses and treats disorders of
the human eye. It utilizes medications and procedures in
accordance with professional training and competency.
DR. GONNASON explained that, historically, medical doctors have
enjoyed unlimited legislative trust in their scope of practice.
Alaska's optometrists have had their scope of practice unduly
restricted by old state statutes which do not account for modern
advancements in education and training. This bill, HB 195, was
carefully drafted to give the board the authority to authorize the
use of advanced methods and procedures for those optometrists who
meet additional board qualifications. Currently optometry school
graduates, trained in modern technology, cannot fully utilize their
training in Alaska.
DR. GONNASON said the bill will allow the board to determine the
scope of practice through regulation within limited guidelines.
This is currently done for dentistry and nurse practitioners. The
limited use of lasers and other modern technology and limited non-
evasive surgical procedures may be allowed through the board under
this bill. Dentists and podiatrists perform surgery and do not
attend medical school. He questioned why optometry should be
subject to discrimination.
DR. GONNASON stated a laser is a tool used in many different facets
in health care as well as industry. This legislature trusted
optometry in 1988 and in 1992, passing diagnostic and therapeutic
medication legislation. Optometrists have shown themselves to be
reasonable, competent and trustworthy under the expanded
privileges. Previous testimony on the 1988 and 1992 legislation
described the great harm that would occur to patients, including
death and blindness, if optometrists were allowed to expand their
scope. As of now, there have been no complaints of harm to the
Division of Occupational Licensing in regard to the expansion of
optometrists' privileges. Malpractice insurance rates have
remained the same in states where the scope of optometric practice
has been expanded.
DR. GONNASON referred to the state audit report of the Board of
Examiners in Optometry which concluded that, "the 1992 Optometry
legislation benefited the public and furthered the public interest
health and welfare and that the board does provide assurance that
licensees are qualified and act in a competent manner."
Optometrists are held to the same standards of care as medical
doctors and other health care professionals.
DR. GONNASON stated that HB 195 would provide better access to
quality, affordable and cost effective health care. This is
especially true for many of the smaller towns and villages which
are only served by an optometrist. Optometrists are reasonable,
educated and caring professionals. They are licensed by the state
with strict standards. They are regulated by the state board, by
legal liability concerns, community opinion, by medicine and by the
legislature looking carefully over their shoulders. The state
Board of Optometry should be allowed to determine the scope of
practice through regulations, as is done by other health
professions in Alaska, to keep current with advances in health
care. No optometrist would attempt to perform a procedure or
treatment that he or she was not trained or comfortable with doing.
Optometrists should be treated as the trusted, learned
professionals that they are.
Number 1859
REPRESENTATIVE DYSON received letters from people in the medical
community which informed him that no other state currently allows
the expansion of responsibilities as would occur with the passage
of HB 195. He stated that 47 states currently prohibit optometric
surgery, 30 of these states have passed this legislation since
1991.
Number 1886
DR. GONNASON said 37 states say that optometrists cannot use
lasers. The reason why the Alaskan law says that optometrists
cannot use lasers is because, in order to get the 1988 legislation
passed, optometrists had to accept language prohibiting this
procedure. Lasers are used by optometrists in four or five states.
Optometrists do not use lasers because there is specific language
stating that they can use them, but because they are not prohibited
in their state. The use of lasers is currently taught in optometry
school. Dr. Maynard Falconer, a recent retiree, has a daughter who
just graduated from college and is trained in lasers. He
emphasized that there are types of laser procedures that
optometrists are not trained in such as retina treatment. There
are also laser procedures which are straightforward and simple to
use. Lasers are tools.
DR. GONNASON referred to a study done by John Hopkins University
which shows an Alaskan Native woman in the "slit lamp" laser. The
article states that paraprofessionals and technicians, can learn to
perform this sight saving procedure in a matter of minutes with no
complications. This bill would specifically say that optometrists
could use lasers as determined by the board based on the proper
credentials and qualifications. Some older optometrists are not
trained in the more modern procedures and would not be allowed to
perform these additional procedures.
Number 1985
REPRESENTATIVE DYSON stated that this bill allowed optometrists to
prescribe more prescription drugs and asked if this was done in
other states.
DR. GONNASON answered that there are 33 or 34 states which allow
optometrists to go beyond topical medications and prescribe
systemic medications. The department was concerned whether or not
the board would need to ask for more credentials. Currently those
optometrists who use medications need to have an endorsement on
their license. The board designed this endorsement to include the
ability to prescribe systemic medications. In 1992, the oral
portion of the bill was compromised in order to pass the bill.
This left the ability to administer topical medications in the
endorsement. The bill, HB 195, specifically excludes controlled
substances, schedules I and II. Those drugs are considered
dangerous.
TAPE 97-33, SIDE A
Number 0000
DR. SAM McCONKEY, M.D., testified next via teleconference from
Fairbanks. He said he has been a board certified ophthalmologist
with the eye clinic in Fairbanks since 1975. As a physician he is
morally and ethically obligated to advocate for the patient. There
are two important issues to identify in this discussion. The first
issue is patient care and who is qualified to deliver it. He said
a physician has a college degree followed by four years of medical
school and three or more years of specialty training in medical and
surgical diseases of the eye. This adds up to at least 12 years of
school after high school. An optometrist has, in most cases, a
college degree and four years of optometric school. Clinical
training and experience is the path to competency, not legislation.
It is difficult for the lay public to understand that even the
drops used to treat eye problems can cause strokes, cardiac arrest,
high blood pressure, depression, suicide and shock.
DR. McCONKEY stated that the committee was being deceived by
organized optometry. This bill by request is all about money. It
has nothing to do with patient care. It has to do with the medical
care dollar and how it is divided. For the last 25 to 30 years,
organized optometry has realized that there are too many
optometrists in the United States and cannot make a decent living
fitting glasses and contact lenses. Optometric school
administrators do not want their students to realize that there are
too many optometrists because their schools would not remain full.
DR. McCONKEY explained that practicing optometrists are not to be
blamed for this, they are only the pawns in the larger scenario.
This is an ingenious, well thought out, well financed, political
strategy. It has been successful. Unsuspecting state assemblies
have legislated optometrists into positions of medical care givers.
Passage of these bills convinces state and federal agencies that
optometrists should be included in the split of the health care
dollar. He referred to the 1988 and 1992 bills, the legislature
asked the two separate components to resolve this issue outside of
the legislative process. Optometrists were given a few low risk
drops to treat minor eye problems. The quid pro quo for this
agreement was that optometrists would not initiate legislative
initiatives until they received proper education, training and
medical testing by someone other than their board.
DR. McCONKEY said HB 195 would allow (indisc.) medical prescription
drugs except narcotics, cataract surgery, eye muscle surgery on
children, surgery for injuries and laser procedures. He said these
items have to do with training and experience. The citizens of the
state of Alaska do not deserve to be confused further about who is
qualified and who has the responsibility for the medical and
surgical care of their eyes.
Number 0386
DR. PETER CANNAVA testified next via teleconference from Kenai. He
presented a scenario where he was a flight attendant who has
decided that he wanted to fly the airplane because he was no longer
content with being a flight attendant. If someone asked him why he
wanted to be a flight attendant pilot, he could answer that his
flight attendant school gave a course in piloting and that they
will tell him when he is qualified to pilot and will regulate him.
He would redefine what a pilot is. His definition says that a
pilot is going to be someone who only flies above 20,000 feet so it
will be non-dangerous or non-invasive flying. There is a precedent
for this shown by helicopters, jet pilots and test pilots who are
only regulated by their boards. The legislature might retort that
all the people mentioned are pilots by training, from the beginning
of their school, whereas a flight attendant has no historical basis
or schooling. The legislature might say that it is not the
function of the legislature to give sanctions to born again
professions and that to be a real pilot, he should go to the proper
schools, pass the proper tests and be regulated by the proper
authorities and stop trying to short circuit the system.
DR. CANNAVA mentioned that the committee would hear some testimony
by a physician who claims that optometrists are well trained. He
encouraged them to ask this physician how much of his income is
generated by optometric referrals and how much he has just invested
in a clinic solely dedicated to take care of optometric referrals.
DR. CANNAVA stated that if HB 195 was as innocuous as Dr. Gonnason
explained, they would not have redefined non-invasive surgery as
surgery done without a general anesthetic. Physicians and surgeons
are currently doing everything under local anesthetic including
neural surgery, knees, hips, hysterectomies, gall bladders and
appendectomies. For optometry to be so naive as to classify all of
these things as non-invasive, simply because they are done under
local anesthetic, indicates the paucity of their training.
DR. CANNAVA commented that the other part of HB 195 that should be
questioned is where optometrists claim they need to use systemic or
oral antibiotics and pain killers. Part of his responsibilities
include plastic surgery, repairing broken sinuses and treating
infections of the face and paranasal sinuses. It is only in
treating sinuses, skin infections and things like that where he
uses systemic antibiotics. The eye rarely needs antibiotics, other
than by drop form. When antibiotics are needed it involves an
injection into the eye.
DR CANNAVA said optometrists claim they need oral pain killers. He
probably writes three prescriptions for pain killers by mouth a
year. There are topical medications which adequately take care of
pain.
Number 0739
DR. RONALD ZAMBER, M.D., testified next via teleconference from
Fairbanks. He described his education and background. He spent no
less than 20,000 hours of intense medical and surgical training to
develop the competency to administer and prescribe appropriate
medical therapeutics and surgical remedies. Despite this training,
he could assure the committee that he was not overtrained. There
are no groups in this nation qualified to provide complete medical
and surgical management of eye diseases other than
ophthalmologists. Neurosurgeons are not qualified to provide
complete medical and surgical management of eye diseases.
DR. ZAMBER said this bill addresses more than vision, it addresses
general medical well being. During those 20,000 hours of training
as an intern and surgical resident, he saw dozens and dozens of
patients who had been prescribed medication which appeared benign
but ultimately wound up causing multi-system failures. The issue
is one of competency and qualifications. This bill talks about
lasers, about instruments that can in a microsecond blind a
patient.
Number 0959
DR. ROBERT FORD, M.D., said he is an ophthalmologist and the
founder of Pacific Cataract and Laser Institute which has 11 sites
in the Northwest including one in Anchorage. He is licensed in
Alaska. When he finished his ophthalmology training he came out
with the same bias that other witnesses have presented. Shortly
after he went into private practice, he started to indirectly work
with optometrists. He began to work more closely with a particular
optometrist who won his respect. He began to make the gradual
transition to respecting optometrists. Ophthalmologists do have
more training and are going to need to do the more complicated
procedures, but optometrists are legitimately going to be the ones
in the future of health care who will do the primary eye care. He
has chosen to work cooperatively with optometry. Optometrists do
the primary care and they refer patients to him to do surgery and
then patients are referred back to do post operative care.
DR. FORD mentioned the two previous pieces of legislation. He said
these bills involved risk, but the risk was balanced by the reward.
Time has proven that the risk was worth the reward. Now is the
next phase of expansion of the optometric practice. The decision
to expand optometric practice has not been an easy one for him.
This bill would allow optometrists to use a YAG laser which
accounts for a significant portion of the revenue that the company
gets. It is harder and harder to make the books balance in
medicine. A cataract surgeon's fee is about half what it used to
be. He questioned whether or not the company could float
financially if the YAG laser procedure was used by optometrists.
He decided to maintain his commitment to principle that by giving
to another profession, he would feel good about himself.
DR. FORD stated that an honest reading of the Idaho law suggested
that optometrists could do these laser treatments, so optometrists
did these laser procedures. Over a hundred of these procedures
were done, without any problems. A number of years ago it was felt
this procedure could legally be done by a physician's assistant.
In summary, he felt it was the American way to allow professions to
grow. Optometry has grown a lot in the last ten years, it is a
different profession than it used to be and he would like to see
them continue to grow. We should allow them to further expand
their practice.
Number 1213
HANS KELL, O.D., cited his education and clinical background.
Optometry is a profession which has grown progressively more
sophisticated and capable. Currently, doctors of optometry
complete eight to nine years of professional training; four years
of undergraduate and four years of graduate training in optometry
and a residency program. The training in optometry includes basic
sciences, preclinical education and clinical experience. Admission
requirements and tests are similar to those for dental and medical
schools. Biomedical science taught in the first two years of
optometry and medical schools are comparable and often share the
same textbooks and instructors. In some universities the
optometry, dental and medical students attend these classes
together. Optometry schools are accredited by the same national
agencies that accredit medical schools. Clinical training for
optometry occurs in various clinics, Health Maintenance
Organizations, Public Health, and Veterans' Administration
hospitals.
DR. KELL said this training prepares doctors of optometry to
provide primary eye care similar to the family dentist providing
general dental care or the family medical doctor providing primary
health care. To establish perspective, there is value in comparing
the education of optometry with that of medicine. In 1980, Dr.
Rushmer conducted a review which observed that the professions of
optometry, dentistry, podiatry and medicine all have similar state
and national board requirements. These professionals attend
accredited educational institutions. He further stated that, "the
basic educational experience of these professions is remarkably
similar and cannot account for consistent underutilization of non-
medical health professionals."
Number 1347
DR. KELL stated that optometry training in pharmacology, the use of
lasers and other methods for the diagnosis and treatment of the eye
are of the same quality as those methods taught to
ophthalmologists. While the clinical application of these tools is
relatively straightforward, their justification for use and
providing follow up care is the most difficult component of
treatment. Optometrists have safely and effectively used their
clinical judgement to evaluate, recommend treatment and perform
follow up care for many years.
Number 1396
REPRESENTATIVE DYSON asked if this was a turf war. He referred to
the similar chiropractic issue.
Number 1432
DR. GONNASON agreed, on the national level, optometrists are paid
to do Medicare procedures and there is competition for those
patients. In managed care plans there is competition as to who
gets to be the gate keeper. If the optometrist is the gate keeper,
then there are a lot less surgeries done.
Number 1456
REPRESENTATIVE DYSON did not want to imply that the medical doctors
were only looking after their vested interest.
Number 1472
DR. KELL agreed that we are all honorable people. Ophthalmologists
as well as optometrists are patient advocates. He thanked the
legislature for the bill that passed in 1992 which has given
optometrists the privilege of following patients after surgery.
Currently, optometrists examine the patient and, if necessary, the
patient is referred for surgery. After surgery, those patients are
followed up with medications. He stated that there are many types
of lasers and their applications. Some procedures are much more
straightforward than others. He felt the most important thing was
the justification for the procedure and the correct follow-up of
potential complications which could occur and what to do. The
money really lies in the procedure itself.
Number 1532
REPRESENTATIVE GREEN asked for a definition of non-invasive.
Number 1547
DR. GONNASON answered that a non-invasive procedure is one which
does not open the globe. A pimple on the eyelid might be drained
under surgical conditions. He said clipping your fingernails is
surgery. There are procedures currently being done that were
authorized in the 1992 legislation, one of which is the removal of
foreign bodies. In this procedure the eye is numbed with a
medication, the metal is picked out and then a battery powered
drill is used to grind out the rust. If that metal had penetrated
the eye ball, then it would be under the realm of the specialty
ophthalmologist.
Number 1620
REPRESENTATIVE GREEN asked how the laser would be used.
Number 1626
DR. GONNASON explained that the best example is one is called a
Peripheral Iridotomy. Alaska Eskimos have the highest percentage
of Acute Angle Closure Glaucoma. As compared with other forms of
glaucoma where pressure slowly goes up, this glaucoma is an attack.
The pressure of your eye builds as if the eyeball is going to
burst. The eye will go blind if it is not treated within 24 or 48
hours. This is a definite medical emergency. The treatment is to
poke a hole in the iris so that fluid can go from the front to the
back. A laser focused inside the cornea burns a tiny hole which
relieves that pressure and the patient is cured. He cited an
example of the time and inconvenience caused when an optometrist
could not do this procedure in Anchorage. He questioned what would
have happened if this situation had occurred in Kotzebue or Barrow.
Number 1711
REPRESENTATIVE PORTER asked if a neutral party could testify on
this bill; someone outside of optometry and ophthalmology. He
assumed giving optometrists the ability to perform these things
would lower health care costs.
Number 1759
REPRESENTATIVE GREEN asked what sort of things an optometrist might
want to treat rather than submitting it to an ophthalmologist.
Number 1786
DR. KELL answered that the most common procedure is a laser
procedure called a YAG Capsulotomy. After cataract surgery a thin
membrane of the patient's lens is removed. He clarified that the
lens is removed during cataract surgery with the skin or the back
of that lens left behind with an implant inserted in front of that.
In approximately 33 percent of the eyes that membrane becomes
opacified or cloudy. Years ago this was treated by having an
ophthalmologist go inside the eye to make a hole in the eye. A
laser is able to make a hole in the center which opens it up and
allows the patient to see. Currently, optometrists evaluate these
patients often and refer these patients for this procedure. The
procedure itself takes a minute, then patients are referred back to
the optometrists for potential complications like retina
detachment. He said this is one procedure that optometrists feel
that they could treat.
Number 1851
REPRESENTATIVE GREEN asked about the other types of illnesses.
Number 1859
DR. KELL mentioned Acne Rosacea which affects the lipid or fat
producing glands around the eyelid. The glands and the vessels
surrounding them become infected affecting either the make-up or
atrophy of these glands so they don't produce the oil layer which
helps keep tears from evaporating. This produces dry, scratchy
eyes. One of the best treatments for this condition, besides the
use of artificial tear lubrication, is to take tetracycline.
Tetracycline is a simple, oral medication with minimal
complications.
Number 1900
REPRESENTATIVE GREEN mentioned the amount of study for both
professions and asked what the differences were once you got past
the basic courses.
Number 1928
DR. KELL answered that ophthalmologists, after four years of
medical school, have a year of internship which usually occurs in
a hospital setting. Currently ophthalmology residency programs are
three years, followed by a voluntary sub-specialty training. At
the Bascom Palmer Eye Institute, the first year ophthalmology
residents are not trained in surgery except for some of these
limited, minor surgical procedures discussed. The ophthalmologists
see the indigent patients. During the second year, an
observational clinic occurs where the residents observe different
sub-specialists. Ophthalmologists that have gone into sub-
specialty training might focus only on the retina, pediatrics or
neuro-ophthalmology. Those residents observe as well as begin to
learn the procedures of their sub-specialties. The third year is
when the residents hone their surgical skills. Ophthalmologists
have a wonderful training, it is more extensive and more
specialized.
DR. KELL said that HB 195 proposes that optometrists not perform
these specialized procedures, but to perform the more non-invasive,
simple procedures.
Number 2008
DR. ZAMBER said ophthalmology training varies a little from Dr.
Kell's description in that the internship is a surgical, medical or
rotating internship. Residents are often involved in emergency
care settings, intensive care unit settings and clinical oncology
cancer treatment settings. These settings expose the residents to
the management of patients with various medical conditions. The
purpose of that training is to develop a respect and competency for
this process. He was appalled at the lack of respect for this
issue. There are no shortcuts, those 20,000 hours were hours well
served. Those are 20,000 hours beyond what an optometrist gets in
training, treating the patients as a whole.
DR. ZAMBER explained that the oral medications which would be
allowed to be administered by HB 195 can kill patients. He has
seen dozens of patients who have experienced Steven's Johnson
Syndrome, a severe allergic reaction which is often life
threatening and results in a scalded skin type syndrome and creates
a ventilatory dependent state. This syndrome is the result of
medications which would be allowed under this bill. Sulfa is the
primary offending agent in these types of reactions. Many of the
oral therapeutics used to treat glaucoma have a sulfa moiety.
DR. ZAMBER explained that he is a published expert on complications
related to topical and systemic beta blockers including the
promotion and induction of beta blocker induced lupus, a life
threatening condition. He emphasized that he is not overtrained.
This is not a turf war, it is about patient care. He suggested
having an O.D.M.D. testify. Those are optometrists who then went
on to receive full medical and surgical training, with most
training to be ophthalmologists.
TAPE 97-33, SIDE B
Number 0000
GORDON PREECS, M.D., said he trained eight years ago with three
other people in his residency level. One of whom was a doctor of
osteopathy, another form of allopathic medicine. This type of
doctor has full licensure and authority to practice medicine in
Alaska and most of the states. This person was the son of an
optometrist and was an optometrist himself. He went back to
medical school and received ophthalmologic training.
DR. PREECS stated that during the first year of residency they did
the dirty work; the injuries, the irritations and red eyes. Their
main task, in part, was to screen the people who came through to
determine what was serious and what wasn't. The osteopathy
resident used to say that he saw more in one day working in the
walk-in clinic, than he saw in his whole senior year of optometric
school. His goal in optometric school was to learn how to fit
contacts and work in a complimentary role to the process of vision
care and refractive services. Eye disease was directed to medical
care. He felt that if there had been a revolution in what is going
on in the course and the exposure of realistic activities in
optometric school, it simply escaped him.
Number 0191
DR. PREECS addressed Section 7 (6), invasive surgery, which showed
a remarkable lack of understanding of the process. He felt
invasive surgery was anything that removed, damaged or intruded the
tissue. Non-invasive procedures are those which allow you to
visualize, allow you to inspect but do not allow you to change the
tissue. Invasive surgery is changing tissue, cutting holes,
drilling passage ways, making new affects. The fact that a knife
is not use does not mean that it is non-evasive. YAG Capsulotomy
is a rather simple procedure, but he did not think that allowing
optometrists to do this procedure would reduce the cost. The goal
would be to acquire access to that well-paid process. He felt that
American medicine was over-equipped. There are competing hospitals
duplicating services and trying to impress the provider and client
communities that they have the best facilities. A ton of money is
spent duplicating these processes.
DR. PREECS felt discouraged by this subject. He commented that it
seemed the medical community would be pecked to death as the state
de-professionalizes the process of rendering care at every level,
from every source. Every managed health care plan which wants to
reduce the access to care by pushing decision-making power farther
down stream in a gate keeper mode. Telephone nurses rather than
on-site physicians, screening telephone technicians who will
understand whether their care will be authorized. He felt this was
a part of the process which says we will save money by trying to
eliminate the expensive provider, ensure that we have enough cheap
providers to go around and hope we don't make many mistakes. He
shared in his colleague's concern that ophthalmologists were going
to be slowly but surely, biannually by biannually, nickeled with
these opportunities to expand and exchange the nature of medical
practice.
Number 0389
REPRESENTATIVE GREEN explained that he only has one eye and as a
result he is nervous about allowing anyone, without the best
possible training working, to treat his other eye. He agreed that
there were procedures which both professions could learn to do. He
refer to his wife's experience, who is a dental hygienist, and
their expansion of care. She stated that she preferred to have a
doctor available in case of a medical emergency.
REPRESENTATIVE GREEN stated that there were some procedures which
could be done by both professions; dentists and dental hygienists,
chiropractors and medical doctors, and optometrists and
ophthalmologists. He felt there had to be a limit put on those
procedures because of the possible side effects. He asked if there
was a concern among professions that a condition, which isn't
obvious, might be overlooked.
Number 0559
DR. PREECS referred to some of his first year textbooks which
contained something of a warning poised in the image of a cartoon.
It was titled, "A patient seen by the ophthalmologist". It
depicted a person in a nice two piece suit with a fedora and an
eyeball over his shoulders. The warning to the ophthalmologists,
as physicians, was not to hone in on the eyeball and forget that
they were operating on an entire human process. Optometrists learn
about the human system components. How hormones result in life
stage changes in the eyes in which neurologic and physiologic
changes involve the eye, but are not limited to the eye. Medical
practice in the United States is based on the principle that we
will start with a profound base of training, a large body of
experience and that we all have to do it no matter what we want to
do when we finish.
DR. PREECS referred to a personal experience when his father-in-law
finally addressed his cataract which covered up a devastating
retinal detachment. This condition was not able to be treated. He
felt that he understood how critical this situation is for his
patients and said it is imperative that we understand that we need
to have concern the entire patient in the training.
Number 0750
CHAIRMAN BUNDE stated that, as is usual, this is the first time the
bill is heard and so the committee will not take action on it
today.
ADJOURNMENT
There being no further business to conduct, CHAIRMAN BUNDE
adjourned the meeting of the House Health, Education and Social
Services Standing Committee at 5:30 p.m.
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