Legislature(2005 - 2006)
04/06/2005 04:26 PM House L&C
| Audio | Topic |
|---|---|
| Start | |
| HB151 | |
| HB169 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
April 6, 2005
4:26 p.m.
MEMBERS PRESENT
Representative Tom Anderson, Chair
Representative Gabrielle LeDoux
Representative Bob Lynn
Representative Norman Rokeberg
Representative Harry Crawford
Representative David Guttenberg
MEMBERS ABSENT
Representative Pete Kott
COMMITTEE CALENDAR
HOUSE BILL NO. 151
"An Act relating to provider responsibility for ocular
postoperative care; and providing for an effective date."
- MOVED CSHB 151(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 169
"An Act relating to the educational requirements for certain
real estate brokers, associate brokers, and salespersons with
new or suspended licenses; and allowing real estate brokers to
hire certain experts to review real estate transactions; and
providing for an effective date."
- MOVED CSHB 169(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 226
"An Act relating to breaches of security involving personal
information; and relating to credit report security freezes."
- BILL HEARING POSTPONED
HOUSE BILL NO. 240
"An Act relating to brewery and brew pub licensing."
- BILL HEARING POSTPONED
HOUSE BILL NO. 180
"An Act relating to a special deposit for workers' compensation
and employers' liability insurers; relating to assigned risk
pools; relating to workers' compensation insurers; stating the
intent of the legislature, and setting out limitations,
concerning the interpretation, construction, and implementation
of workers' compensation laws; relating to the Alaska Workers'
Compensation Board; establishing a division of workers'
compensation within the Department of Labor and Workforce
Development, assigning certain Alaska Workers' Compensation
Board functions to the division and the department, and
authorizing the board to delegate administrative and enforcement
duties to the division; establishing a Workers' Compensation
Appeals Commission; providing for workers' compensation hearing
officers in workers' compensation proceedings; relating to
workers' compensation medical benefits and to charges for and
payment of fees for the medical benefits; relating to agreements
that discharge workers' compensation liability; relating to
workers' compensation awards; relating to reemployment benefits
and job dislocation benefits; relating to coordination of
workers' compensation and certain disability benefits; relating
to division of workers' compensation records; relating to
release of treatment records; relating to an employer's failure
to insure and keep insured or provide security; providing for
appeals from compensation orders; relating to workers'
compensation proceedings; providing for supreme court
jurisdiction of appeals from the Workers' Compensation Appeals
Commission; providing for a maximum amount for the cost-of-
living adjustment for workers' compensation benefits; relating
to attorney fees; providing for the department to enter into
contracts with nonprofit organizations to provide information
services and legal representation to injured employees;
providing for administrative penalties for employers uninsured
or without adequate security for workers' compensation; relating
to fraudulent acts or false or misleading statements in workers'
compensation and penalties for the acts or statements; providing
for members of a limited liability company to be included as an
employee for purposes of workers' compensation; establishing a
workers' compensation benefits guaranty fund; relating to the
second injury fund; making conforming amendments; providing for
a study and report by the medical services review committee; and
providing for an effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 151
SHORT TITLE: RESPONSIBILITY FOR CARE AFTER EYE SURGERY
SPONSOR(S): LABOR & COMMERCE BY REQUEST
02/14/05 (H) READ THE FIRST TIME - REFERRALS
02/14/05 (H) HES, L&C
03/01/05 (H) HES AT 3:00 PM CAPITOL 106
03/01/05 (H) Scheduled But Not Heard
03/08/05 (H) HES AT 3:00 PM CAPITOL 106
03/08/05 (H) Heard & Held
03/08/05 (H) MINUTE(HES)
03/17/05 (H) HES AT 3:00 PM CAPITOL 106
03/17/05 (H) Moved CSHB 151(HES) Out of Committee
03/17/05 (H) MINUTE(HES)
03/18/05 (H) HES RPT CS(HES) 2DP 5DNP
03/18/05 (H) DP: ANDERSON, MCGUIRE;
03/18/05 (H) DNP: CISSNA, GARDNER, SEATON, KOHRING,
WILSON
04/06/05 (H) L&C AT 3:15 PM CAPITOL 17
BILL: HB 169
SHORT TITLE: REAL ESTATE LICENSEES
SPONSOR(S): REPRESENTATIVE(S) ROKEBERG
02/22/05 (H) READ THE FIRST TIME - REFERRALS
02/22/05 (H) L&C, FIN
04/06/05 (H) L&C AT 3:15 PM CAPITOL 17
WITNESS REGISTER
JON BITTNER, Staff
for Representative Anderson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 151.
ERIC CHRISTIANSON, Optometrist
American Optometric Association
Ketchikan, Alaska
POSITION STATEMENT: Testified against HB 151.
DR. CARL ROSEN, Ophthalmologist
Alaska Eye Physicians and Surgeons
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 151.
DR. SHERYL LENTFER, Optometrist
Anchorage, Alaska
POSITION STATEMENT: Testified against HB 151.
DR. RANDY JOHNSTON, Senior Secretary for Advocacy
American Academy of Ophthalmology
Cheyenne, Wyoming
POSITION STATEMENT: Testified in support of HB 151.
BOB LOESCHER, Co-Chairman
Alaska Native Brotherhood
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 151.
DAVE FEEKEN, Industry Issues Legislative Chair
Alaska Association of Realtors
Kenai, Alaska
POSITION STATEMENT: Testified in support of HB 109.
PEGGY MCCONNOCHIE, Member
Key Industry Issues Workgroup,
Alaska Association of Realtors;
Education Chair,
Subcommittee of the Alaska Real Estate Commission
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 109.
BRAD FLETCH, Public Member
Alaska Real Estate Commission
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 109.
JERRY ROYSE, Member
Royse and Associates
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 109.
ACTION NARRATIVE
CHAIR TOM ANDERSON called the House Labor and Commerce Standing
Committee meeting to order at 4:26:34 PM. Representatives
Anderson, Lynn, Rokeberg, and Crawford were present at the call
to order. Representatives LeDoux and Guttenberg arrived as the
meeting was in progress.
HB 151-RESPONSIBILITY FOR CARE AFTER EYE SURGERY
CHAIR ANDERSON announced that the first order of business would
be HOUSE BILL NO. 151, "An Act relating to provider
responsibility for ocular postoperative care; and providing for
an effective date."
4:27:42 PM
JON BITTNER, Staff for Representative Anderson, Alaska State
Legislature, related that on page 1, line 12, changes the
minimum amount of time that an ophthalmologist had to be
available to his or her patient from 120 hours to 48 hours. The
change was made by the sponsor in response to testimony that 120
hours might be too much of a hardship on ophthalmologists. It
was felt that 48 hours would be enough time to notice any major
complications after surgery as well as being a reasonable amount
of time to ask a doctor to stay in touch with his or her
patient. He then stated that HB 151 outlines rules and
restrictions regarding the delegation of postoperative care for
eye surgery patients. He listed the provisional changes as the
following [original punctuation provided]:
Section 1. Adds a new section to AS 08.64
Places limits on how and when a surgeon who performs
eye surgery in this state may delegate responsibility
to someone else for post-operative care of the patient
Mandates that a surgeon who performs the surgery must
remain physically available to the patient for 48
hours
The doctor may delegate this responsibility if they
arrange for another ophthalmologist to care for their
patient for the 120 hours
- Defining the provisions of a co-management agreement.
- Outlines when a co-management agreement for
postoperative care may be entered into.
- Maintains that any fees incurred as a result of a co-
management agreement must reflect fair market value.
- Includes provision for disclosure of the co-management
agreement to the patient
Section 2-3. Amends AS 08.64.370
Requires compliance with Sec. 1 of the bill by certain
people who are exempt from licensing as physicians.
Section 4. Amends AS 08.64.380
Adds definition of "knowingly" which is a term used in
sections 1 and 3 of the bill.
Section 5 and 7 Amends the uncodified law of the State
of Alaska and adds an effective date. These sections
allow the State Medical Board to begin the regulations
process before the rest of the bill takes effect.
Section 6. Amends the uncodified law of the State of
Alaska and applies the amendments made by the bill to
eye surgery occurring on or after the effective date
of Sections 1-4 of the bill.
MR. BITTNER then stated that the intent of this bill is to
provide standards of care regarding co-management agreements for
post-operative care of eye surgery patients. The sponsor of
this bill feels that there is a certain minimum standard of care
each and every Alaskan should expect after receiving eye
surgery, which HB 151 ensures.
MR. BITTNER clarified that this bill in no way reflects poorly
on the co-management system. [The sponsor] is not against the
collaboration of ophthalmologists and optometrists when it is in
the best interests of the patient. The legislation merely
attempts to set certain limits on the co-management system to
ensure that the patients' needs come first. He noted that Dr.
Rosen was in the audience and would be able to answer the more
technical questions.
4:31:00 PM
The committee took a brief at-ease.
ERIC CHRISTIANSON, Optometrist, American Optometric Association,
stated for the record that he and the association are vehemently
opposed to the legislation. He mentioned that he helped craft
very similar legislation last year. Dr. Christianson emphasized
that there is no precedent for legislation of this nature and it
doesn't exist in any other state. Dr. Christianson said,
"Optometrists in Alaska are state licensed to examine, diagnose,
and treat conditions of the human eyes, employing methods they
are educationally qualified to use, as established by the
Optometry Board." Furthermore, co-management of pre- and
postoperative care is already highly regulated under federal
law. Dr. Christianson charged that HB 151 will reduce patient
access to care, limit freedom of choice, and increase costs,
especially for rural patients. "There is no public health
justification for this bill," he said. Dr. Christianson related
that HB 151 doesn't directly impact him because he practices in
Ketchikan where there isn't an ophthalmologist present all the
time. Therefore, practically all of his patients requiring
surgery must travel. This legislation covers the urban
optometrists, who are no different than [those practicing in
areas where there is no ophthalmologist]. The education an
optometrist receives is very similar to that of a dentist and a
family practice doctor. He opined that regular medical
physician education in eye disease has diminished, and therefore
he related that he sees practically every red eye in town.
DR. CHRISTIANSON specified that [the association] is opposed to
HB 151 because clinical decision-making is being legislated. He
related that when he chooses a surgeon to refer a patient, he
chooses the surgeon based on clinical skill and the surgeon's
judgment regarding when to release the patient to the
optometrist. Dr. Christianson said that he didn't see the
epidemiological evidence to support that optometrists are going
beyond the scope [of their education/training].
REPRESENTATIVE LEDOUX related her understanding from Dr.
Christianson's testimony and from others with which she has
spoken that there is an exemption from HB 151 for those
optometrists located in areas without an ophthalmologist. She
asked where this exemption is located in the bill.
CHAIR ANDERSON pointed out that the language is located on page
2, lines 13-15.
DR. CHRISTIANSON highlighted that the language doesn't specify
an optometrist.
4:37:37 PM
REPRESENTATIVE LEDOUX related her understanding from subsection
(c) that a surgeon could only have a comanagement agreement with
another ophthalmologist. Therefore, she interpreted subsection
(d) to mean that [if the distance a patient would have to travel
to the operating ophthalmologist is a hardship], the patient
could only be referred to an ophthalmologist.
DR. CHRISTIANSON commented that this bill is poorly written and
many angles from which one can attack it. Dr. Christianson
opined that he doesn't believe HB 151 serves the public health
of the patient. Furthermore, it calls into question the ability
of optometrists to do a procedure that they have been doing for
25 years and for which no real evidence of problems has
occurred.
REPRESENTATIVE LEDOUX surmised that Dr. Christianson believes
that with or without the exemption, HB 151 is bad bill.
DR. CHRISTIANSON stated that this bill is bad because it treats
people who are in the city different than those in the rural
areas. He characterized HB 151 as anti-patient and geared
toward benefiting special interests. He highlighted that the
committee was provided with studies illustrating that optometric
comanagement of surgical cases has similar outcomes as those
managed by the surgeons themselves.
REPRESENTATIVE ROKEBERG inquired as to the difference in cost
between an optometrist and an ophthalmologist [for 48 hours of
postoperative care].
4:40:49 PM
DR. CHRISTIANSON related that the most commonly performed
procedures are usually covered by Medicare, and therefore
Medicare specifies the charges. Optometrists can only charge 20
percent of the surgical fee, which means that the
ophthalmologist has to reduce his or her fee by 20 percent to
allow for payment to go to an optometrist. This is because the
most common surgeries, such as cataract surgery, occurs with
patients who are over 65 and thus is covered by Medicare.
REPRESENTATIVE ROKEBERG explained that his wife, who is retired
and is not on Medicare, had cataract surgery this past summer.
Therefore, he again inquired as to the cost of care
differential.
DR. CHRISTIANSON said that he could not answer because he didn't
know what ophthalmologists charge for cataract surgery, although
he guessed optometrists would charge less than ophthalmologists.
REPRESENTATIVE LYNN asked how many ophthalmologists [from the
Lower 48] perform cataract surgery in Alaska.
DR. CHRISTIANSON answered that there are two and they are
members of one group.
REPRESENTATIVE LYNN asked how many ophthalmologists who are
Alaskan residents perform surgery in Alaska.
4:42:40 PM
REPRESENTATIVE GUTTENBERG asked what would happen to a patient
when during the 48 hours after the surgery the patient needed
care that is outside the scope of what is allowed in the
profession of an optometrist.
DR. CHRISTIANSON stated that there is a plan in place for such a
situation. He stated that in his area, he would contact an
emergency room physician as well as the surgeon who performed
the cataract surgery and offer suggestions as to the course to
take. If the situation occurred in Anchorage, the optometrist
would consult with the ophthalmologist and the optometrist who
works at the ophthalmologist's facility. He noted that the
aforementioned optometrist is residency trained in postoperative
care of patients. Some of these optometrists, like Paul Barney,
have seen upwards of 30,000 one-day after surgical care visits
with patients over the years. This figure, Dr. Christianson
opined, would seem to be more patients than many
ophthalmologists see for cataract surgery.
REPRESENTATIVE GUTTENBERG inquired as to how often Dr.
Christianson has to refer a patient to whom he is providing
postoperative care to the original ophthalmologist or someone
else.
4:45:13 PM
DR. CHRISTIANSON answered that it rarely happens, although it
would depend upon the surgery. He related that continual
discussion and the patient returning multiple times are more
technical surgeries, such as retinal detachment surgery. Dr.
Christianson informed the committee that the surgeries that the
ophthalmologist impacted by this legislation is cataract surgery
and refractive surgery aren't systemically involved surgeries.
REPRESENTATIVE ROKEBERG surmised that this legislation, as a
practical matter, wouldn't affect Dr. Christianson since there
is not an ophthalmologist in his community.
DR. CHRISTIANSON, in response to Representative Rokeberg,
explained that the concern is with a particular ophthalmologist
who leaves patients in the care of an optometrist after only 48
hours. He questioned why there is a need to regulate this
practice when in the eight years he was on the board there was
not one instance or discussion with the medical board concerning
problems of patients receiving poor care [from an optometrist
provide postoperative care].
4:47:12 PM
REPRESENTATIVE ROKEBERG concluded then that this isn't an issue
of quality of care but rather one based on economic arguments.
DR. CHRISTIANSON agreed that this bill is based on cost of care
arguments. He characterized HB 151 as legislation that detracts
optometrists from focusing on the amplification bill.
Furthermore, legislation similar to HB 151 has been attempted
nationally in order to limit the comanagement for optometrists
in order that [ophthalmologists] can take away care.
4:48:42 PM
DR. CHRISTIANSON offered an example in which an optometrist in
Oklahoma can perform laser surgery after going through the same
education and training to do so. An optometrist doing laser
surgeries in a Veterans' Administration (VA) facility in
Oklahoma. A local ophthalmologist charged that the
aforementioned optometrist was providing improper care despite
the fact that there was no epidemiological evidence. He
explained that the aforementioned situation arose because
optometry does their higher order residencies through the VA and
doesn't receive funds for residencies from the Medicare while
ophthalmology and other medical subspecialties do. He stated
that if the higher order residencies performed at VA facilities
are stopped, it stops optometry from moving forward.
4:49:43 PM
DR. CHRISTIANSON, in response to Representative Rokeberg,
confirmed that a patient located in an urban with postoperative
problems [beyond the scope of the optometrist] would be referred
to an available surgical ophthalmologist.
CHAIR ANDERSON noted that as the Chair of the House Labor and
Commerce Standing Committee he is the sponsor of HB 151 and "it
rubs him wrong" when the optometrist said that HB 151 is an
anti-business and anti-patient bill. He the asked why
Providence Hospital, the Medical Board of Alaska, and
ophthalmologists around the state and the nation support the
bill.
DR. CHRISTIANSON said that all those supporting entities and
individuals are physicians. Although he agreed that there is a
difference of opinion, he reiterated the need bring forth the
evidence to support the notion that optometrists are bringing
forward inferior care. He specified, "You're taking something
away that we have been doing for 25 years without problem."
CHAIR ANDERSON recalled Dr. Christianson's testimony stating
that this legislation is an anomaly since similar legislation
had not passed in other states. However, Chair Anderson
recalled that several years ago similar legislation passed the
Alaska State Legislature, but was ultimately vetoed by Governor
Knowles.
DR. CHRISTIANSON clarified that the legislation which Chair
Anderson recalled was the amplification legislation.
4:51:54 PM
REPRESENTATIVE LYNN inquired as to the meaning of the term
"cataract mill" used in the sponsor statement.
CHAIR ANDERSON deferred to Dr. Rosen.
REPRESENTATIVE LYNN continued by stating that you mention this
derogatory term in the new cover statement, but it isn't found
in the older sponsor statement. He added that the inclusion of
this statement must have some kind of significance.
CHAIR ANDERSON answered that it did, and then directed attention
to the next witness.
DR. CARL ROSEN, Ophthalmologist, Alaska Eye Physicians and
Surgeons, informed the committee that he is the only orbital and
oculoplastic surgeon, and neuro-ophthalmologist specialist in
the state of Alaska. Dr. Rosen stated that common sense would
dictate that a surgeon physician, a graduate of medical school,
should decide, after a discussion with the patient, who should
have surgery. Further, the surgeon should obtain consent for
the surgery and should follow the patient after surgery.
However, the "opposition" would have everyone believe otherwise.
DR. ROSEN firmly stated that all [ophthalmologists] are asking
is that once a surgeon operates on a patient, that the surgeon
be available to the patient for 48 hours after the surgery, or
have another similarly trained ophthalmologist take care of the
patient during this time period when complications most often
occur. After that, he said, an optometrist can assume care. He
then made it clear that rural areas are exempt. If it is
necessary for a patient to be co-managed with an optometrist,
that is fine with [ophthalmologists]. A comanaged arrangement
with an optometrist can also work when there is a hardship issue
or travel constraint by either the patient or the doctor. Dr.
Rosen stressed that [ophthalmologists] aren't advocating
eliminating comanagement. Although comanagement has been going
on for years, it shouldn't be reflexive or routine. "That
relationship ... has occurred ... because of a financial
relationship that has been developed by some of these cataract
mills. What we are trying to do is prevent further itinerant
surgeons. And there are rumors flying around that more are
coming because the business model that has been created works so
effectively," he explained.
4:54:29 PM
DR. ROSEN stated that the Office of the Inspector General and
Medicare never expected or intended comanagement to be done
routinely. Originally, comanagement was intended to be used on
a patient-by-patient basis in which the patient understood what
was going on and this would only occur when the surgeon was not
around. However, it's problematic to establish a situation in
which the surgeon would simply show up for surgery, perform the
surgery [with no follow up], and move on. This business model
is relatively new, which explains why it has received a lot of
interest recently.
4:55:30 PM
DR. ROSEN then turned to a situation in which a patient has a
problem [after surgery]. He pointed out that optometrists don't
carry a beeper that attaches them to a facility all day every
day. Furthermore, an optometrist doesn't have privileges or the
authority to walk into a hospital and see the patient.
Therefore, when a patient of an itinerant surgeon has problems,
the local ophthalmologist is beeped by the hospital. He
commented that an itinerant surgeon who performs 100 cases a
month is a phenomenal amount of cases. Dr. Rosen said that
problems have occurred and one can find the epidemiological data
if one digs deep enough. In fact, six months ago, Dr. Rosen
said his beeper went off at 11:30 p.m., and he could not find
the patient's optometrist. Therefore, he had to deal with the
emergency room, see a patient who had never been to his
facility, which is the largest practice in Alaska. Furthermore,
he had to track down the surgeon, Dr. Ford, which was not easy.
4:56:58 PM
DR. ROSEN then said that this same practitioner, Dr. Ford, has
failed to describe other complications that have occurred. With
so many surgeries, he said that there are bound to be
complications. He acknowledged that he isn't known as a
cataract surgeon, but rather is known for facial reconstruction,
tumors, cancers, plane wrecks, and bear maulings. [This being
the case, he still had to cover the cases that were dropped by
optometrists and other surgeons].
CHAIR ANDERSON informed the committee that Dr. Ford is a medical
doctor who owns a practice [Pacific Cataract and Laser
Institute] in Washington State. Dr. Ford works along side five
other doctors who fly to Alaska to perform these surgeries.
DR. ROSEN agreed and said that's what he means by an itinerant
surgeon. He pointed out that [Dr. Ford and his fellow
ophthalmologists] have never taken "call" [called to the
hospital by his beeper] in the state of Alaska, and they do not
have privileges at Providence Hospital or Alaska Regional
Hospital. However, the medical practitioners in Alaska do take
call, which is a service for the people that is free and part of
the medical care provided to the community. In so doing, it
increases the liability of those [ophthalmologists] in Alaska
and places more demand on his life. He noted that taking call
is not required and he could decide to do what Dr. Ford does and
not have any attachment to either Providence Hospital or Alaska
Regional Hospital.
DR. ROSEN ended by stating that complications will occur, even
to the best of surgeons. He offered [in referring to Dr. Ford]
that when one performs 1,100 procedures, there will be more than
three complications in a seven- to eight-year time period. He
indicated that Dr. Ford failed to mention that there had been
over 15 retinal detachments last year alone, which Dr. Rosen
opined is a complication. In summary, Dr. Rosen characterized
HB 151 as a good bill that will raise the standard of care for
Alaskans.
4:59:42 PM
CHAIR ANDERSON informed the committee that there is a conceptual
amendment to page 2, line 4, following "ophthalmologist", insert
"or optometrist". Such a change should address the concern over
communities.
5:00:04 PM
REPRESENTATIVE LYNN inquired as to how many
complaints/complications Dr. Rosen has received within the last
year resulting from cataract surgery.
DR. ROSEN said that his group did not like to delve into this
area, and noted that his group did not have a database where
they collect information on [the number of] complications. This
is left up to the trial attorneys. He then reminded the
committee that he was not a cataract surgeon per se, but he does
it when required. He indicated that for his testimony today, he
did a little digging and came up with the numbers he presented.
"So, I don't know exactly how many, but it's more than what's
talked about at the last testimony," he emphasized. In further
response to Representative Lynn, Dr. Rosen specified that the
information he provided is more than anecdotal, but he wasn't
sure whether it would be appropriate to "go into it a little bit
more".
5:01:08 PM
REPRESENTATIVE LYNN asked if this bill is aimed at some outside
practitioner.
DR. ROSEN clarified that the desire is avoid itinerant surgeons
in Alaska using this type of business model.
REPRESENTATIVE LYNN returned to the reference in the sponsor
statement to "cataract mill" and asked if Dr. Rosen knew of
anyone practicing in the state who was operating a "cataract
mill".
DR. ROSEN replied yes.
REPRESENTATIVE LYNN asked if he could define what a cataract
mill was.
5:02:04 PM
DR. ROSEN, in further response to Representative Lynn,
classified that surgeons who perform about 100 cases in a three-
day period and don't see the patient before of after surgery to
be running a cataract mill. Dr. Rosen informed the committee
that there are at least five cataract mills that he knew of, but
he reminded the committee that there is no central database for
these procedures done in Alaska.
5:03:04 PM
CHAIR ANDERSON returned to Dr. Rosen's testimony regarding the
fact that physicians, not optometrists, are on call. He
surmised that Dr. Rosen isn't judging itinerant surgeons and
ophthalmologists on their ability to practice but rather the
fact that they aren't staying around to be on call. The
aforementioned, he further surmised, is frustrating for surgeons
in the state.
DR. ROSEN said that [the surgeons in the state] feel abused by
this situation. The itinerant surgeons have been invited to
join [the state call list], but they have continued to rebuff
the association. Dr. Rosen said that itinerant surgeons are
welcome to come up and perform surgeries, but they have not
taken call.
CHAIR ANDERSON reminded the committee that HB 151 had been
amended in the House Health, Education and Social Services
Standing Committee to state that an itinerant ophthalmologist is
required to stay in the state for a minimum of 48 hours after
the procedure to provide postoperative care.
5:04:39 PM
DR. ROSEN emphasized that he has nothing against optometry.
However, for those two critical days after surgery, Dr. Rosen
preferred that the operating surgeon take care of his or her
patient. He pointed out that trying to recreate the entire
[history of the patient] during a critical period can be very
dangerous.
5:05:00 PM
CHAIR ANDERSON referred to the American Academy of Ophthalmology
letter, which stated that common surgical complications in the
immediate postoperative, 48 hours, after eye surgery can occur.
5:05:12 PM
DR. ROSEN concurred, and added that when such complications do
occur, it's bad. In further response to Chair Anderson, Dr.
Rosen agreed that ophthalmologists and optometrists differ in
regard to the amount of education they receive. Although he
wasn't sure whether medical malpractice coverage costs were more
for ophthalmologists than optometrists, he highlighted that in
the Ophthalmology journal reported that comanagement increases
malpractice for refractive surgery.
REPRESENTATIVE ROKEBERG asked if the optometrist on staff at Dr.
Rosen's facility provides postoperative care.
DR. ROSEN said that he did not know if the optometrist does
postoperative care. The optometrist certainly relies on the
ophthalmologists for any problems that might come up. Dr. Rosen
said that he sees [the optometrist's] patients on a regular
basis.
REPRESENTATIVE ROKEBERG, referring to previous testimony,
recalled that Dr. Rosen said that there is epidemiological data
available. However, he also recalled that Dr. Rosen said that
he had no database or data. remarks that some of the testimony
did not add up. Therefore, he asked the doctor to explain.
5:07:35 PM
DR. ROSEN stated that the Academy of American Ophthalmology has
realized how controversial this issue is. Therefore, the
Academy of American Ophthalmology has created a database that
collects [reports of complications], which will be available.
He then added that he has discussed with his peers information
concerning complications [from which he has garnered that the
number of complications] is certainly greater than what has been
indicated by prior testimony. He reiterated that no matter how
good of a surgeon one is there are going to be complications.
Dr. Rosen clarified that he wants to stem the delay of care that
may occur [when there are complications].
5:09:13 PM
DR. SHERYL LENTFER, Optometrist, indicated that she had been
practicing for 10 years in the Anchorage and Wasilla area and
that she is opposed to HB 151. In reference to testimony that
optometrists don't take call, she agreed that optometrists don't
take call at a hospital, but those who are VSP members do have
to carry a beeper. Furthermore, HB 151 mainly deals with
comanagement and it doesn't deal expressively with Dr. Ford.
Dr. Lentfer informed the committee that with cataract surgery
most of the complications that occur are usually referred to a
separate ophthalmologist because it's usually a retinal issue
and the patient is usually sent to a specialist.
DR. LENTFER highlighted that an optometrist or another eye care
professional can't comanage unless there is a contract. In
regard to the earlier indication that there is a financial
arrangement between the optometrist and the outside
ophthalmologists, she said that isn't the case. Dr. Lentfer the
provided the following testimony:
For 20 years in Alaska optometrists have been
comanaging eye surgery for the benefit of Alaskans.
There has been over 100 optometrists in Alaska and
they range from Nome to Southeast. After four years
of doctorate work, inclusive of the whole human body
and the ocular system, both in the classroom and in
the clinic, we are well qualified to treat the ocular
system as well as comanage. This bill would allow
under hardship, ... people not qualified to comanage.
Optometrists would not be able to comanage within this
time period. If an optometrist does intervene, in
this bill it does say that it would be a class A
misdemeanor. This is difficult to understand how this
would benefit Alaskans.
This leads to a second issue of availability.
Optometrist's availability is remarkable in the state
of Alaska. We are located statewide and are commonly
the only eye care professionals within hours. There
are only 26 eye surgeons in the state and they are
located in Anchorage, Fairbanks, Soldotna, Homer,
Wasilla, and Juneau. It would be tragic if an
optometrist received a phone call in the middle of the
night, no surgeon was available, and the care had to
be denied secondary to the risk of it being a
misdemeanor.
5:13:03 PM
In previous testimony on the bill, it was suggested
that comanagement was a financial interest for
optometrists. Since the majority of the testimony was
relating to cataract surgery, this isn't a very valid
point. The majority of cataract surgery patients are
Medicare and there's not too many aspects of medicine
that are paid well by Medicare. Also in previous
discussion about the bill, optometrists were referred
to as "not qualified and provide lesser care". I
mentioned optometrists' four-year doctorate program
covering the whole human body and the ocular system.
In addition, ... we examine the ocular system,
diagnose, manage, and treat eye disease, every working
day. Put in more tangible text, the National
Institute of Health issued a study establishing that
optometrists provide excellent comanagement eye care.
This study was done by medical doctors....
Lastly, the bill restricts outside surgeons, and therefore
competition. And it asks legislators to start regulating
medicine. With medicine constantly evolving, surgeries are
evolving, and the critical period for follow up may barely
exist in the future. This is creating eye care
professionals to return to the legislators to change the
law again. Typically, the medical board regulates its body
and not the legislative body. Comanagement ... is already
federally regulated. Comanagement has been part of our
profession for well before I started practicing. The
patients being talked about in this legislation are
typically our patients ... that we're referring to the eye
surgeon. Optometrists are very educated and qualified to
comanage and we're extremely available. Please vote no on
this bill.
DR. RANDY JOHNSTON, Senior Secretary for Advocacy, American
Academy of Ophthalmology, informed the committee that he is a
practicing ophthalmologist from Wyoming who understands Alaska's
issues in regard to patients having to travel great distances
for eye care. Dr. Johnston opined that this really is a patient
concern. He noted that the committee should have a letter, from
Dr. Day, president of the American Academy of Ophthalmology,
which details complications that commonly occur, if they occur,
within 48 hours of cataract surgery. The problem with
optometrists seeing patients with these common complications is
that many of them require additional surgery. Dr. Johnston
acknowledged that there are areas in Alaska and Wyoming where
optimal coverage by ophthalmologists doesn't exist and the
optometrists do what they can to serve the patients. However,
in areas where there are ophthalmologists, it doesn't make sense
to have someone who isn't capable of surgically intervening
following the patient. Although the complications [following
cataract surgery] are uncommon, they are devastating when they
occur. In fact, infection of the eye, which is a frequently
blinding condition, occurs in about 1 in every 1,000 cases.
DR. JOHNSTON noted his disagreement with Dr. Christianson's
testimony that follow up care provided by an optometrist is a
cost saving device for the patient. He explained that with a
Medicare cataract fee, 80 percent of the fee is for preoperative
and interoperative care while 20 percent is for postoperative
care. This postoperative charge is the same whether it is done
by an optometrist or an ophthalmologist.
DR. JOHNSTON said that he couldn't speak to the problems that
Alaska has. However, in Wyoming comanagement is most often used
as a [business] tool to direct patients to the surgeon of
optometrist's choice in return for the guarantee that those
patients will return for postoperative care. For example, the
four cataract surgeons in Cheyenne, Wyoming are routinely
bypassed by the local optometrists who send their patients 50
miles away to surgeons in Fort Collins, Colorado. The
aforementioned occurs because [the optometrists] have agreements
with the surgeons [in Fort Collins] that the patients will
return to the [optometrists] for postoperative care. However,
the ophthalmologists [in Cheyenne] prefer to perform their own
postoperative care of their own patients and thus the local
optometrists don't refer patients to the local ophthalmologists.
BOB LOESCHER, Co-Chairman, Alaska Native Brotherhood, informed
the committee that he is legally blind as a result of type II
diabetes. Mr. Loescher related that he had seen an optometrist
all his life. In fact, a month before becoming completely
blind, he said that he had seen his optometrist to get new
glasses and the optometrist failed to recognize his problems.
He commented that the blindness wasn't the optometrist's fault
but rather his own failing health. He related that he has had
nine surgeries, office treatment, and laser surgery for macular
degeneration, as well as cataract surgery. He revealed that he
is totally blind in the right eye, and has only a little retina
left in the left eye. With the help of his ophthalmologist, he
related that he has been able to retain a little sight. Mr.
Loescher stated that he supports this bill. He remarked that as
a consumer it seems that this is an argument over fees.
5:20:45 PM
MR. LOESCHER advised the committee of his concern as a citizen
and Alaska Native because Alaska Natives have many complications
with their health. He said he has found that his
ophthalmologist are capable of interacting with his other
doctors who treat other conditions from which he suffers. Mr.
Loescher expressed concern with an optometrist's inability to
treat someone like himself because they aren't able to prescribe
drugs. Mr. Loescher opined that it's best to have an
ophthalmologist that's trained to deal with one's entire body
and communicate with other doctors who may be treating an
individual. He expressed the need for there to be a link
between the optometrist and the ophthalmologist no matter how
the comanagement situation is managed. He expressed further
concern with regard to the arguing between the optometrists and
the ophthalmologists. Mr. Loescher concluded by reiterating his
support of HB 151 and highlighted the importance of addressing
the complications of postoperative care of eye surgeries.
5:24:04 PM
CHAIR ANDERSON closed public testimony. He then offered the
following Conceptual Amendment 1:
Page 2, line 4:
Delete "ophthalmologist; and"
Insert "is an optometrist, or an ophthalmologist
who either".
CHAIR ANDERSON opined that the aforementioned conceptual
amendment will ameliorate the problems in rural Alaska. He
stipulated that he wanted ophthalmologists "to stick around"
after doing surgery for 48 hours, or assign to another
ophthalmologist.
5:25:26 PM
CHAIR ANDERSON asked if there were any objections to the
Conceptual Amendment 1. There being no objection, Conceptual
Amendment 1 was adopted.
REPRESENTATIVE ROKEBERG related his wife's recent experience
with surgery at Pacific Cataract and Laser Institute. He
explained that his wife wasn't covered by Medicare. The total
cost of the surgery was around $6000, although the actual the
surgery only took about five minutes. He expressed concern with
the cost of the surgery. He indicated that the quality of care
was [acceptable] and the [postoperative care] was provided by an
on site optometrist who is a member of the firm. Representative
Rokeberg opined that anything the legislature can do to improve
the quality of care and lower the costs is a positive thing. "I
think there has been some testimony regarding the impacts of
that and [that it] will effect the quality of care, but I'm not
convinced that the incident of problems that result from that
are not outweighed by the overall quality of care and cost
benefits that (indisc.)," he said. He noted that he is very
sensitive to the argument of the optometrists. Representative
Rokeberg stated that he isn't particularly supportive of HB 151.
REPRESENTATIVE LYNN highlighted that eyes and their health are
critical. He opined that the larger issue seems to do more with
business competition rather than actual concern about
postoperative care. He noted that he has problems with HB 151.
5:30:28 PM
REPRESENTATIVE CRAWFORD related that his experiences with
ophthalmologists over the years have not been for cataract
procedures but have been more trauma oriented. He said that it
was good to have a well-trained ophthalmologist available to
address the trauma. Therefore, he opined that it would be in
the best interest of the patient to have a trained
ophthalmologist available during the critical postoperative
timeframe. This legislation makes sense, he opined, because he
wants to have a strong cadre of ophthalmologists who live in
Alaska and take call for the population that lives here. He
then said that he does not want to disparage those medical
practitioners that come up from Washington State. However, he
reiterated the need for [itinerant ophthalmologists to be
responsible and provide reasonable postoperative care for the
patients upon which they perform surgical procedures]. He
concluded by saying that the bill makes sense and that he
supported it.
5:32:07 PM
REPRESENTATIVE LEDOUX indicated that she isn't thrilled about
the bill, since she isn't convinced that there is really a
problem. She related that her core philosophy is "if it ain't
broken don't fix it".
REPRESENTATIVE GUTTENBERG noted his agreement with
Representative Crawford and Chair Anderson. He said that some
of the arguments are economic in nature and others relate to
patient care. He informed the committee that he recently had
surgery after which he had complications. Fortunately, he had a
doctor here that could cover the postoperative time period. He
opined that [itinerant] surgeons should remain in Alaska to take
care of complications that might arise. He ended by noting his
support of the bill.
CHAIR ANDERSON said that he wouldn't have sponsored the bill if
he had thought it was anti-patient or anti-business. In fact,
he thought the legislation is actually the opposite. He said
that he isn't trying to degrade the profession of optometry, but
feels that there is a difference between a surgeon, a medical
doctor and an optometrist. The ophthalmologist has more
experience and understanding of "problems" when it comes to
postoperative care. With regard to the issue of call, the
monetary amounts are compelling. With regard to testimony that
other states don't have similar [legislation], Chair Anderson
pointed out that Alaska could be first.
5:34:46 PM
REPRESENTATIVE CRAWFORD moved to report CSHB 151(HES), as
amended, out of committee with individual recommendations and
the accompanying fiscal notes.
REPRESENTATIVE LYNN objected.
A roll call vote was taken. Representatives LeDoux, Guttenberg,
Crawford, and Anderson voted in favor of CSHB 151(HES), as
amended. Representatives Rokeberg and Lynn voted against it.
Therefore, CSHB 151(L&C) was reported out of the Standing House
Labor and Commerce Committee by a vote of 4-2.
HB 169-REAL ESTATE LICENSEE EDUCATION
CHAIR ANDERSON announced that the next order of business would
be HOUSE BILL NO. 169, "An Act relating to the educational
requirements for certain real estate brokers, associate brokers,
and salespersons with new or suspended licenses; and allowing
real estate brokers to hire certain experts to review real
estate transactions; and providing for an effective date."
REPRESENTATIVE ROKEBERG moved to adopt CSHB 169, Version 24-
LS0424\S, Bannister, 4/04/05, as the working document. There
being no objection, Version S was before the committee.
5:37:40 PM
REPRESENTATIVE ROKEBERG informed the committee that there is a
three-page sectional analysis of the proposed CS. He explained
that aside from some conforming amendments, there are only two
substantive sections. He indicated that those two substantive
sections include Section 4, which creates 20 hours of post-
licensing education within the first year of an individual
receiving his or her initial license. The aforementioned
section was requested by the Alaska Association of Realtors.
The other substantive section, Section 14, provides that a real
estate broker may contract with an attorney or an associate
broker to assist with the review of real estate transactions.
He noted that statute requires that brokers supervise all the
activity of the licensees underneath them. Section 14 allows
brokers to obtain additional personnel in the form of an
attorney.
5:39:30 PM
REPRESENTATIVE ROKEBERG stated that he has a conceptual
amendment [that he would like to offer].
REPRESENTATIVE LYNN declared a conflict of interest because he
is an licensed real estate associate broker.
REPRESENTATIVE ROKEBERG declared a conflict of interest as well.
CHAIR ANDERSON announced that both members would be required to
vote.
REPRESENTATIVE ROKEBERG moved that the committee adopt
Conceptual Amendment 1 [with handwritten changes], which read as
follows:
Page 1, Lines 2-3:
Delete: "allowing real estate brokers to hire
certain experts to review real estate transactions;"
Insert: "allowing for review of real estate
transactions by attorneys or associate brokers;"
Page 4, Line 4:
Delete: "cancel the suspension."
Insert: "renew a suspended license."
Page 4, Line 9:
Delete: "canceling the suspension of a license"
Insert: "renewing a suspended license"
Page 5, Line 13:
Delete: "five"
Insert: "seven"
Page 8, Line 20
Delete: "Use of experts."
Insert: "Review of transactions."
CHAIR ANDERSON objected for discussion purposes.
5:41:04 PM
REPRESENTATIVE ROKEBERG explained that the first section of
Conceptual Amendment 1 changes the term "experts" in the title
to "review of". Representative Rokeberg then said that he
needed to make an amendment to Conceptual Amendment 1.
CHAIR ANDERSON asked for a brief at ease.
The committee took an at-ease from 5:41:31 p.m. to 5:41:52 p.m.
5:41:52 PM
REPRESENTATIVE ROKEBERG moved that the committee adopt the
following amendments to Conceptual Amendment 1, such that on
page 4, line 4, the language reading "renew a suspended
license." would be replaced by "reinstate a suspended license."
and the language on page 4, line 9, reading "renewing a
suspended license" would be replaced by "reinstating a suspended
license". There being no objection, the amendment to Conceptual
Amendment 1 was adopted and thus Conceptual Amendment 1, as
amended, was before the committee.
REPRESENTATIVE ROKEBERG, continuing to discuss Conceptual
Amendment 1 [as amended], stated that the change specified for
page 5, line 13, and is per the request of the Real Estate
Association. He explained that the rationale for the
aforementioned change is that the associate broker should be
consistent with brokers because they are one in the same.
5:43:21 PM
REPRESENTATIVE ROKEBERG, in response to Representative
Guttenberg, specified that the change on page 5, line 13, of
Conceptual Amendment 1 [as amended] conforms to existing
statute.
REPRESENTATIVE ROKEBERG, continuing to discuss the Conceptual
Amendment 1 [as amended], finished by stating that on page 8,
line 20, the header on that section needed to be changed from
"Use of experts." to "Review of transactions."
CHAIR ANDERSON removed his objection.
5:44:24 PM
CHAIR ANDERSON announced that Conceptual Amendment 1 [as
amended] was adopted.
DAVE FEEKEN, Industry Issues Legislative Chair, Alaska
Association of Realtors, stated that this bill came from the
industry brokers who wanted education to be required for brokers
who were taking over managerial positions. Within the realtor
industry, 95 percent were in favor of this type of legislation.
He indicated that this type of educational requirement is
already mandated by several states. He explained that pre-
licensing education used to obtain a license teaches the
individual how to pass the test, while post-licensing education
addresses practical applications within the industry. He
related that the states that have implemented these kinds of
requirements have seen a reduction in complaints at the real
estate commission level.
5:46:29 PM
MR. FEEKEN stated that the issue of supervision and review of
transactions came from large brokerage firms requesting the
ability to retain an attorney to help review the large number of
transactions, and from firms that only perform large commercial
transactions.
CHAIR ANDERSON asked if there were any questions.
REPRESENTATIVE CRAWFORD related that over the years he has
bought several homes and has noticed that some realtors are
better than other realtors, which he attributed to the years of
experience of the realtor. He agreed that more education is a
good thing. He asked if Mr. Feeken could describe what the
education would consist of and whether there could be some sort
of apprenticeship before the [realtors] are "turned loose."
5:48:12 PM
MR. FEEKEN agreed that education is important and that the
emphasis is primarily put on practical applications of writing
offers, legal matters, and the use of good solid language in
sales and customer relations. The impetus is on the real estate
commission to create this [education], he said.
REPRESENTATIVE LYNN opined that he would like to see the
emphasis be placed on practical real estate rather than just
salesmanship.
MR. FEEKEN said that the biggest complaint that he receives is
the lack of knowledge in practical things like filling out forms
and doing paperwork.
REPRESENTATIVE LYNN suggested that perhaps the first listing an
agent works up and for which he or she receives a deposit, the
agent can be mentored by a more experienced agent or broker.
CHAIR ANDERSON stated that this was so noted, and then indicated
to the committee that they needed to adopt a zero committee
fiscal note, since the committee is waiting for a fiscal note
from the Department of Administration. He noted that the fiscal
note could be amended [during the remaining committee process].
5:50:33 PM
CHAIR ANDERSON announced that there being no objection, the
committee would adopt a zero fiscal note for the House Labor and
Commerce Standing Committee.
MR. FEEKEN mentioned that the [Alaska Real Estate Association]
supports all of the previously adopted amendments.
PEGGY MCCONNOCHIE, Member, Key Industry Issues Workgroup, Alaska
Association of Realtors; Education Chair, Subcommittee of the
Alaska Real Estate Commission, informed the committee that the
aforementioned educational subcommittee had originated the idea
here in Alaska. She then stated that she looks forward to
increasing the professionalism and consumer protection of the
industry.
5:51:40 PM
BRAD FLETCH, Public Member, Alaska Real Estate Commission, gave
his full support of the bill as well as Version S, as amended.
JERRY ROYSE, Member, Royse and Associates, noted that he
supported the bill. He pointed out that Section 11 requires
Alaskan applicants to complete the post-education requirements
before the license is issued. However, "Section 26-3" specifies
that applicants have a year to complete this, and therefore it's
not accurate in regard to what this legislation specifies.
5:53:37 PM
MR. ROYSE then turned attention to Section 14, which specifies
that use of experts are allowed. He suggested using the
language "attorney, broker, associate broker through their
employing broker" rather than "attorney or associate broker" in
Section 14. He explained that per [AS 08.88].403 a broker can
technically pay an associate broker from another firm directly
based on the language in the legislation, although that's
inconsistent with the requirement that all payments made to a
licensee be paid through the employing broker. If it is an in-
house broker versus an independent broker, then it's not a
problem. However, if it's a small broker without an associate
broker, then that small broker must rely on [an outside reviewer
from another firm]. He opined that he did not want an
inconsistency in state law such that a broker from a different
firm pays an outside associate broker directly [to review a
transaction]. He suggested that the payment should go through
the associate broker's broker.
5:54:53 PM
MR. ROYSE then pointed out in Section 16, under [AS 08.88].990
(12)(A), that the definition of "initial license" is a little
confusing. It appears that [an initial license] would require a
person moving from a broker to an associate broker status, that
it would be necessary to do the required educational update
every time the individual's [professional] status is changed.
5:56:38 PM
REPRESENTATIVE ROKEBERG stated firmly that Mr. Royse's
interpretation of Section 14 is flawed in that an associate
broker cannot work for more than one broker at a time.
MR. ROYSE highlighted that the language [in Section 14]
specifies that [a broker] can pay an associate broker, but it
doesn't specify that the associate broker has to be under the
[broker's] license. Therefore, he suggested that the language
allowing an associate broker to be brought in could be construed
to mean that an associate broker from another firm could be
brought in to review [transactions].
REPRESENTATIVE ROKEBERG specified, "You can't, because that's
the way the statute is; you have to be employed by a broker."
He reiterated that [an associate broker] can only work for one
broker at a time. He emphasized the need to read the language
in the context of the entire chapter.
MS. MCCONNOCHIE explained that once the education is given after
licensing, there is not a requirement to take the post-licensing
education again throughout a real estate career.
CHAIR ANDERSON, upon determining there was no one else who
wished to testify, closed public testimony.
5:58:44 PM
REPRESENTATIVE LYNN moved to report CSHB 169, Version 24-
LS0424\S, Bannister, 4/04/05, as amended, out of committee with
individual recommendations and the accompanying zero Labor and
Commerce fiscal note. There being no objection, CSHB 169(L&C)
was reported from the House Labor and Commerce Standing
Committee.
5:59:17 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
6:00 p.m.
| Document Name | Date/Time | Subjects |
|---|