SENATE BILL NO. 55 "An Act relating to the practice of optometry." 9:15:15 AM Co-Chair MacKinnon passed the gavel to Vice-Chair Micciche. SENATOR CATHY GIESSEL, SPONSOR, introduced the legislation: This bill moves the continuing education (CE) requirements back into regulation, as desired by the Department of Commerce, Community and Economic Development. Continuing education is still required by current statute, but the hours and subjects will be determined by the Board of Optometry, as with other professions. The current regulations require more CE hours than the statute subsection deleted by this bill. SB 55 allows the board to determine prescribed drug schedules anticipating federal regulations that may change again in the future as they did in 2014; that regulation required another statute change, and this bill would allow the board to move in step with its industry. This bill updates the optometry definition to reflect current education and training, but specifically prohibits invasive surgery. This allows for future new and improved diagnostic and therapeutic procedures as determined by the board, while not having to return to the legislature for every new technological advance. It also defines that optometrists must be qualified for any procedure that they perform. This bill also further defines and clarifies the prohibited surgical procedures under an "invasive surgery" definition. Alaska optometrists already do superficial surgical procedures such as removal of corneal foreign bodies under current statute, but nothing invasive would be allowed. 9:24:31 AM Senator Bishop thought the bill's purpose was clear. He referred to the bill allowing "new and improved diagnostic and therapeutic procedures." He wondered whether that was a "catch all" or would there be additional efforts to assist the optometrist. Senator Giessel deferred to an optometrist. 9:25:53 AM JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, discussed the sectional analysis (copy on file): 1. Section 1 Amends 08.72.050 Regulations. Adds to this section the power for the board to adopt regulations allowing the prescription and pharmaceutical agents for the treatment of eye disease and also that under agreement with the State Medical Board, it will describe the scope of practice for a licensee to perform ophthalmic surgery and noninvasive procedures. 2. Section 2. Amends 08.72.181 (d) by requiring specified hours and period of continuing education requirements for the renewal of an optometrist's license but retains delegation of those requirements to the board in regulation. 3. Section 3. Repeals and reenacts AS 08.72.272(a) to provide that pharmaceutical agents, including controlled substances, may be used by a licensed optometrist if consistent with standards adopted by the board and any limitations on practice under section 5 of the bill. 4. Section 4. 08.72.272 amends and adds new subsections prohibiting an optometrist to make injections into the ocular globe of the eye and limits the prescribing of a controlled substance in a quantity exceeding a 7-day supply and requires a referral to a physician or ophthalmologist if a longer prescription is needed. 5. Section 5. 08.72 is amended and a new section is added 08.72.278 Limitation on Practice. Provides that a licensee may perform only services within the licensee's education, training and experience as provided by board regulation. 6. Section 6 08.72.300(3) revises the definition of optometry. 9:28:17 AM JILL MATHESON, ALASKA OPTOMETRIC ASSOCIATION, testified in support of the bill. Senator Bishop asked Ms. Matheson to restate her concern. Ms. Matheson replied at Section 1, line 6. Senator Olson asked if Ms. Matheson had been on the Optometry Board. Ms. Matheson stated she was on the board for eight years, and in that time there had been no complaints. Senator Olson asked how the bill changed the scope of practice for optometrists. Ms. Matheson thought the bill allowed for optometrists to provide for patients at the highest level of care. Senator Olson asked if Ms. Matheson had ever practiced in rural Alaska. Ms. Matheson replied in the negative. 9:35:10 AM JEFF GONNASON, LEGISLATIVE CHAIR, ALASKA OPTOMETRY ASSOCIATION (via teleconference), testified in support of the bill. Senator Olson wondered if there were any other trained professions that were classified under two boards. Mr. Gonnason replied in the negative. 9:40:24 AM Senator Olson wondered if there were any significant changes in training. Mr. Gonnason relayed that medicine, dentistry, optometry, and health care had expanded greatly in ten to twenty years. There were new drugs and procedures. 9:41:39 AM DR. PAUL BARNEY, CHAIRMAN, BOARD OF OPTOMETRY, ANCHORAGE (via teleconference), testified in support of the bill. He thought the CS for SB 55 (L&C) was excellently written with the exception of the aforementioned language specifying the State Medical Board. He urged the committee to strike the State Medical Board language from the bill. 9:46:22 AM DR. CARL ROSEN, OPTHAMOLOGIST, ANCHORAGE (via teleconference), testified in opposition to the bill. He discussed primary eye care, which was part of his purview. He thought the bill was a big pivot point for optometry, and urged caution. He thought it was important that the State Medical Board was involved. Senator Olson thanked Dr. Rosen for practicing in the state. He asked if Dr. Rosen had ever been on the medical board. He shared that he had never been an elected member of the medical board. Dr. Rosen replied in the negative, but he had worked closely with someone on the medical board. Senator Olson asked if Dr. Rosen was familiar with the training for optometrists. Dr. Rosen recounted that he had visited an optometry school, and was boycotted. He stressed that ophthalmology was a select sub-specialty within medicine. 9:52:47 AM Senator Olson asked if Dr. Rosen had ever practiced in rural Alaska. Dr. Rosen replied in the negative. Senator Olson wondered if the ophthalmologists were behind the negative media advertisements. Mr. Rosen stressed that it was an onerous task to testify about this issue. He remarked that optometrists should become ophthalmologists, should they want to achieve the proposals laid out in the legislation. Senator Olson commented that he was somewhat offended by the advertisements. 9:55:18 AM Senator Dunleavy asked for an explanation of what the bill would allow or not allow optometrists to do in terms of surgery. Senator Giessel stated that there were invasive surgeries that ophthalmologists did on the eye that were prohibited. Senator Dunleavy asked about the surface of the eye, and procedures such as Lasik surgery or cataracts. He wondered what medical professionals currently performed the surgery. Senator Giessel believed that Lasik and cataracts surgeries were not performed by optometrists. 10:00:40 AM Vice-Chair Micciche referred to Section 4 and Section 5, which discussed the limitations of optometry practice. Senator Bishop felt that there could be a referral for an emergency procedure. Senator Giessel thought that certainly a fish hook penetrating the globe of the eye in to the vitreous, and remarked there would probably be a referral. She shared that telehealth was currently expanding. 10:04:02 AM Vice-Chair Micciche CLOSED public testimony. Senator Olson asked about medical professionals that were governed by two boards. SARA CHAMBERS, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, stated that the current model was not like any other model. Senator Olson wondered whether the medical board could take action against the licensee. Ms. Chambers looked at page 1, line 12, which posed logistical concerns. She noted that because AS 08.08.64 were not amended, there was not requirement for the medical board to enter into an agreement with the Board of Examiners in Optometry. She felt that there were some logistical concerns that would stymie the efforts of the bill. Senator Olson wondered whether the department was in support of the current version of the bill. Ms. Chambers replied that the department did not have a position on the bill. There was concern with the logistics and operations. There were conversations with the Department of Law. Senator Olson agreed with that concern. Senator Dunleavy asked why the department had not taken a position on the bill. Ms. Chambers stated that when there was a clear desire from one board to accomplish a goal, the department may take a position to support the board. She remarked that there were two entities involved in support and opposition to the bill, so the department would not take a position. 10:08:02 AM Senator Dunleavy thought it made sense that the department should take a position, when the issue was related to a life or death situation. He wondered if the bill contained anything dangerous. He assumed that not taking a position indicated no problem with the bill. Senator Olson replied that the department was not full of trained medical professionals. Senator Dunleavy thought the bills he had sponsored had garnered opinions from those who were not experts in the field. Vice-Chair Micciche thought it was specifically a "Dunleavy problem." 10:09:58 AM Senator Olson MOVED to ADOPT Amendment 1: Page 1, line 12: Delete "by agreement with the State Medical Board." Vice-Chair Micciche OBJECTED for discussion. Senator Olson explained the amendment. He felt that optometrists should not be overseen by two boards. Co-Chair Kelly asked the sponsor's opinion on the amendment. Senator Giessel expressed her support for the amendment. Vice-Chair Micciche removed his objection. There being NO OBJECTION, Amendment 1 was ADOPTED. Vice-Chair Micciche stated that the committee would hold the bill. He discussed the afternoon schedule. SB 55 was HEARD and HELD in committee for further consideration.