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