SB 55-OPTOMETRY & OPTOMETRISTS  1:32:55 PM CHAIR COSTELLO reconvened the meeting and announced the consideration of SB 55. SENATOR CATHY GIESSEL, Alaska State Legislature, sponsor of SB 55, introduced the legislation, speaking to the following sponsor statement: SB 55 modernizes and updates the Alaska Optometry Statute. 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. SENATOR GIESSEL noted that detractors will say the bill would allow optometrists to perform surgery on the eye, and that is not true. That authority is specifically prohibited in the bill. Current statute already authorizes Alaska optometrists to do superficial surgical procedures such as removal of corneal foreign bodies, but nothing invasive would be allowed. She said the vast majority of Alaskans visit one of Alaska's [195] optometrists for their eye care needs. By contrast, there are approximately 20 ophthalmologists in Alaska. They are eye surgeons. It's these 20 ophthalmologists who are opposing this bill, she said. She discussed the history of the credible, safe healthcare providers that were routinely opposed by physician groups to regulate themselves and highlighted that safe, affordable healthcare was expanded when the legislature listened to the facts. She also point out that optometrists have one of the lowest malpractice insurance rates in the nation. SENATOR GIESSEL summarized that SB 55 gives the Board of Examiners in Optometry the authority to oversee and regulate its own profession, just as other professional boards are trusted to do. 1:39:27 PM JANE CONWAY, Staff, Senator Cathy Giessel, presented the following sectional analysis for SB 55 on behalf of the sponsor: Section 1 requires the Board of Examiners in Optometry to adopt regulations governing prescription and use of pharmaceutical agents. Section 2 amends AS 08.72.181(d) by removing 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. 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. Section 4 reenacts and modifies the prohibition by a licensee to perform an intravitreal injection. Section 5 provides that a licensee may perform only services within the licensee's training and experience as provided by board regulation. Section 6 revises the definition of optometry. Section 7 adds a definition of "invasive surgery." 1:41:34 PM CHAIR COSTELLO asked what pharmaceutical agents optometrists are currently allowed to prescribe and how the bill expands that authority. SENATOR GIESSEL said optometrists can prescribe simple antibiotics as well as schedule II and schedule III opioids. Responding to a further question, she said the bill would allow any updates to be regulated by the board. For example, it could adjust to federal regulation changes without coming before the legislature. CHAIR COSTELLO asked the statutory definition of "optometry" and if the bill changes that. MS. CONWAY read the definition of "optometry" in AS 08.72.300(3) found on page 2, lines 24-27. The bill repeals and reenacts that section of statute. CHAIR COSTELLO asked how the definition changed when the definition was repealed and reenacted. 1:44:53 PM MS. CONWAY said it's very similar but the new definition removed specific reference to x-rays and scans. They were removed because those things are already being practiced within the scope of optometrists' education. CHAIR COSTELLO asked if including the term "preventive procedures" within the definition is intentional. SENATOR GIESSEL deferred the question to optometrists online. CHAIR COSTELLO asked if the bill makes Alaska unique compared to other states. MS. CONWAY said it's unique in that other states allow more use of lasers and other techniques that will continue to be prohibited in Alaska. 1:46:59 PM SENATOR STEVENS asked who makes up the board, its powers, and if it is limited to regulating optometrists. SENATOR GIESSEL said ophthalmologists are eye surgeons and are regulated by the State Medical Board. Optometrists are regulated by the Board of Optometry, which is a five-member board consisting of one public member and four practicing optometrists. SENATOR STEVENS asked if the Board of Optometry has the power to authorize the increased use of lasers. SENATOR GIESSEL clarified that laser technology currently is used in diagnostic procedures, and the board only authorizes practices for which the person is educated. SENATOR STEVENS asked for information on injections in the eye. SENATOR GIESSEL explained that optometrists are prohibited from performing an intravitreal injection. SENATOR STEVENS asked what modifications were made to [AS 08.72.272]. 1:51:30 PM MS. CONWAY explained that subsection (e) was added to specifically state that a licensee cannot perform an intravitreal injection. SENATOR MEYER asked what the educational requirements are for optometrists. SENATOR GIESSEL read the qualifications in AS 08.72.140; the education is doctoral level and has a residency option. MS. CONWAY added that it's 4 years for a bachelor's degree, an additional 4 years in optometry school, and an optional residency. SENATOR MEYER asked if optometrists would be prohibited from treating conditions of the eyelid. SENATOR GIESSEL replied optometrist currently are qualified to remove fish hooks, metal fragments from the cornea, debris from the eye, and treat maladies of the eyelid such as a stye. SENATOR MEYER asked if the bill expands what optometrists can do to the eyelid. SENATOR GIESSEL answered no. CHAIR COSTELLO asked if she said that ophthalmologists do not have a separate board; they are regulated by the State Medical Board so they. SENATOR GIESSEL replied ophthalmologists are specialty surgeons regulated by the State Medical Board. An ophthalmologist may or may not sit on that board, but they do not have their own board. CHAIR COSTELLO mentioned the list in the packets and asked if the bill will shift work away from ophthalmologists toward optometrists. SENATOR GIESSEL indicated that optometrists will continue to practice within the scope of their education and refer patients to ophthalmologists when appropriate. 1:56:38 PM CHAIR COSTELLO asked Ms. Hovenden to address the fiscal note and tell the committee whether or not the administration has a position on the bill. 1:57:11 PM JANEY HOVENDEN, Director, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), said the division doesn't have a position on SB 55 because of the situation that two boards have opposing views. She explained that the fiscal note reflects a $2,500 regulations project. This is a receipt supported service so the costs would be paid for by licensing fees. CHAIR COSTELLO opened public testimony. 1:58:19 PM FORREST MESSERSCHMIDT, Optometrist, said he is representing himself and the Alaska Optometric Association testifying in support of SB 55. He has been practicing for 27 years and just completed a four-year term on the Board of Examiners in Optometry. He described SB 55 as good legislation. It puts the regulation of optometry where it belongs, modernizes the statutes, allows details of regulation to be determined by the board, and is the current standard with other professions in Alaska. Optometrists should be held to the same high standard of care as other medical professionals, but it defies logic to suggest that the profession cannot regulate standards through its own board. He talked about how eye care has changed in the last 27 years; now more than 70 percent of his patient business is medically oriented. A few years ago many of the cases he manages would have required referrals. Consultations and close work with eye surgeons and other medical providers is done on a daily basis. DR. MESSERSCHMIDT said there will be claims that harm will come if SB 55 passes, but the past 40 years of optometry scope expansion law has not shown that to be the case. Optometry malpractice insurance rates are among the lowest of all providers for a reason. He said the people that don't like the bill miss the point that this is all about patients' best interest. There are not enough skilled ophthalmologists to serve the population, so all eye care physicians need to be able to practice to their full level of training and expertise. DR. MESSERSCHMIDT said his practice won't change with the passage of SB 55, and it probably won't change for other optometric physicians practicing in Alaska. He concluded saying that SB 55 is good for optometry and it's good for Alaskans. 2:02:26 PM SENATOR STEVENS asked if the responsibilities of the board will increase if SB 55 were to pass. DR. MESSERSCHMIDT replied it will be a bigger job for the board but it won't change the mindset. 2:03:36 PM JILL MATHESON, Optometrist, said she is representing herself and the Alaska Optometric Association testifying in support of SB 55. She has served two terms on the board, once as chair. As a practicing optometrist for over 24 years she has testified on four different optometry bills. Each time the legislature has carefully considered the information put forth and passed bills to get the optometry profession where it is today. SB 55 is the next step. It gives the board the autonomy to run the optometric profession in the state. The legislature continues to have oversight by approving members of the board. The malpractice insurance rates are under $500 per year, which is an indication that the profession is run safely and conservatively. She opined that the bill protects the public by keeping optometrists at the highest level of training. 2:06:42 PM SENATOR STEVENS asked how she gets training. DR MATHESON replied continuing education is offered in different locations throughout the state and approved classes are also offered at the numerous optometry conferences. Optometry schools also offer continuing education classes. She discussed what qualifies as continuing education and noted that when optometrists were approved to do injections, a class was offered in the state to ensure that optometrists received the training if they hadn't gotten it in school. CHAIR COSTELLO asked if optometrists charge by the hour or procedure. DR. MATHESON replied charges are based on the procedure. CHAIR COSTELLO asked how optometrist charges compare to ophthalmologist charges. DR. MATHESON said she doesn't know but the reimbursement rate from insurance companies is the same because it's based on the procedure. 2:09:24 PM OLIVER JORSHIN, Ophthalmologist, testified in opposition to SB 55. He has been in private practice since 1985 and before that was chief of ophthalmology at the Alaska Native Medical Center. He related that he has had four years of medical school, a year internship in internal medicine, and an obligatory three-year residency in ophthalmology. He has worked alongside optometrists and is well acquainted with their skills in diagnosing and treating eye conditions. His respect for the profession is great, but optometrists are not medical doctors. DR. JORSHIN maintained that the broad language in SB 55 substitutes the judgement of the members of the board of optometry for the years of training and experience ophthalmologists must go through before they can practice. The bill defines what surgery an optometrist cannot perform, but leaves open what they can perform. Invasive surgery is prohibited but is defined in such narrow terms that optometrists could legally perform complex procedures that involve the eyeball, eyelid, eye socket, and surrounding tissues. He questioned why the bill permits optometrists to use controlled substances when they are used so infrequently in ophthalmology. He related his experience is to write such a prescription every couple of years. Also, adding a new class of subscribers won't help alleviate the epidemic of misuse of prescription narcotics. He urged the committee to vote against the bill in the interest of patient safety. 2:13:28 PM RACHEL REINHARDT, Ophthalmologist, American Academy of Ophthalmology, testified in opposition to SB 55. She explained her concern with how the bill relates to surgery. She noted only four other states allow lasers. The language is misleading and would allow optometrists to do all procedures not mentioned in the bill. The bill does not list all surgical procedures needed; there are more procedures not listed, such as laser surgery. The bill removes existing safeguards about injections. She stressed the importance of understanding that the bill creates loopholes. She described the education needed to become an ophthalmologist; four years of medical school and four years of surgical residency. She expressed concern that the bill allows the use of prescription narcotics, which undermines state and federal efforts to stem the epidemic of prescription narcotic abuse. She said the claim that Alaskan's have limited access to ophthalmologists isn't a valid argument. The ratio of ophthalmologists to residents is about one in 24,000 in Washington state and about one in 27,000 in Alaska. She concluded that if the proponents of the bill say it's not a surgery bill, it either needs to be rejected or redrafted. CHAIR COSTELLO asked how the malpractice rates were affected in the four states that allow lasers. DR. REINHARDT said it's too early to have any data. SENATOR STEVENS asked how often she prescribes a prescription narcotics to a patient. DR. REINHARDT said it's rare and generally for a surgical patient. 2:23:32 PM JEFF GONNASON, Optometrist and Legislative Chair, Alaska Optometry Association, testified in support of SB 55. He shared his professional background. He shared the history of Alaska's optometric journey and the opposition by the American Academy of Ophthalmology. He described how optometrists work, their limitations on practice, and that they use their professional judgement as to when to refer patients to specialists. Optometrists have been defined as physicians under Medicare for many years and have had the authority to prescribe narcotics for nine years. SB 55 updates the statutes and gives the state board better autonomy to regulate itself. The board would never authorize optometrists to do anything they are not trained to do. 2:27:56 PM CHAIR COSTELLO held SB 55 in committee with public testimony open.