ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
May 10, 2007
1:36 p.m.
MEMBERS PRESENT
Senator Johnny Ellis, Chair
Senator Gary Stevens, Vice Chair
Senator Bettye Davis
Senator Con Bunde
MEMBERS ABSENT
Senator Lyman Hoffman
COMMITTEE CALENDAR
SENATE BILL NO. 170
"An Act requiring that health care insurers provide insurance
coverage for well-baby exams."
MOVED CSSB 170(L&C) OUT OF COMMITTEE
CS FOR HOUSE BILL NO. 14(JUD)
"An Act relating to the purchase of alcoholic beverages and to
access to licensed premises; relating to civil liability for
certain persons accessing licensed premises; requiring driver's
licenses and identification cards to be marked if a person is
restricted from consuming alcoholic beverages as a result of a
conviction or condition of probation or parole and relating to
fees for the marked license or card; relating to the information
contained on driver's licenses; requiring the surrender and
cancellation of driver's licenses and identification cards under
certain circumstances; and providing for an effective date."
MOVED CSHB 14(JUD) OUT OF COMMITTEE
SENATE CS FOR CS FOR HOUSE BILL NO. 113(HES)
"An Act relating to the prescription and use of pharmaceutical
agents, including controlled substances, by optometrists; and
providing for an effective date."
MOVED SCS CSHB 113(L&C) OUT OF COMMITTEE
SENATE BILL NO. 165
"An Act relating to required onboard disclosures about
promotions, tours, flightseeing operations, other shoreside
activities, shoreside vendors, and visitors bureaus; and
providing for an effective date."
BILL HEARING CANCELLED
CS FOR HOUSE BILL NO. 205(FIN)
"An Act relating to real estate broker and real estate
salesperson licensing; and providing for an effective date."
BILL HEARING CANCELLED
CS FOR HOUSE BILL NO. 110(L&C)
"An Act amending the powers and duties of the legislative audit
division regarding the Regulatory Commission of Alaska; amending
annual report requirements for the Regulatory Commission of
Alaska; extending the termination date for the Regulatory
Commission of Alaska; and providing for an effective date."
BILL HEARING CANCELLED
CS FOR HOUSE CONCURRENT RESOLUTION NO. 8(L&C)
Establishing a legislative task force to make recommendations
regarding job descriptions and salary changes for the
commissioners and support staff and the possible need for
additional support staff of the Regulatory Commission of Alaska.
BILL HEARING CANCELLED
CS FOR HOUSE BILL NO. 209(JUD)
"An Act relating to the chair of the Regulatory Commission of
Alaska and amending the timeline requirements for a final order
of the commission; and providing for an effective date."
BILL HEARING CANCELLED
PREVIOUS ACTION
BILL: SB 170
SHORT TITLE: INSURANCE COVERAGE FOR WELL-BABY EXAMS
SPONSOR(s): SENATOR(s) MCGUIRE
05/03/07 (S) READ THE FIRST TIME - REFERRALS
05/03/07 (S) L&C, HES, FIN
05/09/07 (S) L&C AT 1:30 PM BELTZ 211
05/09/07 (S) --Meeting Postponed to Thursday, May
10--
05/10/07 (S) L&C AT 1:30 PM BELTZ 211
BILL: HB 14
SHORT TITLE: RESTRICT ACCESS TO ALCOHOL
SPONSOR(s): REPRESENTATIVE(s) CRAWFORD
01/16/07 (H) PREFILE RELEASED 1/5/07
01/16/07 (H) READ THE FIRST TIME - REFERRALS
01/16/07 (H) L&C, JUD, FIN
02/09/07 (H) L&C AT 3:00 PM CAPITOL 17
02/09/07 (H) -- Meeting Canceled --
02/23/07 (H) L&C AT 3:00 PM CAPITOL 17
02/23/07 (H) Scheduled But Not Heard
02/26/07 (H) L&C AT 3:00 PM CAPITOL 17
02/26/07 (H) -- MEETING CANCELED --
02/28/07 (H) L&C AT 3:00 PM CAPITOL 17
02/28/07 (H) Moved CSHB 14(L&C) Out of Committee
02/28/07 (H) MINUTE(L&C)
03/01/07 (H) L&C RPT CS(L&C) NT 2DP 5NR
03/01/07 (H) DP: GARDNER, LEDOUX
03/01/07 (H) NR: BUCH, NEUMAN, RAMRAS, GATTO, OLSON
04/11/07 (H) JUD AT 1:00 PM CAPITOL 120
04/11/07 (H) <Bill Hearing Rescheduled to 04/13/07>
04/13/07 (H) JUD AT 1:00 PM CAPITOL 120
04/13/07 (H) Moved CSHB 14(JUD) Out of Committee
04/13/07 (H) MINUTE(JUD)
04/16/07 (H) JUD RPT CS(JUD) NT 3DP 2NR
04/16/07 (H) DP: GRUENBERG, LYNN, HOLMES
04/16/07 (H) NR: SAMUELS, RAMRAS
04/30/07 (H) FIN AT 9:00 AM HOUSE FINANCE 519
04/30/07 (H) Moved CSHB 14(JUD) Out of Committee
04/30/07 (H) MINUTE(FIN)
05/01/07 (H) FIN RPT CS(JUD) NT 6DP 2NR
05/01/07 (H) DP: FOSTER, GARA, NELSON, CRAWFORD,
JOULE, KELLY
05/01/07 (H) NR: HAWKER, STOLTZE
05/05/07 (H) TRANSMITTED TO (S)
05/05/07 (H) VERSION: CSHB 14(JUD)
05/07/07 (S) READ THE FIRST TIME - REFERRALS
05/07/07 (S) L&C, JUD, FIN
05/10/07 (S) L&C AT 1:30 PM BELTZ 211
BILL: HB 113
SHORT TITLE: OPTOMETRISTS' USE OF PHARMACEUTICALS
SPONSOR(s): REPRESENTATIVE(s) SAMUELS
01/30/07 (H) READ THE FIRST TIME - REFERRALS
01/30/07 (H) HES, L&C
03/20/07 (H) HES AT 3:00 PM CAPITOL 106
03/20/07 (H) Heard & Held
03/20/07 (H) MINUTE(HES)
03/31/07 (H) HES AT 12:30 AM CAPITOL 106
03/31/07 (H) Moved CSHB 113(HES) Out of Committee
03/31/07 (H) MINUTE(HES)
04/02/07 (H) HES RPT CS(HES) 4DP 1NR 2AM
04/02/07 (H) DP: CISSNA, SEATON, NEUMAN, FAIRCLOUGH
04/02/07 (H) NR: GARDNER
04/02/07 (H) AM: ROSES, WILSON
04/11/07 (H) L&C AT 3:00 PM CAPITOL 17
04/11/07 (H) Moved CSHB 113(HES) Out of Committee
04/11/07 (H) MINUTE(L&C)
04/13/07 (H) L&C RPT CS(HES) 1DP 6NR
04/13/07 (H) DP: LEDOUX
04/13/07 (H) NR: GARDNER, BUCH, RAMRAS, NEUMAN,
GATTO, OLSON
04/19/07 (H) BEFORE THE HOUSE
04/20/07 (H) TRANSMITTED TO (S)
04/20/07 (H) VERSION: CSHB 113(HES)
04/23/07 (S) READ THE FIRST TIME - REFERRALS
04/23/07 (S) HES, L&C, FIN
05/02/07 (S) HES AT 1:30 PM BUTROVICH 205
05/02/07 (S) Heard & Held
05/02/07 (S) MINUTE(HES)
05/04/07 (S) HES AT 1:00 PM BUTROVICH 205
05/04/07 (S) Moved SCS CSHB 113(HES) Out of
Committee
05/04/07 (S) MINUTE(HES)
05/07/07 (S) HES RPT SCS 1DP 2NR NEW TITLE
(TECHNICAL)
05/07/07 (S) DP: ELTON
05/07/07 (S) NR: THOMAS, COWDERY
05/09/07 (S) L&C AT 1:30 PM BELTZ 211
05/09/07 (S) --Meeting Postponed to Thursday, May
10--
05/10/07 (S) L&C AT 1:30 PM BELTZ 211
WITNESS REGISTER
MARIT CARLSON-VAN DORT
Staff to Senator McGuire
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Sponsor of SB 170.
STEPHANIE BIRCH, Section Chief
Women & Children, Family Health
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, AK
POSITION STATEMENT: Supported the essence of SB 170.
HEATHER BEATY
Staff to Representative Harry Crawford
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Commented on HB 14 for the sponsor.
ED O'NEIL, Owner
Brown Jug
Anchorage, AK
POSITION STATEMENT: Supported HB 14.
MR. O. C. MADDEN
Brown Jug
Anchorage, AK
POSITION STATEMENT: Supported HB 14.
REPRESENTATIVE RALPH SAMUELS
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of HB 113.
DR. DONALD CINOTTI Chairman
State Governmental Relations Committee
American Academy of Ophthalmology
New Jersey
POSITION STATEMENT: Opposed HB 113.
BOB LOSHER
Consumer
Juneau AK
POSITION STATEMENT: Opposed HB 113.
DR. MICHAEL BENNETT, President
Alaska Optometric Association
Alaska
POSITION STATEMENT: Supported HB 113.
DR. JILL MATHESON, President
Board of Ophthalmology
Juneau, AK
POSITION STATEMENT: Commented on HB 113.
CINDY MORGAN
Staff to Representative Ralph Samuels
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Sponsor of HB 113.
ACTION NARRATIVE
CHAIR JOHNNY ELLIS called the Senate Labor and Commerce Standing
Committee meeting to order at 1:36:31 PM. Present at the call to
order were Senators Davis, Stevens and Ellis.
SB 170-INSURANCE COVERAGE FOR WELL-BABY EXAMS
CHAIR ELLIS announced the consideration of SB 170.
1:39:23 PM
MARIT CARLSON-VAN DORT, staff to Senator McGuire, sponsor of SB
170, explained that this bill would require private health
insurance plans to cover well-baby exam coverage for infants
during their first 24-months of life in their standard coverage
for dependents. These exams are considered to be routine
pediatric health care and generally each visit costs from $125
to $250, not including immunizations. These exams would include
monitoring development and growth rate, hearing, vision,
language skills, motor development, diet and general
preventative health care as well as infectious diseases. They
would provide a cost effective way to insure a child's good
health by preventative intervention, as opposed to addressing
the child when he is in the ER and very sick with a high fever.
Twenty-one other states require commercial insurance companies
to cover some level of well-child care.
SENATOR STEVENS remarked that someone would have to pay for the
exams.
MS. VAN DORT replied that the cost of these exams would be borne
by the insurance companies who might or might not pass it on to
consumers through higher premiums.
SENATOR STEVENS asked how much they would cost.
MS. VAN DORT replied somewhere around $1,500 for six visits per
year.
CHAIR ELLIS noted that committee members now have a CS, version
C.
MS. VAN DORT explained that the CS deletes language on page 1,
lines 10-11, that limits coverage to $1,500 a year for each
covered baby. The sponsor did not want to unduly mandate a limit
which may or may not already exist with the insurance carrier.
CHAIR ELLIS said they would hold off consideration of the CS
until they received further testimony.
1:44:08 PM
STEPHANIE BIRCH, Section Chief, Women & Children, Family Health,
Division, Department of Health and Social Services (DHSS), said
she has a master's degree in Public Health and explained that a
foundation of periodic and regular visits to a health care
provider during the first two years of life is more commonly
termed as "health supervision." The focus of these visits is not
just prevention or treating illness or injury, but activity
promoting the physical, emotional, mental and social well-being
of children and their new parents.
MS. BIRCH said the American Academy of Pediatrics recommends
that new-borns through age 2 receive a total of 10 visits, with
7 of them occurring in the first year of life. This schedule of
visits reflects the anticipated developmental milestones that
most children will demonstrate at a given period of time as they
mature. In addition, many of the scheduled visits occur in
coordination with the recommended immunization schedules.
She explained that health supervision visits generally include a
health interview or history, an assessment by a health care
provider of the physiological, emotional, cognitive and social
development which also includes developmental milestones. There
is also observation of the parent/child interaction, a physical
exam from head to toe, screening procedures, and an evaluation
of strength and issues within the parent/child relationship. The
intent is for parents to participate as full partners in health
supervision visits.
She said that families who establish long-term trusting
relationships with a primary health care provider tend to
receive continuous, coordinated and comprehensive care. Many
studies have shown that children in a medical home utilize
emergency rooms less often, have less of a tendency to doctor-
shop and are less likely to have issues of child abuse or
neglect. In addition, developmental lags are much more quickly
identified and children can be referred in a more-timely manner
for community based or specialty services.
MS. BIRCH concluded saying that the DHSS supported the essence
of SB 170 as it will set a pattern for regular screening and
assessments and assist in establishing a relationship with a
consistent health care provider.
1:45:55 PM
SENATOR BUNDE joined the committee.
1:47:56 PM
SENATOR STEVENS asked Senator McGuire how much the exams would
cost and who would pay for them.
SENATOR MCGUIRE, sponsor of SB 170, responded that most private
health care providers already offer well-baby exams and this
bill tries to catch those that may not. It recognizes that the
cost of a sick baby is much higher than the cost of the exams -
therefore representing a net gain to both the insurance
recipient and the insurance pool. An exam for her own baby costs
$110 and she noted that one can't put a child in a state-run
school system without their inoculations.
CHAIR ELLIS asked her to explain why she eliminated the cap.
SENATOR MCGUIRE responded that the director of the Division of
Insurance, Linda Hall, said that some companies already cover
more than what this bill requires and she did not want to limit
that coverage.
1:53:27 PM
SENATOR BUNDE asked if the state health plan covers well-baby
exams.
SENATOR MCGUIRE replied that the state plan does not cover them
now, but she thought it should and she would welcome a letter of
intent that any state-administered plan cover well-baby exams.
SENATOR BUNDE said it would seem inconsistent to require private
enterprises to adopt a standard the state doesn't have.
SENATOR MCGUIRE didn't disagree and said that for the most part,
private companies are already offering them - and she would
welcome a fiscal note. She believed that well-baby exams would
save money in the long run.
1:57:03 PM
SENATOR BUNDE said that letters of intent often get ignored and
he recommended that the requirement for all plans be written in
the bill.
SENATOR MCGUIRE agreed.
SENATOR STEVENS read a letter from the National Federation of
Independent Businessmen calling this an unfunded mandate and
saying that it should be handled in discussions between employer
and employees.
SENATOR MCGUIRE responded that you can expect those kinds of
letters in dealing with insurance companies and while she
respected their right to defend their philosophical position,
she thought it sometimes takes public policy to encourage
insurance companies to do the right thing. "It's just a common-
sense provision that you know is going to pay off in spades,
because one visit to the emergency room these days is in the
$30,000 figure." There are places for those negotiations to take
place between an employer and an employee, but sometimes a
public policy enhances the employees' negotiation position.
1:59:48 PM
CHAIR ELLIS turned to the CS that eliminated the cap that has
the Linda Hall stamp of approval.
SENATOR DAVIS moved to adopt CSSB 170, version C. There were no
objections and it was so ordered.
SENATOR DAVIS said she would take up the intent in her HESS
committee.
2:01:43 PM
SENATOR STEVENS said he sides with business and he didn't get a
good answer as to how much the exams will cost and who will pay
for them.
2:03:01 PM
SENATOR DAVIS said she understood where he was coming from, but
that businesses would be better off with the bill. Preventative
procedures will keep them from having a larger bill on down the
line. This will make all companies pick the exams up - and it is
an issue that will never be resolved if left up to
employer/employee negotiations.
2:05:33 PM
SENATOR DAVIS moved to pass CSSB 170(L&C), version C, from
committee with individual recommendations and attached fiscal
notes.
SENATOR STEVENS objected because they are looking at raising the
insurance cost to businesses throughout the state and this
committee is the Labor and Commerce Committee where it should be
looked at.
SENATOR BUNDE said he was still concerned that the state did not
offer this coverage.
A roll call vote was taken. Senators Bunde, Davis, and Ellis
vote yea; Senator Stevens voted nay; and so CSSB 170(L&C) moved
from committee.
CSHB 14(JUD)-RESTRICT ACCESS TO ALCOHOL
2:07:17 PM
CHAIR ELLIS announced CSHB 14(JUD) to be up for consideration.
HEATHER BEATY, staff to Representative Harry Crawford, sponsor
of HB 14, said this bill was introduced in an effort to find a
new approach to reducing the number of drunk driving injuries
and fatalities in Alaska. The way it would work is that when a
judge or parole board issues an order that a convicted drunk
driver not consume alcohol, a mark would be placed on that
person's driver's license or state I.D. card. This mark would
let bars, liquor stores and clubs know that that person is
prohibited from consuming alcohol. If the person attempts to
purchase alcohol, he faces a $1,000 penalty that would be
collected by the bar or the liquor store that catches them.
The $1,000 civil penalty is modeled after the penalties for
minors attempting to purchase alcohol on behalf of a minor. The
legislation has received broad support including a unanimous
vote of support by the House of Representatives. There are
letters of support in the packet from CHARR, the Advisory Board
on Alcoholism and Drug Abuse, and the Alaska Mental Health
Board.
2:10:06 PM
CHAIR ELLIS asked if this bill in any way interplays with one
brought up by Representative Ramras about vertical and
horizontal configurations of I.D.s.
MS. BEATY replied that she wasn't familiar with that proposal,
but Alaska licenses have a stripe with a navy blue background
and under this bill, that stripe would be red for those who are
court-ordered to not drink.
SENATOR BUNDE asked if they were referring only to DWI folks and
asked what if someone were a chronic alcohol abuser and was
involved in domestic violence, would they also be required to
get this license.
MS. BEATY replied that expanding this bill to include everyone
who was court-ordered to not drink was discussed, but the fiscal
note for that was astronomical and the court already has an
automatic way to communicate with the Division of Motor Vehicles
(DMV) on drunk driving offenses. Adding the red stripe to drunk
driving offenders is an additional check-box on a form that
doesn't generate much cost. The support system is not capable at
this time of communicating all of those orders to the DMV.
SENATOR BUNDE asked how the court communicates a DWI to the DMV
now.
MS. BEATY said it sends a form to the DMV indicating there has
been a conviction and this would go along with the license
revocation paperwork.
2:12:54 PM
ED O'NEIL, owner, Brown Jug, said he sees a lot of benefit in
this legislation especially with the help of the Judicial
Branch. He said there is a lot of sexual abuse in the villages
and a lot of the towns are small and you know who you are
dealing with.
SENATOR BUNDE asked when he gets a Bush order, does it include a
driver's license or another form of I.D. because everyone in the
Bush does not drive.
MR. O'Neil replied that it is either a state I.D. or a driver's
license that has been scanned into the system now. He said 1 in
5 people between the ages of 9 and 18 are abused and this is a
huge issue.
SENATOR BUNDE asked if someone had a DWI red mark on their
driver's license, couldn't they use a state I.D. instead.
MR. O'NEIL replied that he understands that this applies to
state I.D.s as well as driver's licenses.
MS. BEATY agreed that this bill applies to both state I.D. cards
as well as licenses. After a DWI conviction the driver's license
and state I.D. would be confiscated and marked. "We've done our
best to capture everyone under the bill."
MR. O. C. MADDEN, Brown Jug, added that since the civil penalty
law went into effect in 1998, they have intercepted 1,700 minors
and taken civil action against them. He said there is no way to
gauge how many lives have been saved by those efforts. It
couldn't have been done without that legislation.
SENATOR BUNDE said he appreciated the work they do to try to
reduce alcohol abuse and he was concerned that people who are
trying to escape this problem would require bars and package
stores to card everyone putting businesses in a very liable
position.
MR. MADDEN replied that he understands there is no liability for
a licensee unless they know with absolute certainty that the
person has a red stripe on their license.
SENATOR BUNDE wondered if the practical realities are if you
don't card someone and they get served, "I'm sure there would be
a lawyer knocking on your door.... And I find it very irritating
to be carded at my advanced age."
MR. MADDEN replied this bill doesn't create additional
liability.
MS. BEATY added that two memos from Legal Services address the
concern of adding additional liability to an industry that
already has quite a bit of criminal and civil liability. That
was not the intent and both memos state that there isn't an
additional liability.
SENATOR BUNDE maintained his concern that a determined creative
attorney would find a way to pursue liability issues.
SENATOR STEVENS moved to pass CSHB 14(L&C) from committee with
individual recommendations. There were no objections and it was
so ordered.
CSHB 113(HES)-OPTOMETRISTS' USE OF PHARMACEUTICALS
2:22:08 PM
CHAIR ELLIS announced CSHB 113(HES) to be up for consideration.
REPRESENTATIVE RALPH SAMUELS, sponsor of HB 113, said this bill
attempts to open access to health care for more Alaskans. Forty-
five other states let optometrists do more than they do here. If
there is any one state that probably needs it, it's Alaska
because of its geographic size and small population. We have
more problems with access than any other state.
CHAIR ELLIS asked how many states allow exactly what is proposed
in the current version of this bill.
REPRESENTATIVE SAMUELS replied that he didn't have the exact
numbers.
CHAIR ELLIS mentioned that he had drafted some amendments as
options that could be offered later.
SENATOR STEVENS said he thought that ophthalmologists can do
what he is asking optometrists to be able to do. He asked how
many ophthalmologists are in Alaska.
REPRESENTATIVE SAMUELS replied roughly 20 ophthalmologists.
2:27:24 PM
CHAIR ELLIS brought up Amendment 1, labeled 25-LS0411\V.1,
emphasizing that he wasn't moving to adopt any of them at this
time.
AMENDMENT 1
OFFERED IN THE SENATE
TO: SCS CSHB 113(HES)
Page 2, line 30:
Delete "and"
Page 3, line 1, following "eye":
Insert "; and
(E) has been reviewed and approved by the
State Medical Board for prescription and use by
optometrists"
Page 3, line 22:
Delete "and"
Page 3, line 25, following "eye":
Insert "; and
(E) has been reviewed and approved by the
State Medical Board for prescription and use by
optometrists"
CHAIR ELLIS explained this amendment would provide that any
pharmaceutical allowed to be prescribed by an optometrist would
first have to be approved for that use by the State Medical
Board. He said this is a big point of contention from the two
sides of this argument. The argument is made that some people
don't think the State Medical Board would approve of any of
these being prescribed by optometrists because of their
interpretation of the public interest. He said this is one
option. Another option is Amendment 2, labeled 25-LS0411\V.2.
AMENDMENT 2
OFFERED IN THE SENATE
TO: SCS CSHB 113(HES)
Page 2, line 15, following "agents;":
Insert "and"
Page 2, lines 16 - 17:
Delete all material.
Renumber the following paragraph accordingly.
Page 2, line 31, through page 3, line 1:
Delete "injected, unless the injection is for emergency
anaphylaxis and is not injected into the ocular globe of the
eye"
Insert "administered by injection"
Page 3, line 13, through page 4, line 1:
Delete all material.
Renumber the following bill sections accordingly.
Page 4, lines 17 - 18:
Delete "secs. 1 - 3, 5, and 6"
Insert "secs. 1 - 5"
Page 4, line 22:
Delete all material.
He explained that Amendment 3, labeled 25-LS0411\V.3, would
prohibit all injections by optometrists and this also seemed to
be a point of contention. The third option would prohibit the
injection of botox by optometrists.
AMENDMENT 3
OFFERED IN THE SENATE
TO: SCS CSHB 113(HES)
Page 2, line 30:
Delete "and"
Page 3, line 1, following "eye":
Insert "; and
(E) is not a derivative of clostridium
botulinum"
Page 3, line 22:
Delete "and"
Page 3, line 25, following "eye":
Insert "; and
(E) is not a derivative of clostridium
botulinum"
CHAIR ELLIS said he has heard that optometrists don't want to be
in the cosmetic procedure business.
2:29:25 PM
REPRESENTATIVE SAMUELS said he opposed the first amendment.
SENATOR STEVENS asked if he might support giving this authority
to a board other than the State Medical Board.
REPRESENTATIVE SAMUELS replied that the conflict between the two
groups would make it impractical and using the Board of
Optometry would be a good idea.
SENATOR DAVIS asked if they had talked to the Medical Board
because she didn't think they would agree with this.
CHAIR ELLIS said he hadn't talked to them.
SENATOR BUNDE asked if it would be fair to characterize
discussion about this bill as turf battles.
REPRESENTATIVE SAMUELS replied that he would characterize it
that way, but others wouldn't. He said Amendment 3 sounded
pretty reasonable. The debate on Amendment 2 on the House floor
and in the House HESS committee was about injections into an
eyelid and centered around an optometrist could spend his entire
career every day all day dealing with the eyes, but could not do
something that a general practitioner could do. He said the
optometrists and ophthalmologists could clarify the risks and
how often they are taken. The idea is to open access to the
health care system by allowing a larger number of doctors to
provide a little bit more service. So, if he could vote, he
would vote against Amendments 1 and 2.
2:33:17 PM
DR. DONALD CINOTTI, Chairman, State Governmental Relations
Committee, American Academy of Ophthalmology, said his expertise
is in scope of practice and ophthalmology. He said his main
concern is when an optometric degree becomes an ophthalmologist
degree. In every state bills continue to pop up to increase the
scope of practice of optometry and this bill is by far one of
the most liberal. It essentially makes an optometrist an
ophthalmologist who doesn't do surgery.
He went over some of the myths that are heard is that the main
reason for expansion of practice always comes down to access to
care and this is a turf battle. In every state optometrists say
they have to refer some patients to an ophthalmologist to get
care. He said probably the only time they hear from constituents
about access to care is when bills like this are in committee.
DR. CINOTTI stated that rural communities have taken care of
access in all fields of medicine for time immemorial by the
physicians, the optometrists, the emergency rooms having
friendly ophthalmologists who they call and will guide them
through the care of the patient and be told which patients need
to be referred in and for which patients a prescription can be
called in. "So, there really is no access problem in any state
in this country."
2:36:14 PM
Second, he said training is an issue. He has been training for
26 years and small ophthalmology programs have been ended; the
majority of programs are very highly supervised and
standardized. The average three-year ophthalmology residence
program would have five residents per year or 15 residents. The
average residency is about 10 to 15 patients per day. So, taking
the small number, that would be 15 times 10 or 150 patients a
day would have to be seen in the clinic to qualify for the set
standards - plus the patients that are seen on nights and
weekends.
An average optometric program has many more students - 60 per
year for four years and that would result in 240 students times
10 patients or 2,400 patients a day to be equivalent to the
experience that an ophthalmology resident has during his
training.
DR. CINOTTI said that ophthalmology residency programs see a
tremendous amount of pathology every day. They are supervised
from medical school through residency by another ophthalmologist
or someone who has more training. All of their prescriptions are
looked at before they are written.
So, in medicine, we have always learned and been
trained before we were given the right to prescribe.
What this bill and all of the expansion bills around
the country do is they get the right to prescribe and
then we worry about how they are going to be trained -
whether it's going to be a weekend course or how much
training do they need to take.
2:38:21 PM
Specifically, Dr. Cinotti said he was concerned about the oral
medications part of the bill - especially with off-label use. He
said that many diseases now, especially Uvitis, which is an
inflammation inside the eye, are now being treated with anti-
cancer drugs. He asked if an optometrist is trained to be
prescribing anti-cancer drugs and would they know the side
effects. Would they require medical consultations and would all
of their patients be seen by medical doctors.
He was also very concerned about the use of medications in the
pediatric population. There is no equivalent between a child and
a baby and a new born to an adult; the doses are completely
different and the danger is extremely high. This bill allows an
optometrist to treat a baby who is one hour old and up through
adult life.
He was concerned about what he has seen happen in other states
where optometrists were found writing prescriptions for Viagra
and birth control - things they are not entitled to. He was also
concerned that these prescriptions would be given unwittingly to
drug addicts. Ophthalmologist and medical doctor graduates have
training in psychiatry and recognizing when a patient is in the
office complaining about something so they can get drugs. He
asked where the optometrist would get the training to prescribe
the narcotics and would they recognize if a patient is a drug
addict.
He also said that people who prescribe narcotics have a much
higher incidence of addiction to them. The highest addiction
rate in medicine is in anesthesiology. He asked if optometrists
who prescribe narcotics would have an increase in rate of
addictions and said that in general ophthalmologists don't write
narcotics. They manage pain with topical drops. He concluded
saying:
We in medicine feel that these bills and this bill, in
particular, is creating a medical graduate from an
optometrist without the education. We understand the
difficulty that you have in Alaska with the rural
population, but we know that those people have been
taken care of. And I think it's difficult for you to
talk to your constituents and really say to them 'Hey,
today we did a good job. We got you second best.'
2:42:02 PM
BOB LOSHER, Juneau consumer of health care services, said he
opposed this legislation. He said he is legally blind as a
result of diabetes and a kidney transplant. He has spent a lot
of money and has a lot of experience with both ophthalmologists
and optometrists having had nine eye surgeries and many other
treatments.
MR. LOSHER said he had traveled extensively through Alaska and
helped many people with their health, jobs, energy and other
things including building medical clinics in rural communities.
He was concerned that legislators should not diminish the
quality or safety of health care and delivery to any Alaskan
whether they live in an urban or rural area; and that is one of
the main premises he is hearing. He said this is a consumer
protection issue and he is more concerned that people have
qualified people providing their health care services. He
believed the legislature should protect consumers in these
areas.
2:45:29 PM
Second, Mr. Losher said that the Boards of Optometry and
Ophthalmology say two different things and the Medical Board
didn't even want to deal with this issue at all. As a consumer,
he is concerned that these boards are charged with the
responsibility of making sure that Alaskans get qualified
practitioners and have qualified facilities and treatment
programs. He didn't think they were being well-served by these
boards because they can't come forward with a uniform opinion on
the subject.
2:47:07 PM
Third, he said he was surprised there was no fiscal note and
certainly thought there would be costs to the Department of
Commerce, Community & Economic Development from, at least, more
applications, certifications and testing. This legislation
represents an expansion of service that would impact delivery of
the state medical programs like Medicaid.
2:48:23 PM
He concluded saying that he knows from his own experience with
diabetes and a kidney transplant that your eyes' health can't be
disassociated from health in the rest of your body. "My
experience teaches me that you need a fully qualified medical
doctor to deal with your comprehensive health, including your
eyes."
CHAIR ELLIS thanked him for his testimony and apologized that
the committee could not accommodate Dr. Steiner's surgery
schedule, but that he had submitted written testimony.
2:50:25 PM
DR. MICHAEL BENNETT, President, Alaska Optometric Association,
urged the committee to support HB 113. He said it would
authorize licensed and trained optometrists to prescribe
medications for the treatment of eye and surrounding tissues -
not for birth control or other purposes. This is stipulated
directly in the bill. The pain medications are somewhat limited
and for very brief periods of time - four days. It also provides
for the treatment of anaphylactic shock, which can occur in rare
instances of topical administration of drugs. This is a critical
part of this bill because people can die from anaphylactic
shock. Under current law, he would have to treat the person
illegally or let them die on the floor.
DR. BENNETT reiterated that the bill is quite narrow in scope
and does not allow prescription of the most abused controlled
substances such as oxycodone and specifically prohibits
injections inside the eye. It in no way grants surgical
privileges and it mandates continuing education and competency.
The course work that is mandated is meant as refresher course
work; it is not intended to teach somebody off the street how to
prescribe medication for eye care.
Supported HB 113.
He said the bill stipulates only eye treatment and eye issues,
on other purposes, somewhat limited pain medications for a
limited amount of time - 4 days. It provides for treatment of
anaphylactic shock which is critical. It specifically prohibits
injections into the eye and mandates continuing education and
competency. The course work is refresher work, not to teach
more.
2:53:35 PM
DR. BENNETT said optometrists have been well-qualified for these
rights for a long time; they are a doctoral level profession -
that's four rigorous years beyond a bachelor's degree. Optometry
school provides over 200 hours of classroom pharmacology which
is comparable to pharmacology training in medical and dental
schools. There is greater than 2,000 hours of supervised patient
care. These patients are not limited to the young and the
health. Elderly people and folks with serious illnesses form the
preponderance of most eye care practices. People with
debilitating diseases are far more likely to have serious eye
health problems and they form the bulk of most practices.
DR. BENNETT said that complete medical case history is always
taken on every patient he has ever seen. Medications are looked
at and interactions are considered. New medications, drops or
otherwise, are looked at for interactions. If there are any
questions or concerns, he contacts the patient's primary care
physician before proceeding.
Under current law, when you see a patient who requires an oral
antibiotic or an antiviral, or something that is covered in this
bill, they must be referred to either an eye surgeon or to their
primary care doctor, a nurse practitioner, or a physician's
assistant to get the prescriptions covered. Many times it's the
end of the day and you try to call the patient's primary care
physician and get them to call in the prescription to cover it.
That's an awkward position to put the physician in. Or since
they have almost no specific eye training, it's difficult for
them to make that diagnosis if an eye surgeon is not available.
Generally, it results in the wait of a day or two for the
patient to see them. This results in unnecessary travel and
always results in delayed treatment, additional fees and
additional lost time at work.
He said being allowed to write these prescriptions would result
in cost savings; he makes the diagnosis and it doesn't cost any
more to write the prescription form. And the patient doesn't
have to go to another doctor.
SENATOR BUNDE asked if he anticipated getting more patients if
this bill passed.
DR. BENNETT replied no; patients aren't aware that he can treat
their glaucoma and eye infections with topical drops, but that
he can't necessarily treat an infection that has spread a little
further into the eyelid with an oral antibiotic. The patient
comes to his office assuming he can take care of their problem.
He said a lot has been made of the idea that the things they are
talking about are not run-of-the-mill every day occurrences and
that is true. He might not write even one prescription a week
and it's very unusual that one would need to prescribe pain
medication - especially in Juneau or Anchorage. A good example
would be if a battery blows up in someone's face who is in
Kotzebue. That person is going need to get to Anchorage and it
would be nice to provide them some pain relief for a day or two
until they could get there.
2:57:58 PM
SENATOR BUNDE asked if an office visit to an optometrist would
have a different rate than a visit to an ophthalmologist. He
assumed an informed consumer would go the rate is lowest and he
would get more business that way.
2:58:29 PM
SENATOR STEVENS asked Dr. Bennett about an optometrist writing
prescriptions for drugs other than for the eye - specifically
Viagra and narcotics. He asked if this bill encompassed more
than just medication for the eye.
DR. BENNETT replied that this bill specifically states it's for
treatment of eye disorders only.
SENATOR STEVENS said that the comment that he would be supplying
narcotic addicts is not really legitimate.
DR. BENNETT replied that is correct and that you couldn't help
an addict much with a four-day legal supply anyhow.
2:59:55 PM
CHAIR ELLIS said he wanted to turn to the amendment options and
brought up Amendment 1.
SENATOR STEVENS commented that this might be a more appropriate
issue for the Board of Optometry to take up and suggested
amending Amendment 1 to that effect.
CHAIR ELLIS asked Dr. Matheson if it would be redundant to
change to the State Medical Board to the State Optometric Board.
3:01:10 PM
DR. JILL MATHESON, President, Board of Optometry, said the
statute as written is an optometry statute, which is then
automatically regulated by the Optometry Board. So, it would be
unprecedented to give the State Medical Board jurisdiction over
what optometrists do. That doesn't happen anywhere else and it
would be redundant.
It would be unprecedented to have the Medical Board have
jurisdiction over what another profession does. It would open
another can of worms.
CHAIR ELLIS said that amendment would be set aside and brought
up Amendment 2 that would prohibit all injections by
optometrists.
SENATOR STEVENS asked if language on page 3, line 25, didn't
already say that.
CHAIR ELLIS replied that he understands the issue to be the
injecting into the eye or around the eye.
3:03:09 PM
SIDNEY MORGAN, staff to Representative Samuels, said that the
bill specifically says no injections directly into the eyeball.
CHAIR ELLIS remarked that this amendment is more expansive in
prohibiting all injections by optometrists.
MS. MORGAN replied that is correct and that the last committee
made some changes regarding injections. It was going to allow
immediate injections for anaphylactic shock which makes sense.
However, it also took the injections which the original bill
allowed and put in an effective date that allowed the Optometry
Board to insure that everyone was educated and trained properly
for those injections, even though they believe that is already
the case.
CHAIR ELLIS set that amendment aside and moved to Amendment 3
prohibiting the injection of botox by optometrists.
SENATOR DAVIS said that the bill doesn't mention that at all,
but the people who wanted the bill didn't object to it.
3:05:31 PM
CHAIR ELLIS moved to adopt Amendment 1, labeled 25-LS0411\V.3,
[formerly Amendment 3] as follows:
AMENDMENT 1
OFFERED IN THE SENATE
TO: SCS CSHB 113(HES)
Page 2, line 30:
Delete "and"
Page 3, line 1, following "eye":
Insert "; and
(E) is not a derivative of clostridium
botulinum"
Page 3, line 22:
Delete "and"
Page 3, line 25, following "eye":
Insert "; and
(E) is not a derivative of clostridium
botulinum"
There were no objections and Amendment 1 was adopted.
3:06:49 PM
SENATOR DAVIS moved to pass SCS CSHB 113(L&C) from committee
with individual recommendations and a zero fiscal note. CHAIR
ELLIS said he was personally conflicted about this and deferred
to the will of the committee. There were no objections and it
was so ordered.
There being no further business to come before the committee,
Chair Ellis adjourned the meeting at 3:08:13 PM.