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Committee considers bill allowing optometrists to increase their scope of practice

Brandon Moseley

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Wednesday, the Alabama Senate Health Committee debated a bill that would allow optometrists to add minor surgical procedures to their scope of practice.

Ophthalmologists, doctors with a medical degree who treat the eye as a specialty, oppose the legislation.

Sen. Tom Whatley, R-Auburn, is the sponsor of Senate Bill 114.

Whatley said that he has an eye condition that requires him to wear three contact lenses. Sometimes his contacts will scratch his eye in the middle of the night and he will get a minor infection. He was under the care of an ophthalmologist, but that doctor changed professions and went to law school, leaving no ophthalmologist in the Auburn area at that time.

A simple prescription cures those infections. Prior to 1994, optometrists could not give that. Now his optometrist can do that after the legislature changed the law. SB114 is similar. It allows optometrists to perform simple procedures in their offices as part of their practice. Whatley commended his optometrist for the care that he receives.

“Auburn has grown since then and now there are a couple of ophthalmologists practicing here,” Whatley said.

There are many communities across this state that don’t have access to ophthalmologists.

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Sen. Cam Ward, R-Alabaster, asked if there were any amendments to this bill, and a couple have been proposed.

Sen. Jim McClendon, R-Springville, is the chairman of the Senate Health Committee and an optometrist.

McClendon said, “Optometry made a couple of suggestions, but medical would not meet in the middle.”

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Ward said, “The amendments addressed a lot of the issues that I had.”

Sen. Linda Coleman-Madison, D-Birmingham, asked, “How much training do optometrists have doing surgery?”

McClendon replied, “None of the procedures covered in the bill covers anesthesia. All of the procedures would be allowed in the office or in the clinic.”

To respond to questioning from Coleman-Madison, McClendon asked someone who is more current on optometry to address the committee’s concerns.

Dr. Josh Driver is the President of the Alabama Optometrist Association and practices in Opp.

“Our original bill had a list of excluded surgeries and procedures that we believe should be in a doctor’s office that are performed in a hospital setting,” Driver said. In the proposed amendments, “We excluded Lasix and injection to treat diabetic retinopathy.”

Driver said that procedures that would be allowed would be things like cleaning the lens off after cataract surgery and laser surgery to control pressure on the eye or any type of bumps on the lid that can easily be removed.

“These are very simple procedures that can be done in the office,” Driver said.” These are procedures that optometrists in other states perform regularly as part of their practice.”

Sen. Dan Roberts R-Mountain Brook, asked, “Is there anybody that could address this from the ophthalmology perspective?”

McClendon said, “We had a public hearing on this last week.”

Roberts said, “I would like to hear from the other side.”

Sen. Larry Stutts, R-Sheffield said, “We already had a public hearing, and we should hear from the other side.”

An ophthalmologist from Birmingham said that these are still surgical procedures, none of their optometrist colleagues have the training to perform any of them, and that is why they did not meet in the middle.

“Nothing surgical is a minor procedure,” he said.

Whatley asked that SB114 be carried over until next week, because he has to attend a public hearing in the Senate Agriculture and Forestry Committee where he is the chairman.

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National

Lawmaker files bill to ban treatments for transgender kids

Jessa Reid Bolling

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Republican Wes Allen, R-Troy, filed a bill to prevent doctors from providing hormone replacement therapy or puberty suppressing drugs to people younger than 19 who identify as transgender.

HB303, the Alabama Vulnerable Child Compassion and Protection Act,  would make it a Class C felony, punishable by up to 10 years in prison, for doctors to prescribe puberty-blocking medications or opposite gender hormones to minors. Allen’s legislation would also ban hysterectomy, mastectomy or castration surgeries from being performed on minors.

“I was shocked when I found out doctors in Alabama were prescribing these types of drugs to children,” Allen said in a news release. “This is something you hear about happening in California or New York but it is happening right here in Alabama and it’s time we put a stop to that practice.”

Allen said that children experiencing gender dysphoria are struggling with a psychological disorder and that they need therapeutic treatment from mental health professionals instead of medical intervention that would leave their bodies “permanently mutilated.” 

“These children are suffering from a psychological disorder, just as someone who is suffering with bipolar disorder or schizophrenia but we treat those patients and try to help them. We should treat these psychological disorders as well.”

In 2018, a policy statement from the American Academy of Pediatrics (AAP) said that:

  • “Transgender identities and diverse gender expressions do not constitute a mental disorder; 
  • Variations in gender identity and expression are normal aspects of human diversity, and binary definitions of gender do not always reflect emerging gender identities; 
  • Gender identity evolves as an interplay of biology, development, socialization, and culture; and
  • If a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child”

The World Health Organization (WHO) announced in 2018 that it was removing “gender identity disorder” from its global manual of diagnoses and reclassify “gender identity disorder” as “gender incongruence,” which is now listed under the sexual health chapter rather than the mental disorders chapter. 

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In a 2018 interview, Dr. Lale Say, a reproductive health expert at the WHO, said that gender incongruence was removed from the list of mental health disorders because “we had a better understanding that this was not actually a mental health condition and leaving it there was causing stigma. So in order to reduce the stigma, while also ensuring access to necessary health interventions, this was placed in a different chapter.”

In 2012, the American Psychiatric Association revised the Diagnostic and Statistical Manual of Mental Disorders (DSM) to remove the term “gender identity disorder” from the manual and add the term “gender dysphoria.”

Allen’s bill will be considered by the Alabama House of Representatives in the coming weeks.

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Elections

Doug Jones raises $2.4 million in first fundraising period of 2020

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U.S. Sen. Doug Jones, D-Alabama, raised $2.4 million in the first fundraising period of 2020, according to his reelection campaign, which was $500,000 more than he raised during the fourth quarter of 2019. 

Jones has $7.4 million cash at hand, according to his campaign, which released the totals on Thursday. Jones’s latest campaign finance reports weren’t yet posted to the Federal Election Commission website on Thursday. 

“Alabamians across the state are showing their commitment to Doug’s message of One Alabama and his proven track record of standing up for all Alabamians,” said Doug Turner, Senior Advisor for Jones’s campaign, in a statement Thursday. Doug’s work to support working families, fund our HBCUs, modernize our military and expand and protect our health care is resonating with folks throughout Alabama. We are well-positioned to continue to grow our grassroots support and win in November.” 

Jones ended 2019 leading all of his Republican contenders in fundraising, ending the year with $5 million in cash.

 

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Courts

Alabama Democratic Party lawsuit was back in court on Thursday

Josh Moon

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The dispute goes on forever and the lawsuit never ends. 

A Montgomery County Circuit Court judge on Thursday delayed a decision on whether he has the standing to settle an internal dispute within the Alabama Democratic Party but indicated that he’s leaning towards ruling that he does. 

Judge Greg Griffin said he would rule soon on the matter, but made no promise that the decision would come before Alabama’s primary elections on March 3. 

Thursday’s hearing was the latest in the seemingly endless fight over control of the ADP and was the next step in a lawsuit brought by former ADP chairwoman Nancy Worley. Worley and her supporters, which have proven to be a decided minority of the State Democratic Executive Committee, filed the lawsuit late last year after the Democratic National Committee invalidated her re-election as chair and forced the party to change its bylaws and hold new elections. 

Those new elections resulted in Rep. Chris England being elected as party chairman and former Rep. Patricia Todd being elected vice-chair. The new party leadership has the backing of the national party, which pulled funding from ADP because Worley and others refused to rewrite the state party’s bylaws to be more inclusive. 

Worley filed her initial lawsuit prior to the elections in which she was booted out of her position, and Griffin, who was widely criticized for his handling of the case, granted a temporary restraining order that prevented the Reform Caucus of the ADP from meeting. That decision by Griffin was immediately overturned by the Alabama Supreme Court, in a rare, late-Friday evening emergency ruling. 

However, the ALSC did not rule on whether Griffin had standing to settle a dispute within the state party. The court left that question up to Griffin, which was why Thursday’s hearing was held. 

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The entire thing seems to be an exercise in futility at this point. 

The ADP has moved on, with England certifying candidates and DNC officials clearly recognizing him as the rightful party chair. The DNC has no desire to work with Worley, who was stripped of her credentials for failing to follow directives and bylaws of the party. 

Even if Griffin creates a reason to invalidate England’s election, it doesn’t seem to matter much. The DNC has validated it, and it accepted the ADP’s new bylaws and changes to leadership structure. 

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If Worley were to prevail in court, it’s unclear exactly what she would win.

 

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House

House passes landfill bill allowing alternative materials as temporary cover

Brandon Moseley

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The Alabama House of Representatives passed a bill Thursday to change the statutory definition so that temporary “cover” in landfills can be a material other than “earth.”

House Bill 140 is sponsored by State Rep. Alan Baker, R-Brewton.

The bill allows landfills to use alternative daily covers in place of earth to cover landfills until the next business day. “The EPA has allowed this since 1979,” Baker said. It would save landfills the cost of using earth for daily cover.

“This does not change anything in the operating rules for landfills,” Baker said.

A number of members from both parties expressed concerns about this bill on Tuesday, so the bill was carried over until Thursday.

Speaker of the House Mac McCutcheon told reporters, “Sometimes in a debate you can see that the debate is not a filibuster or anti-debate; but rather is an honest effort by members to understand a bill.”

“There was a lot of misinformation out there,” McCutcheon said. The Environmental Services Agency and ADEM were brought in to explain the members and address their concerns.

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McCutcheon said that human biosolids is a separate issue and that Rep. Tommy Hanes has introduced legislation dealing with that issue.

Alternative daily cover is often described as cover material other than earthen material placed on the surface of the active face of a municipal solid waste landfill at the end of each operating day. It is utilized to control vectors, fires, odors, blowing litter, and scavenging. Federal and various state regulations require landfill operators to use such earthen material unless other materials are allowed as alternatives (Mitchell Williams writing on Oct 31 in JDSUPRA).

Soil cover can use valuable air space. Further, it can generate the need to excavate and haul soil to the facility. Alternative daily covers are often advocated to be a more efficient and cost-effective means of cover (Williams).

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Baker said that it would be up to ADEM (the Alabama Department of Environmental Management) in the permit whether to allow a proposed alternative cover or not.

Baker said, “This bill does not change any of the materials used as cover.” “This would keep us from having to use that good earth in landfills when other materials are available. If it becomes a nuisance ADEM can revoke a cover on the permit. Daily cover has to be approved at the discretion of ADEM.”

Baker said that only materials not constituted as a risk to health or are not a hazard can be used.

An environmental attorney shared the list of ADEM alternative covers with the Alabama Political Reporter. The list includes: auto fluff, excavated waste, synthetic tarps, coal ash, petroleum contaminated soil, automotive shredder residue, shredder fluff, wiring insulation, contaminated soils, paper mill (including wood debris, ash shaker grit, clarifier sludge, dregs, lime), 50 percent on-site soil and 50 percent tire chips, spray-on polymer-based materials, reusable geosynthetic cover, automobile shredder fluff, tarps, foundry sand, clay emulsion known as USA Cover Top clay emulsion, non-hazardous contaminated soil, non-hazardous solid waste clarifier sludge, steckle dust all generated from Nucor Steel Tuscaloosa Inc., non-coal ash from Kimberly Clark operations, lagoon sludge from Armstrong World Industries operations, meltshop refractory material from Outokumpu Stainless USA operations, paper mill waste (non-coal ash, slaker grits, dregs, and lime), biodegradable synthetic film, fly ash, residue from wood chipper or paper, slurry with a fire retardant and tactifierl, Posi Shell Cover System, waste Cover, foundry waste, 50 percent soil and 50 percent automobile shredder fluff, incinerator ash, green waste to soil. Sure Clay Emulsion Coating, alternative cover materials (manufactured), compost produced by IREP Montgomery-MRF, LLC, 50 percent saw dust mixed with 50 percent soil, and waste soils considered to be special waste.

McCutcheon said that members did not understand that these were just temporary covers. That was explained to them.

Alabama landfills have used alternative covers for years; but three people sued saying that this was not allowed under Alabama law and that ADEM had exceeded its mandate by permitting alternate covers. On October 11, 2019 the Alabama Court of Civil Appeals found in favor of the plaintiffs.

HB140, if passed, would address this oversight in the Alabama legal code so that ADEM and the landfills can legally continue to use alternate covers and not have the added expense of quarrying dirt for daily cover.

A Senate version of the same bill received a favorable report last week from the Fiscal Responsibility and Economic Development Committee.

HB140 now goes to the Alabama Senate.

 

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