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Senate Health Committee bill advances despite clash between ophthalmologists, optometrists

Brandon Moseley

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The Alabama Senate Health Committee last week narrowly voted to give a favorable report to a bill that would allow Alabama optometrists to expand their scope of practice to include seven procedures that are currently performed exclusively by ophthalmologists.

Senate Bill 66 is sponsored by State Senator Tom Whatley (R-Auburn).

Whatley said that he has eye issues and has been treated by both ophthalmologists and optometrists over the years. This bill would improve access to care for people in rural Alabama.

Ophthalmologists are doctors who have been to medical school and have chosen to specialize in eyes. Optometrists are doctors who have to optometry school to study treating conditions of the eye.

The Chairman of the Senate Health Committee is Senator Jim McClendon, R-Springville. McClendon is an optometrist and is a cosponsor of the legislation.

The bill would expand the scope of practice of optometrists to perform: injections, excluding injections into the posterior chamber of the eye to treat any macular or retinal disease; incision and removal of a chalazion; removal and biopsy of skin lesions involving the lid and adnexa; laser capsulotomy; laser trabeculoplasty; laser peripheral iridotomy; and corneal crosslinking.

Ophthalmologists like Dr. Chris Girkin Chair of the Department of Ophthalmology at the University of Alabama oppose the bill.

Optometrists support expanding their scope of practice to include these procedures, which currently are only performed by the ophthalmologists. The ophthalmologists and the Alabama Medical Association oppose expanding the scope of practice of the optometrists. These medical doctors say their objection are relayed to patient safety not a turf war between professions.

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A similar bill was defeated in the legislature last year. That bill, also sponsored by Sen. Whatley, would have expanded the scope of practice for the optometrists to make those seven procedures. That bill also would have allowed optometrists to perform LASIK surgeries and make injections into the posterior chamber of the eye to treat conditions, such as diabetic retinopathy and macular degeneration. LASIK “laser-assisted in situ keratomileusis” is the most commonly performed laser eye surgery to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.

Chairman McClendon said that the optometrists have dropped the LASIK surgeries and the injections into the posterior chamber of the eye. McClendon said that the optometrists have offered to compromise and the ophthalmologists have refused to accept any expansion of the current scope of practice for optometrists.

Whatley said that SB66 would expand healthcare options for Alabamians particularly rural Alabamians. There are ophthalmologists in just 24 Alabama counties while 57 counties are served by optometrists.

Dr. Brendan Wyatt said, “I am a board-certified ophthalmologist and Vice president of the Association of Ophthalmologists. I practice in Dallas County.”

Dr. Wyatt said that SB66 would be, “Giving non-surgeons the ability to perform surgery on our poorest most vulnerable citizens.”

Wyatt disputed that there was an “Access to care problem. That is not true.”

Wyatt said that the optometrists said that the information provided by the optometrists, “Shows Autauga County as not having an ophthalmologist. I pay $2000 a month for a satellite office there.”

Wyatt said that another ophthalmologist has a satellite office in Marengo County. “You guys have been fed false information. We did our own research using Medicare billing data. Over 91 percent of our population is within a 30 minute drive to an ophthalmologist and 98 percent are within an hour drive to an ophthalmologist.

Wyatt took, “Issue with this being safe and no harm will be done. These lasers cause controlled explosions in your eyeball.” “I implore you to do the right thing and kill this bill.”

McClendon said that optometrists are being trained how to do all of these procedures in optometrist school and that Alaska, Kentucky, Arkansas, Louisiana, and Oklahoma all already allow optometrists to perform these procedures.

Senator Cam Ward, R-Alabaster, said, “I want to make sure that we don’t do something that ham string us going forward.”

Dr. Josh Driver is an optometrist and the immediate past president of the Alabama Optometric Association.

Dr. Driver said that passing SB66, “Would improve access to care for thousands of Alabamians.”

“This bill would address some of the open ended questions in the bill last year,” Driver said. “These are seven in office procedures that do not require anesthesia.” All of them are being taught in optometry school. UAB is graduating optometrists and they are leaving our state for states where they can better practice their profession. This is about improving access to optometry care for all of Alabamians not just those who live in a major city.

Dr. Chris Girkin is the Chair of the Department of Ophthalmology at the University of Alabama.

Girkin said that he is currently researching model of providing access to care for rural Alabama more effectively through other models including telehealth that can be done without increasing the scope of practice of optometrists.

Dr. Girkin warned that if this bill passes then every optometrist will add a laser to their practice and up to 20 percent of their patients could be negatively impacted.

Dr. Rob Pate, an optometrist, told the Alabama Political Reporter that medical doctors spend time learning to birth babies and do all of the things that they do before deciding what they want to specialize in. We spend all of our education studying the eye and conditions of the eye.

McClendon said that there are quite a few scope of practice bill that are ready to come forward soon. All of these bills were killed last year by the Alabama Medical Association who doesn’t want to compromise on anything.

The legislature limits the scope of practice of optometrists, nurse practitioners, pharmacists, chiropractors, nurse midwives, lay mid-wives , etc. Many of these professions want expanded scopes of practice.

Whatley made a motion to give a favorable report to the bill. There were several ayes. McClendon did not ask for nays and said the ayes have it. This meeting is adjourned.

Sen. Tim Melson, R-Florence, said that he wanted it on the record that he is opposed to this.

Sen. Larry Stutts, R-Sheffield, said that Robert’s rules of Order were violated in the vote.

SB66 now can be considered by the full Alabama Senate.

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Governor

Legislature returns to a much different Statehouse

Brandon Moseley

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The Alabama Legislature will return from their spring break vacation Tuesday, but nothing is the same as it was two weeks ago.

Monday, the press was informed that the corps will be removed from the press rooms behind the chambers. Those rooms are being given to the legislators so that they can sit the necessary six feet apart. The press will move to the gallery looking down on the House Chambers. That will be our space exclusively as the public and the lobbyists are barred. The additional space will allow members of the press to also stay a minimum of six feet apart to avoid transmission of the coronavirus.

The Alabama Political Reporter asked if we would still have access to the fifth-floor lobby where citizens and lobbyists regularly met with members of the legislature who stepped off of the House floor. APR was told that we would not have access to any part of the fifth floor except by appointment and that extended to the entire Statehouse building.

Legislators were told in a conference call that if they feel sick, are showing symptoms of anything that they should just stay away from today’s meeting which is not essential. Legislators will gavel in and set April 17 as their next meeting date.

The reason they have to gavel in is that if they do not the session would automatically end and the constitutionally mandated budgets for the 2021 fiscal year beginning on October 1 have not been passed yet.

State Rep. Tim Wadsworth, R-Arley, said that the legislator spoke with Gov. Kay Ivey and her team as well as legislative leaders.

Wadsworth said that they were told that conference calls are helpful and that members will receive a letter detailing the procedures to be followed by the members for the rest of this legislative year. There will be no visitors in the State House and all voting will be by voice so there will be no touching of voting machines.

The governor was to participate in a conference call with President Donald Trump and Vice President Mike Pence later that day.

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Ivey told them that Alabama will test for counterfeit supplies and watch for coronavirus scams and that the state will have an advance web site operating later this week. The state is, “Working with various Alabama companies to manufacture and produce various medical safety products.”

Wadsworth said that they were told that the state had had 831 confirmed cases of COVID-19 and 15 reported deaths, though not all had been confirmed by the Alabama Department of Public Health, by that morning and that there were over 2500 deaths already in the United States.

Wadsworth said that the subject of hospitals came up. Hospitals are looking at expanding their ICU (intensive care unit) areas to deal with the demand for intensive care beds by COVID-19 patients. Hospital rooms are freeing up due to the elimination of elective procedures.

Wadsworth said also that the Apple Company, through President Tim Cook, is delivered 100,000 N-95 masks and surgical masks, the schools will not reopen physically this year, and teachers, workers and aides will practice social distancing when they go back into the school buildings on April 6,

Wadsworth said that State Superintendent Eric Mackey told them that the focus will be on graduating and getting students ready for this year. The State Board of Education building is being cleaned.

Legislators were informed that the Alabama National Guard is ready for when they are needed.

Wadsworth said that they were told that teletherapy will be used for mental health patients except for extreme patients. A 24/7 mental health help telephone lines available and that mental health patients are only being discharged when teletherapy is available at home.

Wadsworth said that State Finance Director Kelly Butler assured them that, “All vendors are being paid.” In the first six months of the fiscal year revenue held up good; but that he anticipates a decline though in revenues for the last six months of the current fiscal year. Butler did not anticipate calling for proration due to the strong first six months of the year. $300 million is being moved from the stabilization fund to the education trust fund (ETF) to ensure stable budget.

The 2020 legislative session will end by May 18.

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Governor

State ramping up for COVID-19 fight

Brandon Moseley and Nicole Jones

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Alabama Gov. Kay Ivey, State Health Officer Scott Harris, Commerce Secretary Greg Canfield, Public Health Commissioner Lynn Beshear and Alabama National Guard Major General Sheryl Gordon briefed state legislators Monday about how the state intends to address the looming wave of COVID-19 cases as the virus spread across the state of Alabama virtually unchecked.

Ivey said that the U.S. Army Corps of Engineers has a team in the Montgomery area currently visiting the six major metro areas in our state studying existing facilities that can be used to provide additional hospital beds. The new hospitals would be in the greater Huntsville, Birmingham, Montgomery, Mobile, Tuscaloosa and Auburn areas.

U.S. Army Major General Diana Holland, who commands the South Atlantic Division of the U.S. Army Corps of Engineers, will be working with the Alabama Department of Public Health on this effort and will provide a report on their findings later this week.

It was explained that hotels provide the easiest conversion to hospitals as they already have bathrooms connected to each room and are built to handle large numbers of guests and staff.

Harris told the legislators that there were 831 cases of COVID-19 in Alabama as Monday morning, that number has risen now to nearly 1,000, and that there already have been 15 deaths reported, though the ADPH has publicly acknowledged 13 because not all have been officially investigated yet. The United States is up to 2,500 deaths nationwide.

Harris said that clinics are opening in Macon and Dallas counties on Monday, in Wilcox County Wednesday, and Houston on Thursday to provide more testing in the Wiregrass and Blackbelt. There are now 30 pop-up sites in these areas.

Harris said that hospitals are using available space to add additional ICU areas and that hospital unnecessary capacity has been diminished due to a recent health order prohibiting elective procedures.

Harris said that the ADPH has received its third and final shipment of personal protection equipment from our strategic national stockpile allocation. A certain amount of that is going to hotspot hospitals in crisis right now using the same formula based on the size and reported needs of the counties.

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Canfield said that his Department is working diligently to identify companies across Alabama that can manufacture PPE or who can quickly learn how to make the items we are most in need of. Canfield said that they have identified 30 companies so far.

Gordon said that the Alabama National Guard is assisting with logistics and warehousing of vital supplies. The Guard’s 12,000 soldiers and airmen are ready to serve. Gordon said that the Guard is abiding by CDC guidelines for the safety of the soldiers and airmen.

State Finance Director Kelly Butler said that his Department’s goal is to continue operations with social distancing and ensure that payments are made to health providers, Medicaid, and vendors that provide services.

Butler said that they implemented plans that allow them to do remote work with employees working at home continuing to process payments and transactions. “All vendors are being paid,” Butler said.

Butler warned that the revenues that are coming in for the 2020 budget will decline; but we have not seen a decline in the first six months of the fiscal year.

“We think that March receipts are based on February economic activity and expect to see sales and income tax decline in April’s numbers,” Butler said.

Butler said that because of the strong first six months, we do not expect to call for proration in the remainder of this fiscal year, which ends on Sept. 30.

Ivey included changes to normal purchasing rules so Alabama can acquire the PPE we need.

Beshear said that the community mental health centers are using telemedicine. Home visits are required only in extreme cases.

President Donald Trump has extended his social distancing order to 30 April, Ivey said.

“Remember the 6-foot rule,” she said.

The U.S. is confronted with an unparalleled health threat.

On Sunday, noted Trump coronavirus task force member Dr. Anthony Fauci told CNN’s Jake Tapper that a lot of Americans are going to die.

“I mean, looking at what we’re seeing now, I would say between 100,000 and 200,000,” Fauci said. “We’re going to have millions of cases.”

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House

Alabama Legislature plans to return to work briefly March 31

Eddie Burkhalter

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The Alabama Senate is planning to get to only a few big, constitutionally mandated items before calling an end to the year’s legislative session amid the COVID-19 pandemic, but whether they’ll get those tasks accomplished remains to be seen. 

Senate leadership is advising lawmakers who fall into “at-risk” categories because of their age or pre-existing medical conditions to not attend the Senate’s meeting when it resumes.

Among the items legislators tentatively plan to tackle before gaveling the session closed sometime in the future are the passage of the Education Trust Fund budget and the General Fund budget, which is the Legislature’s only constitutionally mandated duty.

And “other bills deemed necessary.” 

The state Senate’s Plan of Action, obtained by APR Friday, states that the Senate will meet at 2 p.m. on March 31 for its 14th legislative day. 

“The intent for this legislative day is to advance only essential attendance items and then to adjourn to a date certain for the 15th Legislative Day. April 28 has been discussed with the House,” the plan reads. 

The State Senate’s plan: 

“As leaders, it is imperative that we demonstrate that the business of this state carries on in an orderly and systematic fashion while adhering to the recommendations of our public health officials.

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The Alabama Senate will meet on Tuesday, March 31 at 2:00 pm at the Statehouse in the Senate Chamber as scheduled. This will be the 14th Legislative Day.

The intent for this legislative day is to advance only essential attendance items and then to adjourn to a date certain for the 15th Legislative Day. April 28 has been discussed with the House.

Below is a draft agenda for Tuesday, March 31.

  • Gavel In
  • Pledge and Prayer
  • Roll Call
  • Excuse all Senators
  • Points of Personal Privilege
  • President Pro Tem Marsh
  • Majority Leader Reed
  • Minority Leader Singleton
  • Adjourn to date certain for 15th Legislative Day.

“It is highly recommended that any Senator that falls into any of the at-risk categories stay away from the March 31 Legislative Day,” the plan advises. “However, each Senator’s personal wish will be accommodated.”

Any Senator or staff member that is ill, has been ill, or has been in the same room of anyone that has had any symptom of illness in the 72 hours preceding the March 31 Legislative Day must stay away from the March 31 Legislative Day, according to the Senate’s leadership.

A disinfecting station will be provided under the canopy of the second-floor rear entrance for each senator to disinfect hands and cell phones as they enter the State House and as they leave the Statehouse.

“We must ensure that we practice all Health Department recommendations while at the Statehouse,” the plan reads.

Social distancing will be accomplished by having senators report to their offices by 1:45 p.m. They will then walk into the chamber as the roll is called and then go back to their offices.

“As much separation as possible is required therefore greetings must be verbal only from a distance of 6 feet or greater,” the plan reads.

The remainder of the session will be held possibly Tuesday, April 28 through Monday, May 18.

This timeframe includes three weeks of the session plus the last day of May 18.

A specific plan for meeting more days than normal will be developed and provided prior to the next legislative meeting date.

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House

$200,000 in campaign finance penalties deposited into State General Fund

Staff

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Act 2015-495, which went into effect beginning with the 2018 Election Cycle, allows the Secretary of State’s Office to issue penalties to Political Action Committees (PACs) and Principal Campaign Committees (PCCs) that fail to timely file campaign finance reports.

As of today, the Office of the Secretary of State has collected $202,504.20 which has been deposited into the State General Fund to benefit the people of Alabama.

Conversations with the Senate and House General Fund Chairmen are currently underway to determine the best way to allocate these resources to counties.

Anyone who receives a campaign finance penalty is able to appeal their penalty to the Alabama Ethics Commission who has the authority to overturn a penalty.

“When I campaigned for this office in 2014, I made a promise to the people of Alabama that I would work to see that it is easy to vote and hard to cheat in this state. Since then, we have worked to make the electoral process more fair and transparent through requiring the honest reporting of all PACs and PCCs,” stated Secretary of State John H. Merrill.

Anyone who suspects an individual may be in violation of the Alabama Election Fairness Project is encouraged to report suspicious activity to StopVoterFraudNow.com.

 

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