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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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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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Economy

Daniels: We have to get help to those who need it most

Josh Moon

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There is not enough help coming fast enough to the people struggling the most. 

That was the message from Alabama House Minority Leader Anthony Daniels, who was asked on the “Alabama Politics This Week” podcast about the efforts of Alabama’s state government to address the COVID-19 pandemic. 

“If you’ve never been poor, you don’t fully comprehend how things like this affect the poor and the unique problems the poor people face,” Daniels said. “I commend Gov. (Kay) Ivey and her staff for working to try and address this crisis the best they can, but I just think there’s a lack of understanding among all of us in some cases of how people need help.” 

To address those issues, at least in part, Daniels is writing a series of letters to different entities, including Ivey, to explain how they can best help the state’s most vulnerable. 

Daniels plans to ask the Alabama Supreme Court to order lower courts to halt foreclosure proceedings and evictions for those affected by coronavirus job losses and illnesses. He also will ask Ivey to intervene with banks on behalf of customers who are falling hopelessly behind on mortgage, car loans and other installment loans. And he will seek additional assistance from the state for borrowers with overwhelming student loan debt. 

“I want people to understand that I’m not criticizing what’s being done or trying to take control, I just hear from these folks on a daily basis and believe there are some better ways to help people,” Daniels said. “President Trump has addressed student loan debt by knocking the interest of those loans, but what does that really do for a person who just lost a job? Or someone who’s had hours and pay cut? We need to pause those payments and give people substantial forgiveness. 

“Otherwise, it’s going to be ugly.”

Democrats in the House also have been putting together potential legislation that could be passed to help the state’s poorest citizens and those who have been laid off from jobs. The specifics of those pieces of legislation weren’t available, but Daniels said they would have the same focus — providing real help for those who need it most. 

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If those bills are anything like the measures taken during the last economic downturn, you can expect a relaxing of rules on social programs, such as the Supplemental Nutrition Assistance Program and unemployment assistance programs. 

One of the first moves could be overturning a measure passed during the last legislative session that cut the number of weeks of unemployment pay in the state from 26 to 14. State Sen. Arthur Orr sponsored that legislation, and critics argued at the time that a downturn, such as the one that occurred in 2008, could suddenly leave thousands in the state without jobs and job prospects. It passed anyway.

 

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House

Alabama House cancels March 25 committee meetings due to coronavirus

Jessa Reid Bolling

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The Alabama House of Representatives announced on Monday that committee meetings scheduled for Wednesday, March 25 will be cancelled due to the coronavirus (COVID-19) outbreak.

The legislative day on March 26 has not technically been cancelled but the House is not expected to have a quorum for that day.

A “quorum” is the minimum number of House members that must be present at any meeting to make the proceedings of that meeting valid. If there are not enough members present, then the meeting cannot proceed and House rules state that the speaker of the House is allowed to set a new date for the meeting. 

The Legislature is currently on an annual spring break. The House and Senate are both expected to reconvene on March 31. According to the statement from the House, a joint decision will be made regarding the future legislative meeting days.

The full statement reads:

“The leadership of the Alabama House of Representatives has made several changes to the upcoming meeting calendar because of the coronavirus crisis in the state.

House committees that were scheduled to meet on Wednesday, March 25, 2020 have been cancelled.

The House is scheduled to meet on Thursday, March 26, 2020 at 9:30 a.m. but no quorum is expected that day.

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Under House Rule 5(b), if there’s no quorum to conduct business during a state of emergency declared by the governor, the speaker of the House is allowed to set the date and time of the next meeting day. 

Both the House and Senate will reconvene on Tuesday, March 31, 2020 and at that time a joint decision will be made as to future legislative meeting days.”

 

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