STAND. COM. REP. NO. 817-00

                                 Honolulu, Hawaii
                                                   , 2000

                                 RE: H.B. No. 1934
                                     H.D. 2




Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 2000
State of Hawaii

Sir:

     Your Committee on Consumer Protection and Commerce, to which
was referred H.B. No. 1934, H.D. 1, entitled: 

     "A BILL FOR AN ACT RELATING TO OPTOMETRY,"

begs leave to report as follows:

     The purpose of this bill is to remove duplicative regulation
that delays the inclusion of the most current Federal Drug
Administration approved medications in the formulary of
medications that optometrists are allowed to prescribe to their
patients.  This bill amends the process by which the formulary
applicable to optometrists is recommended and adopted.  Under
existing law, the Formulary Advisory Committee (Committee)
recommends the formulary, and the recommended formulary must be
adopted by the Board of Examiners in Optometry (Board).  This
bill gives the Committee an advisory role, and gives the Board
the authority to adopt or reject the formulary.

     Testimony in support of this measure was received from the
Board, the Hawaii Optometric Association, numerous optometrists,
and a student of optometry.  Testimony in opposition was
submitted by the Hawaii Ophthalmological Society, Hawaii Medical
Association, and numerous doctors who are practicing
ophthalmologists.

     Your Committee has assembled, primarily from supporting
testimony, the following background to this measure.  Educational
training for optometrists in the treatment and management of eye
diseases first began in the 1960s.  By 1986, all schools and

 
 
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colleges of optometry nationwide included a standardized
educational curriculum on therapeutic drug training.  Today all
50 states including the District of Columbia have enacted laws
granting optometrists therapeutic privileges.  Presently, 37
states allow optometrists the right to prescribe oral medications
for the treatment of various eye conditions, and 44 states allow
optometrists to treat glaucoma.

     In 1996, Hawaii enacted Act 292, Session Laws of Hawaii
1996, which took effect on July 1, 1999.  Act 292 gives
optometrists who fulfill the requirements for therapeutic
certification under the Act, the authority to prescribe topical
therapeutic pharmaceutical agents (TPAs).  Oral agents and
injectable medications are excluded from the scope of
prescriptive authority.  Act 292 established the Committee and
provided for its membership of two optometrists, two pharmacists,
and two ophthalmologists.  Under the Act, the Committee
recommends the TPA formulary, and the Board must adopt the
recommended formulary.

     Your Committee heard testimony that the procedure for
adopting the formulary is duplicative, creates significant delays
in making even minor changes to the formulary, and prevents
optometrists from providing the best and most current therapies
available.  Testifiers also stated that although formulary
committees were enacted in seven other states, in every instance
the state had repealed the committee or made it purely advisory
to the state's board of optometry.

     Objections to this measure included the concern that the law
giving optometrists prescriptive authority has only recently
become effective, and that there has not been enough time for
optometrists to demonstrate competence in their newly authorized
practice.  Other testifiers stated that the Committee was
established to protect consumers through the inclusion of
ophthalmologists and pharmacists in Committee oversight of the
newly established prescriptive privileges of optometrists.
Testifiers stated that making the Committee advisory would remove
this protection.

     Upon consideration of the testimony submitted, your
Committee finds that this bill raises important consumer
protection issues that deserve further discussion.  To ensure
that examination of these issues continues, your Committee has
amended this measure by replacing its effective date with a
blank.

     As affirmed by the record of votes of the members of your
Committee on Consumer Protection and Commerce that is attached to

 
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this report, your Committee is in accord with the intent and
purpose of H.B. No. 1934, H.D. 1, as amended herein, and
recommends that it pass Third Reading in the form attached hereto
as H.B. No. 1934, H.D. 2.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Consumer
                                   Protection and Commerce,



                                   ______________________________
                                   RON MENOR, Chair