obtained; (c) prohibits designation that one is an optometrist if he is not licensed under the act; (d) prohibits an individual from practicing during any time his license is suspended or revoked.

(4) Prohibits the sale of eyeglasses, frames, etc., without a written prescription from a physician or optometrist licensed under the act.

(5) Prohibits price advertising of ophthalmic materials.

This is to outlaw "bait" advertising for the protection of the public and was sustained by the U.S. Supreme Court in the Oklahoma case referred to above. (6) Prohibits offering free eye examinations, premiums, discounts, credit, or other inducements to obtain patronage.

(7) Prohibits rebating by persons filling prescriptions to the individual who wrote the prescription.

(8) Prohibits any person other than an optometrist to utilize the services of an optometrist on a salary, commission, lease, or any other basis in the practice of optometry.

This protection for the public outlaws corporate practice, which for more than 20 years has been barred in the great majority of jurisdictions. The District of Columbia is one of the few jurisdictions where it exists.

(9) Prohibits the use of any sign offering ophthalmic materials for sale in violation of the act or the Commissioners' regulations issued under the act.

(10) Requires an optometrist to display his license and his current annual renewal registration certificate where he practices.

Section 8(b). Declares a violation of any of the provisions of this section to be a misdemeanor, provides punishment for the first offense by a fine of not more than $500; on second conviction a fine of not less than $500 or more than $1,000 or by imprisonment for not less than 3 months or more than a year, or by both such fine and imprisonment.

Section 9(a)-Exemptions.-Provides for exemptions from this act as follows: (1) A student of optometry in a school approved by the Commissioners. Although there presently is no optometry school or college within the District of Columbia, it is possible that one could be commenced in the future. During the last 2 years of the 4 years of required professional study, the student optometrist is obliged to perform refractions and do other optometric work in the clinic attached to the school. This subsection exempts the student-optometrist from the provisions of the act.

(2) Commissioned officers in performance of military duties.

The authority of the Defense Department takes precedence over the District Commissioners with all personnel performing functions which require a license. (3) Exempts an individual licensed in another jurisdiction who is in the District of Columbia for the purpose of making a clinical demonstration before an optometric society, convention, association, or school or college of optometry. This exemption enables students and practicing optometrists in the jurisdiction to benefit from recognized authorities in the field without requiring those authorities to secure a District of Columbia license.

Section 9(b).-Relieves physicians from obtaining a license to practice optometry if they are licensed to practice medicine in the District of Columbia.

Section 9(c). This exemption enables opticians to fill the written prescriptions of physicians or optometrists, excluding the fitting of contact lenses.

It conforms to the existing practice; and the fitting of contact lenses by opticians is, in an opinion of the District of Columbia Corporation Counsel, in violation of the present law.

Section 9(d).-(1) This exemption permits nonprofit optometric clinics approved by the Commissioners to be conducted in the District of Columbia.

Such a clinic exists at the present time. It serves the District of Columbia by providing vision care for indigent and needy patients.

(2) Permits optometrists to be employed by hospitals, clinics, group health practices, nonprofit health services, and health expense indemnity corporations or groups, and also to act as an employee to render optometric services solely to the employees of the employer.

This conforms to present practice and to the rules in practically all other jurisdictions.

(3) Permits a surviving spouse of a deceased optometrist to continue his practice for not more than 1 year through the services of a duly-licensed optometrist.

The practice of a licensed professional practioner is built up after a lifetime of service. If he dies or is incapacited and the practice cannot continue for a reasonable period of time, not only will the practice be destroyed, but the interests

of his patients will be seriously affected. The patient desires and seeks continuity of professional care. The purpose of this section is to afford a reasonable time so that continuity can be established and the best interests of the visual care of the patient served.

(4) This section permits a wife or husband of an optometrist who is temporarily mentally incapacitated to continue the practice through the services of another optometrist.

Where the incapacity is temporary, the husband or wife should be permitted to employ a licensed optometrist to continue the practice for a temporary period. (5) Where an optometrist is permanently mentally incapacitated the husband or wife is given the same right to continue the practice as though the spouse were

deceased.

The purpose is to protect a valuable asset of the incapacitated individual. Section 9(e).-Authorizes the use of the title “Doctor" or any abbreviation thereof by an optometrist if he clearly indicates to the public that he is an optometrist.

In all States, license to practice optometry requires graduation from a school or college of optometry. All such schools in the United States are recognized by the National Commission on Accrediting and give the O.D. (Doctor of Optometry) degree.

Section 10(a).—Authorizes the Commissioners to adopt rules and regulations on such subjects as signs, professional cards and announcements not in violation of the specific provisions of the act.

Section 10(b)-(1) The Commissioners are authorized after public hearing to fix fees and charges to defray the approximate cost of administering the act.

(2) Funds collected are to be paid into the Treasury of the United States to the credit of the District of Columbia.

Section 10(c).-Authorizes the Commissioners to adopt a seal and provides that documents authenticated by the seal shall be received in evidence in all courts of the District of Columbia equally and with like effect as the original record. Also provides that the records pertaining to the licensing and regulation of optometrists shall be open to reasonable inspection.

Section 11-Investigations.—Authorizes the Commissioners to make studies, investigations, require answers under oath, and issue subpenas in connection with the enforcement of the act. The court of general sessions, upon application of the Commissioners, may enter an order requiring obedience to the subpena, which if ignored may be punished by contempt.

Section 12-Injunctions.-Authorizes the Commissioners to obtain a restraining order to prohibit violations or threatened violations of the act.

Section 13(a)-Prosecution.—Directs that prosecutions for violations shall be conducted in the name of the District of Columbia in the District of Columbia court of general sessions by the Corporation Counsel or his assistants.

Section 13(b).-Provides that proof of a single act prohibited by law, without proving a general course of conduct, shall constitute a single violation.

Section 13(c)-Certification.—Directs that the testimony of a licensed optometrists shall be received at any trial or hearing in the courts of the District of Columbia as qualified expert evidence and testimony in respect to the practice of optometry. Also that certificates of ocular or visual condition, acuity, and efficiency issued by any duly-licensed optometrist should be accepted as qualified evidence of ocular condition, acuity, and condition to whom such certificate shall relate.

Section 14-Freedom of choice.-Provides freedom of choice of practitioner. Prohibits officers or employees of the District from administering any law applicable to the District from depriving any person of his freedom of choice of practitioner with respect to his visual problems.

Section 15-Delegation.-(1) Provides the Commissioners with the necessary authority to delegate to the Board of Optometry, established by Reorganization Order 59, or to any other officer or employee of the District, all or any part of the powers, duties, or functions invested in them by this act.

This conforms to the present law.

(2) Continues in effect valid licenses issued when the amendment becomes effective.

This is a necessary and common practice in an amendment of this character. (3) Adds a paragraph to subsection (a) of section 11 (742 of the District of Columbia Code, as amended) by adding a new paragraph to read as follows:

"(11) final decisions and orders of the Commissioners of the District of Columbia denying, suspending, or revoking any license, denying any renewal of a

license or reinstatement of a license, pursuant to the District of Columbia Optometry Act."

The effect of this is to make such actions by the Commissioners reviewable in the courts.

(4) Provides that the act shall take effect on the 90th day after its enactment. A reasonable time should be allowed in which those who are now engaged in activities contrary to the new law will have an opportunity to conform to it.

Mr. DOWDY. Is there any other Member here sponsoring these other bills? If not, we will proceed with the witness list. have Dr. McCrary, president of the American Optometric Association. Come around, Doctor, and have a seat. If you have others with you, you might bring them around at the same time and introduce them. I don't know if you all come as a group.

STATEMENT OF V. EUGENE MCCRARY, O.D., PRESIDENT AMERICAN OPTOMETRIC ASSOCIATION

Dr. MCCRARY. Mr. Chairman, the Optometric Society of the District of Columbia and the American Optometric Association are the principal proponents of the bill which is now before you, and I do have with me today Dr. Henry J. Hoff, president of the Optometric Society of the District of Columbia; Dr. Meredith W. Morgan, Jr., who is the dean of the School of Optometry at the University of California; and Mr. Harold Kohn, Esq., general counsel of the American Optometric Association, and with your permission I would like to have them join me.

Mr. DOWDY. Yes, sir, all of you have a seat there.

Dr. MCCRARY. We would like to file for the record a statement and make a brief oral statement.

Mr. DowDY. That will be satisfactory. Your statements will be made a part of the record. You may be seated and just brief it for us. Dr. MCCRARY. Mr. Chairman, we realize the tremendous demands of time placed on this committee, and we, therefore, plan to present our testimony in four parts which will be both complementary and supplementary to each other.

In the interests of time and because we believe the complete four parts will answer many of the questions which will doubtless be raised in the minds of the members of the subcommittee, we would like to present our four parts as a unit. With your permission, sir, I will proceed with the first statement.

My name is V. Eugene McCrary. I am an optometrist engaged in the private practice of optometry at 6901 Baltimore Avenue, College Park, Md. I am a past president of the Maryland Optometric Association, and have served two terms as a member of the Maryland Board of Examiners in Optometry. I am here today as president of the American Optometric Association, an organization with more than 14,000 members.

The American Optometric Association is supporting H.R. 12937 because the public, the citizens of the District of Columbia, are today subjected to hazardous and slipshod eye care, and our paramount concern is the protection of the public from unethical and harmful practices. Specific examples of these unethical practices will be detailed in subsequent testimony by myself and my colleagues.

We are also here today because the District of Columbia Optometric Society has requested our assistance.

There are flagrant abuses of the public trust prevalent in the District of Columbia and the present law is woefully inadequate to cope with them. The District of Columbia Optometry Act was enacted in 1924 42 years ago-and, in spite of the tremendous changes which have been made in the vision care field, the law has not been changed since that time. The 1924 District of Columbia optometry law is as inadequate and out of date as a model T Ford on the Capital Beltway. In regard to sections 2 and 3 of the bill, it may be desirable to define some terms which are often confused.

An "optometrist" is a doctor of optometry-O.D.-who is specifically educated, trained, and licensed to examine the eyes, and related structures, to determine the presence of vision problems, eye diseases, or other abnormalities. He may prescribe lenses, visual training, specialized services, or other optical aids to preserve, restore, and enhance the comfort and efficiency of vision.

An "ophthalmologist" is a medical doctor-M.D.—who specializes in diagnosis and treatment of defects and diseases of the eye, performing surgery when necessary.

An "optician" is a craftsman who serves an apprenticeship of several years in grinding lenses to prescription specifications and assembling lenses in frames. Some opticians, who are called dispensing opticians, fill the prescription and complete the work of the ophthalmologist.

The practice of optometry, along with other professions, is subject to regulation for the protection of the public against ignorance, incapacity, deception, and fraud. When Congress and State legislatures undertook to regulate the practice of optometry, they recognized that the public interest is definitely involved in the treatment of the human eye and this public interest far outweighs the inconvenience caused to an optometrist in complying with the regulations.

As is true with other professions, members of the American Optometric Association abide by a code of ethics and professional standards of our association. Each new licensee in optometry is provided the "Manual of Professional Practice for the American Optometrist.” The members of the American Optometric Association subscribe to these rules of practice, among which are the following:

(B) No member shall practice in or on premises where any materials other than those necessary to render his professional services are dispesned to the public. (J) No member shall use other than his professional card on or in any publication or in any public display; said card shall not exceed two (2) columns by two (2) inches, and it shall not contain any more than his name, profession, address, telephone number, office hours, eye examinations by appointment, practice limited to *** (any one optometric specialty). Educational material may be published only when it has been specifically approved by the executive committee of the respective State association.

(K) No member shall use boldface type or in any other manner attempt to attract special attention to himself in any telephone or other public directory.

(L) No member shall display any merchandise, ophthalmic material, or advertising of any kind in windows or in any room of his office for the purpose of inducing patronage.

Some may say that our code of professional practice should provide sufficient regulation of optometrists. However, the offending optometrists are invariably outside the AOA's membership. In addition, we do not have the authority to enforce these tenets. Medical doctors, on the other hand, are able to withhold hospital privileges from members who violate their code of ethics, a very effective enforcement

The opto

tool. We, unfortunately, have no comparable device. metric profession, in general, accepts its awesome responsibility to the public in establishing and adhering to the highest standards possible, but we need and urgently request your help in regulaging those on the fringe who will not voluntarily subscribe to an ethical standard of conduct and practice.

It is fundamental that the sole and exclusive responsibility of a professional practitioner is to his patient. To be employed by a lay person, firm, or corporation, to be dictated to either directly or indirectly, implicitly or explicitly, as to how long an examination should take or now much care and attention the practitioner should give to the patient, is completely contrary to the concept of proper practice. Neither the optometrist nor any other professional health care practitioner should be subject to the conflicting interests of two responsibilities-to his patient on the one hand and on the other hand to a nonprofessional employer whose primary concern is with making a profit.

With respect to section 8(2). A corporation is incapable of rendering this type of personal professional service because, by its very nature, it is profit oriented. Because of the highly personal nature of services rendered and the unique individual needs of each patient, adequate vision care is a highly complex service which is in direct conflict with production-line methods. The advice of efficiency experts and the shortcuts resulting from time-motion studies do not lend themselves to an environment where professional services are rendered according to individual needs and where each patient must have as much time as is required to adequately care for his particular vision problems.

Oklahoma has a provision in its optometry law similar to that in the proposed law for the District of Columbia and, when this section went before the U.S. Supreme Court on this question in the Williamson v. Lee Optical Case (348 U.S. 483), the court said in part:

It seems to us that this regulation is on the same constitutional footing as the denial to corporations of the right to practice dentistry. It is an attempt to free the profession to as great extent as possible, from all taints of commercialism. It certainly might be easy for an optometrist with space in a retail store to be merely a front for the retail business. In any case, the opportunity for the nexus may be too great for safety, if the eye doctor is allowed inside the retail store.

There are many unethical practices in the eye field which grow out of the evils of corporate practice. In this mercantile atmosphere of corporate practice, the level of vision care is lowered to the level of the marketplace. This attitude may be all right when buying furniture or other merchandise, but it certainly is not appropriate for those seeking professional services to protect something as priceless as their eyes. The commercial eye-care operation is noted for its big splash advertisments claiming "low prices," "easy credit," "fast and accurate service." and so forth. Dr. Hoff, president of the District of Columbia Society of Optometrists, will have more to say about that a little later.

Several of our prominent chainstore merchandise establishments have what they call "optical departments" and employ a physician or optometrist to examine the eyes of their customers. These chain optical groups have numerous outlets in the major urban centers of some of the States and these outlets are rated on the volume of business they transact.