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I would like to quote from some of the bulletins issued by one of these companies:

Hail the champ. It's Cleveland No. 1060.

This fine operation repeated its stellar performance of 1958, and 1959 found them ranking No. 1 again.

Our congratulations to this fine optical department ***

I salute you.

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Then I quote further:

How does your optical ranking compare to your store ranking? Do poorer stores have a better optical ranking than you?

We are in the process of discussing this report with the various optical concessionaires with a view of planning a program for each of the stores to help achieve the sales potential that admittedly exists in your particular area. You will hear of this program as it concerns your store in due time. In the meantime, if you have any suggestions that have as their purpose the increasing of the optical sales and profits in your store, kindly let me have them.

The optical business is big business in our store, and if your store does not already include an optical department, you are foregoing the numerous advantages of this fine business.

Our Retail Shopping Service visited New York's Lord & Taylor as a result of the attached advertisement which ran in the New York Tribune on January 4. The shopper indicated that the items offered were plastic framed sunglasses with optically ground lenses. The decor of these same frames included floral glitter, jewels, and novelty design.

These same frames were available in a variety of colors and styles. The price range was from $5 to $11. All of the advertised styles were displayed on a counter stand with other styles as offered by the same source. The source of this merchandise was A. A. Sutain of 29 West 37th Street, New York City.

The reason that this information is being passed on to you is that our shopper reports an exceptionally strong customer response to this ad and to the merchandise offered.

You are undoubtedly making your summer promotional and merchandise plans at this time and it is strongly recommended that you not overlook this type of merchandise.

And I quote further:

During these past months I have been commenting on the good performance of several of our stores; however, there are many other stores whose sales performance show the need for improvement. Let's pick them up.

And I quote further:

The month of September was a good sales month. It saw the attainment of an alltime sales high which accounted for an increase of 25.5 percent over September of last year.

A fine job, and all of you concessionnaires are deserving of a word of commendation.

That is the end of the quotations.

I ask you, gentlemen: Is it possible for a patient in need of vision care to receive the professional care and attention he needs in this type of crass, commercial, sales-oriented atmosphere?

When an interested third party-an individual or a corporationinterposes himself between the doctor and his patient-the professional man is not free to place the welfare of the patient above all else. If the optometrist's income depends on the volume of patients he sees in the day and on the number of lenses and frames which he "sells," the professional vision care of the patient must certainly suffer.

I know of one individual who practices optometry under about 20 different names in 9 different States and 200 offices. In fact, he has multiple optical outlets in the same city which compete with each other, each aiming their advertising campaign at different levels of the vision market.

With respect to section 10(a) of the proposed bill, I would like to point out that the codes of ethics of medicine, dentistry, and optometry declare that advertising to the public is unethical. The practitioner can offer only his reputation, skill, training, ability, experience, and the trust and confidence of his patients. These are not matters to be offered via the usual means of advertising.

The argument is sometimes raised that the optometrist dispenses to his patient an article of personal property such as eyeglasses and it is claimed that, therefore, advertising should be permitted. A simple analogy refutes this argument. When the orthopedist furnishes his patient with the neck collar or the brace to support a limb or a back, these, too, are articles of personal property; but they may not ethically be advertised. When the dentist supplies his patient with dentures, bridgework or similar dental appliances, he, too, is furnishing articles of personal property; but these likewise do not fall in the category of being ethically advertised. Likewise, in optometry. Eyeglasses are not optometry per se; they are incidents of the practice of optometry, the results which may be indicated. The practice of optometry is primarily and basically the exercise of training, talent, discretion, and professional judgment involved in the examination of a person's eyes to determine whether anything is needed, and just what it shall be, for the purpose of correcting, improving, and making comfortable the vision of the patient.

When a package price is offered in advertisements, profit-oriented companies must turn over a high volume of patients and therefore, are unable to give the professional, detailed personal attention which the patients require. There is a very definite danger in shortcut quickie eye examinations, especially those for contact lenses.

The poor, the uneducated, and the elderly are ready prey for these unethical charlatans who lure them with advertisements and seem to have no compunction to taking advantage of their gullibility to make a quick profit. Advertisements by these purveyors of vision goods are often misleading and serve as "bait" for those who feel they must look for a bargain. Too often it turns out to be a very costly bargain. Unfortunately, it is the poor, the uneducated, and the elderly who are most likely to choose someone to help them with their vision problems on the basis of advertising, low price, or the personality of some salesman.

It is imperative that only well trained, properly licensed professional vision specialists be called upon to help these people overcome their vision problems.

Each patient and, indeed, each eye of each patient, is unique unto itself, presenting problems which require the total time, training, skill, and energy of a professionally trained, licensed, and experienced optometrist or physician. The responsibility for such a delicate and complex procedure cannot be delegated to nonprofessionals who have, at best, only a superficial knowledge of the physiological, psychological, and anatomical principles involved.

To protect the public against unscrupulous persons, the proposed licensing law is urgently needed and essential to make certain that those prescribing eye care meet qualifications of training competence and character.

Contact lenses are a special problem.

It has long been the position of AOA that unlicensed, untrained laymen should not be permitted to fit contact lenses and instruct patients in their use, handling, and hygiene. It is imperative that only licensed optometrists or physicians prescribe and fit them. All persons cannot wear contact lenses and it takes a well-trained, competent vision specialist to know who should and should not wear them. Furthermore, in order to properly design a pair of contact lenses so that they will be visually correct, physiologically sound, psychologically acceptable, and physically useful, the professional person responsible must spend a great deal of time with the patient. Fitting a person for contact lenses is a complex, tedious process, requiring from 5 to 20 visits and return visits thereafter at least once a year.

The examination for contact lenses involves much more than that for spectacles. A number of different instruments must be used because contact lenses must be fitted to minute, exacting tolerances. As I have pointed out, no two eyes are alike. Not only do eyes differ from person to person, but it is exceptionally rare when a person's own two eyes are alike. The differences may be measurable only in thousand parts of an inch. Consequently, contact lenses must be made individually for each eye according to carefully worked out details of a complex prescription. Aside from the question of competence, a person who depends for his livelihood on the sale of merchandise is unlikely to have the time or inclination to give the patient the time and attention which is required to adequately instruct and supervise the contact lens patient.

Contact lenses should be prescribed and fitted only by a licensed optometrist. No part of this practice should be delegated to the untrained and unlicensed so-called contact lens fitter. In all States and the District of Columbia, only optometrists and physicians are licensed to prescribe contact lenses. In actual practice, however, unlicensed, untrained, and unsupervised laymen are fitting contact lenses for a tremendous number of patients. This currently prevalent health hazard would be corrected by H.R. 12937.

Applicants for examination for optometry license must have at least 2 years of a preoptometry training and 4 years in a school of optometry. They must have received complete training both didactic and practical, in physiological optics, geometric optics, ocular anatomy and pathology, general anatomy, diagnosis of ocular pathology, vision training, refraction, subnormal vision practice, contact lenses, ocular histopathology, physiology, psychology, general human anatomy, et cetera. Before being licensed they are required to pass rigid State board examinations covering all of the above subjects and must demonstrate their proficiency in refraction, vision training, visual field studies, subnormal vision, contact lens practice, and diagnosis of ocular pathology. Laymen who have not received this extensive type of training and backgrounds are simply not qualified to fit contact lenses.

An interesting point to illustrate this is that malpractice liability insurance rates for opticians-that is, laymen-are 50 percent higher than for optometrists, according to insurance specialists. I would like to quote from an article which was by Arthur Schwartz, a contact-lens insurance specialist, entitled "Some Observations About Contact Lens Fitting by Technicians." Mr. Schwartz said:

There is an interesting relationship between the rates charged optometrists and those charged opticians for malpractice liability insurance. The optometrist bears

a heavy professional responsibility—for which he is thoroughly trained, examined, and State-licensed-without supervision, or the need thereof. The optician, in theory, exercises no judgment. In theory, the optician has no function except to complete the work begun by the physician and to do so under the physician's personal supervision. Despite this great disparity in duties and, in consequence, exposure to acts or omissions which could lead to malpractice suits, the base rate charged optometrists is $10 per year. The base rate charged opticians who maintain one-man establishments grossing under $75,000 per year is $15-50 percent higher. That is, the National Bureau of Casualty & Surety Companies, which makes rates for most insurers, has found that its members' claim experience with opticians, despite the reduced exposure described, is much greater than among optometrists. This would indicate a higher frequency and severity of claims, claim reserves, and claim payments among opticians.

Mr. Chairman, I am most appreciative of this opportunity to appear before this subcommittee to point out some of the evils which H.R. 12937 is designed to correct. We earnestly request your approval of this vitally needed legislation.

At this point, and with the permission of the Chair, I would like to introduce the president of the Optometric Society of the District of Columbia, Dr. Henry J. Hoff.

(The complete statement of V. Eugene McCrary, O.D., follows:) STATEMENT OF V. EUGENE MCCRARY, O.D., PRESIDENT, AMERICAN OPTOMETRIC ASSOCIATION

Mr. Chairman and members of the subcommittee, my name is V. Eugene McCrary. I am an optometrist engaged in private practice in College Park, Md. I am a past president of the Maryland Optometric Association, and 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.

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 opthalmologist.

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 dispensed 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 tool. We, unfortunately, have no comparable device. The optometric 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 regulating those on the fringe who will not voluntarily subscribe to an ethical standard of conduct and parctice.

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 how 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 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 an 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 establishment. 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 advertisements claiming "low prices," "easy credit," "fast and accurate service," etc. Dr. Hoff, president of the D.C. 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.

I think it will be enlightening for members of the committee if I insert into the record copies of some sales-stimulating bulletins which one of these optical chains disseminated to its outlets. I'd like to quote from some of the bulletins issued by one of these companies:

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