requirements could be brought about without either this bill or some similar piece of legislation? Dr. DRYDEN. The present law, sir, could be amended any time. It was amended as late as 1951 to include the fitting of contact lenses. It could be amended tomorrow without any law at all. Mr. SISK. That is, of course, what we are proposing to do here. Mr. SISK. As I say, that is what we are proposing to do. We are proposing to amend the existing law and update it. Dr. DRYDEN. What I am trying to say is the Commissioners already have the authority to do this. Mr. SISK. I beg to differ with you on that. Dr. DRYDEN. Well, we shall let the lawyers bat that one out. I cannot answer you on that. Mr. SISK. What we are attempting to do is assert the authority of Congress in this field and, as you know, that is our responsibility in this field. I want to comment just briefly, because we have to leave in a few minutes. You mentioned several things with reference to automobile licenses, the matter of a doctor's technician in the hospital, quite a number of things that I simply want to say that I would disagree with you on, that you say would be precluded. Well, under our own law in California, I am thoroughly familiar with the way these things are handled. We have had testimony from the State of New York, and there is no interference of this type and kind there. Here again, I do not believe that this bill would interfere, but, if it should, then, again, as I said, we certainly will make changes. We have already, I repeat, drafted language with reference to the repair of a broken frame or something of this kind, because primarily the intent of the legislation is for the benefit of the public, not for the benefit of the ophthalmologist, not for the benefit of the District of Columbia Medical Association, and not for the benefit of the present licensed optometrists in the District, but for the better visual care of the people in the District of Columbia. This is the one single objective of this particular piece of legislation. Mr. Chairman, I must leave now. I thank you, Dr. Dryden. Mr. WHITENER. Mr. Harsha? Mr. HARSHA. Doctor, you made a statement about section 14 of the bill. Would you repeat what you said about section 14? Mr. Sisk was asking you about a specific portion of the bill that you felt was detrimental to the Dr. DRYDEN. There were two portions that I wanted to answer that question-I did not get the opportunity to answer the other one. I did answer on section 14. Mr. HARSHA. What was your interpretation of section 14? Dr. DRYDEN. I interpret section 14 as meaning that an employee of the District government cannot distinguish between an optometrist and a physician. Any employee of the District government-that includes a health officer, public health nurses, schoolteachers, and everyone else, cannot distinguish between an optometrist and a physician in referring eye patients for eye care. Exactly that. There is no other way to interpret it. As a matter of fact, this has crept into some State laws, and State employees have been prosecuted for distinguishing between the two. Mr. HARSHA. That is a little different statement than you made to Mr. Sisk about that section. I do not recall, myself, what you said, but I was surprised at the interpretation you gave to section 14. I do not know whether we have the same section or not. Dr. DRYDEN. That is the interpretation. I hope I gave that same interpretation to Mr. Sisk. No officer or employee of the District of Columbia shall, in the administration of any law applicable to the District of Columbia, deprive any person of his freedom of choice of practitioners with respect to his visual problems. Dr. DRYDEN. That is exactly what I am talking about. Mr. HARSHA. What does that have to do with making a suggestion that you might go to Dr. so-and-so? Dr. DRYDEN. It has everything to do with it. Mr. HARSHA. That does not deprive him of any freedom of choice. Dr. DRYDEN. It deprives the health officer and the school nurse of freedom of choice. Mr. HARSHA. You surely do not believe that interpretation? Dr. DRYDEN. I most certainly do. People have been prosecuted for it under this. Mr. HARSHA. You mean merely to suggest that he might see Dr. Smith or Dr. Jones, then they are depriving somebody of his freedom of choice? Dr. DRYDEN. That is exactly it. It sounds ridiculous, but it is true. Mr. HARSHA. It certainly does. Is the rest of your testimony so interpreted, along similar lines, as this section? Dr. DRYDEN. Yes, sir; they define optometry as including all of these things on the first page of the bill. No place do they exclude anybody except the physician alone. That means that every technician who works for a physician will be practicing optometry under the provisions of this bill. That means that every nurse in every hospital in this city who takes a person's visual acuity, will be practicing optometry under this bill, and there is no other way to interpret it, because they are not excluded. Mr. HARSHA. I am not arguing with you about somebody giving a clinical test of some kind, but I certainly think you have a strained interpretation of that section 14. I am not debating the proposition, whether you have somebody actually examining the individual; that may be true to a degree, but Dr. DRYDEN. I have talked this over with health officers and attorneys both, sir, and they concur in that opinion. Mr. HARSHA. Do they have any case history for such an interpretation? Dr. DRYDEN. Sir? Mr. HARSHA. Do they have any case history for such an interpretation of section 14 or similar sections of any kind? Dr. DRYDEN. Let us let the legal counsel discuss that with you. Mr. HARSHA. You have one there with you. Could he answer that? Mr. MAGEE. There are decisions but I cannot give you them this morning. This is the practice as it was followed in the State of North Carolina. This is the very point. This section was incorporated in a law which was applied in North Carolina in the optometric field and in this field the State authorities could not refer a medically indigent, a person who had a medical problem in the eye, to a physician. If forbids it because it deprives, in effect, the freedom of choice of the patient to go to an optometrist if the health officer says, See a doctor. This is the way the law is construed. Mr. HARSHA. Was this so interpreted by a court of law? Mr. MAGEE. I am sure it has been. We shall find this and submit it to you. I shall look it up for you gentlemen, go into this for you. We are giving you the physical results of it. What is it in there for? What would it do in your opinion, Mr. Harsha? Mr. HARSHA. Well, I would interpret the instruction to deprive somebody would be a little stronger language, a little stronger act rather than recommending that you go to Dr. Smith or Dr. Jones to see about your eyes. Mr. MAGEE. Why does an optometric act need a section 14? Why should not a health officer be authorized, without any prohibitions or privilege or preference, or taking something from an optometrist, to send a case to a doctor of medicine? Why should it be in such an act? Mr. HARSHA. I do not know why he should be deprived of such a thing. Mr. MAGEE. He is by this provision, sir, as we interpret it. You may differ with us as lawyers, but that is our opinion. Mr. HARSHA. I shall yield to Mr. Grider. I cannot see that interpretation. Mr. GRIDER. I want to ask counsel a question. As I understood this, it was an amendment to the Social Security Act, which permitted the optometrists to certify the blind in North Carolina. Mr. MAGEE. That is correct. Mr. GRIDER. This had nothing to do with the local law of North Carolina? Mr. MAGEE. No, but it works this way, sir. They receive funds and they have grants and the administration of these funds and grants to persons who are put on a total disability list because they are blind is done on the opinion of an optometrist, and because of this provision, they cannot refer it to a doctor to see if it can be corrected. Mr. GRIDER. Do you see anything in the present bill which will have the same effect? Mr. MAGEE. Section 14 has this same effect. Why not eliminate it? What is its purpose? Mr. GRIDER. Is that the only provision which does it? Mr. MAGEE. Oh, no, I have other objections to this bill, sir. Mr. GRIDER. No; I mean which has the effect of forcing the requirement or encouraging persons to seek an optometrist when they should go to an ophthalmologist? Mr. MAGEE. We are referring to the bill as drawn, are we, Mr. Congressman? Mr. GRIDER. Yes. Mr. MAGEE. This bill is designed, sir, to forbid the corporate practice of optometry by anybody; it is designed to put the optician out of business; it is designed to prevent a nurse in a doctor's office, anyone except a person licensed to practice optometry, under this act, to do it, and the bill so states. Mr. Grider. That may all be true, but now, will you answer my question? Is there anything in this bill which would require or encourage any Government agency or any private citizen to send a person to an optometrist rather than to an ophthalmologist? Mr. MAGEE. Section 14 forbids it. Mr. GRIDER. You have answered that. Mr. MAGEE. Yes, sir. Mr. GRIDER. Is there anything else in the bill? Mr. MAGEE. No; I would not say there is anything else in the bill which would require, except for the one provision, sir, that it can only be done by an optometrist, because the act restricts it to an optometrist. Go to the act. Let us use the language: It is further declared to be a matter of public interest and concern that the practice of optometry be limited to qualified persons Then you define what the practice of optometry is: admitted to the practice of optometry in the District of Columbia under the provisions of this act. That would bar a doctor from doing it if you did not except them from the act. Mr. GRIDER. That would make the practice of optometry of perhaps a little higher quality, but it will not require anybody to send a patient to an optometrist instead of an ophthalmologist, except section 14. Mr. MAGEE. When you get into the uplifting of quality, may I answer that? Mr. GRIDER. I have not asked that, and I do not care to get into that. Mr. WHITENER. Mr. Roudebush? Mr. ROUDEBUSH. I do not want to haggle with you, sir. You are reading things into this section 14 that I certainly cannot see. I shall have to agree with the gentleman from Ohio, Mr. Harsha. I cannot see how-section 14 says that no officer or employee of the District of Columbia shall, in the administration of any law applicable to the District of Columbia, deprive any person of his freedom of choice of practitioner. That could be medical, M.D., ophthmologist, optician, and so forth, with respect to physical problems. Where do you see "optometrist"? Mr. MAGEE. I interpret it simply as this, that if a health officer refers an optical case to a doctor of medicine, it is depriving the patient of his freedom to go to an optometrist. That is what it means. Mr. WHITENER. That is particularly true in the case of welfare patients, where they get an order designating them to go to a certain practitioner, is it not? As I understand it, under the welfare program, even under social security, the patients have appointments set up for them where they are claiming a certain disability to work, and the agency says, "You report to Dr. Jones at the Professional Building on Monday morning, October 8, at 10 o'clock," and the patient has no choice unless he appeals to the Board and says, "I do not like this doctor. What about sending me to another doctor?" I suppose in that way, it would be depriving him of freedom of choice, and it seems to me the language, the word "practitioner" goes further and means that, as you say, it not only applies to the optometrist but applies to M.D.'s, and if they send him to an optometrist and he wants an ophthalmologist, then he could claim that he had been deprived of the privilege of going to an ophthalmologist and, therefore, this section 14 would have the effect that these gentlemen say. Mr. ROUDEBUSH. I can agree with that, Mr. Chairman. But how-the point I cannot get in my head is how the employee of the District of Columbia, and this says "officer or employee of the District of Columbia" would know to whom to refer such a man? Should he go to the M.D.? Has he a visual defect that should be treated by a doctor? Or does he have a simple refractive error? In this case, would you have to refer every case to an M.D. and would you demand that everybody who wants to buy a pair of glasses would that the M.D. would have to examine him? Mr. WHITENER. I did not mean to get into an argument with you. But I have an eye problem, and I called over to the Capitol physician and said, "I do not know whom to go to here in Washington. What do you recommend?” They called downtown and arranged an appointment for me with a very fine ophthalmologist. I do not know whether they had a hundred on their list or one or two. Mr. HARSHA. That surely does not deprive you of your freedom of choice. Mr. WHITENER. No; but if I am a welfare patient, it may be different. If I went down to the Welfare Department and said, “I cannot work because I cannot see the difference between a green suit and a blue suit" and this becomes an issue as to whether I am eligible for welfare. Then the Welfare Department, I imagine, has authority now to say, "You go to Dr. Jones who will report back to us." Mr. ROUDEBUSH. Who makes determination of the proper area of practice? How could you fellows be satisfied without every single man and woman with a visual defect coming to an M.D.? How would you satisfy your complaints if every single person did not go to an M.D.? Dr. DRYDEN. We are satisfied with the situation as it is, and they are not all going to M.D.'s. As a matter of fact, we hold no brief with M.D.'s practicing optometry. You get back to section 14, and I would like to make one point clear. The Health Officer of the District of Columbia is an M.D. Mr. ROUDEBUSH. This does not say Health Officer. Dr. DRYDEN. It says "employee" and he is an employee. Mr. ROUDEBUSH. But there are Capitol policemen and all other kinds of employees Dr. DRYDEN. These are persons who recognize that a person needs medical care and they are prohibited under this law from telling people, "You must get medical care." If it is a matter of glasses, the medical officer has no objection whether it is an optometrist or Mr. ROUDEBUSH. You say that said employee is capable of telling this man, even though he is just an employee of the District of Columbia, maybe just a typist |