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Dr. DRYDEN. No, sir, I did not say that. I said nurses and physicians. In our school programs, we have nurses and physicians who are qualified people, who are qualified to determine what is a medical eye problem and what is an optometric eye problem. If it is an optometric eye problem, we have no objection where they send them. But we maintain their hands should not be tied by this section 14 enforcement to give the patient his choice when the patient does not have an idea.
Mr. ROUDEBUSH. Would you tell me where, in section 14, it appears, school nurses
Dr. DRYDEN. School nurses and health officers are employees of the District of Columbia government.
Mr. ROUDEBUSH. They are employees of the District of Columbia. But it does not say that in section 14. It says no officer or employee of the District of Columbia shall. Where does it say health officer and nurse?
Dr. DRYDEN. But the health officer, sir, is an employee.
Mr. ROUDEBUSH. So is a man who picks up paper out here on the curb.
Dr. DRYDEN. We are talking about the doctor who takes care of health. The man who picks up paper on the street is not going to be able to tell a person where to go.
Mr. ROUDEBUSH. This includes every employee of the District of Columbia.
Dr. DRYDEN. How could a man picking up paper on the street be qualified to tell a patient where to go? Mr. ROUDEBUSH.
But the bill as proposed does not say that. Mr. WHITENER. Did you want to say something, Mr. Grider? Mr. GRIDER. Yes.
Doctor, let me say I am sure we are all in accord that what we want is the best possible eye care for people who live in the District and for people who visit here. You do not have any objection, I take it, to a bill that would stop the practice of optometry by department stores and people of that type? You do not look upon that as good for the public, do you?
Dr. DRYDEN. Sir, that is a problem that the medical profession has never taken issue with.
Mr. GRIDER. You do not want to take a position on that?
Dr. DRYDEN. You mean on the selling of glasses in department stores?
Mr. GRIDER. Yes, sir.
Dr. DRYDEN. We are not taking issue with it. We think that is a legal problem for the optometric board and the legal profession to decide.
Mr. GRIDER. Regarding it generally as a practice, do you think it is good or bad?
Dr. DRYDEN. If you want my honest opinion about it, sir, I can tell you this: We see patients who come from the department stores, who come from the fourth floor optometrist's offices, we see them come from physicians practicing here in the District. I must say in all sincerity we see as many referred cases of eye diseases from the department stores as from the other places. We make no distinction.
Mr. GRIDER. I take it your answer is that you do not think it makes much difference whether they sell them
Dr. DRYDEN. I think it is the training of the individual himself. Whether he works in a department store or in another place, he is an optometrist. If he practices optometry as he does usually and should, it makes no difference what kind of a place he practices in, whether it be a department store or any other place.
Mr. GRIDER. Now, I find it difficult to reconcile what looked to me like ambivalent attitudes in your testimony. First, you seem to be saying that optometrists are not, by the nature of their training, qualified to diagnose illnesses of the eye.
Dr. DRYDEN. That is correct, sir.
Mr. GRIDER. I do not disagree with you on that. I think that is correct.
However, in the next breath, you say that if this bill is passed, it will prohibit teachers, members of the PTC, and medical students from screening people.
Dr. DRYDEN. That is correct, sir.
Mr. GRIDER. Do you believe that they are better qualified to diagnose diseases of the eye than optometrists?
Dr. DRYDEN. Why, they are working under the supervision of a physician. Medical students, of course, are in training under a physician. They are not working as independent producers. Technicians, medical students, nurses are working under the supervision of a physician.
Mr. GRIDER. Surely there is not a physician present in every classroom?
Dr. DRYDEN. They do not have to be present, sir.
Mr. GRIDER. What happens to the report after the teacher tests the eyes?
Dr. DRYDEN. It becomes part of the patient's record and the information thereon is used for the benefit of the patient.
Mr. GRIDER. Is it then reviewed by an M.D.?
Mr. GRIDER. I take it, speaking candidly, that you do not seem to believe that if an optometrist found a patient with a disease of the eye, he would be inclined to refer him to an M.D. Does that trouble you?
Dr. DRYDEN. I have to accept the basis of this document here in answering your question, sir. And this is proof enough. It was promulgated by a well-established board set up by a State agency. I think it speaks for itself in answering your question.
Mr. GRIDER. Do you mean the North Carolina data?
Dr. DRYDEN. Yes, sir, and I must say our experience here does not differ from it a great deal
Mr. GRIDER. Do you find anything in our present act which is similar to that in the social security requirement?
Dr. DRYDEN. Yes.
Dr. DRYDEN. I hate to embarrass you, by referring back to section 14. It certainly does. It equates optometry and ophthalmology.
Mr. GRIDER. "If we could amend section 14, then that objection would be removed?
Dr. DRYDEN. Amend it? It should be eliminated. There is no need for it.
Mr. GRIDER. Thank you.
Mr. WHITENER. Mr. Brovhill?
Mr. BROYHILL. Mr. Chairman, the sponsor of this legislation has agreed that if there is any misinterpretation of the thrust of section 14 he would agree to amend it for clarification. Certainly, we have built up a record here as to what was the intent, or what the feeling of intent was, on the part of some of the members of the committee and what the witnesses feared was the intent. I think we can clarify that, if not in the language, certainly in the report on the legislation, so that there will be no fear in that regard.
Doctor, back to this question of the nurses and the technicians, and the teachers participating in the examination of eyes, would you elaborate on just what it is that a nurse or a technician in a physician's office does in the examination of the eyes that this bill would prevent?
Dr. DRYDEN. Many of us use our nurses to check our patients' vision as they come in. They read the chart and put on the record how much the patient can see. Some of us use our nurses for taking visual fields; a purely mechanical art.
In the Washington Hospital Center—I am on the staff over there and I can speak better from their point of view than any other hospital's, we have about 30,000 patients a year that come through our clinic over there. Every one of those patients, the nurses chart their visual acuity the minute they enter the building. That is part of their record.
The physicians working over there could not possibly do all of these tasks. We have our glaucoma clinic over there, we also have the retinal attachment clinic, we have the orthoptic clinic. We have technicians who prescribe in this field of optometry. They are not excluded under this act, and if this act becomes law without amendment, even though they are working in our hospitals for the physicians, or the Department, they still are not going to be able to do this.
Mr. BROYHILL. I wonder if your attorney would point out what language in the bill would prevent, let us say, your nurse from having one of your patients read a chart?
Mr. MAGEE. Turn to page 3 of the bill, Congressman, which has on it, under section 3, beginning on the bottom of page 2, "or the fitting or adaptation of contact lenses to the human eye; and the identification of any departure from the normal condition or function of the human eye, including its associated structures.")
. Now, the nurses and technicians and the aids to the doctors are certainly doing just that. This bill says this can only be done by an optometrist admitted to practice in the District of Columbia under this act.
Mr. BROYHILL. That is when the ophthalmologist asks the nurse to have a patient read a chart and she reports to him her findings. This language prevents that type of service?
Mr. MAGEE. Yes, sir; it precisely does, because that is exactly what she is doing, looking for abnormalities in the eye and its related, associated structures. That is what all the visual tests that are being done to ascertain, whether or not there are deficiencies in vision or whether you have a medical problem which is causing the deficiency in vision.
Now, I am told, and you gentlemen can check this, that where you have difficulty in vision, usually behind this is a biological problem of
some sort which is in the field of medicine. I know the psychiatrists take this position. I am their general counsel.
So you see anything abnormal in the conduct of a human person's body and mind, there is a biological reason for it.
Now, what the optometrist does, he can supply glasses to correct a vision problem which the patient has, but he does not know what causes it, whether it can be eliminated by operative procedures, whether the vision can be improved by use of medicine.
Mr. BROYHILL. I agree with the gentleman on that. Again, my question was directed as to whether that language that you refer to did prohibit the nurse from just taking a reading of the eye chart.
Would the suggested amendment that you offer for page 13 at the bottom, on line 21, pretty well clarify that without necessarily striking out the language that you recommend on page 3, where the bill, as now written, says:
This Act shall not be deemed to require a physician or surgeon licensed under the laws of the District of Columbia for the practice of medicine or surgery, to have a license under this Act to perform those services defined by this Act as the practice of optometry.
Then you made the change, or recommended the change, that this act shall not provide a bar to a physician or a surgeon licensed under the laws of the District of Columbia for the practice of medicine and surgery, nor to nurses and technicians acting under their direction, by striking the lines out which appear. Would that clarify that doubt in your mind?
Mr. MAGEE. That would clarify it, yes, sir. But may I make this observation, that optometry has been defined by Congress before in this jurisdiction, in the original 1924 act. Now, that has been construed by our court of appeals and what this act is attempting to do, gentlemen, is to take what is called a skilled mechanical art in the visual field and turn it into a learned profession. The purpose of the act would be then to apply learned principles to this mechanical art, and the act so forbids.
For example, it forbids a corporation from hiring for profit an optometrist.
Now, if an optometrist is not a member of the learned professions and he is merely an artisan, as our court of appeals and our district courts have twice ruled, he cannot be forbidden to work for a corporation like any other person.
This is the problem.
Mr. BROYHILL. I have heard individually from some of the ophthalmologists in my district, and I get a little difference of opinion as to what the objections are to this legislation. I believe that most of those who have communicated with me indicate that they have the fear that Dr. Dryden has expressed here this morning, but indicated that if this could be clarified so that it was not preventing proper referral, was not prohibiting the nurses and technicians under the doctor's supervision from doing the tasks that they now perform, and not creating public confusion and public inconvenience, as the requirement for a prescription in order to get a temple brace, or arm, or whatever it might be—temple bar—that if these things could be clarified in the legislation, they would not object to it.
Now, I know that you have practically rewritten the bill by your proposed amendments here, but in substance, now, if these things
could be done, and we have spent a little time here arguing this morning as to what the meanings of words were—if we could clarify that in about two or three areas that have taken up most of our time in discussion, you are not objecting to legislation that might upgrade the practice of optometry and regulate it a little more effectively?
Mr. MAGEE. No, sir. we have never objected to that.
Our position is that the Commissioners can do this. They have done it before at the behest of the American Optometric Association. You have given the Commissioners the authority to do it.
I have a thing in the pamphlet submitted to you which I would hope the committee would read. The Commissioners can do every one of them.
Mr. WHITENER. The committee must recess its hearings because we must go to the House. Can you gentlemen come back tomorrow morning?
Mr. MAGEE. Yes, sir; I shall be back.
Mr. WHITENER. We are going to have to recess but before we do if there are any here who would like to file statements, we would be glad for it to be done at this time and make it a part of the record.
How about you, Dr. Cowan, can you come back tomorrow?
Dr. Cowan. I shall try. I will file a statement in the event that I do not get back, if I may, Mr. Chairman.
Mr. WHITENER. All right, Doctor.
COLLEGE OF MEDICINE,
Washington, D.C., March 21, 1966. Re: H.R. 12937. HOUSE COMMITTEE ON THE DISTRICT OF COLUMBIA, Washington, D.C.
GENTLEMEN: This bill has many fine features and the zeal of the optometrists to police their act is to be commended. However, this endeavor has led to the seeking through legislation a status which is possible only through education. As one engaged in the training of ophthalmologists I am concerned when it is proposed to grant the same rights and privilgees to any group with less training. I feel the health and welfare of the public is at stake. For your information, to become an ophthalmologist quires a college degree, 4 years in medical school, 1 year rotating internship, and a 3-year residency in ophthalomology. The student must then spend at least another year in some phase of ophthalmology before he is eligible to take an examination in order to be certified by the American Board of Ophthalmology. For the foregoing reason I specifically object to line 9, section 2, which declares optometry to be a profession and not a mechanical art. I also specifically object to paragraph 2 under section 3 which would permit the employment of any objective or subjective examination of the human eye. The terms“objective" and "subjective examination” is so broad it encompasses practically every type of eye examination. It would not only on the one hand, permit an optometrist to extend himself beyond his training but on the other hand prevent such a simple procedure as a nurse taking vision or an ophthalmic technician taking fields or measurements of the eye pressure under the supervision of an ophthalmologist. This means that nurses will be prevented from performing such a simple task as visual screening in our schools, clinics, and offices. result of these visual screening tests thousands of children enjoy better vision.
Many of us employ ophthalmic technicians who do visual acuity, visual field and tonometric tests. Since 1957, Howard University College of Medicine has employed a glaucoma technician. Every patient over 35, entering the hospital is screened for glaucoma and if suspicious is referred to the glaucoma clinic. We also employ a glaucoma technician to perform similar duties in a research study to determine if there is a correlation between glaucoma and diabetes. To conduct such a study in which it is necessary to examine a large number of patients, an ophthalmic technician is vital. This bill will jeopardize this and similar studies.