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Mr. BABB. Mr. Chairman, I apologize for taking so much of the committee's time. I know you have been patient in hearing me, and that you have a lot of witnesses, but we feel that these are good examples, once you open the door, of the things that this act is trying to stop. This is the type of consideration that the public in the District will get from those who try to commercialize this profession.
I thank you and with that I will be glad to answer any questions by any member of the committee.
Mr. Dowdy. Thank you, Mr. Babb. We appreciate your coming and presenting this testimony in this case. I am sure it will be quite helpful to the committee in its deliberations when it gets to the bill.
Mr. BABB. Thank you, Mr. Chairman.
Mr. SISK. Mr. Chairman, I think we ought to commend Mr. Babb for a very excellent and very thorough statement here which I think brings out very ably some of the very things that we have had some experience with here in the District, particularly with this type of advertising which the witness mentioned, and I certainly want to commend him on making a very clear statement as to the problems involved and the basic objectives sought to be achieved here.
Mr. Dowdy. Thank you, Mr. Babb.
Mr. Dowdy. Dr. Dryden, Dr. Albert, and Mr. Magee, you were here yesterday, and we are sorry to interrupt, but these people were from out of the District and from afar, and we did want to relieve them and allow them to testify so that they may leave.
Mr. MaGEE. We will be willing to step down any time, Mr. Chairman, if any other witness is in the same position-any time.
Mr. Dowdy. I am informed that Dr. Dryden had completed his statement, and Dr. Albert had not, and I didn't know whether he had one or not.
Mr. MAGEE. Dr. Albert has a statement, and I have a statement also, Mr. Chairman, which I would like to give, just a brief one.
STATEMENT OF DAN G. ALBERT, M.D., PRESIDENT, SECTION ON
OPHTHALMOLOGY OF THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA
Dr. ALBERT. Mr. Chairman, members of the committee, ladies and gentlemen, I am Dan G. Albert. I have practiced ophthalmology in the Greater Washington area for the past 12 years. In 1938 I was graduated from the Ohio State University School of Optometry, receiving a B.S. degree. I practiced optometry in the State of New York for the next 4 years. During this time it became increasingly obvious to me that I was not satisfied with the limited training I had had to render eye care that I felt the public should receive. Following a 4-year tour of duty in the armed services, I entered Syracuse University College of Medicine and received an M.D. degree from that university in 1950. Following a year of internship, I took a 3-year residency program at the old Episcopal Eye, Ear, Nose, and Throat Hospital here in Washington, D.C., and started the private practice of pediatric ophthalmology with Frank D. Costenbader, here in Washington. In 1955 and 1956 I took the special examination in ophthalmology and am now board certified. It appears to me that I have, by extending my education, done through education what the bill under consideration is apparently trying to accomplish by legislation.
I am president of the Section on Ophthalmology of the District Medical Society. This is an organization of over 120 members. To be a member of this organization one must be a member of the medical society and must be certified by the American Board of Ophthalmology or be board eligible. Board eligible means that one have the
. educational requirements sufficient to take these examinations which at the present time requires graduation from medical school, a year of internship, 3 years of residency in ophthalmology, and a year of private practice. One is then entitled to take the written examination. If
. successful in the written examination he is invited to take the oral examination which is a very extensive 3-day oral examination covering all phases of ophthalmology.
The Section on Ophthalmology of the District Medical Society is opposed to H.R. 12937 because we feel that it is not in the public interest. We realize that the present Optometry Act leaves some things to be desired. However, we have been informed by legal counsel that these changes could be made by the existing authority vested in the District Commissioners. It is our understanding that the Commissioners, acting through the board of optometry set up under existing law, can change the educational requirements of optometrists and as the optometrists indicate they desire to raise these standards. We are of course in favor of this and of all efforts of optometrists to raise their standards in this particular field. But I wish to point out that the Commissioners, at the request of optometrists, have twice enacted regulations. The first of these was to increase the educational requirements of optometrists and this is covered by an order of the Board of Commissioners, dated September 26, 1930, which appears in the District of Columbia Code. The Commissioners also included the fitting of contact lenses as being covered by the provisions of the Optometry Act of 1951. However, if the Congress feels that a new optometric law should be written for the District of Columbia the Medical Society of the District of Columbia recommends that the following changes be made in H.R. 12937.
I will now discuss the changes which the medical society recommends and with which the section on ophthalmology fully agrees.
Before going over the bill with our suggestions I want to state that I have listened to the statement given here yesterday by Dr. Dryden and I fully support his statement.
Section 2, referring to the present bill, on pages 1 and 2 of the bill should be amended to definite optometry correctly. Optometry should be defined "a skilled mechanical art involving human vision, which it is. It is not a learned profession. The last sentence in section 1 should be amended by deleting therefrom the words "admitted to the practice of optometry in the District of Columbia under the provisions of this Act.” This should be done because as the act is now drawn up the practices covered by this bill can only be done by optometrists licensed under the provisions of this act. If not changed, this will eliminate the nurses and technicians working under a physician's supervision and other areas of concern which Dr. Dryden covered in his statement yesterday.
We further recommend that section 3 be amended and that optometry be defined as it is now defined in the District of Columbia Code. As presently defined by law, "the practice of optometry is defined to be the application of optical principles through technical methods and devices in the examinations of the human eye for the purpose of determining visual defects and the adaption of lenses or prisms for the aid and relief thereof.” We have left in the definition the provisions that deal with the prescribing of contact lenses or eyeglasses which are as presently worded.
As Dr. Dryden pointed out yesterday for this committee, the bill would authorize optometrists to engage in "the identification of any departure from the normal condition or function of the human eye including its associated structures.” Such broad terminology would carry the optometrists into the field of practicing medicine. "Associated structures” in medical terms includes the brain, the lacrimal apparatus, the eyelids, the paranasal sinuses, the endocrine glands, and many other things which the optometrist should not be involved with at all.
We further recommend that the present provisions of the District of Columbia Code section 2–511 be inserted in lieu of section 4section 7
Mr. Dowdy. You said in your statement, section 4.
Rather than have the Congress of the United States attempt to fix the qualifications of optometrists, we feel this matter should be left to the discretion of the District of Columbia Commissioners. Educational qualifications can be changed from time to time as the Commissioners determine to be in the public interest.
We further suggest that section 5(a) of the bill be deleted and there be inserted in its place section 2–518 of the District of Columbia Code which is a very simple, clear statement to the application of the reciprocity principle of optometry.
It has been brought out in the hearings that an optometrist under the existing law cannot use drops, dyes, drugs, or any other chemical which comes in contact with the human eye; therefore, we suggest that Congress make this clear by adding on page 7 of the bill a new subsection titled (1A) reading as follows: "The use of drops, dyes, drugs, or any other chemical which comes in contact with the eye.
We suggest that the word "profession" be deleted from section 7(a), line 15, on page 9 of the bill and the word "optometric" be substituted. We also suggest that a new section (2) be inserted on page 9 of the bill and that this be clarified in order to provide that the adapting and fitting of lenses, prisms, and contact lenses be the only phase of the bill which requires a written prescription from a physician or an optometrist licensed to practice medicine or optometry. Accordingly, we suggest that section 8(4) on page 11 of the bill be rewritten to read as follows:
“Adapt and fit lenses, prisms, or contact lenses without a written prescription from a physician or optometrist licensed to practice medicine or optometry.' We feel that the requirement that the physician or optometrist be licensed to practice in the District of Columbia only, should be eliminated from the bill in order to afford the millions of visitors who come to the District of Columbia the right to have lenses, prisms, or contact lenses made when they have
a written prescription from a physician or optometrist licensed to practice outside the District of Columbia.
We further suggest that section 8(7) which appears on page 12 of the bill be taken out of this section of the bill and be added as paragraph (20) to section 7 of the bill as I have indicated earlier in my statement.
Page 13 of the bill should be amended to read as follows:
SEC. 9(a)(2). "To any member in the armed services in the District of Columbia acting in the performance of his military duties;''
We further feel that section 9(b) should be amended to read as follows:
“This Act shall not apply to a physician and/or surgeon practicing medicine or surgery under the laws of the District of Columbia, nor to nurses or technicians acting under their direction."
Section 9(c) page 14 of the bill should be clarified and we recommend it should read as follows:
"This Act shall not apply to any person who fills the written prescription of a physician, surgeon or an optometrists."
We further suggest that on page 13, section 9(e) be amended to read: "Nothing in this Act shall be deemed to authorize an optometrist to use the title 'doctor or any abbreviation thereof except that if he uses such title or such an abbreviation it must be followed by the title 'optometrist'."
Page 15, section 10(a). We recommend the word "ophthalmic” be deleted and “optometric” inserted in lieu thereof, and after the word "materials” insert "by optometrists”. Line 23 “ophthalmic” should be deleted and “optometric” be substituted.
The word “ophthalmic” also appears on lines 9 and 13 of page 16 of the same section; this word should be deleted and in its place the word “optometric” inserted in lieu thereof.
On line 9 of the same page, we recommend the words "by optometrists” be inserted after the word "materials”.
We recommend that section 13(c), page 19, be deleted in its entirety. This section of the bill attempts by legislation to make the optometrist an expert to testify in any trial by merely possessing a license and also attempts to have his certificate received in evidence once he obtains a license under the act to practice optometry.
I respectfully submit, as Dr. Dryden pointed out yesterday, that section 14 appearing on page 19 should be deleted in its entirety. Our real objection to this so-called antidiscrimination provision is that it will prevent a public health physician, who feels that a medical problem is involved, from sending a pupil in a public school to his family physician for examination. It is just that simple.
As I pointed out earlier, I have been trained both in the field of optometry and in the field of ophthalmology. I have been a member of the American Optometric Association. On June 25, 1964, in Seattle, Wash., the American Optometric Association passed Resolution 4 which declared that “the field of visual care is the field of optometry and should be exclusively the field of optometry.” This resolution further recommended to State optometric associations that they “make serious study of the optometry laws prevailing in their States to the end that exemption be restricted and ultimately eliminated, and that encroachments by untrained, unqualified, and unlicensed persons into the exclusive field of optometry be prevented
through the establishment of enforcement agencies in the respective States."
As an optometrist and as an ophthalmologist, in my opinion, an optometrist has nothing to do with the care of the human eye. The function of an optometrist is to attempt after an examination of the eyes to alleviate certain visual problems in the eye at the time of his examination. The optometrist is neither qualified nor competent to examine the eye for any pathology, to make a diagnosis of any conditions in the eye or to recommend any treatment or care of the eye. The sole function of an optometrist is to furnish lenses and glasses to aid in the vision area. He is not trained to treat the
any way. In my opinion, the attempt of this committee, by legislation, to improve the care of the human eye in the field of optometry will not have any effect on the type of care or to improve the care of the eye.
Yesterday the question was asked of Dr. Dryden whether eye care could be improved in the District of Columbia. I hope that we can understand that eye care is primarily a function of ophthalmology and that vision is a function of the optometrist. The eye is part of the body which is in the province of medicine. The optometrist should merely be concerned with visual anomalies in the normal eye.
We are very fortunate to have a very progressive ophthalmological community in this area. We have three universities which are training residents in opthalmology. We have several hospitals with active programs. At least 20 residents in ophthalmology are currently being trained by these jurisdictions. These are the men who will be dealing with eye care. We can look forward to the day when Washington will be an important eye center of this Nation. Here in Washington we have the facilities of the National Institutes of Health, the excellent facilities of the Army and Navy hospitals, and our own hospitals where we can train
eye care. This eye care is all inclusive. It would appear to me that what is being attempted under this bill is exactly the intent of Resolution No. 4 of the American Optometric Association.
I feel extremely fortunate that since I have training in both the field of optometry and ophthalmology that I am able to realize that optometry has this goal in mind and they are using legislative methods to attain this goal.
The Medical Society of the District of Columbia believes that no new legislation is necessary to regulate optometry in the District of Columbia. I hope that if the Congress sees fit to change this legislation that it will give due consideration to the changes which we have suggested so that the fields of eye care and visual need in the District of Columbia can proceed in the public interest.
Mr. Chairman, I wish to tahnk you for the opportunity extended to me to present the views of the Section on Ophthalmology of the District Medical Society.
Mr. Sisk (presiding). Thank you, Dr. Albert. That completes your statement now?
Dr. ALBERT. Yes. Mr. Magee, our counsel, has a statement to make.
Mr. HARSHA. This question again has been raised about the existing authority of the District Commissioners to act under existing law, and I believe you raised the point yestereday that you were informed it did not have such authority. I wonder if we are going to