This provision of the bill is intended to prevent school nurses from advising the parents of children with eye problems to seek medical treatment for them. The Commissioners strongly oppose a statutory provision which prohibits any person, including District personnel, from advising anyone to seek medical care.

Now, I have heard quite a bit of testimony on just what this section 14 means. We have had discussions with the proponents of the bill, representatives of the Optometric Society, and their contention is that they do not want any District employees such as schoolteachers, school nurses, school doctors, or anyone who examines children to say to the parent of the child or write any note to the parent of the child saying, "Take this child to an ophthalmologist." They do not mind any note which says, "Take this child to an ophthalmologist or an optometrist." or "Take this child to an eye doctor." But they do object to an ophthalmologist being singled out, without an optometrist being also mentioned.

Mr. SISK. If I may interrupt, we went over that with the Virginia organization, and I feel basically that what the intent of the committee ultimately would be would not be to mention nondisrimination against referral. There would be no prohibition against referral, but certainly it would be nondiscrimination in referral.

Mr. MOYER. As the committee discussed the other day, in the welfare field, where there is much more chance that the free will be interfered with by the District through referrals to the proper person, I received this morning from the Director of our Department of Public Welfare a statement in regard to this provision of the bill. This is very short, and I would like to quote it. This is signed by Donald D. Brewer, Director of the District Department of Public Welfare. He states:

The Department of Public Welfare raises no objection to this section so long as it is understood that while the Department of Public Welfare cannot require a recipient to go to any particular practitioner, we cannot pay for such services. In the case of aid to the blind, under Federal requirements while certification may be secured by the recipient from either an ophthalmologist or optometrist, all such medical reports have to be reviewed by an ophthalmologist under contract with the Department of Public Welfare.

So in that case, we are bound by Federal regulations in the welfare field where patients must be referred to an ophthalmologist. (The statement referred to follows:)

MEMORANDUM FROM THE DISTRICT OF COLUMBIA DEPARTMENT OF

PUBLIC WELFARE

MARCH 18, 1966.

To: Milton D. Korman, Acting Corporation Counsel, District of Columbia. From: Donald D. Brewer, Director. Subject: H.R. 12937, a bill to amend the act of May 28, 1924, to revise existing law relating to the examination, licensure, registration, and regulation of optometrists and the practice of optometry in the District of Columbia, and for other purposes.

We have reviewed the conditions of H.R. 12937 with particular reference to the proposed section 14, page 19.

The Department of Public Welfare raises no objection to this section so long as it is understood that while the Department of Public Welfare cannot require a recipient to go to any particular practitioner, we cannot pay for such services. In the case of aid to the blind, under Federal requirements while certification may be secured by the recipient from either an ophthalmologist or optometrist, all such medical reports have to be reviewed by an ophthalmologist under contract with the Department of Public Welfare.

DONALD D. BREWER. Director.

Mr. SISK. We have made the entire statement, of course, part of the record, so I do not think except for the highlights you wish to make, that we need any more detail. We are making the entire statement part of the record.

Mr. MOYER. That was the last point I wanted to make.

Mr. SISK. Dr. Heath, did you want to add anything to what Mr. Moyer stated at this time?

Dr. HEATH. Just a short statement, Mr. Chairman.

First of all, my regrets that I could not spend the other days during the hearings of your subcommittee, but it just was not possible. have been here this morning and I have listened to the testimony.

I would like to point out that the Department of Public Health's principal interest is to serve the interest of the public health in the District of Columbia and not the interest of ophthalmologists, optometrists, or opticians. We did review the bill, and we sent our comments to the Commissioners and the Corporation Counsel, and they have been incorporated in the Commissioner's letter to Congressman McMillan of which you have a copy.

I think that from what I have heard this morning, practically all the points that we have had questions about have been raised. I do not mean that we had questions about everything that was raised this morning, but some of our questions you have already had under discussion in quite a bit of detail.

I appreciate the opportunity of being here. If you have any specific questions that you would like to ask, I am not an ophthalmologist or optometrist, I am a public health specialist, and I would answer any of your questions which would be related to the public health and welfare of the District of Columbia.

Mr. SISK. Thank you, Doctor.

Mr. WHITENER. Mr. Moyer, I would take it from the statement of the Commissioners and from your followup statement that they feel very strongly that this legislation should not be enacted upon favorably?

Mr. MOYER. Yes, sir, that is their position.

Mr. WHITENER. Well, now, I know that you probably cannot speak for the Commissioners on that, but does this imply that if Congress should pass it the Commissioners would then urge the Executive to veto it?

Mr. MOYER. I could not speculate on that, Mr. Whitener. The Commissioners have been informed by the D.C. Medical Society that the standards of eye care in the District are excellent and that this bill is not needed. They have accepted that statement, and on that basis, they have recommended against enactment of this legislation.

Mr. WHITENER. Well, would it be proper for you to seek to ascertain what their attitude would be on that?

Mr. MOYER. In this present form, or what form?

Mr. WHITENER. Substantially the present form. If that is going to happen, it would be well, I think, for us to know it as soon as possible. Not that we are going to legislate in a way that will be directed by the Commissioners, but I think if they have any idea of following through and trying to get whatever we do vetoed, we ought to know it. This is what we usually ask when we have bills in the Judiciary Committee and the Justice Department objects. We try to find out, if we can, if we are going to be running head on into a veto.

60-677-66--17

Mr. MOYER. Mr. Whitener, I shall ask the Commissioners.

Mr. WHITENER. I am not suggesting that they ought to recommend it. I am just trying to find out where we stand. I know Mr. Sisk has spent a lot of time, not only in hearings but in preliminary work on the bill. He does not have any time to waste, and I do not believe that the rest of us do. It would be interesting to know, because there is no point in our doing a vain thing here.

Mr. MOYER. It is just, Mr. Whitener, that there have been statements by the members of the committee that there are going to be substantial revisions to the bill. Of course, I can only speak to the bill the way it is now.

Mr. WHITENER. I do not think there is any doubt that even the proponents of the legislation now, in the light of the hearings, are agreeable to some rather significant amendments, and on some of the provisions which the Commissioners have mentioned, such as the expert-witness section. I have an idea that everybody pretty well understands now that there will have to be some new language added or some change in the language in section 14 to which they object.

But this is the position of the Commissioners, as I see it. The Commissioners are saying we do not think you ought to have any kind of legislation except the massive piece of legislation giving the Commissioners absolute authority to regulate all the trades and professions. If they have that attitude and they are going to adhere to it, there is nothing we can do in this bill to meet that objection.

Frankly, and I can only speak for one member, I do not think that that big broad bill is going to come down to the District Building any time in the near future.

Mr. SISK. I agree.

. Mr. WHITENER. I do not think it is the mood of this committee to turn all that authority over to the Commissioners. It is not that we do not like or trust them, but some of us feel that we have a constitutional responsibility. So if that is their attitude, we either get our big bread baskets full or nothing, and anything short of that we are going to recommend a veto on; I think we are entitled to know it.

Mr. MOYER. Mr. Whitener, when these comments were prepared, we understood from the staff that comments should be prepared not only the basis of the licensing procedures bill, but also the comments should be directed to the merits of the bill. On the merits of the bill, the Commissioners have come to this conclusion.

Mr. WHITENER. But before they got to the merits of the bill they started commenting that they still adhere to all propositions that nothing short of their broad-based piece of legislation they have sent up there will suit them. Is that not what they said at the outset?

Mr. MOYER. I think the report says first of all, regardless of the merits of the bill. They say if after that paragraph, they came to the conclusion that they were in accord with the provisions of the bill, they would not say that the bill should not be passed, but they would still say that they think the better approach would be by a broad licensing bill to cover this.

Mr. WHITENER. It may well be but when you go down to talk to them, they will say, well, "that is meddling in our business by the Congress," and we will not comment on it. I think it would be helpful to us to know how adamant their positions are going to be, because they are going to have the last whack at this thing when it gets over to the White House, if it does.

Mr. MOYER. Mr. Whitener, I will certainly ask the Commissioners the first opportunity I get as to what their feelings are or what they would do if the bill were enacted in substantially the form it now exists in, with the exception of possibly section 14.

Mr. WHITENER. You have been here a couple of days at the hearings, have you?

Mr. MOYER. Yes.

Mr. WHITENER. I think you have pretty well captured the ideas that are out in the wind now about amendments. I think you could do about as well as anybody in the room in sensing what the areas of amendment would probably be. You could probably have a meeting with them and this might be helpful to know.

Mr. MOYER. I will certainly let you know as soon as possible, Mr. Whitener.

Mr. WHITENER. It may well be that they may have other suggestions which will make the bill palatable. I do not think that these gentlemen who propose the legislation want to engage in an exercise of futility. What they want is meaningful legislation, and if we have any, that is what we want it to be.

Mr. SISK. That is right.

Mr. MOYER. I am sure, Mr. Whitener, if the Commissioners conclude that the evils which this bill is attempting to solve do exist here and that these provisions are necessary, they will support such a position. They have said in their report that they know of no evils that will be taken care of by this bill.

Mr. WHITENER. Suppose the Commissioners have some strong ideas about certain provisions in the bill, say two or three provisions that are, in their judgment, unacceptable under any conditions. I think it would help us if we knew that that is the position they are going to take. If they say, "We can live with this thing and we will agree to it if we can do something about section A, B, C, or so-and-so" then maybe we could get our heads together and work out something.

Mr. MOYER. I'll try to get the Commissioners' feelings as to the different sections of the bill.

Mr. SISK. Mr. Moyer, I wanted to ask you just briefly, you mentioned a hearing which apparently the District of Columbia Commissioners called, a public hearing on this bill the other day; is that right?

Mr. MOYER. No, Mr. Chairman, it was a Commissioners' board meeting, one of their regular board meetings. It was on Thursday afternoon. The representatives of the Guild of Opticians had asked the Commissioners to be present so that they could present their views for the Commissioners' consideration. Then the District of Columbia Medical Society also appeared, and the representatives of the District of Columbia Medical Society and the Guild of Opticians presented their positions to the Commissioners.

Mr. SISK. Who called the hearings?

Mr. MOYER. This is one of the Commissioners' regular board meetings.

Mr. SISK. Who put this on the agenda, the consideration of the pending bill?

Mr. MOYER. This was under the usual-when the Commissioners consider legislation or proposed legislation, they do this at all their meetings. During the discussion on this bill, where the Commis

sioners' report had not yet been drafted, the Commissioners permitted the opticians and the District of Columbia Medical Society to come and state their views.

Mr. SISK. Did they invite the American Optometric Association? Mr. MOYER. No, Mr. Chairman, but they invited the District's Board of Optometry.

Mr. SISK. I wonder why, because it seems to me this bill is pretty much of concern to the optometrists, is it not?

Mr. MOYER. Yes, sir. The Commissioners invited their own Board of Optometry, which is a part of the District of Columbia government. However, none of the members of the Board appeared.

Mr. SISK. Is this the usual situation when you have a bill under consideration, that you invite the members of the public in and hold a hearing?

Mr. MOYER. This was the regular Commissioners' Board meeting, not a hearing. On regular things that affect people in the District, Commissioners have been known to allow them to appear at Commissioners' Board meetings to state their views on a thing in consid

eration.

Mr. SISK. I was unaware that they had a practice of holding public hearings on legislation of this nature, and particularly if they know we were going to have such a hearing-and I am sure it was known beforehand. This was planned, I assume, because the other groups would not have been there. I was curious to know if the American Optometric Association were invited.

Mr. MOYER. Not the American Optometric Association.
Mr. SISK. Why were they not invited?

Mr. MOYER. The Commissioners invited their own Board of Optometry. As I understand it, a good number of the members of the Board of Optometry are also members of the American Optometric Association. They are members of the Board of Optometry, the Commissioners' Board.

Mr. SISK. I am still, let us say, somewhat puzzled. I noticed you mentioned a number of times that there was not any need for this bill because the District Medical Society said there was not any need. I wonder if that was the complete determining factor of the Commissioners on any matters of this kind?

Mr. MOYER. As well as that the District Department of Public Health has stated that these provisions of the bill which I have now going into in our report are not desirable.

Mr. SISK. Of course, this bill, I think you will agree, Mr. Moyer. is strictly for the regulation and so on of the practice of optometry here in the District. I do not necessarily think that the District of Columbia Medical Society should be the sole arbitor of regulations or rules pertaining to another group that has to do with practices in matters concerning health in the District.

I will say this quite bluntly to you, Mr. Moyer, because there is nothing personal in it, but I am somewhat critical of the way this proceeding went on and has been reported to me. I am perfectly happy to make it known to the Commissioners that it seems to me that if they were going to have such a hearing and such a discussion, the interested people should have been invited.

Mr. MOYER. I know for a fact that the District Board of Optometry was invited and they did not appear.