If Congress feels or if people generally feel, that if somebody wants to injure their eyes and this is the type of procedure they want to engage in, and if somebody does not want to come forward and enact laws, which will tend to protect people against this sort of thing, that is something quite different. But I do think this bill will tend to prohibit that, and I think it is good that it is prohibited.

Mr. WHITENER. I think code annotation in Indiana pretty well sums up what everybody ought to be striving for when it says this: "Construction of the Act."

This definition of the practice of optometry when read as a whole pertains to the scientific professional examination of the eyes and vision and the furnishing of measures including lenses, for the correction of their abnormal condition.

But I have a little difficulty in seeing the reason for going beyond that and saying that if a man has some crooked glasses or a broken set of frames, he has to go to an optometrist to get that done. It has no relationship whatever to the correction of abnormal conditions.

Mr. McNEVIN. I think in answer to that, if a man or a party or an individual involved does have abnormal vision and a lens is broken, then I certainly, under the Indiana law, I think he would need a prescription to have that lens replaced; I know he would. But if you are talking only about the adjustment of the frames or the replacement of parts, then I would tend to agree with you, but I think it tends to go perhaps too far to legislate and require an individual to get a prescription to get minor changes or adjustments made. But the eyeglass itself, this is where you are getting into the abnormal vision and correcting procedure. When one lens is broken, then I think it is time perhaps this is not a limitation, that when one gets an eyeglass broken, he ought to get a new examination. But I think from a protective standpoint, he ought to get a prescription, it ought to be checked out and have it ground to that prescription, and it ought to be checked by the optometrist in order to correct, in order to protect himself and, as a member of the driving public, to protect him and others against his abnormal vision.

Mr. WHITENER. It may well be that there ought to be some control over the competence of people who actually grind the glasses and do the mechanical side of this important work. But it seems to me that is out of place in an optometric bill.

Mr. MCNEVIN. I do not know that this law could be construed as applicable to or designed to limit or restrict the general operation of an optical house or an optician. The idea, as I understand it, is to invoke a degree of professionalism surrounding the practice of optometry and to eliminate some of the evils attendant upon the so-called corporate practice, and somewhere within the framework of it, it may have an effect on what the optician does in terms of eye examinations, and so forth. I think this is certainly proper.

But to say that it is directly applicable to the optician or that it goes too far in including the optician within its purview, I do not believe it really does this, Congressman. I could be mistaken, but that is my understanding and my view of the bill under consideration.

Mr. WHITENER. Of course, our responsibility is to write a bill which would preclude any court adjudication which was in conflict with what you and we are trying to do.

Mr. McNEVIN. I understand that.

Mr. WHITENER. I do not want you to assume from my question that I am hostile to your point.

Mr. McNEVIN. I appreciate that. I recognize, and said earlier, that we may sit here today and later and talk about what is intended, what the legislative intent is, but we do not really know, and so the court says, this is what they intended. It may be something entirely different. This is more true perhaps in Indiana, where we do not have the benefit of journals and records where testimony is maintained.

But certainly you are absolutely right in now is the time to look at it carefully in all of its various aspects and clarify the various things which need to be clarified before it does get into a court of law, which might be prevailed upon by one side or another to go off and completely misinterpret or misconstrue the legislative intent.

Mr. WHITENER. Are there any other questions?

Mr. Grider?

Mr. GRIDER. As you read this act, this bill, could an optometrist prescribe for a person anything other than visual aids? He could not prescribe eye drops or any sort of medicine, could he?

Mr. McNEVIN. As I view it, Congressman, he could not. He is limited to, again, the practice of optometry, which is basically surrounding the corrective measures to be taken to bring abnormal eyesight back into normal limitations.

Mr. GRIDER. Well, sometimes using the wrong glasses will cause conjunctivitis. It is a very simple little disease and you can clear it up in a couple of days with a good eye drop, but he would not be allowed to prescribe eye drops. He would just be allowed to tell you, go out and buy Murine or boric acid or something like that.

Mr. McNEVIN. I think that is right. I think fiducially, the optometrist in every state, and I cannot say that for a certainty, but I believe it to be the law, that they do not prescribe medicine as such, even to the extent of eye drops.

I might add that nowadays, with the advent of drug advancements and the method of packaging used by most pharmaceutical houses, it probably would not be too far afield to permit optometrists to do this, because by the time the drugs get to them, the pharmaceutical houses probably have everything outlined, and it is often very easy to read and guide one through the use of medicine in that regard.

But I think this statute or this bill, as written here, would not permit the optometrist to prescribe medicine or eye drops as you have indicated, sir.

Mr. GRIDER. I have no further questions.

Mr. WHITENER. Than, you very much, Mr. McNevin.

Mr. McNEVIN. Thank you, gentlemen.

Mr. WHITENER. I wonder if we could ask the staff to get from the Library of Congress 140 A.L.R. 466 and 68 A.L.R. (2d) 426 and insert them in the record. (For these reprints, see appendix pp. 265285.) They deal with a question raised yesterday about malpractice and the liability for it.

The next witness is Dr. J. Spencer Dryden of the Medical Society of the District of Columbia, and I believe Dr. Dan Albert.

Have a seat, Doctor.

STATEMENT OF J. SPENCER DRYDEN, M.D., CHAIRMAN OF THE EXECUTIVE BOARD, THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA, ACCOMPANIED BY DR. DAN ALBERT, CHAIRMAN, SECTION OF OPHTHALMOLOGY, DR. CLAUDE L. COWAN, PROFESSOR OF OPHTHALMOLOGY, HOWARD UNIVERSITY SCHOOL OF MEDICINE, AND WARREN E. MAGEE, COUNSEL, DISTRICT OF COLUMBIA MEDICAL SOCIETY

Dr. DRYDEN. Mr. Chairman, and members of the committee, my name is J. Spencer Dryden. I am a physician specializing in the eye and its diseases. I have practiced medicine in the District of Columbia for the past 21 years. I appear here today as a representative of the Medical Society of the District of Columbia as its past president and, at present, chairman of the executive board. With me. are Dr. Dan Albert, chairman of the Section on Ophthalmology of District of Columbia Medical Society, Dr. Claude L. Cowan, professor of ophthalmology, Howard University School of Medicine, and Mr. Warren L. Magee, legal counsel for the District of Columbia Medical Society.

Mr. WHITENER. Dr. Dryden, maybe it would be well for those gentlemen to come up and sit with you.

Dr. DRYDEN. Thank you, sir.

As many of you gentlemen may know, the Medical Society of the District of Columbia is the only medical society ever chartered by act of Congress and it is the oldest scientific organization chartered by Congress, having been founded in 1817, during the Monroe administra

tion.

Our medical society, consisting of 2,435 members, is very much alarmed about numerous features of H.R. 12937, H.R. 13049, H.R. 13155, and H.R. 13176, identical bills dealing with the practice of optometry in the District of Columbia. If any of these bills are enacted it will in effect amend the Healing Arts Practice Act, which we feel would not be in the public interest and which we believe would not be the intent of Congress.

This state of alarm in the medical society is not solely limited to those members who are ophthalmologists (eye physicians and surgeons) but is shared by all members regardless of their specialty status or field of interest. The bill, as proposed, will prevent any physician or surgeon from using his nurse or any of his technicians in recording a patient's visual acuity, checking a patient's visual field, or performing any other technical task under his direction which the Healing Arts Practice Act now provides.

The bill will also grossly interfere with or eliminate some of the vital activities of our local hospitals' eye clinics, the Department of Public Health, school screening programs, and the eye departments of Georgetown University Medical Center, George Washington University School of Medicine, and Howard University School of Medicine. The professors of the above-mentioned medical schools are so concerned about these bills that they have requested permission to testify before this committee and will clearly state the reasons for their concern and how this legislation will grossly interfere with the teaching program of their medical students, nurses, and the efficient operation of their eye clinics which serve thousands of District residents; the

vast majority being indigent patients. The same restrictions proposed in these bills would also apply to all nonprofit, government, or private hospitals and clinics in the District of Columbia.

The bill will eliminate the nurses, teachers, PTA's, and other volunteer groups from the school eye screening programs and force these simple screening procedures to be performed by an optometrist. Is this the intent of the authors of these numerous bills?

I wish to point out that even the District of Columbia Society for the Prevention of Blindness of the Metropolitan Area, a red feather agency which has been in existence since 1936 and which makes a remarkable contribution in the prevention of blindness in this area by virtue of its screening programs, would be guilty of practicing optometry without a license under the provisions of these bills.

The long established policy of vision screening applicants for motor vehicle operator's permits as adopted by the Director of Motor Vehicles of the District of Columbia will be modified to require an optometrist to perform this simple technical procedure presently being performed in a very efficient manner by a trained employee of the District of Columbia.

On the principle of "equal justice under law" it is inconceivable how either the courts or members of the bar could tolerate a situation whereby an expert witness could qualify by an act of Congress by virtue of a simple license procedure. I know that many Members of Congress are also members of the legal profession and they know that all expert witnesses, including medical, must qualify on the basis of their individual merits, and not on the basis of a licensing procedure. Furthermore, such expert witnesses must be acceptable to the court and subject to cross-examination by both prosecuting and defense attorneys.

We object to that provision of the bill which would require an individual to secure a written prescription from his physician to replace a broken frame or duplicate a broken lens because it serves no public good and would act only as a restraint of trade among those individuals who engage in the dispensing of eyeglasses. Of the millions of visitors to the Nation's Capital every year there are thousands who carry on their person a duplicate prescription for their eyeglasses from "back home" for that very purpose. Can you imagine the unnecessary inconvenience and expense that would be imposed upon persons in an emergency situation under the restriction of this bill? How would you feel if you were on official business in another city and were forced to pay for a written prescription in order to replace a broken temple on your eyeglasses?

The so-called nondiscrimination portion of this bill as stated in section 14 which makes it unlawful for any employee of the District of Columbia to advise an individual as to the proper place to obtain eye care is certainly not in the best interest of the citizens of this city. To illustrate, suppose the school physician or school nurse is confronted with a child who sustained an injury to his eye or who had a severe infection of his eyes which is obviously a medical problem and beyond the purview of optometry. This bill would prevent the nurse, school physician, or even the child's teacher from sending the child directly to a physician, regardless of his specialty of medicine, for immediate and definitive treatment. By allowing this child to go to an optometrist under the parent's impression that the op

tometrist is an "eye specialist" and is capable of rendering such treatment will at best act as an unfortunate delay and unnecessary expense in obtaining proper medical care and, at worst, could result in the child going blind.

Is Congress really prepared to accept the claim of the American Optometric Association that optometrists are capable of identifying eye diseases and referring these for proper medical care? As a practicing physician of 30 years' experience, I can say in all humility that the most difficult diagnosis for a physician to make is that no disease is

present.

In 1950, an amendment to the Social Security Act made it incumbent upon the States that they accept the report of optometrists in certifying recipients for aid to the blind under the provisions of this act, enacted by Congress. This provision was enacted over the objections of the medical profession. On several other occasions. before committees of Congress the medical profession has repeatedly pointed out that this and similar proposals are not and could not possibly be in the best interest of the public despite the claims of the American Optometric Association.

In order to point out the fallacy of optometry's claim to recognize disease whenever it is present and to determine which individuals do and which individuals do not require medical care and the unnecessary loss of vision which results from government actions which equate the optometrist with other "ocular practitioners" (which always means physicians) referred to as ophthalmologists, may I respectfully call to your attention the 1962 Report of the North Carolina State Commission for the Blind.

A study was done at the request of the North Carolina State Commission for the Blind under the direction of the medical advisory board of the commission. Every record subsmitted by optometrists to the North Carolina State Commission for the Blind was reviewed, covering a 2-year period from March 1960 to March 1962. The total number of records examined was 2,485. The study revealed 115 records, 4.5 percent in which the reporting optometrist stated that the patient should be referred to an ophthalmologist. The study also revealed that 351 records, 14 percent contained information supplied by the optometrists which indicated a need for referral but were not referred. These were patients with less than 20/40 vision or with visual field defects, or records that had medical diagnosis made by the optometrist. It was the consensus of the study committee, on the basis of reports of optometrists, that 351 patients of 14 percent of the total number of patients seen by the optometrists for the North Carolina State Commission for the Blind during this 2-year period did not have proper care and were not referred for ophthalmological care when they should have been. Many of these unreferred persons had profound loss of vision to the point of legal blindness. We do not believe that this is what the Congress wants for the residents of the District of Columbia. The medical profession certainly does not recommend it.

If the State of North Carolina representing 2.5 percent of this country's population has this many of its residents who were deprived of proper medical eye care under this so-called nondiscrimination system, imagine the unknown thousands of persons throughout the Nation who are also victims of this false and misleading philosophy.

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