Mr. DOWDY. Mr. Sisk is one of the valued members of this subcommittee. One of the bills is his. Do you have a statement that you would like to make at this time, Mr. Sisk?

Mr. SISK. Mr. Chairman, I would like to make a very brief oral statement and then have permission to insert a more extensive statement into the record.

Mr. DOWDY. Go right ahead.

STATEMENT OF HON. B. F. SISK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA

Mr. SISK. Mr. Chairman, the bill which I introduced, H.R. 12937, and which I might say I understand is wholly similar or identical to the majority of the other bills, was introduced because of what seemed to me to be a rather grave need to update legislation pertaining to the regulations and licensing of optometry in the District of Columbia. As we know, the original regulatory legislation was passed in 1924, and my own experience with the practice and the profession of optometry in my home State of California, and I know this generally to be true in other States. The law has been updated over the years. Certainly when we examine what has been happening here in the District of Columbia it is apparent that the need to update the law here is long overdue.

Let me say, Mr. Chairman, that my prime interest in this legislation is to see to it that the public is protected from unethical practices which would lead to the detriment of people.

We have had local experiences here, even in recent months, of practices which certainly I am sure are foreign to anyone in the medical profession or anyone else who is concerned about the care and are concerned for the eyesight of the American people. It is, as I say, for that purpose that I introduced the legislation.

I might just say, Mr. Chairman, that there have been, I noticed within recent days, quite a few charges as to the possible effect of this particular piece of legislation. I personally want to say that there is no intent here to do anything other than what is done in the majority of the States of our Union with reference to the profession and the practice of optometry. There is certainly no intention here to include the sale of sunglasses or eyeshades by normal outlets such as we find across the country. There is certainly no intent here to change the requirements as far as drivers' tests and many other tests that are made, because from my own experience in my home State, where we do have legislation in existence regarding the practice of optometry very similar to what is proposed in this legislation, we have no such problems. I am sure that as these hearings proceed, Mr. Chairman, these things will be made clear.

I recognize, of course, that, upon the introduction of any piece of legislation, it is not necessarily always perfect in its initial form. A great deal of work has been done in attempting to perfect this legislation, but at the same time I am sure that the committee in its widsom may find changes that will be necessary, because if there is any concern. about the intent, I am sure that will be very clearly spelled out.

Now, simply to conclude my comments, my opening comments, Mr. Chairman, I was somewhat amazed to find some of our friends in the medical profession apparently somewhat concerned. This

recalls to my mind a situation that has been going on for the past couple of years, where the ophthalmologists, for whom I have great respect, have been quite concerned about an attack upon their dispensing of glasses, by the Guild of Opticians. I am sure that they recall the occurrences of the Hart hearings in the other body, and the Senate bill which has been introduced. I met with the ophthalmologists. I find myself frankly very favorably impressed by their position with reference to that legislation. So I was a little bit amused, Mr. Chairman, to find them getting in bed with the opticians and in opposition to this bill. But I suppose here again it is a matter of whose ox is being gored.

But I am sure that the medical profession is as concerned as the rest of us with reference to eye care. All we seek to achieve is improved eye care and care of the public and the treatment of the public in this particular legislation. Mr. Chairman, I appreciate. the opportunity to make this brief statement.

(A prepared statement submitted by Mr. Sisk follows:)

LEGISLATION FOR EYE CARE IN THE DISTRICT OF COLUMBIA

The bill which I have introduced (H.R. 12937) amends the act which regulates the practice of optometry in the District of Columbia.

Present law was approved by the Congress on May 28, 1924 (43 Stat. 177, D.C. Code, title 2, secs 501-522). It has not been amended during the more than 40 years which have intervened. Prior to its enactment, all of the 48 States which then constituted our Union, had enacted laws to regulate the practice of optometry. Every one of those laws has since 1924 been amended; most of them several times.

The Washington Daily News, during the past few days, has reported that men who are not required to meet any educational or technical standards are now fitting customers with contact lenses. These men are not licensed, regulated, or supervised in any manner. The News reports that some of the work they are doing is both inadequate and unsanitary. In at least one case, a woman lost the sight of an eye.

Two men have been arrested and charged with violating the District's 42-yearold optometry law. According to the News, one of their reporters who sought to secure contact lenses did not have a doctor's prescription and was not even sent to a doctor to secure one. The salesman attempted to figure out the prescription from the glasses the reporter was wearing. This is highly dangerous, as not everyone can be fitted with contact lenses and those that can wear them generally need a different prescription from the one given them for their spectacles. The contact lenses may cause an abrasion of the eyeball, which, if infected, may result in the total loss of the eye.

Even if the accused are convicted, the existing law does not adequately protect the public from those operators who, according to the News report, are at best bilking the public out of its money, and at the worst, damaging their customers' eyesight. The News reports that frequently the unsuspecting public believes it is being served by licensed and well regulated vision specialists.

High-powered advertisements and fancy but expensive installment plans that conceal high rates of interest are being used to sell a health device which, when properly prescribed and fitted, can be highly beneficial to the user; but, on the other hand, it may and often is highly dangerous.

President Johnson is well aware of the importance of vision. Pursuant to a joint resolution of the Congress, approved December 30, 1963, the President, on January 28 of this year, issued his Save Your Vision Week proclamation. He began it with a quotation from Shakespeare:

"He that is stricken blind cannot forget the precious treasure of his eyesight lost."

He went on to say:

"Those words of Shapespeare are relevant to us today as we proclaim Save Your Vision Week, 1966. They remind us that the gift of sight is one of the glories of life. To the child it is a red balloon-a mother's smile-a form in a passing cloud-a tree with autumn leaves.

"Those words of Shakespeare remind us, too, that the eyesight which most of us take for granted in our daily lives can be snatched from any of us almost without warning."

He then listed the optometric profession as one concerned with programs for the improvement and preservation of vision. As a matter of fact, optometry is the first line of defense against blindness and is dedicated to improving and conserving the vision of our entire population.

The members of this profession were the first to volunteer their services in the war on poverty. Last summer through their organization called Volunteers for Vision, they made an outstanding contribution to Project Headstart for preschool children. The honorary chairman of Volunteers for Vision is Miss Luci Baines Johnson.

This Congress and the preceding Congress have wisely included schools and colleges of optometry and optometry students in the health education legislation authorizing the expenditure of Federal funds for the expansion and improvement of the health professions by providing more and better educational and library facilities.

Most of you will recall the battle which medicine and dentistry fought to eliminate fraudulent and deceptive advertising from their profession. Today optometry is fighting the same battle and has succeeded in most of the States of the Union. But, unfortunately, this is not true in our Nation's Capital.

As far back as 1955, the U.S. Supreme Court, in the case of Williams v. Lee Optical (348 U.S. 483), sustained the Oklahoma law which contained provisions similar to provisions in the bill just introduced. The Court held that "State regulation of advertising relating to eye examinations was a matter reasonably and rationally related to the health and welfare of the people." The Court went further and reversed the lower court, which struck down the provision of the Oklahoma law relating to the sale of eyeglass frames. In sustaining the statute the Supreme Court said:

"If the advertisement of lenses is to be abolished or controlled, the advertising of frames must come under the same restraints; or so the legislature might think. We see no constitutional reason why a State may not treat all who deal with the human eye as members of a profession who should use no merchandising methods for obtaining customers."

That is one of the purposes of the bill which I have introduced.

Last year the Senate Subcommittee on Frauds and Misrepresentations Affecting the Elderly included among its many recommendations the following statement: "Testimony taken by this subcommittee reveals that the last congressional action in this field (eye care) within the District dates back to 1924. Testimony taken by this subcommittee suggests that new merchandising methods have occurred since that action, and it is recommended that the Senate District of Columbia Committee examine the adequacy of present District laws on

"(a) Widespread fixed-price advertising for regular glasses and contact lenses; "(b) Sale of over-the-counter nonprescription glasses;

"(c) Possible need for greater authority to the District Commissioners for regulation of the corporate practice of optometry."

My proposal contains 15 sections to correct the problems uncovered by this Senate subcommittee.

Under date of January 7, 1966. Dr. Zachary Ephraim, president of the Board of Optometry of the District of Columbia, addressed a letter to the President of the District Board of Commissioners, in which he transmitted a draft of a bill which had been prepared by the Board of Optometry in cooperation with the District of Columbia Department of Occupations and Professions, the Optometric Society of the District of Columbia, and the American Optometric Association. It was designed to improve the District law as it pertains to the practice of optometry.

The bill I have proposed contains all of the essential provisions of the Board's draft. As pointed out in Dr. Ephraim's letter, there is nothing in it that is not now contained in the laws of one or more of the States. The purpose of the revision is to bring the standards of practice in the city of Washington up to a level which exists in most of our States and will provide adequate protection for the visual needs of persons seeking vision care within the District of Columbia.

As the Nation's Capital, we have visitors from all over the world and from every part of our country. They are entitled to the same high standards for the practice of optometry which prevail in their home communities. That is the purpose of the bill which I have introduced. I hope that it will receive prompt and favorable action by the House District Committee and the House of Representatives itself.

Description

Title.

Purpose.

Definitions.

Licenses (secs. 4-7):
Qualifications for.

Reciprocity.

(a) Authorization for issuance.
(b) Revocation, time limitation.
Annual renewal.

Denial, suspension, revocation.
(a) Causes for.
(b) Charges for.
(c) Reinstatement.

Unlawful acts

Exemptions.

(a) Description.
(b) Penalties.

Exemptions.

(a) Not applicable to.

(b) Physicians or surgeons.

(c) Opticians (filling prescriptions).
(d) Clinics, hospitals, widows, etc.
(e) Use of doctor title.

Rules and regulations governing practice.
(a) Sales, signs, advertisements, etc.
(b) Commissioners' fees and charges.

(c) Commissioners' authenticating seal.
Inspections, investigations by Commissioners.
Injunctions, restraining orders.

Prosecutions for violations.

(a) How conducted.
(b) Proof of.

(c) Testimony of optometrists.
Freedom of choice of practitioner.
(1) Delegation to Board of Optometry.
(2) Validity of present license.

(3) Commissioners' decisions on licenses.
Effective date of act.

DISTRICT OF COLUMBIA OPTOMETRY ACT

SECTION-BY-SECTION ANALYSIS AND SUPPORTING DATA

The bill consists of 15 sections.

Section 1-Title.-Authorizes the citation of the act as "The District of Columbia Optometry Act."

Section 2-Purpose.-This is a customary declaration of legislative intent. Optometry is a profession which should be regulated in the public interest.

The optometry laws of most of the States have affirmatively and directly stated that optometry is a profession. It is designated a "learned profession" by the laws of 12 States, Arkansas, Colorado, Georgia, Kentucky, Florida, Idaho, Montana, New Jersey, New York, North Dakota, South Dakota, and Virginia. The U.S. Supreme Court in Williamson v. Lee Optical Company (348 U.S. 483), in sustaining the constitutionality of the Oklahoma statute stated: "We see no constitutional reason why a State may not treat all who deal with the human eye as members of a profession."

Optometry is a profession coordinate to the professions of medicine and dentistry and it is following the pattern of the newer amendments to the laws relating to those professions in utilizing the format of legislative intent.

63-977 0- -66

Section 3-Definitions.—This section defines the following terms: (1) District of Columbia Commissioners, (2) practice of optometry, (3) optometrist, (4) person, (5) individual, and (6) State. They are self-explanatory with the possible exception of subsection (2), practice of optometry.

It is the universal custom in all statutes regulating the practice of any of the healing arts to define the scope of the profession. In the case of optometry, the definition varies somewhat in the statutes of the 50 States as it does in any of the health arts. The proposed definition conforms to the practice of optometry as it exists today.

The proposed definition is a combination of the definitions of several States which have recently amended their optometry laws to bring it in accord with the teachings and practices of modern optometry. Everything set forth in the definition is the responsibility of the optometrist in fulfilling his obligation to protect, conserve and improve the vision of his patients.

Section 4-Qualifications.-Eight qualifications for an individual to secure an original license to practice optometry in the District are set forth in detail. They are: (1) 21 years of age, (2) good moral character, (3) mentally competent, (4) preliminary education equivalent to a 4-year course in high school, (5) completion of a preoptometry course of at least 2 years at the college level, (6) graduation from a school or college of optometry approved by the Commissioners after completion of a course of study of no less than 4 years, (7) passage of the written, oral, and practical examinations as prescribed by the Commissioners in the subjects generally taught in schools and colleges of optometry, and (8) payment of the required fees.

A comparison of the provisions of this section with the educational requirements set forth under the existing law indicates the educational advances made by the profession of optometry. It also sets forth the minimum subject matters in which the candidate for licensure must be examined. The section is sufficiently elastic to permit the Board to add additional subject matters as the knowledge in the field further advances.

Section 5-Reciprocity.-Provides for the issuance of reciprocity licenses to an individual licensed to practice in another State, provided the State grants a like privilege to the holder of a District of Columbia license, and the individual successfully passes a practical and oral examination.

Similar reciprocity clauses are found in the laws of the various States. There are occasions when an optometrist licensed to practice in the District of Columbia must, for reasons of health or otherwise, seek licensure in another State. So likewise, an optometrist licensed in another State may desire to practice within the District of Columbia. This section sets forth with clarity the requirements necessary before an out-of-State optometrist may be granted a reciprocity license. Section 6-Renewal.- Requires that licenses shall be automatically renewed annually by the payment of the annual renewal fee.

The renewal fee is to help finance the work of the Commissioners, and enable them for the protection of the public to keep track of the practitioners.

Section 7-Denial.-Authorizes the Commissioners to refuse to issue, renew, or restore any license authorized by the act and also to suspend or revoke such a license. There are 19 grounds for action which are listed. The first seven grounds are self-explanatory.

(1) The use of any title or other word or abbreviation indicating that the licensee is engaged in the practice of medicine or surgery.

(2) Conviction of a crime involving moral turpitude.

(3) Repeated violations of the act or any regulations promulgated by the Commissioners under the act.

(4) Gross incompetence.

(5) Chronic or persistent inebriety or the habitual use of narcotics.

(6) Affliction with a contagious or infectious disease.

(7) Conduct which disqualifies the licensee from practicing optometry with safety to the public.

(8) Advertising, directly or indirectly, the performance of optometric services or any part thereof.

The several codes of ethics of medicine, dentistry, and optometry declare that advertising to the public is unethical. The laws and the Board rules in all of the State jurisdictions have provisions making advertising of professional care illegal. The practitioner can offer only his reputation, skill, training, ability, experience, and the trust and confidence of his patients. These are not matters to be offered via the usual means of advertising.

The specious argument is sometimes raised that the optometrist dispenses to his patient an article of personal property such as eyeglasses and it is claimed that