Mr. SISK. I might say that is why they are attempting to do it now. Dr. DRYDEN. Why have they not done it? They have the authority to do it.

Mr. SISK. No, according to the best advice that we can get, the Commissioners do not have the authority. I am sorry, but you are in error, Doctor. According to the Board of Commissioners, the authority of the Board of Commissioners with respect to the regulation and licensing of optometry does not cover that. As a person who has worn eyeglasses and used the services of ophthalmologists and opticians, and I might say at the present time I have my own ophthalmologist and I also use an optometrist, I have great respect for the profession of medicine and the job the ophthalmoligist does, because I have certain problems that require medical treatment. But, frankly, I am really amazed that the medical profession here in the District would take the position that seems to me to oppose efforts to upgrade the quality of eye care in the District.

If you can point out to me one single provision for eye treatment, or one single thing in this bill that would lower the quality of eye care in the District, I wish you would point it out. Certainly, I would correct an error if such a thing is there, because the only intent and only objective of this legislation is to upgrade the quality and type of eye care available to the people of the District of Columbia.

I think you will agree with me that nothing is more important than a person's eyes.

Dr. DRYDEN. Sir, you have before you a document which I have read. If you will turn to the North Carolina report, you say, "Why is the medical society opposed to this bill?" In this bill, every effort is made to cause the public to think, when they go to an optometrist that they are getting full eye care, that they are going to be diagnosed and are going to be referred for treatment if they have any diseases. Is that not true?

Mr. SISK. That is correct.

Dr. DRYDEN. Here is a documentation of 315 cases, 100 of which are given initials, visual acuity, diagnosis, not referred. And these are the diagnoses of optometrists. How can the medical society support something like this? Tell me why should an individual in North Carolina, who has light perception in both eyes, be seen by an optometrist and the optometrist says if you will refer to case No. 86 in your documentation you have in front of you, the diagnosis of the optometrist is light perception in the right eye, light perception in the left eye, the diagnosis is cataracts, and the quotation after that, "Patient physically unfit for surgery.'

Mr. SISK. Well, stop right there. I appreciate the report from North Carolina, and I presume that similar reports in varying percentages might be found almost anywhere in the country. As I said in the beginning I have great respect for your profession. I think that your objective, I would hope, this morning is improvement in visual care of the people of the District.

Dr. DRYDEN. That is right.

Mr. SISK. What is your answer to that problem in North Carolina? What would the medical society suggest be done?

Dr. DRYDEN. The medical society suggests that these people be seen by a physician when they are blind and not just put on a blind

pension on the report of an optometrist. That is the medical society's suggestion.

Mr. SISK. I do not want to put words in your mouth. Let me ask you this: You are saying then, that there should be no licensing of optometrists, that it has no place in the field?

Dr. DRYDEN. I am not saying anything of the kind, sir. I made it perfectly clear in my statement that we go along 100 percent with optometrists' efforts to improve the education, to discipline their members, but we do not go along with optometrists' efforts to invade the field of medicine and push this kind of thing on the American public, including the people of the District of Columbia.

This is an atrocity, for people to be condemned to blindness the rest of their lives on the virtue of an optometrist's opinion and never see a physician. It is a crime, sir.

Mr. SISK. What do you recommend?

Dr. DRYDEN. I recommend these people have a medical examination when they are determined to be blind.

Mr. SISK. What I understand you to be saying, and I say again I have no desire to put words in your mouth, is that people who have eye trouble should go to a medical doctor. Is that not what you are saying?

Dr. DRYDEN. Certainly. If they do not see normally, they have a medical problem. It is more than glasses. Any person who cannot be made to see well with glasses has a medical problem.

You heard testimony before this subcommittee yesterday according to what I read in last night's newspaper, from an individual as far away as California, inferring that 75 percent of the pathology was being diagnosed by optometrists. Yet you heard testimony before this committee yesterday by one of our local optometrists who said that 214 cases of pathology were referred to ophthalmologists by their members during an 18-month period. Now, if you will consult the book and see, there are 33 members, and if you divide that out, it will tell you that each member refers 4% cases each year.

Can an optometrist, even a busy optometrist, not see more than four cases a year? That just does not add up.

Mr. SISK. That goes back to the original question-What is the remedy?

Dr. DRYDEN. The remedy is not to equate optometry with medicine. The remedy is that every State in the Union license them as a separate license. They recognize that the qualification for medicine is higher than that for optometry. If the law recognizes that there is a difference, why should the Congress or the State legislatures come along and try to befuddle the public into thinking that there is no difference? Mr. SISK. Let me ask you this, Dr. Dryden. Will you point out to me any place in this proposed legislation-and I admit that it is not perfect and in fact, in a number of areas, certainly I should expect to offer amendments to it, and I must say you have mentioned several places where we have already recognized that there needs to be changes do you find anything in this legislation where we class optometrists as medical people?

Dr. DRYDEN. In two places, sir.

Mr. SISK. Does this bill not provide for licensing for optometrists and designate what the practice of optometry is?

Dr. DRYDEN. That is just the point, sir; it does not.

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In the first place, section 14 very clearly tells the employees of the District government, including the health officers and the nurses, that they cannot send a medical eye case to a physician, that if the patient chooses to take it to an optometrist, it is a violation of the law to tell him which is the difference. That is a case of equation. Mr. SISK. Let me say this, Dr. Dryden. If section 14 says or is interpreted, would be so interpreted, as you interpret it, certainly we will change section 14 because nothing in this act, and I am sure, Dr. Dryden, that you would not assume that any Member of Congress, and I will take in the whole 435, would attempt to legislate by saying to a teacher that that teacher could not send a child to a medical doctor or to an ophthalmologist if he has an injured eye.

Dr. DRYDEN. He is violating the law, in effect.

Mr. SISK. I do not think you really believe that. If any language in this bill could be so interpreted, then certainly we will change it because this is the whole point of the hearing. It is a fact that any piece of legislation which is introduced is not always perfect.

I would very much appreciate you people suggesting places where you feel the bill could be strengthened.

Dr. DRYDEN. We have done so, sir.

Mr. Sisk. I understand that you do have that included with your statement, and I expect to pursue those suggestions because I am positive that this bill is going to get a very thorough working over. am sure there are going to be substantial amendments.

I am concerned, though, with just the basic concepts of your statement here, Doctor, which seem to me to indicate that the Medical Society of the District of Columbia, in spite of things which I know personally because I have walked into places that advertise here in town, and I recently went in to purchase for my own sake to see how it was done, a pair of so-called prescription glasses, from a local operation. For you to come in and say "Everything is perfect here".

Dr. DRYDEN. I did not say "Everything is perfect."

Mr. SISK. "And the eye care is far above average," I am concerned about this, Doctor.

Let me say in all sincerity, everyone has a right to his own position on legislation, but I am concerned with improving eye care in the District of Columbia. I know that the licensing procedure in the law as it is set out in the State of California has not proved to be detrimental to eye care. Certainly, I do not believe it has.

Do you feel that the present law in California regulating optometry, is detrimental to the care of eyes and that we would be better off if we had no regulation?

Dr. DRYDEN. May I answer the question, please?

Mr. SISK. Yes.

Dr. DRYDEN. You heard the definition of optometry in the State of California read here by the previous witness?

Mr. SISK. Yes, that is right.

Dr. DRYDEN. I am sure it is evident to everyone here that that definition of optometry and this definition of optometry are two different things.

Mr. SISK. I would say that basically the intent is the same.

Dr. DRYDEN. Well, let us read what it says, sir.

It says that any and all subjective and objective means of examination, including the eye and its associated structures.

Now, what are the associated structures of the eye?

You could name an indefinite number of them. You have the lids, you have the lachrymal gland, you have the paranasal sinuses, you have the pituitary gland, the brain, you have all the circulation. Gentlemen, that is all-inclusive.

An objective means could be interpreted-and I have been advised by counsel that it could well be interpreted-to mean the use of drugs and drops. That is an objective means. No place in here is

Mr. Sisk. Doctor, I would say that there is nothing in this bill which would permit the use of drugs by optometrists, and I think that is stretching it pretty far.

Dr. DRYDEN. Why do we not put an exclusion in there? We have one in the other bills.

Mr. SISK. This would be a matter which, of course, will be considered by the committee.

But getting back again to your general principle, you are completely satisfied with the present practice of optometry and the way it is conducted here in the District? Apparently you feel it needs no upgrading whatsoever?

Dr. DRYDEN. I did not mean to imply I believe the practice of anything in the District or anyplace, for that matter, could be improved. We see nothing in this bill that could possibly improve anything.

As a matter of fact, this bill could possibly befuddle the public into thinking that the practice of optometry is the practice of medicine, more than they are befuddled now.

Congress went into this in 1950, when they passed this amendment to the Social Security Act, and that is what brought about this deplorable state of affairs. Here, again, you are trying to duplicate the same principle or philosophy. That is what we object to.

If every State in the Union recognizes that optometry and medicine are two different things and they issue licenses for two different practices one is at one level and one at another-why should Congress and the State legislatures come along and try to fix it so the public does not know what these differences are?

Mr. SISK. In other words, you are opposed to the various State laws, the same as we have in Oklahoma, Indiana, California, New York, and so on? You feel that the States should not attempt any regulation at all; is that right?

Dr. DRYDEN. No, not at all: States have to attempt regulations. But they do not have to equate the two.

Mr. SISK. Do you object to attempts to regulate the practice of optometry and the protection of licensed, qualified people in the field in the District of Columbia?

Dr. DRYDEN. Of course not. As a matter of fact, it is stated in my statement that we go along with that, we want to help them do these things.

Mr. Sisk. I understood you to state in here that this bill is unnecessary.

Dr. DRYDEN. That is correct.

Mr. SISK. Could you tell me how the practice could be upgraded and the protection by qualified people, and the increased educational

requirements could be brought about without either this bill or some similar piece of legislation?

Dr. DRYDEN. The present law, sir, could be amended any time. It was amended as late as 1951 to include the fitting of contact lenses. It could be amended tomorrow without any law at all.

Mr. SISK. That is, of course, what we are proposing to do here.
Dr. DRYDEN. But you already have the provisions to do it.

Mr. SISK. As I say, that is what we are proposing to do. We are proposing to amend the existing law and update it.

Dr. DRYDEN. What I am trying to say is the Commissioners already have the authority to do this.

Mr. SISK. I beg to differ with you on that.

Dr. DRYDEN. Well, we shall let the lawyers bat that one out. I cannot answer you on that.

Mr. SISK. What we are attempting to do is assert the authority of Congress in this field and, as you know, that is our responsibility in this field.

I want to comment just briefly, because we have to leave in a few minutes.

You mentioned several things with reference to automobile licenses, the matter of a doctor's technician in the hospital, quite a number of things that I simply want to say that I would disagree with you on, that you say would be precluded.

Well, under our own law in California, I am thoroughly familiar with the way these things are handled. We have had testimony from the State of New York, and there is no interference of this type and kind there.

Here again, I do not believe that this bill would interfere, but, if it should, then, again, as I said, we certainly will make changes.

We have already, I repeat, drafted language with reference to the repair of a broken frame or something of this kind, because primarily the intent of the legislation is for the benefit of the public, not for the benefit of the ophthalmologist, not for the benefit of the District of Columbia Medical Association, and not for the benefit of the present licensed optometrists in the District, but for the better visual care of the people in the District of Columbia.

This is the one single objective of this particular piece of legislation. Mr. Chairman, I must leave now.

I thank you, Dr. Dryden.

Mr. WHITENER. Mr. Harsha?

Mr. HARSHA. Doctor, you made a statement about section 14 of the bill. Would you repeat what you said about section 14? Mr. Sisk was asking you about a specific portion of the bill that you felt was detrimental to the

Dr. DRYDEN. There were two portions that I wanted to answer that question-I did not get the opportunity to answer the other I did answer on section 14.

one.

Mr. HARSHA. What was your interpretation of section 14?

Dr. DRYDEN. I interpret section 14 as meaning that an employee of the District government cannot distinguish between an optometrist and a physician. Any employee of the District government-that includes a health officer, public health nurses, schoolteachers, and everyone else, cannot distinguish between an optometrist and a physician in referring eye patients for eye care. Exactly that. There is o other way to interpret it.