Mr. HORTON. Of course I realize you are limited by the law. Mr. HORTON. Do you strictly interpret the law or are you liberal in your interpretation? Dr. EPHRAIM. We strictly interpret the requirements on educational background. We are not allowed to grant a license by reciprocity; so anybody granted a license must have the proper background and must pass the examination required by law. Mr. HORTON. Are the examinations based on technical questions relating to the practice of optometry? Dr. EPHRAIM. Yes. Mr. HORTON. They have nothing to do with an applicant's personal background but only the technical requirements? Dr. EPHRAIM. As part of the requirements or qualifications the Department of Occupations and Professions have the Police Department run a personal check as to any record of arrests or misconduct. Mr. HORTON. What kind of examination do you give? Is it a lengthy one? Is it complicated? Dr. EPHRAIM. It is about 20 hours per group of examinations. There are about ten examinations of two hours each. Mr. HORTON. How many are licensed for the practice of optometry in the District of Columbia? Dr. EPHRAIM. About 175 are holding licenses, of which about 80 practice here. Mr. HORTON. So you have about 80 practicing optometrists in the District of Columbia? Dr. EPHRAIM. Yes, sir. Mr. HORTON. Are these individual licenses or do you issue licenses to corporations? Dr. EPHRAIM. They are strictly a personal license. Mr. HORTON. Thank you. Mr. NELSEN. What is the history of license revocation in the District? Has there ever been a license revoked in the District of Columbia? Mr. EPHRAIM. Not to my knowledge. Mr. NELSEN. What is the history of revocation in outlying States? Is there any history of revocation? Dr. EPHRAIM. Yes, sir, there have been. Suspensions, I would say, as much as revocations. Mr. HORTON. Will you yield at that point? Mr. NELSEN. Yes. Mr. HORTON. When you issue a license does that license have to be renewed? Dr. EPHRAIM. Yes, every year. Mr. HORTON. It has to be renewed annually? Dr. EPHRAIM. Yes. Mr. HORTON. Do they have to take an examination for that. renewal? Dr. EPHRAIM. No, it is automatic. It is just a matter of paying fees. Mr. NELSEN. Has your Board ever advanced any request for added authority through the legislative process to the Commissioners? Is there anything you have suggested to them that would strengthen your hand in the handling of licenses. Dr. EPHRAIM. Yes. About a year or a year and a half ago the Commissioners drew up a bill to remedy some of these evils and at the hearing there were so many changes made that when the bill was submitted to the Corporation Counsel for opinion the Corporation Counsel said, "You are essentially back where you were.' But the Commissioners saw the need and drew up a law about one and a half years ago. Mr. NELSEN. In other words, the problem lies in the lack, so far, of proper drafting Have you examined the Sisk bill? Dr. EPHRAIM. Yes. Mr. NELSEN. Do you feel there is a need for legislation as outlined in this bill? Dr. EPHRAIM. Yes, sir. Mr. NELSEN. Do you feel there are some changes that should be made for clarification? Dr. EPHRAIM. Very definitely. Mr. NELSEN. Have you examined the suggested changes? Dr. EPHRAIM. Yes, but there has been so much confusion I do not know what they are today. Mr. NELSEN. Confusion is not hard to find. Mr. NELSEN. I have no further questions but it seems to me the intent of any licencing procedure is not just to collect fees but it is to police the professions and occupations that are licensed. It appears to me there should be more authority in the hands of the Board, and if legislation is needed, let us provide it. Dr. WARREN. If I might say one other thing to follow up on Mr. Nelsen's remarks, it brings to mind that the wording in our bill is almost identical with the wording in the Dental Act and in the Podiatry Act. Dentists and podiatrists have found it necessary to restrict advertising. You cannot display part of a foot, for example, or display bridgework. In 1939 you could. As I have said before, artificial teeth were hanging in the breeze. I have asked a rather facetious question: Which is more important, your feet or your teeth or your eyes? Mr. DowDY. Any further questions? Mr. SISK. To follow up the questions asked by the gentleman from Minnesota, Mr. Nelsen, I believe, Dr. Ephraim, you said you did feel legislation was needed? Dr. EPHRAIM. Yes. I Mr. SISK. Is this feeling shared by all members of the Board? would like each of you to state your position because I do feel this is important to know. You are Dr. Greenwood? Dr. GREENWOOD. Yes, John Greenwood. Mr. HORTON. Will you yield? Somebody referred to the Commissioners' bill. Is there another bill? Dr. EPHRAIM. No. The bill I referred to when you asked if the Commissioners were aware of this need was a bill the Commissioners drew up one and one-half years ago and when they finished amending it the Corporation Counsel ruled they were back to the original law and there was no sense in going further with it. Mr. HORTON. Thank you. Mr. SISK. Dr. Greenwood, do you feel legislation is needed in this field? Dr. GREENWOOD. I feel very strongly that it is needed, both as a member of the Board and as a practicing optometrist. I do not feel the public in the District of Columbia is adequately served by the present law. I think the present law is doing the public an injustice and we, as members of the Board, are very limited in what we can do to police our profession. We do not have some of the weapons other professions have and we are powerless to do anything. The evils, the way I see them, extend on both sides of the spectrum, not only with. gross overcharges which are next to highway robbery, but on the other side of the spectrum where the fee is ridiculously low in order to have quantity rather than quality that it is impossible to render a professional service to the public. In order to render good professional services there must be a direct doctor-patient relationship which cannot exist if the allegiance of the optometrist is to the stockholders of the corporation rather than to the patient. Mr. SISK. Thank you. Dr. Witten, do you agree that legislation is necessary? Dr. WITTEN. Yes. I thoroughly agree with what Dr. Greenwood has said. I have only been on this Board approximately a year but we spend most of our time doing nothing except examining and licensing people who make application. Our hands seem to be tied. Mr. SISK. Dr. Teunis, I do not think you have made any comment. What is your feeling as to whether legislation is necessary? Dr. TEUNIS. Definitely there should be some authority given to the Board to regulate the profession. One remark was made that since there was only one corporation that we had evidence on to present here, that this was our chief problem. It is a big problem but I think you will find any of the advertisements you see in the newspapers or in the phone book and so forth, which are legal under the present bill, if you could account for the time. of the doctors who advertise you would find the patients get less service. This is the big thing; the ethical practitioner gives a lot more service to his patients Mr. SISK. Thank you. I think you, Dr. Ephraim, and Dr. Warren, have already expressed your position. I think probably some of you were here at the earlier hearings. In the earlier hearings there was some material placed in the record with regard to a report from North Carolina. I do not want to step on the toes of my colleague from North Carolina, but I did want to discuss this report. I believe you are familiar with the report that was put in the record from the North Carolina Commission for the Blind. Do optometrists participate in that State program? Dr. EPHRAIM. In North Carolina? Mr. SISK. Yes. Dr. EPHRAIM. Yes, they do. Mr. SISK. In what way? Dr. EPHRAIM. Under the Social Security Act where no discrimination was permitted between free choice of practitioner the patients were referred to both optometrists and ophthalmologists for certification as to their vision. Mr. SISK. What is the responsibility of an optometrist in an eye clearance case where a patient needed medical attention? Dr. EPHRAIM. The optometrist takes a responsibility and he is trained to recognize pathology. His responsibility is to see that that patient is referred to the proper practitioner. Mr. SISK. In a North Carolina case, as I recall, the records or report that went in the record shows optometrists did make referrals. Is that true? Dr. EPHRAIM. Yes, sir, they made referrals but Mr. SISK. How are those referrals made, direct to the physician or ophthalmologist or state board? Are you familiar with that? Dr. EPHRAIM. In that case I think there was a misunderstanding upon instructions. When that program was set up the optometrists at that time were instructed to register their findings on the form they use, which is called B-A-2. These forms then were to be forwarded to the North Carolina Commission for the Blind who would then make the referrals in the needy cases. I saw initially a copy of the original instructions which were issued in February 1960. Later on when these records were examined--they started examining the records submitted in March 1960 through March 1962-the claim at that time was made that these men did not refer properly but they followed the letter of their instructions. Mr. SISK. That is what I am trying to bring out. It is my understanding that that referral was to be made to the state board and I believe more recent reports show those referrals were made? Dr. EPHRAIM. Yes, sir. Mr. SISK. Do you know of any failure of optometrists to comply with these state requirements? Dr. EPHRAIM. No, sir, I think the records submitted in criticism of this program showed that diagnoses were made and it was the duty of the consulting ophthalmologists of the commission to see that these patients were properly cared for. Mr. SISK. After the cases had been referred to the state board then was it the board's responsibility to refer for medical attention? Dr. EPHRAIM. Yes, sir, that is how the instructions were set up. Mr. SISK. I simply felt there should be some clarification on that in view of the fact there is quite a little bit made at the time that the report was put in the record. If you had some clarification on that it places it in a considerably different light than was placed on it at the time it was inserted. I think we wanted to get that in the record. Actually under North Carolina law, as I understand it-and I am sure my colleague, Mr. Whitener knows much more about it than I do-but it was my understanding that the law requires they refer it to the board and it is the board's responsibility to refer it to the physician. Failure to refer then becomes an obligation of the board rather than the optometrist even though there were abundant records the optometrists did refer to the board. Mr. WHITENER. May I? Mr. DOWDY. Yes. Mr. WHITENER. I do not think that your answer is exactly correct about the procedure according to the correspondence which has been furnished to me by one of my optometrist friends in North Carolina. As I understand it from this correspondence, the procedure, back in 1961, the year of this report put in the record by Dr. Dryden, it was supposed to assume certain things. The procedure was as follows: If in the opinion of the examining optometrist a patient was found to be in need of other than optometric care this information was to be indicated on the commission's form B-A-2. That form was sent to the nearest District Office for the Commission of the Blind and I assume that then the District Office of the Blind would refer the patient to one of the ophthalmologists who had entered into agreement with the State Commission on the Blind to participate. As I understand it further, where the optometrist found that the referred patient, referred by the Commission on the Blind, was in need of glasses, then the optometrist could refer that patient to an optical company which dispensed glasses under agreement with the Commission on the Blind, or you under contract. But in those cases, the optometrist would send a copy of his referral to the Commission on the Blind. The reason that the Commission on the Blind required that was to prevent the commission from ordering two pairs of glasses on the same prescription. Another reason they set forth that requirement was that the optometrist could only prescribe the type of frames and lenses which the commission had approved. In other words, they did not want to buy from a New York jewelry company a fancy set of glasses for $180. They had a certain type of lens and type of frame they would pay for. So that seemed to me to be the procedure. If they found he needed treatment, medical treatment, he sent that form B-A-2 to the commission and the "need slip" they called it, form CR-2, and then the commission would authorize this patient to go to one of the ophthalmologists who indicated a willingness to cooperate. Is that not the way it works? Dr. EPHRAIM. Yes, sir. Mr. WHITENER. The optometrists in North Carolina say that the report which Dr. Dryden made a part of the record in his testimony is unfair to them because this report indicated that certain patients examined by the optometrists were in need of medical care but were not referred to an ophthalmologist. The optometrists say that that is true. But they say that they followed the procedure prescribed by the Commission on the Blind and sent in the form B-A-2 to the local or regional office of the State Commission on the Blind and that they, the optometrists, had no responsibility or authority to make a direct referral to the ophthalmologist. Is that the function of the Commission on the Blind? Dr. EPHRAIM. Yes, sir. Mr. WHITENER. Is that not the difference of opinion which we have here between the District of Columbia Medical Society and the North Carolina optometrists really what this report of the Commission on the Blind held? Dr. EPHRAIM. Yes, sir. That is it in a nutshell. I think there is another piece of information there which Mr. Wood has had forwarded, who is the executive chairman of that commission, which was the original instruction sent out to the optometrists to the effect that they merely followed these procedures that you set out, fill out the form, send it to the commission, and they in turn would refer out. Somewhere along the path this bit of information I think was lost or misinterpreted because if the optometrists had not done their |