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"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.

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14. 15.

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.

(4) 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.

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

therefore, advertising should be permitted. A simple analogy refutes this argument. When the orthopedist furnishes his patient with the neck collar or the brace to support a limb or a back, these too are articles of personal property, but they may not ethically be advertised. When the dentist supplies his patient with dentures, bridgework, or similar dental appliances, he, too, is furnishing articles of personal property but these likewise do not fall in the category of being ethically advertised.

Likewise, in optometry. Eyeglasses are not optometry per se; they are incidents of the practice of optometry, the results which may be indicated. The practice of optometry is primarily and basically the exercise of training, talent, discretion, and professional judgment involved in the examination of a person's eyes to determine whether anything is needed, and just what it shall be, for the purpose of correcting, improving, and making comfortable the vision of the patient.

Perhaps the reasons have been best stated by Chief Justice Hughes in the case of Semler v. Oregon State Board of Dental Examiners. Dr. Semler had been an advertising dentist. The Oregon Legislature had passed a law against advertising. Dr. Semler attacked the validity and constitutionality of this action. The Chief Justice stated:

"We do not doubt the authority of the State to estimate the baleful effects of such methods and to put a stop to them. The legislature was not dealing with traders in commodities, but with the vital interest of public health, and with a profession treating bodily ills and demanding different standards of conduct from those which are traditional in the competition of the marketplace. The community is concerned with the maintenance of professional standards which will insure not only competency in individual practitioners, but protection against those who would prey upon a public peculiarly susceptible to imposition through alluring promises of physical relief. And the community is concerned in providing safeguards not only against deception, but against practices which would tend to demoralize the profession by forcing its members into an unseemly rivalry which would enlarge the opportunities of the least scrupulous. * * *"

(9) Practicing under a name other than that under which he has been licensed. The name of a professional practitioner is his most valuable asset. Practicing under a trade name or fictitious name is not only an imposition upon the public but is deemed unethical by all health-care professions.

(10) Offering free examinations and other forms of bait.

There is no such thing as "a loss leader” in the practice of a profession. It is demeaning and belittling to the very essence of a profession to seek patronage by allegedly offering free services, bonuses, premiums, and the like. What confidence could the public have in the profession of medicine if the physician were permitted to advertise a premium of a free appendectomy with every gall bladder operation. (11) Display of spectacles.

This is simply the implementing of another part of the underlying reason for the existence of a profession, that the professional services offered must be based upon skill and ability, not an advertising or show-window display. Physicians do not have scalpels or forceps in display cases outside their offices, dentists do not have crowns and artificial teeth, bridgework and dentures displayed in the windows of their offices.

(12) The act requires that the license be displayed, but not in such a manner that it can be seen from the outside of the premises.

The display of the license is for the patient's protection, not as a form of quasiadvertising.

(13) Except as provided in section 9, the use of certain words, such as "clinic," "infirmary," "hospital," etc., either in Fnglish or any other language in connection with any activity which is essentially the practice of optometry, is prohibited.

Many people are inclined to attach importance to descriptive words such as clinic, infirmary, hospital, etc., which may be misleading.

(14) Authorizes the Commissioners to discipline an optometrist who permits the use of his name or professional title in conjunction with advertising of his professional services in any form or manner by any person.

The public seeks out the optometrist because of the respect and confidence they have in him for excellency in the practice of his profession rather than because he might happen to be associated with some other group or association. (15) Prohibits an optometrist from claiming professional superiority or the ability to perform professional services in a superior manner.

(16) Authorizes disciplinary action against an optometrist who employes a third person to influence or direct patients to him.

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(17) Prohibits a licensed optometrist from practicing in any retail, mercantile, or commercial store or premises not exclusively devoted to the practice of optometry or other health professions.

This section follows the sociological trend of furnishing the public a comprehensive health-care service. While the optometrist usually practices in his own office which is devoted exclusively to optometry, there exists a growing trend to small health centers housing the offices of physicians, dentists, and optometrists. The day has long passed when physicians might practice in mercantile or commercial surroundings. A decade or two later, dentistry adopted the same ethical principle of location. As with these other professions, it is important to the health and welfare of the citizen that the optometrist practice only in a professional office.

A retail or commercial store office for an optometrist does not lend itself to a professional practice. Such locations do not generate an atmosphere conducive to a proper doctor-patient relationship and seldom afford the optometrist the opportunity to provide the patient total vision care as defined in the bill, section 3. (2).

(18) Authorizes disciplinary action against an optometrist who practices as an employee of a third person other than a duly licensed optometrist or in accordance with the provisions of section 9 of the act.

It is fundamental that the sole and exclusive responsibility of a professional practitioner is to his patient. To be employed by a lay person, firm, or corporation, to be dictated to either directly or indirectly, implicitly or explicitly, as to how long an examination should take or how much care and attention the practitioner should give to the patient, is completely contrary to the concept of proper practice. Neither the optometrist nor any other health-care practitioner should be subject to the conflicting interest of two responsibilities (a) to his patient and (b) to a nonprofessional employer whose primary concern is making a profit.

It is proper and normal for an optometrist to be what might be termed a "house" optometrist. In such case, he offers his services and performs his professional tasks for the employees of an industrial plant, bank, or any other organization which seeks to have an optometrist in its health-care department. On the other hand, the bank, insurance company, or manufacturing plant which employs the optometrist should not be permitted to offer the optometrists' services to the outside public.

A lack of con

There is a very proper public antipathy to the sharing of fees. fidence must ensue where the fee the optometrist receives from the public never belongs to him at all, but goes to an employer who simply pays the optometrist a salary and thereby promotes and exploits the professional services of a heath-care practitioner. Respect for a profession is vital. Respect deteriorates when a practitioner may be hired at will by an unlicensed person to perform professional services upon the public. Optometry and the care of vision are far too important to permit such a situation to exist.

(19) Applies to any other unprofessional conduct.

Section 7(b)-Revocation.-Specifies the procedure for disciplinary actions, requires written charges, notice of hearing, service upon the respondent at least 20 days before hearing, waiver of hearing must be in writing, respondent is entitled to counsel and to call witnesses at the hearing.

This conforms to the usual procedure before administrative agencies to conform with the Supreme Court's interpretation of the "due process" clause of the U.S. Constitution.

Section 7(c)-Reinstatement.-Authorizes the Commissioners to reinstate a license previously revoked, provided at least a year has expired from the date of revocation.

It is customary to permit the reinstatement of any license which has been revoked. The provision specifying that 1 year must elapse before the application for reinstatement may be accepted is to protect the Commissioners from a multiplicity of reinstatement applications.

Section 8(a)-Unlawful acts. This section applies to "any person," including a licensed optometrist, and declares it to be unlawful to do numerous acts, including the following:

(1) To practice optometry without a valid license.

(2) To practice or offer to practice optometry under the name of any company, corporation, trade name, etc., except the name which appears on the license issued under the act.

(3) (a) To sell or fraudulently obtain a license or diploma or to aid and abet therein; (b) to practice under cover of any document or record required by the Commissioners under authority of the act which was illegally or fraudulently

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