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. I 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

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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 one. I did answer on section 14.

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 no other way to interpret it.

As a matter of fact, this has crept into some State laws, and State employees have been prosecuted for distinguishing between the two. Mr. HARSHA. That is a little different statement than you made to Mr. Sisk about that section. I do not recall, myself, what you said, but I was surprised at the interpretation you gave to section 14. I do not know whether we have the same section or not.

Dr. DRYDEN. That is the interpretation. I hope I gave that same interpretation to Mr. Sisk.

No officer or employee of the District of Columbia shall, in the administration of any law applicable to the District of Columbia, deprive any person of his freedom of choice of practitioners with respect to his visual problems.

Dr. DRYDEN. That is exactly what I am talking about.

Mr. HARSHA. What does that have to do with making a suggestion that you might go to Dr. so-and-so?

Dr. DRYDEN. It has everything to do with it.

Mr. HARSHA. That does not deprive him of any freedom of choice. Dr. DRYDEN. It deprives the health officer and the school nurse of freedom of choice.

Mr. HARSHA. You surely do not believe that interpretation?

Dr. DRYDEN. I most certainly do. People have been prosecuted for it under this.

Mr. HARSHA. You mean merely to suggest that he might see Dr. Smith or Dr. Jones, then they are depriving somebody of his freedom of choice?

Dr. DRYDEN. That is exactly it. It sounds ridiculous, but it is

true.

Mr. HARSHA. It certainly does.

Is the rest of your testimony so interpreted, along similar lines, as this section?

Dr. DRYDEN. Yes, sir; they define optometry as including all of these things on the first page of the bill.

No place do they exclude anybody except the physician alone. That means that every technician who works for a physician will be practicing optometry under the provisions of this bill. That means that every nurse in every hospital in this city who takes a person's visual acuity, will be practicing optometry under this bill, and there is no other way to interpret it, because they are not excluded.

Mr. HARSHA. I am not arguing with you about somebody giving a clinical test of some kind, but I certainly think you have a strained interpretation of that section 14. I am not debating the proposition, whether you have somebody actually examining the individual; that may be true to a degree, but

Dr. DRYDEN. I have talked this over with health officers and attorneys both, sir, and they concur in that opinion.

Mr. HARSHA. Do they have any case history for such an interpretation?

Dr. DRYDEN. Sir?

Mr. HARSHA. Do they have any case history for such an interpretation of section 14 or similar sections of any kind?

Dr. DRYDEN. Let us let the legal counsel discuss that with you. Mr. HARSHA. You have one there with you. Could he answer that?

Mr. MAGEE. There are decisions but I cannot give you them this morning. This is the practice as it was followed in the State of North Carolina.

This is the very point. This section was incorporated in a law which was applied in North Carolina in the optometric field and in this field the State authorities could not refer a medically indigent, a person who had a medical problem in the eye, to a physician. If forbids it because it deprives, in effect, the freedom of choice of the patient to go to an optometrist if the health officer says, See a doctor. This is the way the law is construed.

Mr. HARSHA. Was this so interpreted by a court of law?

Mr. MAGEE. I am sure it has been. We shall find this and submit it to you. I shall look it up for you gentlemen, go into this for you. We are giving you the physical results of it. What is it in there for? What would it do in your opinion, Mr. Harsha?

Mr. HARSHA. Well, I would interpret the instruction to deprive somebody would be a little stronger language, a little stronger act rather than recommending that you go to Dr. Smith or Dr. Jones to see about your eyes.

Mr. MAGEE. Why does an optometric act need a section 14? Why should not a health officer be authorized, without any prohibitions or privilege or preference, or taking something from an optometrist, to send a case to a doctor of medicine?

Why should it be in such an act?

Mr. HARSHA. I do not know why he should be deprived of such a thing.

Mr. MAGEE. He is by this provision, sir, as we interpret it. You may differ with us as lawyers, but that is our opinion.

Mr. HARSHA. I shall yield to Mr. Grider.

I cannot see that interpretation.

Mr. GRIDER. I want to ask counsel a question. As I understood this, it was an amendment to the Social Security Act, which permitted the optometrists to certify the blind in North Carolina. Mr. MAGEE. That is correct.

Mr. GRIDER. This had nothing to do with the local law of North Carolina?

Mr. MAGEE. No, but it works this way, sir. They receive funds and they have grants and the administration of these funds and grants to persons who are put on a total disability list because they are blind is done on the opinion of an optometrist, and because of this provision, they cannot refer it to a doctor to see if it can be corrected. Mr. GRIDER. Do you see anything in the present bill which will have the same effect?

Mr. MAGEE. Section 14 has this same effect.

Why not eliminate it? What is its purpose?

Mr. GRIDER. Is that the only provision which does it?

Mr. MAGEE. Oh, no, I have other objections to this bill, sir.

Mr. GRIDER. No; I mean which has the effect of forcing the requirement or encouraging persons to seek an optometrist when they should go to an ophthalmologist?

Mr. MAGEE. We are referring to the bill as drawn, are we, Mr. Congressman?

Mr. GRIDER. Yes.