Mr. MAGEE. This bill is designed, sir, to forbid the corporate practice of optometry by anybody; it is designed to put the optician out of business; it is designed to prevent a nurse in a doctor's office, anyone except a person licensed to practice optometry, under this act, to do it, and the bill so states.

Mr. Grider. That may all be true, but now, will you answer my question? Is there anything in this bill which would require or encourage any Government agency or any private citizen to send a person to an optometrist rather than to an ophthalmologist? Mr. MAGEE. Section 14 forbids it.

Mr. GRIDER. You have answered that.

Mr. MAGEE. Yes, sir.

Mr. GRIDER. Is there anything else in the bill?

Mr. MAGEE. No; I would not say there is anything else in the bill which would require, except for the one provision, sir, that it can only be done by an optometrist, because the act restricts it to an optom

etrist.

Go to the act. Let us use the language:

It is further declared to be a matter of public interest and concern that the practice of optometry be limited to qualified persons

Then you define what the practice of optometry is:

admitted to the practice of optometry in the District of Columbia under the provisions of this act.

That would bar a doctor from doing it if you did not except them from the act.

Mr. GRIDER. That would make the practice of optometry of perhaps a little higher quality, but it will not require anybody to send a patient to an optometrist instead of an ophthalmologist, except section 14. Mr. MAGEE. When you get into the uplifting of quality, may I answer that?

Mr. GRIDER. I have not asked that, and I do not care to get into that.

Mr. WHITENER. Mr. Roudebush?

Mr. ROUDEBUSH. I do not want to haggle with you, sir. You are reading things into this section 14 that I certainly cannot see.

I shall have to agree with the gentleman from Ohio, Mr. Harsha. I cannot see how-section 14 says that 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 practitioner. That could be medical, M.D., ophthmologist, optician, and so forth, with respect to physical problems. Where do you see "optometrist"?

Mr. MAGEE. I interpret it simply as this, that if a health officer refers an optical case to a doctor of medicine, it is depriving the patient of his freedom to go to an optometrist. That is what it means.

Mr. WHITENER. That is particularly true in the case of welfare patients, where they get an order designating them to go to a certain practitioner, is it not? As I understand it, under the welfare program, even under social security, the patients have appointments set up for them where they are claiming a certain disability to work, and the agency says, "You report to Dr. Jones at the Professional Building on Monday morning, October 8, at 10 o'clock," and the patient has no choice unless he appeals to the Board and says, "I do not like this doctor. What about sending me to another doctor?"

I suppose in that way, it would be depriving him of freedom of choice, and it seems to me the language, the word "practitioner" goes further and means that, as you say, it not only applies to the optometrist but applies to M.D.'s, and if they send him to an optometrist and he wants an ophthalmologist, then he could claim that he had been deprived of the privilege of going to an ophthalmologist and, therefore, this section 14 would have the effect that these gentlemen say.

Mr. ROUDEBUSH. I can agree with that, Mr. Chairman. But how-the point I cannot get in my head is how the employee of the District of Columbia, and this says "officer or employee of the District of Columbia" would know to whom to refer such a man? Should he go to the M.D.? Has he a visual defect that should be treated by a doctor? Or does he have a simple refractive error?

In this case, would you have to refer every case to an M.D. and would you demand that everybody who wants to buy a pair of glasses would that the M.D. would have to examine him?

Mr. WHITENER. I did not mean to get into an argument with you. But I have an eye problem, and I called over to the Capitol physician and said, "I do not know whom to go to here in Washington. What do you recommend?"

They called downtown and arranged an appointment for me with a very fine ophthalmologist. I do not know whether they had a hundred on their list or one or two.

Mr. HARSHA. That surely does not deprive you of your freedom of choice.

Mr. WHITENER. No; but if I am a welfare patient, it may be different. If I went down to the Welfare Department and said, “I cannot work because I cannot see the difference between a green suit and a blue suit" and this becomes an issue as to whether I am eligible for welfare. Then the Welfare Department, I imagine, has authority now to say, "You go to Dr. Jones who will report back to us."

Mr. ROUDEBUSH. Who makes determination of the proper area of practice? How could you fellows be satisfied without every single man and woman with a visual defect coming to an M.D.? How would you satisfy your complaints if every single person did not go to an M.D.?

Dr. DRYDEN. We are satisfied with the situation as it is, and they are not all going to M.D.'s. As a matter of fact, we hold no brief with M.D.'s practicing optometry.

You get back to section 14, and I would like to make one point clear. The Health Officer of the District of Columbia is an M.D. Mr. ROUDEBUSH. This does not say Health Officer.

Dr. DRYDEN. It says "employee" and he is an employee.

Mr. ROUDEBUSH. But there are Capitol policemen and all other kinds of employees

Dr. DRYDEN. These are persons who recognize that a person needs medical care and they are prohibited under this law from telling people, "You must get medical care."

If it is a matter of glasses, the medical officer has no objection whether it is an optometrist or

Mr. ROUDEBUSH. You say that said employee is capable of telling this man, even though he is just an employee of the District of Columbia, maybe just a typist

Dr. DRYDEN. No, sir, I did not say that. I said nurses and physicians. In our school programs, we have nurses and physicians who are qualified people, who are qualified to determine what is a medical eye problem and what is an optometric eye problem. If it is an optometric eye problem, we have no objection where they send them. But we maintain their hands should not be tied by this section 14 enforcement to give the patient his choice when the patient does not have an idea.

Mr. ROUDEBUSH. Would you tell me where, in section 14, it appears, school nurses

Dr. DRYDEN. School nurses and health officers are employees of the District of Columbia government.

Mr. ROUDEBUSH. They are employees of the District of Columbia. But it does not say that in section 14. It says no officer or employee of the District of Columbia shall. Where does it say health officer and nurse?

Dr. DRYDEN. But the health officer, sir, is an employee.

Mr. ROUDEBUSH. So is a man who picks up paper out here on the curb.

Dr. DRYDEN. We are talking about the doctor who takes care of health. The man who picks up paper on the street is not going to be able to tell a person where to go.

Mr. ROUDEBUSH. This includes every employee of the District of Columbia.

Dr. DRYDEN. How could a man picking up paper on the street be qualified to tell a patient where to go?

Mr. ROUDEBUSH. But the bill as proposed does not say that.
Mr. WHITENER. Did you want to say something, Mr. Grider?
Mr. GRIDER. Yes.

Doctor, let me say I am sure we are all in accord that what we want is the best possible eye care for people who live in the District and for people who visit here. You do not have any objection, I take it, to a bill that would stop the practice of optometry by department stores and people of that type? You do not look upon that as good for the public, do you?

Dr. DRYDEN. Sir, that is a problem that the medical profession has never taken issue with.

Mr. GRIDER. You do not want to take a position on that?

Dr. DRYDEN. You mean on the selling of glasses in department stores?

Mr. GRIDER. Yes, sir.

Dr. DRYDEN. We are not taking issue with it. We think that is a legal problem for the optometric board and the legal profession to decide.

Mr. GRIDER. Regarding it generally as a practice, do you think it is good or bad?

Dr. DRYDEN. If you want my honest opinion about it, sir, I can tell you this: We see patients who come from the department stores, who come from the fourth floor optometrist's offices, we see them come from physicians practicing here in the District. I must say in all sincerity we see as many referred cases of eye diseases from the department stores as from the other places. We make no distinction. Mr. GRIDER. I take it your answer is that you do not think it makes much difference whether they sell them

Dr. DRYDEN. I think it is the training of the individual himself. Whether he works in a department store or in another place, he is an optometrist. If he practices optometry as he does usually and should, it makes no difference what kind of a place he practices in, whether it be a department store or any other place.

Mr. GRIDER. Now, I find it difficult to reconcile what looked to me like ambivalent attitudes in your testimony. First, you seem to be saying that optometrists are not, by the nature of their training, qualified to diagnose illnesses of the eye.

Dr. DRYDEN. That is correct, sir.

Mr. GRIDER. I do not disagree with you on that. I think that is correct.

However, in the next breath, you say that if this bill is passed, it will prohibit teachers, members of the PTC, and medical students from screening people.

Dr. DRYDEN. That is correct, sir.

Mr. GRIDER. Do you believe that they are better qualified to diagnose diseases of the eye than optometrists?

Dr. DRYDEN. Why, they are working under the supervision of a physician. Medical students, of course, are in training under a physician. They are not working as independent producers. Technicians, medical students, nurses are working under the supervision of a physician.

Mr. GRIDER. Surely there is not a physician present in every classroom?

Dr. DRYDEN. They do not have to be present, sir.

Mr. GRIDER. What happens to the report after the teacher tests the eyes?

Dr. DRYDEN. It becomes part of the patient's record and the information thereon is used for the benefit of the patient.

Mr. GRIDER. Is it then reviewed by an M.D.?

Dr. DRYDEN. That is correct.

Mr. GRIDER. I take it, speaking candidly, that you do not seem to believe that if an optometrist found a patient with a disease of the eye, he would be inclined to refer him to an M.D. Does that trouble

you?

Dr. DRYDEN. I have to accept the basis of this document here in answering your question, sir. And this is proof enough. It was promulgated by a well-established board set up by a State agency. I think it speaks for itself in answering your question.

Mr. GRIDER. Do you mean the North Carolina data?

Dr. DRYDEN. Yes, sir, and I must say our experience here does not differ from it a great deal

Mr. GRIDER. Do you find anything in our present act which is similar to that in the social security requirement?

14.

Dr. DRYDEN. Yes.

Mr. GRIDER. What?

Dr. DRYDEN. I hate to embarrass you, by referring back to section It certainly does. It equates optometry and ophthalmology. Mr. GRIDER. If we could amend section 14, then that objection would be removed?

Dr. DRYDEN. Amend it? It should be eliminated. There is no need for it.

Mr. GRIDER. Thank you.

Mr. WHITENER. Mr. Broyhill?

Mr. BROYHILL. Mr. Chairman, the sponsor of this legislation has agreed that if there is any misinterpretation of the thrust of section 14 he would agree to amend it for clarification. Certainly, we have built up a record here as to what was the intent, or what the feeling of intent was, on the part of some of the members of the committee and what the witnesses feared was the intent. I think we can clarify that, if not in the language, certainly in the report on the legislation, so that there will be no fear in that regard.

Doctor, back to this question of the nurses and the technicians, and the teachers participating in the examination of eyes, would you elaborate on just what it is that a nurse or a technician in a physician's office does in the examination of the eyes that this bill would prevent? Dr. DRYDEN. Many of us use our nurses to check our patients' vision as they come in. They read the chart and put on the record how much the patient can see. Some of us use our nurses for taking

visual fields; a purely mechanical art.

In the Washington Hospital Center-I am on the staff over there and I can speak better from their point of view than any other hospital's, we have about 30,000 patients a year that come through our clinic over there. Every one of those patients, the nurses chart their visual acuity the minute they enter the building. That is part of their record.

The physicians working over there could not possibly do all of these tasks. We have our glaucoma clinic over there, we also have the retinal attachment clinic, we have the orthoptic clinic. We have technicians who prescribe in this field of optometry. They are not excluded under this act, and if this act becomes law without amendment, even though they are working in our hospitals for the physicians, or the Department, they still are not going to be able to do this.

Mr. BROYHILL. I wonder if your attorney would point out what language in the bill would prevent, let us say, your nurse from having one of your patients read a chart?

Mr. MAGEE. Turn to page 3 of the bill, Congressman, which has on it, under section 3, beginning on the bottom of page 2, "or the fitting or adaptation of contact lenses to the human eye; and the identification of any departure from the normal condition or function of the human eye, including its associated structures."

Now, the nurses and technicians and the aids to the doctors are certainly doing just that. This bill says this can only be done by an optometrist admitted to practice in the District of Columbia under this act.

Mr. BROYHILL. That is when the ophthalmologist asks the nurse to have a patient read a chart and she reports to him her findings. language prevents that type of service?

This

Mr. MAGEE. Yes, sir; it precisely does, because that is exactly what she is doing, looking for abnormalities in the eye and its related, associated structures. That is what all the visual tests that are being done to ascertain, whether or not there are deficiencies in vision or whether you have a medical problem which is causing the deficiency in vision.

Now, I am told, and you gentlemen can check this, that where you have difficulty in vision, usually behind this is a biological problem of