Honorable Calvin K.Y. Say

Speaker, House of Representatives

Twenty-First State Legislature

Regular Session of 2001

State of Hawaii

Sir:

Your Committee on Consumer Protection and Commerce, to which was referred H.B. No. 223 entitled:

begs leave to report as follows:

The purpose of this bill is to:

The Board, Hawaii Optometric Association, Hawaii Nurses' Association and numerous individuals, including many optometrists, submitted testimony in support of this bill. Hawaii Medical Association and numerous individuals, including many opthamologists, submitted testimony in opposition to this bill.

Your Committee finds that optometrist prescriptive authority is well established. All fifty states and the District of Columbia have granted optometrists the authority to use and prescribe drugs in patient care. Since 1986, schools of optometry, nationwide, have standardized their therapeutic drug education and training curriculum. Forty-five states now allow optometrists to use all topical drugs and treat glaucoma. Thirty-eight states allow the use of oral drugs. Your Committee heard testimony that optometrist prescriptive authority has had an excellent safety track record. A provider of insurance coverage for over 8,000 optometrists, nationwide, found that over the five years prior to 2000, no claims were specifically attributed to prescription error on the part of insured optometrists.

Hawaii gave prescriptive authority to therapeutically certified optometrists in Act 292, Session Laws of Hawaii 1996. Qualified optometrists have been prescribing and using drugs under the law since 1999. Hawaii's law is one of the most restrictive in the country. Unlike the 45 states that allow all topical drugs and glaucoma treatment, Hawaii allows some topical drugs and no glaucoma treatment. Unlike the 38 states that allow all or some oral drugs, Hawaii allows no oral drugs. In addition, Hawaii is the only state in the nation that does not allow its Board of Optometry to establish and administer the profession's drug formulary.

Your Committee finds that Hawaii's regulation of optometrists runs contrary to the policies of the Hawaii Regulatory Licensing Reform Act, which provides that a profession should only be regulated when reasonably necessary to protect the health, safety, or welfare of consumers, and not where regulation results in unjustified costs to consumers. Your Committee finds that the law's prohibition against oral drugs, and the required oversight of the Joint Formulary Advisory Committee, impose unjustified costs on consumers.

Your Committee finds that oral medication will, in some cases, provide the best method of treating an eye disease that an optometrist is qualified by training and education to diagnose and treat. There is no evidence that optometrists are inadequately trained to determine which medication would be safe and most effective. This is especially true in light of the insurance statistics provided your Committee that showed no claims specifically attributed to improper prescription. In addition, there is no evidence Hawaii's optometrists, who are therapeutically certified in one of the most rigorous certification programs in the nation, are less qualified than other optometrists to prescribe oral drugs. Your Committee thus finds that the prohibition on oral prescription drugs serves to unreasonably limit the treatment alternatives available to Hawaii's prescribing optometrists, and that its primary effect is to lower the quality of eye care that the State allows Hawaii's consumers to receive.

Your Committee further finds that the Joint Formulary Advisory Committee imposes an unnecessary level of oversight of the profession of optometry. Hawaii is the only state of 51 jurisdictions that gives a board other than its Board of Optometry, authority to establish the profession's formulary. Yet there is no evidence of risks specific to Hawaii's Board of Examiners in Optometry that justifies this unusual level of regulation. Your Committee cannot assume that Hawaii's optometrists, unlike those of other states, lack the ability to govern their own profession. Your Committee does find that the unusual level of regulation required by Hawaii's law has already imposed unjustified costs on consumers by depriving them of the newest and most efficacious drug treatments available.

Your Committee has amended this bill:

As affirmed by the record of votes of the members of your Committee on Consumer Protection and Commerce that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 223, as amended herein, and recommends that it pass Third Reading in the form attached hereto as H.B. No. 223, H.D. 1.

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