Honorable Robert Bunda

President of the Senate

Twenty-Second State Legislature

Regular Session of 2004

State of Hawaii

Sir:

Your Committee on Commerce, Consumer Protection and Housing, to which was referred H.B. No. 1797 entitled:

begs leave to report as follows:

The purpose of this measure is to expand the practice of pharmacy by:

The Board of Pharmacy (Board) and numerous optometrists testified in support of this measure. The Hawaii Medical Association, Hawaii Psychiatric Medical Association, Hawaii Ophthalmological Society, Hawaii Coalition for Health, numerous physicians, and other individuals opposed the measure.

Under the current optometry licensing law, therapeutically certified optometrists may use and prescribe Board-approved topical TPAs only, subject to certain restrictions. Current law also prohibits TPA certified optometrists from dispensing or administering nonprescription oral pharmaceuticals, from using prescription anti fungal, injectable, or oral agents, and from treating glaucoma.

This measure repeals the above restrictions and allows TPA certified optometrists to use and prescribe Board-approved TPAs, in general, including steroids, but retains the exclusion for controlled substances. Restrictions on methods of administration are also lifted, although the authority to administer injectable agents is limited to the treatment of anaphylaxis. Additionally, this measure permits the treatment of glaucoma.

Your Committee finds that, in order to become TPA certified, an optometrist must complete a one hundred hour course in the treatment and management of ocular disease at an accredited school of optometry, pass the National Board of Examiners in Optometry's treatment and management of ocular disease examination, and complete a minimum of one hundred hours of preceptorship under the supervision of an ophthalmologist, that includes training in the diagnosis, treatment, and management of ocular diseases. Additionally a TPA certified optometrist must complete at least thirty-six hours of TPA continuing education biannually.

Your Committee further finds that since the law authorizing the use of TPAs by optometrists has been in effect in this State, the Board has not received any complaints against an optometrist for the improper or inappropriate use of any TPA. With respect to the liability issue, the primary liability insurer for 10,000 optometrists nationwide has reported that premium rates for optometrists who prescribe TPAs are no higher than rates for optometrists with a standard practice, and that rates have essentially remained constant since 1993.

Your Committee further finds that the majority of states, the District of Columbia, and Guam, allow optometrists to treat glaucoma and administer oral medication, and that half of the states permit the use of injectables for anaphylaxis.

Finally, your Committee finds that examinations by optometrists account for approximately seventy per cent of all routine eye examinations performed in this country. Since an optometrist is often the first medical professional to detect an ocular problem or disease, this measure will facilitate early and timely treatment by an appropriately trained professional. Further, this measure will provide consumers with increased access to care, increased treatment options, and greater continuity of care.

As affirmed by the record of votes of the members of your Committee on Commerce, Consumer Protection and Housing that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1797, and recommends that it pass Third Reading.