Committee Summary for House Executive Departments and Administration (01/23/2025)

Bill/Time	Type	Title	Sponsor
HB144 00:01:41.079 - 9:00:42 AM	Public Hearing	relative to the practice of dental hygiene.	Grote, Jaci(D)[CT]2024
HB144 00:06:24.160 - 9:05:25 AM	Executive Session	relative to the practice of dental hygiene.	Grote, Jaci(D)[CT]2024
HB145 00:46:27.520 - 9:45:28 AM	Public Hearing	relative to background checks for licensed dietitians and adopting the dietitian licensure compact.	Grote, Jaci(D)[CT]2024
HB214 03:00:13.040 - 11:59:14 AM	Public Hearing	relative to the regulation of recreational therapists and respiratory care practitioners.	McGuire, Carol(R)[A+]2024
HB227 03:16:03.640 - 12:15:04 PM	Public Hearing	relative to licensure for psychotherapy activities or services.	Layon, Erica(R)[A]2024
HB236 03:34:53.960 - 12:33:54 PM	Public Hearing	relative to the granting of retired status to certified public accountants.	Muns, Chris(D)[CT]2024
HB236 03:51:48.199 - 12:50:49 PM	Executive Session	relative to the granting of retired status to certified public accountants.	Muns, Chris(D)[CT]2024
HB349 04:06:35.399 - 1:05:36 PM	Public Hearing	relative to the practice of optometry and authorization to perform ophthalmic laser procedures.	Kofalt, Jim(R)[A+]2024

HB144: Jackie Groa, State Representative, Rockingham District 24 Information Only00:01:41.079 - 9:00:42 AM; Representative Groa introduced House Bill 144, which was requested by the Board of Dental Examiners. The bill addresses a discrepancy between the rule making and statute regarding the administration of nitrous oxide and local anesthesia by dental hygienists. The current rule allows hygienists to use these substances, but the statute lacks authority and requirements for such practices. The bill aims to align the statute with the rule making to ensure that dental hygienists are properly qualified to administer these substances.
HB144: Lori Rosado, Practicing Dentist, Concord, Council for Governmental Affairs, New Hampshire Dental Society Support00:04:53.840 - 9:03:54 AM; Lori Rosado confirmed the use of nitrous oxide in New Hampshire, stating it is used in sedation settings like oral surgeons' offices and general dental offices. She supported the bill, noting that the practice by dental hygienists is already safe and within their scope, but the bill would ensure statutory alignment with the rule making, as requested by the board.
HB144: Representative Broa Support00:06:24.160 - 9:05:25 AM; Representative Broa moved to pass House Bill 144, explaining it was at the request of the Board of Dental Hygienists to align statute with rule making regarding the administration of nitrous oxide and local anesthesia.
HB144: Representative Land Support00:06:24.160 - 9:05:25 AM; Representative Land seconded the motion to pass, stating that the bill would increase patient protection by ensuring that the practice of dental hygienists is held to standards in law.
HB144: Representative Schmidt Support00:07:17.160 - 9:06:18 AM; Representative Schmidt emphasized the importance of ensuring that dental hygienists are examined to demonstrate their training and proficiency in administering nitrous oxide and local anesthesia, supporting the bill's intent to formalize these requirements in statute.
HB144: Representative (unspecified) Information Only00:07:57.680 - 9:06:58 AM; An unnamed representative inquired about whether there had been any issues in this area that necessitated the bill. It was clarified that an audit of the Dental Board had identified discrepancies between rules and statutes, and this bill was one step in addressing those discrepancies. The representative also expressed concern about the increasing licensing requirements but acknowledged that if licensing continues, ensuring training and proficiency is important.
HB145: Jackie Groa, State Representative, Rockingham District 24, representing Rye and Greenland Information Only00:46:27.520 - 9:45:28 AM; Representative Groa introduced House Bill 145, a compact for dieticians, explaining that compacts were originally designed by the Department of Defense to facilitate professional portability for military spouses. The bill aims to allow dieticians who meet certain licensure requirements to practice in states that are part of the compact. The Board of Dieticians is enthusiastic about joining this compact, and Groa sponsored the bill at their request.
HB145: Abby Svards, Chair of the Board of Licensed Dietitians Information Only00:48:25.440 - 9:47:26 AM; Abby Svards, representing the Board of Licensed Dietitians, provided information on HB145. She emphasized the role of dietitians in New Hampshire, highlighting the challenges in distinguishing between credible and non-credible nutrition information. She discussed the importance of RSA 326-H:2, which outlines the value of dietitians in treating medical conditions and improving quality of life, while also ensuring that anyone can provide nutrition advice but with established qualifications for practicing dietitians. Svards explained the compact's governance and how New Hampshire residents would maintain licensure under state laws and compact provisions. She noted that HB145 introduces a criminal history check requirement, aligning with the compact's standards, to ensure public safety and facilitate information exchange among compact states. She concluded by welcoming questions and expressing readiness to answer them to the best of her ability.
HB145: Representative Pearson Information Only00:52:08.599 - 9:51:09 AM; Representative Pearson asked Abby Svards about the procedure for withdrawing from the compact, to which Svards replied that it involves a 180-day notice period and referred to section 12 of the compact document. Pearson also inquired about the distinction between state and compact licenses, and Svards clarified the two models of compacts: multi-state and privilege to practice, explaining how practitioners can choose between a single state license or a compact license that allows practice in multiple states.
HB145: Representative Le on Information Only00:55:31.000 - 9:54:32 AM; Representative Le on questioned the necessity of adding criminal records checks to align with the compact, to which Svards confirmed that it is to ensure compliance with compact language. Le on also asked about the status of the compact's adoption and potential modifications, and Svards noted that four states have enacted legislation, with ten, including New Hampshire, having pending legislation, indicating room for modifications before it becomes an active compact.
HB145: Representative Sitch Information Only00:57:49.000 - 9:56:50 AM; Representative Sitch asked about the implications of a criminal background check and the possibility of reciprocity without the compact. Svards explained that while reciprocity is possible, maintaining credentials in other states can be challenging. She admitted not having specific details on how the results of a criminal background check would be used but promised to follow up with more information via email.
HB145: Kevin Grady, 25-year Air Force Veteran, representing the State Veterans Advisory Committee from Hooksett, New Hampshire Support00:59:58.039 - 9:58:59 AM; Kevin Grady, a 27-year resident of Hooksett and a member of the State Veterans Advisory Committee, spoke in support of HB145, particularly highlighting section six concerning military and military spouses. He emphasized the importance of facilitating professional credential reciprocity for military families, who often move between states. Grady expressed the committee's support for the concept but noted they are not experts on the detailed implementation. He offered the committee's resources for future legislation with veteran impacts and encouraged lawmakers to reach out for assistance in refining bill language to avoid unintended consequences.
HB145: Schmid, former member of the Armed Forces Information Only01:02:50.680 - 10:01:51 AM; Schmid spoke about his experiences with food issues in the military and expressed support for well-qualified dietitians. He raised concerns about the mobility of military personnel and their spouses, suggesting that a compact could benefit them by recognizing their training and service when they move to New Hampshire. He inquired if the bill would consider such a compact, to which it was confirmed that efforts are being made to ease the process for military personnel and their spouses, including considerations for where they might choose to retire.
HB145: Courtney Costello, licensed dietitian and owner of a private practice in New Hampshire Support01:10:38.040 - 10:09:39 AM; Courtney Costello expressed strong support for House Bill 145, emphasizing the importance of background checks for dietitians to ensure public safety. She clarified that dietitians often work in various settings, including K-12 schools and private practices, both virtually and in-person, highlighting the need for safety measures. Costello also discussed the benefits of the dietitian licensure compact, which would improve access to care, especially for patients who relocate or are in rural areas, enhance workforce mobility, and contribute to economic growth by attracting professionals and retaining revenue. She urged the committee to pass the bill, emphasizing its role in improving nutrition services.
HB145: Schmidth, former military member Information Only01:15:38.440 - 10:14:39 AM; Schmidth expressed concerns about the importance of licensed dietitians in large food service settings like hospitals, where improper training could cause significant damage. He questioned whether organizations check the licensing status of dietitians in such settings, to which it was clarified that this is a matter of current statute and not directly related to the bill under discussion.
HB145: Kate Pyer, registered and licensed dietitian from New Hampshire Support01:18:22.920 - 10:17:23 AM; Kate Pyer voiced her support for the dietitian licensure compact proposed in House Bill 145. She emphasized the importance of the compact for enhancing telehealth, which is crucial for rural communities and for maintaining continuity of care. Pyer also highlighted the benefits for military spouses and the importance of New Hampshire retaining jurisdiction over its licensing requirements. She detailed the steps to become a registered and licensed dietitian, underscoring the need for such credentials in various healthcare settings, including hospitals and grant-funded programs, to improve workforce mobility and care continuity.
HB145: Victor Muzzy, Captain with the State Police overseeing the Criminal Records Unit Information Only01:26:29.000 - 10:25:30 AM; Victor Muzzy provided information about the implications of the bill on the dissemination of FBI records. He explained that if the bill passes and includes an FBI record, it would need to be reviewed and approved by the FBI's legal unit, a process that can take several months. He noted that the FBI no longer reviews draft language, only final legislation post-governor's signature. Muzzy highlighted that the effective date of the bill would be problematic as the state police cannot disseminate FBI records without approval, which could delay the intended outcomes of the bill. He suggested that involving the state police early in the drafting process and setting a longer effective date could help mitigate these issues. Additionally, he clarified the process of criminal background checks, distinguishing between state and FBI checks, and discussed the current state of fingerprinting technology and the elimination of backlog in record checks.
HB145: Tina Leighton, Licensed Registered Dietitian and Certified Diabetes Care and Education Specialist from Deerfield, New Hampshire Support01:42:57.639 - 10:41:58 AM; Tina Leighton spoke in support of HB145, highlighting her experience as a dietitian with 18 state licenses. She explained her work at Dartmouth-Hitchcock Hospital and currently with a company providing remote patient monitoring devices, emphasizing the need for licensure to provide education across state lines, particularly for Medicaid patients in rural areas. Leighton shared a patient story from Port Leyden, New York, where she couldn't assist until licensed, which took six months. She mentioned undergoing multiple background checks and the ongoing challenge of managing license renewals across different states. Leighton stressed the importance of the bill in facilitating easier licensure to help patients across the country.
HB145: Jennifer Chadborn, Auburn, New Hampshire, Registered Dietitian, Certified Diabetes Care and Education Specialist, Clinical Assistant Professor at the University of New Hampshire in Durham, Director of the Telehealth Curriculum for the UNH Center for Digital Health Innovation Support01:52:08.560 - 10:51:09 AM; Jennifer Chadborn spoke in strong support of HB145, the Registered Dietitian Licensure Compact. She highlighted her experience with telehealth since 2015, emphasizing the challenges of managing cross-state licensure. She explained how current licensure laws restrict care, particularly for mobile populations like college students and travelers. Chadborn noted the complexity and cost of maintaining licenses across multiple states, which can limit the scope of practice and access to services. She argued that the compact would enhance access to nutrition services, promote continuity of care, reduce administrative burdens, and improve resource allocation, especially crucial amidst workforce shortages. She also mentioned the excitement of her students about the potential impact of the bill on their future careers.
HB145: Hope Damon, Sullivan County District 8, State Representative Support01:57:13.159 - 10:56:14 AM; Hope Damon, a former dietitian and diabetes educator, spoke in favor of HB145. She emphasized the need for continuity of care for patients with chronic conditions like diabetes and eating disorders, who require lifelong treatment. Damon shared her experience of retiring and the challenges of finding enough providers for her patients, suggesting that the compact could have eased this transition. She stressed the importance of timely care, especially for newly diagnosed patients, and how the compact could facilitate care for mobile populations, including those who travel or work remotely.
HB214: Carol Maguire, Marac District 27, State Representative Information Only03:00:13.040 - 11:59:14 AM; Carol Maguire introduced HB214, a bill requested by the Office of Professional Licensure and Certification (OPLC) to clarify rulemaking authority and other statutory sections related to recreational therapists and respiratory care practitioners. She highlighted that the bill includes a breakdown of rulemaking authority and mentioned that it might need amendments to address issues discussed in previous testimonies, such as the inclusion of specific language regarding executive director roles.
HB214: Nick Fry, Office of Professional Licensure and Certification (OPLC) Information Only03:04:07.000 - 12:03:08 PM; Nick Fry from the OPLC provided clarification on the background checks for healthcare professionals, including recreational therapists and respiratory care practitioners. He explained that the goal is to establish a universal standard for criminal background checks across healthcare professions, aligning respiratory care with other health professions. Fry also discussed the need for specific language in the statutes to expedite FBI approval and streamline processes.
HB214: Unknown Speaker Oppose03:09:31.439 - 12:08:32 PM; The speaker expressed concern over the criminal background check requirement for relicensing or new licensing for recreational therapists, questioning its necessity and potential overreach by the government. They suggested that such checks could extend to other professions like plumbers and electricians, and questioned if less serious offenses should disqualify someone from licensing.
HB214: Nick Fry, Office of Professional Licensure and Certification (OPLC) Information Only03:10:18.160 - 12:09:19 PM; Nick Fry clarified that the criminal record checks focus on serious offenses like physical and sexual assault, and that a matrix is being developed to streamline the process for minor convictions, ensuring that those with minor offenses are not unnecessarily delayed in licensing. He highlighted that the review process set by RSA 332-G:10 places a high burden of proof on the state to disqualify someone based on criminal records.
HB214: Unknown Speaker Oppose03:11:04.720 - 12:10:05 PM; The speaker continued to express concern about the criminal background check requirement, arguing that it represents an overreach by the government, turning the state into a 'nanny state.' They questioned if there could be an alternative to this requirement, emphasizing their opposition to this specific aspect of the bill.
HB214: Nick Fry, Office of Professional Licensure and Certification (OPLC) Information Only03:11:53.720 - 12:10:54 PM; Nick Fry reiterated that the current legislative framework under RSA 332-G:10 sets a high standard for disqualifying someone from licensure based on criminal records. He shared his experience as a hearings examiner, noting that very few applicants are denied licensure and that most do not even go to a hearing, suggesting the system is fair and protective of public interest.
HB214: Unknown Speaker Information Only03:12:39.800 - 12:11:40 PM; The speaker asked if the public had demanded criminal background checks for licensees, to which Nick Fry responded that he had not received such feedback in his short tenure. The discussion touched on public assumptions about background checks for various roles, suggesting a need for standardization.
HB214: Nick Fry, Office of Professional Licensure and Certification (OPLC) Information Only03:13:25.560 - 12:12:26 PM; Nick Fry clarified that under the proposed matrix, serious offenses like sexual assault would likely prevent someone from obtaining a license for one-on-one patient care, especially with minors. He emphasized that internal processes do not deny licenses outright but trigger a hearing process to assess the relevance of convictions to public safety.
HB214: Unknown Speaker Information Only03:14:11.640 - 12:13:12 PM; The speaker inquired about the discretion of hearing officers in distinguishing between different types of convictions, to which Nick Fry responded that the board acts as the fact-finder, and the hearings examiner makes legal decisions, allowing for a nuanced approach to determining the relevance of convictions to public safety.
HB227: Representative Land Support03:16:03.640 - 12:15:04 PM; Representative Land supported HB227, arguing for the removal of an exemption that allows unlicensed individuals to practice psychotherapy in schools. They emphasized the importance of ensuring appropriate standards for professionals working with vulnerable children and highlighted existing exemptions for other groups but not for state or educational institutions.
HB227: Representative Roa Information Only03:18:24.479 - 12:17:25 PM; Representative Roa sought clarification on the Department of Education's role in licensing school psychotherapists, to which Representative Land responded that the bill does not affect the Department of Education's process but removes a broad exemption from licensing requirements.
HB227: Representative Pearson Information Only03:20:53.120 - 12:19:54 PM; Representative Pearson inquired about the bill's potential impact on other committees, expressing surprise at the existence of the exemption. They also asked about the definition of 'duly chartered educational institution,' to which Representative Land explained its historical context and argued for its removal due to its outdated nature.
HB227: Representative Sellers Information Only03:22:03.399 - 12:21:04 PM; Representative Sellers asked about the impact on private schools, to which Representative Land responded that it depends on whether private schools are considered under the definition of 'duly chartered educational institution.' They reiterated the focus on removing exemptions for state and educational institutions.
HB227: Unknown Speaker Information Only03:24:20.239 - 12:23:21 PM; The speaker expressed concern about the lack of testimony from practitioners or oversight bodies, to which Representative Land clarified that the exemption applies to unlicensed and unsupervised individuals, and that relevant communities were aware of the bill but did not see it as a significant issue.
HB227: Unknown Speaker Information Only03:27:33.000 - 12:26:34 PM; The speaker questioned the fiscal note of the bill, expressing concern about potential costs of requiring licensed professionals, to which Representative Land responded by highlighting the potential legal and financial risks of unlicensed practice.
HB227: Representative Grato Information Only03:29:55.279 - 12:28:56 PM; Representative Grato asked why the bill does not address another section of the RSA that allows the Department of Education to credential individuals, to which Representative Land explained the focus on removing the exemption for unlicensed practice and expressed willingness to look into the other section in future legislation.
HB227: Nick Fry, Office of Professional Licensure and Certification (OPLC) Information Only03:33:26.720 - 12:32:27 PM; Nick Fry provided clarification on the fiscal note, explaining that it was based on the impact on OPLC and licensing fees, and confirmed that other departments were consulted but did not indicate a common practice of unlicensed psychotherapy.
HB236: Representative Chris Muns, Rockingham District 29, Hampton Support03:34:53.960 - 12:33:54 PM; Representative Muns supported HB236, which would allow retired CPAs to use the title 'CPA Retired.' They emphasized the hard work and dedication required to become a CPA and argued that allowing retired CPAs to use this honorific title would recognize their lifetime achievements and could benefit organizations they volunteer for, without allowing them to practice as current CPAs.
HB236: Representative Pearson Information Only03:39:37.640 - 12:38:38 PM; Representative Pearson posed a hypothetical about the legality of a retired CPA using the title 'CPA Retired' on a business card, questioning if it would violate current law. Representative Muns responded that the bill aims to create a new section in the RSA to allow the use of this title, addressing concerns about the current restrictions on using the CPA title.
HB236: Representative Cite Support03:41:11.800 - 12:40:12 PM; Representative Cite expressed support for the bill, arguing that it does not violate the First Amendment as it is truthful to call oneself a retired CPA, and state law should not restrict this.
HB236: Nick Fry, Office of Professional Licensure and Certification (OPLC) Information Only03:41:59.319 - 12:41:00 PM; Nick Fry stated that OPLC takes no position on the bill.
HB236: Unnamed Speaker, Office of Professional Licensure and Certification (OPLC) Information Only03:42:12.840 - 12:41:13 PM; The speaker addressed a question regarding the cost associated with implementing a retired status certification for CPAs. They mentioned a one-time cost associated with the fiscal note worksheet and discussed the authority to charge fees under RSA 3104 or RSA 3106, though they were unsure which statute specifically applies. They recommended explicitly authorizing the fee to avoid any ambiguity.
HB236: Richard Silverman, New Hampshire Board of Accountancy Support03:43:46.800 - 12:42:47 PM; Richard Silverman, an actively licensed CPA for 49 years and a member of the New Hampshire Board of Accountancy, supported HB236. He explained that the bill would allow CPAs to use the honorific title 'retired CPA'. He detailed the current options for CPAs who no longer wish to provide auditing and attest services - applying for inactive status or letting their license expire. He highlighted that the Uniform Accountancy Act adopted a retired status in 2018, which 22 states have implemented. This status allows CPAs aged 55 and older to place their license in retired status without continuing professional education requirements, enabling them to offer limited volunteer services but not auditing and attest services. Silverman emphasized the importance of this bill for CPAs at the end of their careers and requested support for it.
HB236: Representative Schmidt Information Only03:46:55.840 - 12:45:56 PM; Representative Schmidt inquired about the history and reception of the retired CPA status in other states. Silverman responded that since its inclusion in the Uniform Accountancy Act in 2018, it has been popular among CPAs in states that have adopted it. Schmidt acknowledged the expertise required in the CPA profession and appreciated Silverman's insight.
HB236: Representative Pearson Information Only03:48:33.000 - 12:47:34 PM; Representative Pearson asked about the process for CPAs who wish to return to active status after entering retired status. Silverman explained that they would need to reapply and meet the current continuing professional education requirements, similar to the process for inactive CPAs. This sparked a discussion on the differences between inactive and retired statuses.
HB236: Representative Pearson Support03:51:48.199 - 12:50:49 PM; Representative Pearson moved to pass HB236, expressing that the bill was well-explained and the questions were satisfactorily answered. They noted no perceived risk to the public and viewed the retired CPA designation as non-deceptive.
HB236: Representative Sellers Support03:52:33.920 - 12:51:34 PM; Representative Sellers seconded the motion to pass HB236, emphasizing the importance of titles to individuals and agreeing with the lack of public risk associated with the bill.
HB236: Representative Groda Information Only03:53:19.840 - 12:52:20 PM; Representative Groda expressed uncertainty about the necessity of the bill, questioning why CPAs have specific restrictions on using the 'retired' title compared to other professions. They discussed whether OPLC should charge a fee for the new status and if the bill should explicitly outline this in statute or leave it to OPLC's rules.
HB236: Representative Leon Information Only03:54:57.279 - 12:53:58 PM; Representative Leon discussed the stringent protections around the use of the CPA title and the implications of adding a retired certification. They suggested ensuring an administrative fee is charged for the time OPLC spends processing applications or adding exemptions to the use of the CPA title for those in good standing at retirement.
HB236: Richard Silverman, New Hampshire Board of Accountancy Information Only03:56:29.159 - 12:55:30 PM; Richard Silverman clarified that OPLC already maintains records of CPAs' statuses and that adding a retired category would be minimal additional work. He noted that enforcement would be complaint-based, similar to other violations handled by OPLC.
HB236: Richard Silverman, New Hampshire Board of Accountancy Information Only03:56:29.159 - 12:55:30 PM; Richard Silverman concluded his remarks regarding section 309b, suggesting that the ability to charge a fee might already be covered under existing rulemaking authority. He expressed that if any clarification is needed, it should be made clear in the bill's language that an appropriate fee is intended to be charged for the services described.
HB236: Unnamed Speaker Information Only04:03:21.880 - 1:02:22 PM; The speaker clarified that section 309b falls under the existing rulemaking authority, suggesting that no amendment is necessary to charge a fee for the services mentioned. They confirmed that the expectation is for the fee to be minor.
HB236: Chair Information Only04:04:08.439 - 1:03:09 PM; The chair concluded the discussion on HB236, noting that the motion for 'ought to pass' was made by Representative Pearson. A roll call vote was conducted, resulting in 11 votes in favor and 1 against, with the chair voting no but not planning to write a Minority Report. The bill was recommended to pass and placed on consent.
HB349: Katie Pell, Carol District 6 (Wolfeboro and Tuftonboro) Support04:06:35.399 - 1:05:36 PM; Katie Pell introduced HB349 on behalf of Representative Kofalt, who was absent. She explained that the bill aims to expand the scope of practice for licensed optometrists to include three specific ophthalmic laser procedures, provided the practitioner is certified by the Board of Registration in Optometry. Pell noted that while a similar bill, SB440, expanded optometrist practices more broadly last year, HB349 is more limited in scope. She highlighted the current statutory limitations on optometry practices in New Hampshire and the potential benefits of the bill, such as improved access to care in rural areas and reduced healthcare costs. Pell also addressed patient safety concerns, citing evidence from other states and the negligible risk associated with malpractice insurance premiums.
HB349: Representative Schmidt Information Only04:13:34.640 - 1:12:35 PM; Representative Schmidt inquired about the timeline for implementing the expanded practice if HB349 is passed. Katie Pell responded that it could take at least six months for the rules to be established post-passage, and possibly a year or two for optometrists to invest in necessary equipment and complete training, assuming they are not already trained.
HB349: Representative Howard Information Only04:14:20.720 - 1:13:21 PM; Representative Howard asked about the training optometrists receive for the procedures in question. Katie Pell admitted she did not know the specifics of their training but suggested that other optometrists present might be able to provide that information.
HB349: Alicia Greg, Nashua Support04:15:06.319 - 1:14:07 PM; Alicia Greg supported HB349, emphasizing the need for increased access to eye care due to a decline in the number of ophthalmologists and the increasing number of optometrists. She pointed out that optometrists are already trained in the procedures outlined in the bill during their schooling, and compared the situation to the expansion of nurse practitioners' roles in healthcare. Greg argued that allowing optometrists to perform these procedures would not increase malpractice risks, as evidenced by other states, and would provide more choices for patients, potentially reducing wait times and improving care accessibility.
HB349: Representative Sitch Information Only04:19:42.439 - 1:18:43 PM; Representative Sitch asked Alicia Greg about whether neighboring states like New York, Massachusetts, or Rhode Island allow the procedures outlined in HB349. Greg did not have that information but mentioned that New Hampshire often does things its own way and emphasized the importance of considering what's best for New Hampshire constituents.
HB349: Representative Howard Information Only04:20:27.680 - 1:19:28 PM; Representative Howard asked Alicia Greg about the difference in training between ophthalmologists and optometrists. Greg deferred to the experts for a detailed answer but expressed confidence in the training of optometrists.
HB349: Mark Pearson, Chairman of the Children and Family Law Committee Oppose04:21:25.760 - 1:20:26 PM; Mark Pearson expressed opposition to HB349, citing his experience in healthcare and oversight roles. He mentioned the increasing availability of ophthalmologists in New Hampshire and neighboring areas, reducing the need for expanded optometrist practices. Pearson highlighted his support for reducing unnecessary regulations and widening the scope of practice but emphasized the importance of understanding the levels of training and supervision required for such expansions. He shared his personal experience with eye injections and the importance of specialized training. Pearson also discussed the variability in malpractice reporting between states, suggesting caution in relying on such data for decision-making.
HB349: Unidentified Speaker Information Only04:26:14.279 - 1:25:15 PM; The speaker mentions having written testimony to submit and indicates readiness for questions from representatives.
HB349: Representative Howard Oppose04:26:27.199 - 1:25:28 PM; Representative Howard expresses opposition to the bill, clarifying that while they support optometrists, they do not support the specific requests made in the bill. They respond to a question about supporting increased educational opportunities for optometrists to potentially perform procedures similar to ophthalmologists, indicating support for increased education but not for the current scope of the bill.
HB349: Unidentified Speaker Information Only04:27:18.680 - 1:26:19 PM; The speaker asks a question about nurse practitioners performing procedures that were traditionally done by doctors, specifically inquiring if RNs are performing open heart surgery, to which the response is negative.
HB349: Dr. Dorothy Hitchmoth Support04:28:16.600 - 1:27:17 PM; Dr. Dorothy Hitchmoth, a seasoned practitioner in rural New Hampshire and a professor of Optometry and Medicine, supports House Bill 349. She provides a detailed background of her experience, emphasizing her roles in various institutions, including the VA Medical Center in White River Junction, and her involvement in educational and accreditation processes for optometry. Dr. Hitchmoth advocates for the bill by highlighting the comprehensive training and accreditation of optometrists, stating that the procedures listed in the bill are already part of their curricula. She addresses concerns about safety and outcomes, providing data showing low rates of adverse events for the procedures in question. She also discusses the challenges of attracting and retaining skilled professionals in New Hampshire due to outdated scope of practice laws and shares a personal example of a colleague who was unable to practice fully due to these restrictions. Dr. Hitchmoth offers herself as a resource and submits detailed documentation for further review by the committee.
HB349: Unidentified Speaker Information Only04:39:21.879 - 1:38:22 PM; The speaker asks Dr. Hitchmoth about the number of times optometry students perform laser procedures on patients during their training, to which Dr. Hitchmoth explains that it varies by specialty and provides general information on the minimum supervised procedures required.
HB349: Unidentified Speaker Information Only04:41:13.440 - 1:40:14 PM; The speaker inquires about the safety features of laser equipment used in procedures, to which Dr. Hitchmoth confirms that there are built-in safeguards and protocols to prevent mistakes during use.
HB349: Unidentified Speaker Information Only04:41:51.638 - 1:40:52 PM; The speaker asks if medications are prescribed prior to surgeries mentioned in the bill, to which Dr. Hitchmoth clarifies that the bill does not include cataract surgery, which would require medication, but focuses on other procedures where medication use varies.
HB349: Unidentified Speaker Information Only04:42:42.798 - 1:41:43 PM; The speaker clarified that the surgeries discussed in the bill are not LASIK and are not corrective surgeries. They explained that anti-anxiety medication, often used before LASIK, is typically not required for the procedures mentioned in the bill. The speaker also confirmed that no neighboring states in New England have authorized the procedures discussed in the bill, but provided information on other states' practices, promising to send a detailed list to the committee.
HB349: Chris Muns, Representative from Hampton Support04:44:57.040 - 1:43:58 PM; Representative Chris Muns from Hampton spoke in support of HB349, which would allow optometrists to perform certain procedures they are already certified to perform in 12 other states. He emphasized that these procedures would only be performed by optometrists certified by the New Hampshire Board of Registry. Muns highlighted the extensive training optometrists undergo and argued that allowing them to perform these procedures would increase access to healthcare, especially in rural areas, by utilizing established patient-provider relationships.
HB349: Kimberly Lardi, Ophthalmologist from New Hampshire Eye Associates in Manchester Oppose04:46:59.558 - 1:46:00 PM; Dr. Kimberly Lardi, an ophthalmologist from Manchester, opposed HB349. She emphasized the collaborative history between optometry and ophthalmology but stated that the bill's proposal to allow optometrists to perform three laser surgeries was unsafe. Lardi pointed out that these procedures are already performed by ophthalmologists in New Hampshire and that most states, including all in New England, prohibit optometrists from performing such surgeries. She criticized the adequacy of training optometrists receive for these procedures and provided data showing that optometrists are not leaving New Hampshire due to restrictions on performing lasers. Instead, she suggested focusing on other solutions to improve access to ophthalmic care in rural areas without compromising patient safety.
HB349: Unidentified Speaker from the North Country Information Only04:53:08.920 - 1:52:09 PM; The speaker addressed the issue of access to eye care services in the North Country, highlighting Representative Pedell's estimate of one to two years for the necessary legislative and preparatory steps to allow optometrists to perform the procedures outlined in the bill. The speaker suggested that ophthalmologists could set up services in the North Country within six to eight months, which would be faster than the proposed bill's timeline. They mentioned that there is an ongoing project to enhance access in the North Country, and a colleague would elaborate on it.
HB349: Dr. Allison Ler, Optometrist from Milford Support04:55:40.680 - 1:54:41 PM; Dr. Ler supported House Bill 349, which aims to allow optometrists to perform three specific non-invasive laser procedures in-office. She emphasized that these procedures have been safely performed by optometrists for decades and are taught in every optometry school. She detailed her background and training, which includes over 10,000 hours of education and 2,000 patient encounters, and stressed that optometrists are primary eye care providers across all 50 states. Dr. Ler argued that the bill modernizes the New Hampshire Optometric statute, which has not been significantly updated in over 20 years. She countered opposition claims that optometrists lack the necessary training, explaining that the procedures are within their scope and training. She also addressed potential complications, stating that optometrists are trained to manage them or refer patients to specialists when necessary.
HB349: Dr. Peters, Ophthalmologist Oppose05:12:59.798 - 2:12:00 PM; Dr. Peters opposed the bill, focusing on the lack of access to eye care in the North Country. He discussed a project he has been working on for the past nine months to bring ophthalmological services to the North Country, specifically to Berlin. This project involves over 25 ophthalmologists who will rotate to provide care, addressing a broader range of eye care needs beyond the three laser procedures proposed in the bill. He argued that the bill would only address a small fraction of the eye care needs in the North Country and provided a timeline of 8 to 12 months to get the program up and running. Dr. Peters also expressed concerns about the training and proficiency required for the procedures mentioned in the bill, suggesting that the current training model proposed is inadequate.
HB349: Unidentified Speaker from the Committee Information Only05:16:10.958 - 2:15:11 PM; The speaker engaged in a dialogue about the potential for ophthalmologists to provide services in the North Country more quickly than the timeline suggested for optometrists under the proposed bill. They discussed the feasibility of setting up ophthalmological services within six to eight months and sought clarification on whether optometrists would be included in the team providing services at the hospital in the North Country. The speaker also emphasized the need for detailed discussions in a subcommittee setting to address the complexities of the bill and the proposed alternative solutions.
HB349: Unidentified Speaker from the Committee Information Only05:16:10.958 - 2:15:11 PM; The speaker finished speaking at 05:16:10.958, and the content of their testimony is not provided in the given snippet.
HB349: Unidentified Speaker Information Only05:23:24.080 - 2:22:25 PM; The speaker expressed enthusiasm for the idea of a traveling ophthalmologist to Berlin but raised concerns about bandwidth across the state. They questioned whether allowing optometrists to expand their scope of practice to include three specific surgeries could help ophthalmologists reduce wait times for patients with painful eye conditions.
HB349: Dr. Blake Oppose05:24:10.718 - 2:23:11 PM; Dr. Blake, an ophthalmologist from Nashua, opposed HB349. He argued that New Hampshire has favorable access to ophthalmologists with over 90% of residents living within a 30-minute drive to an ophthalmologist. He noted that states with lower population densities have authorized optometrists to perform laser eye surgery, but New Hampshire has a high density and good access. He also mentioned that increasing providers does not necessarily decrease costs due to Medicare allowables. Dr. Blake emphasized the importance of surgical volume for proficiency and the challenges of surgical training where mistakes can have serious consequences. He highlighted that the majority of optometry schools do not include procedures on live patients in their training, contrasting this with the rigorous standards set by surgical accrediting bodies like ACGME.
HB349: Dr. Angelique Sawyer Support05:25:45.040 - 2:24:46 PM; Dr. Angelique Sawyer, an optometrist from Berlin originally from Nashua, supported HB349. She emphasized the need for better eye care access for her patients in the North Country, specifically in Berlin and North Conway where she practices. Dr. Sawyer clarified that she was surprised no optometrist had been approached for collaborative efforts in the North Country. She detailed her training and experience, including performing these procedures on live patients during rotations in Oklahoma. Dr. Sawyer advocated for a pathway for optometrists to gain supervised experience to perform these procedures, noting that 12 states have successfully implemented similar models. She argued that the bill would not compromise care quality but would utilize the existing training and certification of optometrists to improve access.
HB349: Kevin Smid Oppose05:37:18.760 - 2:36:19 PM; Kevin Smid, a concerned member of the public, opposed HB349. He questioned why optometrists wanting to perform ophthalmological procedures do not become ophthalmologists, suggesting that allowing optometrists to do so could undermine the training of ophthalmologists. He expressed discomfort with the potential confusion between optometry and ophthalmology among laypeople and used analogies like flight attendants captaining airplanes to argue against the expansion of practice scope. He also noted opposition from the medical community in Massachusetts as a reason to not support the bill.
HB349: Timothy Blake Oppose05:40:42.360 - 2:39:43 PM; Timothy Blake, an ophthalmologist from Nashua, opposed HB349. He provided statistics on New Hampshire's favorable access to ophthalmologists, noting that over 90% of residents are within a 30-minute drive to an ophthalmologist. He argued that states with lower population densities have allowed optometrists to perform laser eye surgery, but New Hampshire's higher density and better access make such measures unnecessary. Dr. Blake also mentioned that increasing the number of providers does not decrease costs for patients due to Medicare allowables and stressed the importance of surgical volume for proficiency. He highlighted the challenges of surgical training and the lack of live patient training in most optometry schools, contrasting it with the standards set by surgical accrediting bodies.
HB349: Jim Murphy Oppose05:47:50.320 - 2:46:51 PM; Jim Murphy, a retired orthopedic surgeon and former member of the New Hampshire House of Representatives, opposed HB349. He emphasized that the bill is about quality of care and patient safety rather than a turf battle between ophthalmologists and optometrists. He argued that the training required for surgery, which can take up to 10 years, cannot be compared to a weekend course without live patients. Dr. Murphy highlighted the importance of surgical decision-making and handling complications, which are integral to surgical training. He expressed concern that allowing optometrists to perform laser surgeries would be akin to allowing other non-surgical specialists to perform surgeries outside their training and expertise.
HB349: Representative Leon Information Only05:54:43.798 - 2:53:44 PM; Representative Leon asked Dr. Murphy about the role of statutes versus hospital credentialing and privileging in determining who can perform certain procedures. Dr. Murphy explained that hospitals have credentialing and privileging committees that determine if a doctor is qualified to perform specific surgeries, not statutes. He noted that even within specialties, doctors might limit their practice to procedures they feel comfortable with, emphasizing that hospital-level decisions are crucial for ensuring appropriate surgical practice.
HB349: Representative Nagel Oppose05:57:07.958 - 2:56:08 PM; Representative Nagel, a physician and representative, opposed HB349. He recounted his experience on a subcommittee that examined the training for optometrists to perform these procedures. He criticized the 'see one, do one, teach one' method of training as inadequate for surgical procedures and noted the lack of outcome data from optometrists' training. He suggested that a proper path for scope expansion would involve a fellowship program similar to those in podiatry, veterinary medicine, and dentistry, rather than a short elective course. He concluded that while there might be a pathway forward, the current proposal is not it.
HB349: Unknown Speaker Information Only06:02:04.120 - 3:01:05 PM; The speaker discusses a working arrangement between Dr. Peters and Andrew Goen, which could lead to starting a medical practice in the North Country within six to eight months. The speaker, a doctor, mentions that about 30% of their patients live in the North Country and would appreciate having specialists available locally. However, they also acknowledge that patients are willing to travel for specialty care, and while it would be ideal to have all specialties available locally, the focus should be on primary care rather than surgery and specialty care.
HB349: Christy Morse, Pediatric Ophthalmologist from Concord Oppose06:03:53.120 - 3:02:54 PM; Christy Morse, a pediatric ophthalmologist from Concord, opposes House Bill 349. She clarifies that her opposition does not diminish the role of optometrists, with whom she collaborates in her practice. She notes that there are currently 10 states, not 12, that allow scope expansion for optometrists to perform certain procedures. Morse highlights that a VA directive restricts optometrists from performing therapeutic laser procedures on the eye and eyelids at VA facilities. She expresses concern over the bill allowing optometrists to perform surgery on the eyes, emphasizing the potential complications and the inability of optometrists to manage these complications effectively, which could lead to significant vision loss. She cites a study showing an increased risk of requiring additional treatment when optometrists perform laser surgery compared to ophthalmologists. Additionally, she mentions that malpractice insurance companies are reluctant to insure optometrists for surgical procedures due to lack of data and training. Morse concludes by urging the committee to oppose the bill for patient safety reasons.
HB349: Grant Schulthies, Ophthalmology Resident at Dartmouth Oppose06:11:17.160 - 3:10:18 PM; Grant Schulthies, an ophthalmology resident at Dartmouth, opposes House Bill 349. He shares his personal experience and training, emphasizing the importance of both depth and breadth of surgical training. He argues that the comprehensive training ophthalmologists receive, including various types of procedures, is crucial for performing laser surgeries safely and effectively. Schulthies believes that the limited training of optometrists in laser treatments does not adequately prepare them for the complexities and potential complications of these procedures. He concludes by expressing hope that the discussion around the bill can lead to improved policies for healthcare in New Hampshire.
HB349: Kathy Stratton, CEO of the New Hampshire Medical Society Oppose06:16:39.920 - 3:15:40 PM; Kathy Stratton, CEO of the New Hampshire Medical Society, strongly opposes House Bill 349. She emphasizes that the bill does not expand access to care but rather poses risks due to the lack of comprehensive training among optometrists for the proposed procedures. Stratton highlights that ophthalmologists are uniquely qualified to manage the complexities and potential complications of eye surgeries. She also mentions ongoing efforts by New Hampshire's eye surgeons to expand access in the north regions. The medical society urges the committee to recommend that House Bill 349 ought not to pass, citing the importance of broad medical education and clinical training in providing high-quality healthcare.
HB349: Kathy Stratton, CEO of the New Hampshire Medical Society Information Only06:16:39.920 - 3:15:40 PM; Kathy Stratton concluded her testimony at 06:16:39.920. The Medical Society has taken a clear position on the proposed facility at Anders gaget. They are supporting efforts to expedite procedures for residents of the North country. However, the Society is not in the driver's seat but is working with the Society of Surgeons to move this along. This endeavor is seen as a model for other specialties needing to expand care. Kathy Stratton, being new to the role, expressed happiness in working with physicians toward quality care in New Hampshire.
HB349: Katherine Morando, Ophthalmologist at Eye Center in town, Glaucoma Specialist Oppose06:20:54.638 - 3:19:55 PM; Katherine Morando, an ophthalmologist and glaucoma specialist from Eye Center in town, spoke in strong opposition to House Bill 349 due to concerns over patient safety. She emphasized the complexities and risks involved in laser surgeries, particularly in the context of laser iridotomy and glaucoma treatment. Morando stressed the importance of nuanced decision-making in surgery, which is honed over years of surgical residency and fellowship. She cited a case where incorrect referral could have led to delayed care and potential blindness, underscoring the need for experienced surgeons to make these critical decisions. Morando also expressed concerns about the potential increase in procedure rates and subsequent complications if the scope of practice is expanded. She offered to discuss the details of the lasers involved but highlighted the key points for the committee, emphasizing the need for collaboration among healthcare professionals to maintain high standards of care.

McGuire, Carol(Chairman)(R)[A+]2024	Sytek, John(Clerk)(R)[B]2024	Layon, Erica(V Chairman)(R)[A]2024
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