Dominion Post article on eye docs
by David Beard
Aug. 17, 2009 (McClatchy-Tribune Regional News delivered by Newstex . . .
source: The Dominion Post) --
State optometrists want to expand the scope of their practice, but ophthalmologists don't quite see eye to eye with them about what they want.
Optometrists say they want the freedom to practice what they're trained to do, and to provide more access to affordable eye care.
Ophthalmologists say the optometrists want to perform surgery without medical degrees.
"They've taken this and turned it into a surgery bill," Chad Robinson, spokesman for the West Virginia Optometric Association, said. The true intent is to allow "optometrists who are properly trained to practice what they're trained to do."
They don't want to perform major surgery, he said. "Optometrists should not be doing major invasive surgery."
The ophthalmologists presented their side of the story to Joint Government Organization Subcommittee B at the August interims last week. The optometrists gave their presentation to Subcommittee A in July.
Legislators are studying the topic during interims in the wake of a House bill that didn't make it through the 2009 regular session, but may come back in 2010.
The problem may be the lack of a definition of surgery, said Dr. Steven Powell, a Morgantown ophthalmologist and legislative chairman of the West Virginia Association of Ophthalmologists. He was one of five people to speak against changing the law. The 2009 bill, House Bill 2978, removes some rules and adds others to existing law.
Removed:
Diagnosing and treating eye problems by any method other than surgery. Furnishing or providing prosthetic devices by any means other than surgery. Prohibition to perform surgery or administer drugs by injection.
Added:
Examination of the eye to diagnose, treat or refer for treatment, with or without the use of approved drugs. Administration of drugs approved by the state Board of Optometry.
Dispensing, lenses, prisms, contact lenses, including plano contact lenses [lenses that change the appearance of the eye but don't adjust vision and drugs approved by the West Virginia Board of Optometry.
The performance of any clinical practice necessary to treat, correct or relieve any defects or abnormal conditions of the human eye or its appendages for which the optometrist has been trained through the curriculum of an accredited school of optometry accepted by the West Virginia Board of Optometry or through a continuing education course from an accredited school or program accepted by the West Virginia Board of Optometry, within legislated limits.
Board authority to establish limitations of clinical practice.
Board authority to establish a drug formulary for optometrists.
The opposition:
Lobbyist Thomas J. Stevens, president of Government Relations Specialists, of Charleston, representing West Virginia Academy of Ophthalmology, said Oklahoma is the only state in the nation that allows optometrist to perform surgery. He referred to a 2005 survey indicating that 95 percent of consumers prefer ophthalmologists to perform surgery, including laser surgery.
He said that the optometrists’ proposal is vague. "We really don't know what it is they propose." He also said that the proposed bill would allow optometrists to dispense drugs out of their offices, which physicians don't do. And they could perform procedures that they had been trained for during brief weekend courses.
Judie Charlton, chair of the department of ophthalmology at WVU's School of Medicine, focused on the difference in training between ophthalmologists and optometrists.
She said optometrists receive four years of education beyond their basic degree, while ophthalmologists receive eight.
Ophthalmologists must undergo closely supervised, hands-on training ranging from diagnosis to postoperative care, she said.
"I would advise us not to lower qualifications but to adhere to high qualifications," she said.
Dr. Steve Sebert, president of the West Virginia State Medical Association, said that he's a trained family physician, and "you don't me want operating on your eyes. I'm not going to do a weekend course and profess to be qualified to do surgery."
He also presented a map showing the locations of state ophthalmologists, indicating every resident lives within 40 miles of an ophthalmologist. "Some of the rural areas don't have ophthalmologists, but they don't have Kroger’s either."
Powell presented the agenda of a weekend optometry course on minor surgery offered in Charleston by the Northeastern State University Oklahoma College of Optometry.
Fifty-minute sessions covered local anesthesia, emergency surgery and suturing. A four-hour hands-on segment covered injections, suturing and the operation of a "radiofrequency surgical handpiece." He said this training would qualify the optometrists for these procedures under the proposed bill. Morgantown ophthalmologist Dr. V.K. Raju attended the meeting but did not speak. Afterward, he told The Dominion Post that an optometrist works with him and does "wonderful work." But "if someone wants to do surgery, they have to go through medical school -- that's it."
Q and A time
Powell fielded some questions from legislators. Responding to one, he noted there are no hard statistics on the success or failure of Oklahoma's 1998 law allowing optometrists to perform surgery. Before asking a question, Sen. Randy White, D-Webster, rebutted, with a laugh, Sebert's statement about easy access. "It may be 40 miles as the crow flies, but not as we get there."
He asked Powell whether optometrists can legally remove a shard of glass from a patient's eye.
Powell said that's where the beginning of an answer to the problem may lie. "It depends on the definition
of surgery. If you define what surgery is, we can look at some of these procedures."
The optometrists
The state Board of Optometry referred The Dominion Post to Robinson for questions.
Robinson said optometrists are learning new procedures and new technologies, but are legally allowed to practice only about 2/3 of what they learn. One of the problems lies in the billing code books that define simple procedures, such as a removing a foreign object from the eye, as surgery.
He said optometrists would like the authority to do certain injections around the eyes, such as injecting antibiotics.
Nurses, with far less education, are allowed to do injections, he said.
"They don't want to do anything they're not trained to do," he said. The bill "is absolutely not a surgery bill. It's all about access and healthcare costs."
He also noted that while the bill addresses prescribing and dispensing drugs, optometrists already have limited authority to prescribe certain drugs, and that's all they want.
Finally, Robinson confirmed a statement by Powell that optometrists and ophthalmologists are having regular meetings to find common ground. He hopes that perhaps they might have an agreement by the time the Legislature convenes in January.