Oklahoma Legislation Sparks Ban

Optometric Management, Jun 2004

OPHTHALMOLOGISTS BAR OPTOMETRISTS FROM EDUCATIONAL MEETING

The American Academy of Ophthalmology (AAO) has banned O.D.s from the education portions of its annual meeting in New Orleans. The AAO claims that O.D.s have attended the meeting "and then used their attendance as arguments to legislatures to expand their scope of practice."

The American Optometric Association (AOA) replied that "no state has ever predicated its expansion of scope efforts on the fact that some optometrists may have taken courses at an AAO meeting."

The AOA says that the ban appears to be part of a pattern of behavior by ophthalmology toward optometrists "that raises serious antitrust violation concerns." The AOA will continue to welcome ophthalmologists to its annual Congress.

The ban doesn't affect other allied healthcare professionals, says Allan Jensen, M.D., president of the AAO. "We let nurses take courses, but we would never expect them to perform surgery," he says.

The legislative battle

The ban is in response to H.B. 2321, recently passed in Oklahoma, which reaffirms O.D.s' rights to bill for surgical codes. (O.D.s in Oklahoma and other states have billed for surgical codes for 20 years.)

"In Oklahoma, optometrists are attempting to become ophthalmologists without going to medical school," says Dr. Jensen. "Legislation passed provides that the Optometry Board would be autonomous. Optometrists can decide what they want to do without direction from the medical board."

David Cockrell, O.D., F.A.A.O., president of the Oklahoma Board of Examiners in Optometry, says H.B. 2321 allows optometrists "to practice as we have for more than 20 years." Gov. Brad Henry signed the bill with the commentary that it neither expands nor contracts the scope of practice in Oklahoma.

In passing the legislation, Rep. Dale Wells (D), noted that the state has 600 registered O.D.s, but only 101 licensed M.D.s who practice in 18 of the state's 77 counties.

Oklahoma allows optometrists to correct and relieve ocular abnormalities through means such as contact lenses, eyeglasses, exercises or laser surgery. The law permits O.D.s to perform non-laser surgical procedures; however, optometrists are still forbidden to perform retina, LASIK or cosmetic lid surgery.

Dr. Jensen says that without a medical school education, O.D.s lack the qualifications to perform surgery. "Imagine someone who's assisting in brain surgery saying, 'I've seen it 25 times, so I can perform it now,' " he says.

Dr. Cockrell says that if any doctors, including optometrists, weren't performing procedures safely, then malpractice rates would skyrocket, which would give the doctors' governing board "just cause" to revoke their licenses.

Further accusations

The AAO says optometry "used Oklahoma" to expand its scope to include surgery within the Department of Veterans Affairs (VA) health system. The VA allows an O.D. to perform surgery provided he has received certification from his state board.

The AAO characterized the passage of the optometry provisions in H.B. 2321 as a "backdoor legislative effort." However, the bill's provisions were added in response to a state Attorney General's opinion, prompted by ophthalmology, which ruled that the Board of Examiners in Optometry had no authority to allow O.D.s to perform surgical procedures.

Cynthia Bradford, M.D., affiliated with the Dean A. McGee Eye Institute, requested that Sen. Mark Snyder ask for a review of the Oklahoma Optometry law. Ophthalmology sent the same request to the Attorneys General of nine other states. M.D.s made assertions that O.D.s in Oklahoma performed cataract surgery and cosmetic lid surgeries. A review found that Oklahoma O.D.s filed no claims for cataract surgery or blepharoplasty.

H.B. 2321 marks the latest round of battles between optometry and ophthalmology over refractive surgery in Oklahoma. The Oklahoma Optometry Board of Examiners allowed the state's optometrists to perform anterior segment laser procedures beginning in 1988. Optometrists performed over 15,000 procedures prior to 1995 without a compliant or lawsuit.

In 1995, when laser vision correction became an economic issue, ophthalmology filed a suit with in the Oklahoma state court system. The courts ruled that optometrists couldn't perform laser procedures until legislation outlined the parameters for laser surgeries. The House and Senate passed this legislation overwhelmingly.