Category: Politics

OPTROT: A big win for Optometrists and Legislators Alike!

A few weeks after their stunning legislative maneuver that fundamentally changes the practice of optometry in Kentucky, the Kentucky Optometric Association hosted a reception to thank our legislators. Such receptions are quite common and provide legislators food, drink, and company for what otherwise might be a lonely evening in Frankfort. They are fun. They also provide further opportunities for networking (a.k.a. lobbying). According to Frankfort’s rules, as long as all legislators are invited (even the 17 who voted against) no ethical problem exists. We doctors (and presumably optometrists) have long allowed drug companies and medical device manufacturers to shower us with meals, travel, and gifts. How can we object? If everybody does it, that makes it OK– yes? The optometrists pulled off a wildly successful legislative campaign and they deserve to celebrate. I do not hold it against them.

Not to be overlooked is the fact that our legislators had a big victory to celebrate as well. The optometrists won big, but our legislators won even bigger. The bar for the amount of money it will now take to reliably pass a piece of legislation has been raised. There is an old political joke, that the top three priorities of elected officials are all to get reelected. It would be a funnier joke if there was not so much truth in it. I was immersed in federal and state legislative processes for more than 15 years. I have spoken with or interviewed hundreds of lobbyists. I have hired lobbyists. I was one once! Money counts, and that is why the job of getting reelected in Kentucky has just gotten a little easier. Yes, the optometrists did other things right, like sustained coordinated personal contacts with their representatives. However, in electoral politics, money trumps most everything, including good policy. A new blueprint has been drafted. It will be interesting to watch the cash flows next legislative season.

Peter Hasselbacher, MD

OPTROT? Business as usual? Or both?

Passage of Kentucky’s Optometry Bill into Law.

Gov. Beshear signed Kentucky’s optometry practice expansion bill into law yesterday. Thus ends the remarkable passage of Senate Bill 110 that in one fell swoop transforms the practice of optometry in Kentucky from correcting vision with lenses, to the practice of treating eye disease with medicine and surgery.

Much can be said about many aspects of this episode.  For example, the erosion of the monopoly of MDs to practice medicine. However the special privilege of caring for the sick has been drifting away from us physicians for some time. Some of these sharings are not all bad: you don’t have to be a brain surgeon to manage an immunization schedule or treat a sore throat. I predict that we physicians will continue to share the responsibility of treating illness and that the pace of the sharing will increase dramatically with the inclusion of the concepts of wellness and disease prevention into our financial structure of treating illness. (There is no limit to the demand for wellness, disease prevention, or screening by the public; nor limit to the willingness of healthcare workers of all levels of competence to provide.) This optometry bill was not the only scope of practice legislation before this General Assembly. Why have not the others passed as well? Is this optometry bill a crack in the dam? Did we physicians do something to bring this on ourselves?

Changes in scope of practice are not occurring in isolation from other major shifts in the landscape of healthcare delivery. I am informed that the considerable majority of primary care physicians in Louisville are now direct employees of hospitals. A large and increasing fraction of specialists are also hospital employees. I predict this trend will do more to change the practice of medicine than the sharing of professional responsibilities with optometrists, or nurses for that matter. What is happening is that systems of medical care are largely replacing Mom and Doc operations. That’s probably for the better. Even in a given specialty, there is too much to know, too much to do, and too much efficiency required. What is most important is that the primary obligation of the physician to their patient retains its primacy. That is what we are most at risk to losing. That may not be for the good. Continue reading “OPTROT? Business as usual? Or both?”

The Best Law Money Can Buy?

Or good public policy?  How can we know?

In follow-up to an earlier posting, the wheels were greased sufficiently well that Senate Bill 110,  an Act relating to Optometry, raced through the Senate committee structure and floor in less than 4 days. In less than 4 more work days it passed through the committee and floor of the House. moving through both chambers in spectacular time and with overwhelming majority votes. Only a single other non-housekeeping bill has passed both chambers so far in this session. Talk about “inside-track!”   The bill now goes to the Governor who has promised to meet with interested parties before he makes a decision to veto or not. What facts does the Governor want to hear? Facts that might have come out of testimony in the Health and Welfare Committee that might properly have heard the bill in the first place?

Over the same days, the legislature rejected a bill protecting the public from the usurious interest rates of the Payday Loan industry (that also paid big bucks for the privilege of exercising their free speech),  and allowed a bill to review child deaths from abuse or neglect to falter.   I rather suspect the abused children did not have a PAC to counter the political influence of the anti-abortion lobby who placed their suicide belt around the bill.

SB 110 is a complete overhaul of existing law defining the lawful practice of Optometry. The traditional role of Optometrists in refraction and fitting lenses is no longer central. Instead, Optometrists are now authorized to correct and relieve optical abnormalities using surgical procedures and prescription drugs. The bill is pretty much silent on what kinds of surgery is permitted. “Optical abnormality” is not defined and I interpret it to mean disease of the eye. Instead, the bulk of the text itemizes prohibited surgery, including non-laser surgery of the cornea, sclera, lens, etc. The exclusions are so outrageously obvious that they obscure the implications of what can be done. Much is made of the distinction between laser and non-laser surgery, but this is a false dichotomy. Lasers are used to excise tissues as an alternative to “the knife” in a wide variety of traditional surgeries. In my reading, this bill appears to authorize laser surgery on almost any part of the eye! Curiously, the bill prohibits “laser or nonlaser injection into the posterior chamber of the eye…” I have no idea what “laser injection” into the eye means. This phrase appears to me to be an error in the writing of the bill reflecting its rocket-speed passage. If a nonsensical medical procedure is present in the bill, how well discussed or understood could the rest of the legislation been considered? [I will be happy, even reassured, to stand corrected.] Continue reading “The Best Law Money Can Buy?”

New Site for Louisville Veterans Hospital?

Pending Sign at Bronsboro Site

Actually, this is just my guess, or perhaps wish. Nonetheless, something is happening at one of the finalist sites for the new Louisville Veterans Hospital in Louisville. Over the past few weeks, ground preparations were made for the sign above. Today I noticed that the blank sign itself was erected. I am willing to accept a bet for a drink at your favorite bar that soon there will be a VA Hospital sign there.

Certainly if the Vets themselves had any say in the matter, the deal would have been settled long ago. I attended two major public hearings early in the selection process. Both were heavily attended by veterans and officers of veterans’ organizations. Except for a veteran or two who came with the official party from the University of Louisville and its Hospital, to a person they vigorously opposed a downtown location for the new hospital. One or two representatives of major organizations said they personally had no objection to a downtown hospital, but that their members were overwhelmingly opposed. The most common reason I remember was that they did not want to deal with the parking and traffic of downtown Louisville. They also like the thought and culture of a dedicated facility and staff of their own. They feared being farmed out to other downtown hospitals– indeed this possibility was part of the original planning.

The University and its hospital, and perhaps a partner hospital or two, lobbied very heavily and at the highest levels for a downtown location. They were able to convince the Mayor’s office to take their side. It was and still is big-time politics. The University’s reasons are pretty apparent: the VA is important to them. They desperately need the patients for their various teaching and residency programs. The University likes the faculty salary money that it gets from the government. VA salaries are “hard” money that can be used largely at the discretion of clinical chairmen. The University can place faculty there who cannot qualify for a regular Kentucky medical license. It likes the VA research money that has traditionally been easier to get than NIH money. It likes like having the captive veterans around on which to do commercial drug studies and other research. Like other hospitals in town, University Hospital would like to more easily subcontract for specialty services at its own hospital, or even take over some traditional Veterans Hospital programs. University Hospital by itself does not attract enough of some types of patients to support its training programs. It and the University would clearly benefit from another closer and captive group of patients. No matter where the hospital ends up, I expect to see some maneuvering for access to its patients. Continue reading “New Site for Louisville Veterans Hospital?”