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.]
Another central change in existing optometry licensure law is that the Optometry Licensure Board is given complete authority to determine what constitutes the practice of optometry. Not a bad deal! I would have liked to be able to write my own job description. We should expect to see their scope of Optometry practice to expand considerably in the future without the requirement of legislative review. In the trade, this is called opening the door.
One can hardly blame the optometrists for promoting their self-interest and their desire to serve the public. There are big bucks in prescribing and doing procedures. They will need some big bucks to pay for their new laser machines. (How much money did the laser-makers contribute?) Optometrists want to to be for the eye, what podiatrists are to the foot. Podiatry practice allows its professionals to “do it all” from the ankle down, including total joint replacements. I have to give the optometrists credit for winning the biggest professional turf battle in my recent memory.
Because I have not personally heard any discussion of what changes in the law will mean from a practical point of view, I necessarily have only partially informed opinions about how good or not this bill is for public policy. Certainly other health professionals have successfully had their scope of practice expanded without the end of the world occurring. I am curious for example why the Optometrists did not want to claim the ability to perform LASIK surgery to correct blurred vision or astigmatism. Maybe that would be a good thing. Is it more than just dialing in the prescription and pushing the button? Why it more dangerous than cutting into the eyeball with a laser knife? In my essentially lay opinion, LASIK surgery on the cornea is more central to the traditional mission of Optometrists than doing laser surgery on the eyeball or prescribing drugs to treat eye disease.
Even if there are good public policy reasons for this major expansion in the professional scope of practice of optometrists, the presence of so much money sloshing in the system has polluted the policy and legislative process. You would like to believe that a given legislative issue was decided on the facts and on the public good. It might be fairly asked if I would have reservations with such a bill if the money came from MD physicians? Even if I answered yes, would anyone believe me? Even as our legislators and Governor say the money they received makes no difference to them, should anyone believe them? When this kind of thing goes on in Afghanistan, we call it corruption. Can someone explain how this is different?