Comanagement restrictions fail in Florida

Ophthalmology declared a moral victory despite the defeat of the state House and Senate bills.

Issue: June 15, 2001

TALLAHASSEE, Fla. — Two bills introduced to the Florida State House and Senate that would have restricted optometric and ophthalmic practice in the state failed to pass in May. The bills, HB 553 and SB 924, had been pushed by ophthalmologists and officials of the Florida Medical Association as part of a strategy to keep patients under the care of ophthalmologists instead of optometrists.

The Miami Herald reported May 1 that state Republicans tabled the controversial bill that would have required eye surgery patients to get postoperative care from medical doctors only.

Contentious debate on the measure prompted its sponsor, Rep. Mike Haridopolos, R-Melbourne, to declare the bill dead for the session.

Many state representatives said they did not see any convincing evidence that there was a problem with the current status of comanagement between optometrists and ophthalmologists. Among the representatives who were not convinced was Rep. Rob Wallace, R-Tampa, who never allowed the bill to be heard in his budget committee.

A moral victory?

The Florida Society of Ophthalmologists (FSO) is declaring the dead bill a moral victory for ophthalmology in Florida. In an open letter on their Web site, the society said that optometrists, who for the past 10 years have attempted to expand their scope of practice in a variety of areas such as surgery, systemic drugs and hospital and ambulatory surgical privileges, this session filed no expansion-of-scope legislation.

State Senator Daniel Webster, R-Orlando, sponsored the Senate version of the postoperative ocular care bill, SB 924.

The legislation came close to passing. Sen. Webster attempted to amend the bill to an extensive healthcare reform bill (SB 1558) during the last hours of the session. The amendment, which would have allowed delegation of all postoperative ocular care to an ophthalmologist for all procedures except for cataract surgery, where the delegation was required during the first 10 days after surgery, passed 21 to 13 — a majority vote.

However, Sen. Don Sullivan, who was acting as president of the Senate, ruled that an amendment added to a bill on its third reading required a two-thirds vote to pass. Thus the amendment was not added. SB 1558 later that night passed the legislature without the ocular care amendment.

Originally, SB 924 and HB 553 would have authorized only medical doctors licensed under chapters 458 and 459 of the Florida statutes to provide postoperative ocular care. Those chapters pertain to medical doctors and doctors of osteopathic medicine only.

A victory for optometrists

Speaking on behalf of the Florida Optometric Association, executive director Kenneth Franklin said the bills ultimately failed because they lacked merit. He explained that the Florida sponsors and ophthalmologists in favor of the bill failed to demonstrate the harm that they were trying to correct with the legislation.

“This clearly was an economic-driven vehicle. It had nothing to do with patient harm, had nothing to do with quality of care, there was no documented evidence of failings on the part of the current system of health delivery,” Mr. Franklin said.

“I think the biggest plus in this for us, at least here in Florida, is that we had over half of the ophthalmologists in the state on our side to defeat this bill because it was a no-issue bill. People who are trained as high-skill surgeons want to be surgeons. The system of comanaged care has been working in Florida for 25 years without incident, without malpractice or complaints, and for someone to just suggest we’re going to eliminate comanagement by optometry and require all ophthalmologists or all physicians in the state of Florida to do that procedure, it has no merit whatsoever,” Mr. Franklin said.

For Your Information:

Kenneth L. Franklin, executive director of the Florida Optometric Association, can be reached at P.O. Box 13429, Tallahassee, FL 32317; (850) 877-4697; fax: (850) 878-0933; e-mail: Ken@FOA.vistech.net.

The Florida Society of Ophthalmology Web site can be found at www.MDeye.org.