This article is more than 5 years old. Information may no longer be current.
AOA rallies ODs opposing bill that would ban them from some procedures in the VA
Click Here to Manage Email Alerts
Legislation that would bar optometrists from performing any type of what some consider “eye surgery” at U.S. Department of Veterans’ Affairs Medical Centers has raised strong objections from optometrists across the country.
The Veterans Eye Treatment Safety (VETS) Act of 2003, introduced in November 2003 by Rep. John Sullivan (R-Okla.), would specify that only licensed medical doctors and licensed doctors of osteopathy could perform eye surgery at VA facilities. Under the proposed legislation, optometrists would be prohibited from performing laser procedures, punctal dilation, epilation of lashes and other basic procedures.
According to a statement from the American Optometric Association, the proposed legislation is “an unfounded legislative strike by organized ophthalmology against a long-standing policy at the Department of Veterans Affairs that allows optometrists to serve veterans within the full scope of their training.”
“HR 3473 is an unprecedented and unnecessary intrusion into the area of state regulation of scope of practice and the VA credentialing process,” said Victor J. Connors, OD, AOA president. “There is not one scintilla of evidence that patient safety has been or would be compromised by allowing optometrists to provide care consistent with their licensure within the VA.”
A safety measure?
The impetus for the legislation came from the American College of Surgeons, the American Medical Association, the American Academy of Ophthalmology, the American Osteopathic Association and the American Society of Cataract and Refractive Surgery. These groups requested the introduction of this legislation after discovering that some optometrists had clinical privileges for laser procedures at VA facilities.
“Oklahoma optometrists have successfully performed more than 12,000 of these procedures with no adverse outcomes, no patient complaints and no litigation,” Dr. Connors told Primary Care Optometry News. “The fear in medicine is not that veterans will be harmed. The fear is that physicians’ traditional monopoly on patient care will be further eroded.”
An organization designed to advocate the legislation, the VETS Coalition (Veterans Eye Treatment Safety Coalition), was formed from members of the American Academy of Family Physicians, American Medical Association, American Osteopathic Association, American College of Surgeons, American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery.
This organization’s Web site erroneously maintains that “in some states, optometrists are not even allowed to prescribe medicine,” when, in fact, optometrists in all 50 states have prescribing privileges of some kind.
In listing the respective training for ophthalmologists and optometrists, the VETS coalition site lists ophthalmology training as “4 years of premedical education, 4 years of medical school, 1 year of internship and 3 years of specialized medical training and experience in eye care.” For optometrists, education is listed as simply “4 years of accredited optometry school,” when, in reality, optometrists must also undergo 4 years of premedical education prior to 4 years of optometry school and in some instances also undergo 1 year of residency training.
Broader implications
Practitioners have expressed concern that HR 3473 will likely have far-reaching consequences for all optometrists in all 50 states. According to Stillwater, Okla.-based practitioner David A. Cockrell, OD, the legislation could set a disturbing legal precedent.
“Up to this point, ophthalmology has not been able to change optometric scope of practice in any states, although they have tried,” Dr. Cockrell said. “But when you are able to disallow one group of optometrists from being able to practice to the fullest scope in that state, you’ve just affected scope of practice in that entire state.”
Dr. Cockrell was instrumental in obtaining laser privileges for optometrists in the state of Oklahoma in 1996. He said that to his knowledge this is the first instance of federal legislation restricting practice scope in the individual states.
He said that Undersecretary of Health Dr. Robert Roswell indicated to the Budget Committee that the Veterans’ Administration was not in favor of the legislation. Dr. Roswell also said that he could foresee the legislation having a direct impact on states’ rights.
Dr. Cockrell said the legislation would affect optometrists in all 50 states, on procedures as simple as epilation. He added that optometrists have demonstrated nothing but competence in performing these procedures. “While ophthalmology is making unfounded claims of patient harm, there is zero evidence of harm,” he said. “Not a little bit — zero.”
In addition, Dr. Cockrell pointed out that because veterans are not treated exclusively in VA centers, this legislation could affect the treatment of veterans in other locations.
“I am in a rural practice in Oklahoma, and I see veterans and am paid through the Tri-Care system,” he said. “So certainly I would expect that if a bill like this were to pass, Tri-Care would start to think if optometrists can’t take care of a veteran like that within a VA clinic setting, how can they do it in a VA system of any kind, such as Tri-Care and private practice?’”
He said the issue essentially boils down to control. “The introduction of this legislation is nothing more than what we have seen before,” Dr. Cockrell said. “It is ophthalmology’s attempt to control optometry.”
Optometry speaks out
Optometrists have responded to HR 3473 with letters, e-mails, phone calls and face-to-face meetings with legislators, voicing their strong opposition to the legislation. The AOA has officially expressed its opposition to the bill and its confidence that the legislation will be defeated.
“This bill should be and will be rejected by those who understand the appropriate role of the states and the federal government on licensing issues and who understand and appreciate the VA credentialing process,” Dr. Connors said.
Dr. Connors also emphasized that although its wording suggests an altruistic concern for the health of veterans, HR 3473 may be rooted in less honorable motives. “It is important to understand what this issue is and is not about,” he said. “It is certainly not about patient safety and quality of care concerns. It is in fact about protecting turf and pocketbooks.”
He added that the assertion that medical leadership of the VA is in any way neglectful of patient safety is insulting. “It is sad, really, to see medicine launch a cynical attack on the medical leadership in the VA, who in fact have followed well-established credentialing and privileging procedures and are acutely aware that patient safety concerns must be paramount,” he said. “To suggest that they are insensitive to these concerns is shameful, though not necessarily surprising.”
According to AOA spokesperson Susan L. Thomas, the AOA has galvanized its opposition to the legislation in the form of “e-advocacy” efforts, through which more than 20,000 e-mails were sent by ODs to lawmakers. In addition, Ms. Thomas said the AOA Washington staff spent the month of February visiting congressional offices and has sent bulletins to its keyperson network.
Dr. Cockrell urged optometrists to take this initiative a step further, whether through phone calls, e-mails, or in-person visits.
“I would encourage every single optometrist to personally contact their United States congressman and their United States senator. Certainly optometrists have done a wonderful job of e-mailing their concerns, but there is nothing quite like a personal contact,” he said. “If it takes a trip to Washington, D.C., take time out of your practice. If it takes a visit to your local office, do it. It’s that important.”
Dr. Connors said although this effort by medicine to undermine optometry might create temporary controversy, it is unlikely to stand the test of time. “In the short run, mounting a campaign of misinformation and scare tactics can create an issue where none should exist,” he said. “But this is a marathon, not a sprint. In the end, as people shine a spotlight on the empty arguments supporting this measure, it will be exposed for the sham that it is.”
For Your Information:
- Victor J. Connors, OD, is president of the American Optometric Association. He can be reached at 6602 University Ave., Middleton, WI 53562; (608) 836-0678; fax: (608) 831-8470; e-mail: AmOptBdVJC@aol.com.
- David A. Cockrell, OD is a practitioner in Stillwater, Okla. He can be reached at 1711 W. Sixth St., PO Box 2017, Stillwater, OK 74076; (405) 372-1715; fax: (405) 372-3350; e-mail: dacockrell@aol.com.
- Susan L. Thomas is a spokesperson for the American Optometric Association. She can be reached at 243 North Lindbergh Blvd., St. Louis, MO 63141; (800) 365-2219; fax: (314) 991-4101; e-mail: SLThomas@theAOA.org.