California becomes 47th state to pass TPA legislation

Issue: March 1996

SACRAMENTO, Calif.—The smoke has cleared in a 4-year battle here between not only ophthalmologists and optometrists, but among the state's ODs themselves. California has emerged as the 47th state to approve therapeutic pharmaceutical agent (TPA) privileges for optometrists.

California's controversial Senate Bill 668 was signed Feb. 21 by Gov. Pete Wilson (R), and was sponsored by Sen. Richard Polanco (D) of Los Angeles.

COA applauds the bill

For the California Optometric Association (COA), this marks a successful end to years of political maneuvering. "This bill puts optometry into the primary care market," said Philip B. Smith, OD, COA president. "About 60% of patients in California are in some type of third-party system."

Optometrists are still prohibited from using steroids and glaucoma medications, and the only oral medication they can prescribe is tetracycline. See accompanying chart for specific information.

Smith estimates the bill will allow ODs to treat 80%-85% of red eye problems.

Other members of the state's optometric community also greeted the bill as a chance to contribute more fully to the health care system. "It's going to bring 'Dr.' back to 'OD'," said Richard K. Simonds, OD, a private practitioner from San Diego. "We'll be doctors again, instead of being a bunch of merchants like the profession is becoming."

Not all ODs are pleased

But many in the state's optometric community are unhappy with the bill, which they have derisively dubbed "the Visine Bill." The state's board of optometry voted 6-1 against it.

Eliot Lawrence Bickford, OD, a private practitioner from Santa Barbara, Calif., summed up the two main problems. "First, the very limited scope of the bill," he said. "Second, the certification requirements, which are varied, ambiguous and—for many of my colleagues—will be difficult to achieve."

"I sincerely hope that this will allow us to become primary care physicians, but I sincerely doubt it," said Stanley H. Postar, OD, a Los Angeles private practitioner who has spearheaded optometric resistance to the bill in California. "This bill is so limited—it's aspirins and antibiotics. I believe that we did ourselves out of primary care, because we cannot do enough to be primary care."

And Postar expressed disgust at the preceptorship: "Optometrists have become indentured servants."

Smith said many object because COA members "have not understood the full impact of the bill. It's not the best bill in the world, but it's not a bad bill. It allows us to treat patients." Three other states are still working on getting TPA legislation passed.

Pennsylvania

Pennsylvania optometrists are still trying to get House Bill 1166 through their state legislature. The bill would allow optometrists to administer and prescribe both prescription and over-the-counter drugs for anterior segment treatment. It specifically excludes schedule I and schedule II controlled substances, injections and treatment of systemic disease. While it is still early, the bill does include steroids and glaucoma drugs, said Robert Hall, executive director of the Pennsylvania Optometric Association (POA).

The bill also clarifies that optometrists can remove foreign bodies from the surface of the eye. Current laws are not clear on this issue.

According to Ted Mowatt, POA government affairs director, the bill is in the House Professional Licensure Committee, with action expected in the spring. The next step in the process would be the Senate Consumer Protection and Professional Licensure Committee.

Massachusetts

According to Carmine Guida, OD, executive director of the Massachusetts Society of Optometrists, a recent legislative change in Massachusetts has helped ODs. Before 1995, any bill that was not resolved by the end of the year had to begin the process all over again. That is now not the case, and the 1995 efforts to get Senate Bill 540 passed will carry over to this year. The bill has passed through all Senate committees, Guida said, and is presently in the House Ways and Means Committee.

Guida anticipates that the bill—which does not allow use of glaucoma drugs or steroids—will make it through the House unchanged, avoiding a time-consuming compromise meeting between the two bodies, and then will proceed to the governor. Guida said there was a lot of support in the Senate, and he hopes to get the same in the House before the July vote.

Hawaii

Franklin Lau, OD, legislative chair of the Hawaii Optometric Association, said that their bill is entering its third year of legislation. So far, support for the bill in the legislature has been strong, he said: two unanimous committee voted in favor of it.

While the specifics of the bill have not yet been fully decided, Lau said they are trying to have steroids and glaucoma treatment included. Lau thinks they will probably not get the full bill, but that what is passed will be strong and will "enable optometrists in Hawaii to practice to their level of training."

He speculated that the bill may pass as soon as the end of April.

California TPA Law

What the bill allows:

mydriatics
cycloplegics
anesthetics
topical miotics
topical nonsteroidal anti-allergy agents
topical anti-inflammatory agents
topical antibiotic agents
tetracycline
treatment of peripheral corneal ulcers
(only after physician consultation)

What the bill prohibits:

steroids
glaucoma medications
surgery
therapeutic lasers

Special provisions:

bill cannot be altered until the year 2000
65-hour preceptorship with an ophthalmologist required for certification