Massachusetts final state to pass TPA legislation

Issue: October 1997

BOSTON — Twenty-one years and 5 months after the first therapeutic pharmaceutical agent (TPA) legislation was passed in West Virginia, optometry has made a clean sweep of all 50 states. Massachusetts Gov. A. Paul Celluci (R) signed TPA legislation here July 31, leaving only the District of Columbia without a TPA law.

Effective 90 days from its signing, Massachusetts' 1,000-plus licensed optometrists can declare victory following a 7-year-long pursuit of prescribing privileges. The legislation enables them to prescribe topical pharmaceutical agents and perform foreign body removal. They cannot prescribe orals or controlled substances, and they cannot treat glaucoma.

To become TPA certified, Massachusetts ODs will have to complete a 90-hour didactic course and 30 hours of clinical training under the supervision of an ophthalmologist. As many as two-thirds of ODs here have a head start on this certification process since completing a certification course offered 3 years ago in anticipation of TPA legislation being passed, according to the Massachusetts Society of Optometrists (MSO).

Political support, opposition

Brenda F. Olson, OD, president of the state society, said, "It is very exciting to get this legislation. Although we are the 50th state to get TPA, we feel our bill is a good one that will allow our doctors to expand their scope of practice."

Dr. Olson, in private practice, said that having TPA privileges means she can take more complete care of her patients. "TPA privileges mean I won't have to refer patients for treatment I am trained to give."

Gary Wolf, OD, immediate past-president of the state's optometric society, said optometry garnered big support from state legislators this year. "We had our backs against the wall," said Dr. Wolf. "We had been fighting for 7 years, and we weren't going to compromise. The legislators were solidly with us, and the bill flew through in only 7 months of the 1997 legislative session, unamended."

While optometry enjoyed a good relationship with state legislators, Dr. Wolf said, the main opposition to TPA legislation came from ophthalmology. "Ophthalmology was certainly very strong and a component that kept us from getting this bill earlier," he said.

Richard Lawless, executive director of the MSO, said ophthalmologists were concerned about ODs expanding their scope of practice, but as the bill went through several rewrites since being filed in 1989, it became apparent that TPA legislation made sense.

"Everyone came to realize that our bill was not extraordinary, but was fair and reasonable in terms of the growth of this profession," said Mr. Lawless. "Because 49 other states passed similar legislation, it became apparent to our legislators that there was no reason for this bill not to pass."

Further, Mr. Lawless said, having TPA privileges will give optometrists and ophthalmologists more opportunity to work together. "The more we dispel the myths about optometry, the more ophthalmology sees how the two can complement one another. There should be greater lines of communication as a result, and it makes sense for us to begin working together."

Support from national level

Thomas E. Eichhorst, director of the state government relations center at the American Optometric Association (AOA), said Massachusetts' TPA legislation "is the start of things rather than the end of things. We now have all 50 states, and the next milestone would be the enactment of laws to authorize the treatment of glaucoma by optometrists in the remaining states."

Massachusetts is one of 11 states that has TPA legislation but does not authorize optometrists to treat glaucoma. Other states that have TPA legislation but no glaucoma treatment are California, Hawaii, Michigan, Montana, Nebraska, Nevada, New Hampshire, Pennsylvania, Texas and Vermont.

"We are very happy that Massachusetts now has a TPA law," Mr. Eichhorst said. "Optometry is a legislated profession, and this is a credit to optometrists that there has been a steady progression of TPA laws with no repeals nor legislative dimunitions."

Because each state sets its own timetable and legislative priorities, Mr. Eichhorst said, the role of the AOA as a national clearinghouse of information will continue to be vital to the amplification of TPA laws across the country.

For Your Information:

Thomas E. Eichhorst may be contacted at 243 N. Lindbergh Blvd., St. Louis, MO 63141-7881; (314) 991-4100, Ext. 234; fax: (314) 991-4101.

Richard Lawless may be contacted at the Massachusetts Society of Optometrists, 101 Tremont St., Ste. 600, Boston, MA 02108; (617) 542-9200; fax: (617) 542-6396.

Brenda F. Olson, OD, may be contacted at 1662 Falmouth Road, Centerville, MA 02540; (508) 771-1900; fax: (508) 771-3060.

Gary Wolf, OD, may be contacted at 1140 Thorndike St., Box 909, Palmer, MA 01069; (413) 283-2946; fax: (413) 283-3631.