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Okla. governor signs rule confirming ODs’ scope of practice
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In a state troubled by practice scope controversy, a definitive victory has been scored for optometry with the recent signing of a rule promulgated by the Oklahoma Board of Examiners in Optometry.
The rule, which met with strong opposition from the American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology, was designed to “confirm the existing scope of practice, and more narrowly define the surgical procedures optometric physicians may perform,” according to a press release disseminated by the Oklahoma Association of Optometric Physicians (OAOP).
ASCRS had urged Oklahoma Gov. Brad Henry to reject the rule, which was adopted on Oct. 4, according to an ASCRS press release. The concern was that the rule would broaden the scope of surgeries ODs are permitted to perform to include lid and eye surgery using a scalpel.
In addition, ASCRS claimed, “optometrists would be allowed to inject medication into the eye itself, and to inject Botox [botulinum toxin type A, Allergan] around the eyes.”
“Under this rule, optometrists who have had no medical training at an accredited school of medicine or osteopathy would be able to perform multiple surgical procedures,” said ASCRS president Priscilla P. Arnold, MD, in the press release. “This rule sets a dangerous precedent for patient safety and undermines efforts to raise standards for quality of care.”
Dr. Arnold expressed her organization’s strong opposition to the rule and implored the governor to discard it. “We strongly urge [Gov. Henry] to protect the public and to protect the standards that have assured a high quality of patient care for all Oklahomans,” she said in the press release.
In addition, the AAO expressed its strong opposition to the signing of the rule.
“It will be a sad day for Oklahoma citizens if this brazen move by the Oklahoma optometry board is permitted to stand,” said H. Dunbar Hoskins Jr., MD, AAO executive vice president, in a press release distributed before the rule was signed. “Allowing non-medical doctors to perform eye surgery is an enormous patient safety risk. Ophthalmologists have extensive medical or osteopathy school education, with internships in ophthalmology and surgical residencies before they perform delicate procedures on the eyes.”
David A. Cockrell, OD, president of the Oklahoma Board of Examiners in Optometry, told PRIMARY CARE OPTOMETRY NEWS that the optometry board was forced to formulate a new rule in response to an opinion issued by the Oklahoma State Attorney General. The opinion stated that the optometry board did not have the legal authority to allow ODs to perform surgical procedures.
In April 2004, Gov. Henry signed into law a bill that added the word “surgery” to Optometry’s Practice Act, according to an April OAOP press release. House Bill 2321 also enabled the Board of Examiners in Optometry to define the surgical procedures optometrists can perform.
The addition of the word “surgery” did not mean the scope of practice of Oklahoma optometrists was being expanded, Dr. Cockrell said in an interview with PRIMARY CARE OPTOMETRY NEWS. Instead, it was designed to preserve the right of optometrists to do simple procedures, such as removal of an eyelash, foreign body or eyelid lesion, as well as treatment of chalazion and other minor lid abnormalities. Optometrists have also routinely performed posterior capsulotomies for more than a decade. Because these procedures are technically defined as “surgery,” the word needed to be included in the scope of practice legislation.
Botox injections are not permitted, Dr. Cockrell said. “Our law specifically excludes us from doing cosmetic lid procedures,” Dr. Cockrell. “That is in print, and it has been in print. What is disappointing is that our law is available for all to see, and that one mention of Botox has gotten a lot of play in the journals. It’s inaccurate and misleading.”
Dr. Cockrell said the rule is actually quite strict, despite the descriptions proffered by organized ophthalmology. “This is an extensive rule, and it excludes cataract surgery, corneal transplants and muscle surgery,” he said. “It excludes full-thickness penetration of the sclera and cornea, so we are not going to be cutting into the eye.”
While some surgery with a scalpel is permitted under the rule, that reflects no change in the optometric scope of practice, Dr. Cockrell said. “For years, we have done chalazion removal in Oklahoma. For years, we have done small lump and bump removals. Some of these procedures can be performed with a scalpel; typically they are not, but they could be,” he said. “This is nothing new. This in absolutely no way expands our scope of practice.”
According to an OAOP press release, the Attorney General’s complaint was not spurred by patient complaints or malpractice suits, but by inquiries made by ophthalmology.
The American Optometric Association has expressed its approval of Gov. Henry’s decision to sign the rule.
“We are pleased that Gov. Brad Henry has signed the new rule established by the Oklahoma Board of Examiners in Optometry,” said Wesley E. Pittman, OD, AOA president, in a statement. “This will allow Oklahoma’s optometric physicians to continue to provide the same level of quality eye care they have in the past and will allow patients accessibility and choice when selecting a provider for their eye health care.
“As the national organization for the profession of optometry, we take great pride in the stellar reputation of Oklahoma optometric physicians,” Dr. Pittman continued. “Their extensive optometric training and clinical experience benefit patients throughout the state of Oklahoma and stand as a shining example of accessible and safe quality eye care. We commend the governor and his staff for their diligent work to keep this standard of quality care available to all Oklahomans.”
Dr. Pittman went on to reassure residents of Oklahoma that the governor’s decision will only enhance the quality of eye care in the state. “Residents of Oklahoma can be assured that Oklahoma optometric physicians are providing quality eye care and are doing so with patient safety in mind,” he said. “These doctors of optometry have had rigorous training and clinical experience to perform the procedures for which they are licensed and take great care to only perform those procedures that are within their scope of practice and expertise.”