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Oregon scope expands to orals and injectables
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SALEM, Ore. — Oregon Gov. John Kitzhaber, himself a medical doctor, secured a legislative victory for optometry last month when he signed a bill adding oral and injectable drugs to Oregon ODs’ scope of practice.
Some details remain to be ironed out. Once the law takes effect, its specific parameters must be established by a Non-Topical Formulary Council. This council, which comprises three optometrists, three medical doctors and one pharmacist, will be charged with determining exactly which drugs are permissible under the law.
“Our first choice would have been to have our Board of Optometry make those decisions, just as they do with topical and diagnostic drugs,” said Jack Perkins, OD, president of the Oregon Optometric Association. “But the legislation was not going to move without this.”
The bill, which was signed into law at the end of June, will go into effect Jan. 1, 2002.
Dr. Perkins said optometrists in Oregon are currently restricted to prescribing diagnostic and topical medications. “There are situations where topical medication is not adequate for treating conditions that fall within the scope of our care,” he said. “Even simple things like a sty in the tissue. If it is deep in the tissue, a topical eye drop just doesn’t get to the area of involvement.”
Opposition encountered
When the legislation was first introduced into the state senate, it incurred opposition from the Oregon Academy of Ophthalmology, the Oregon Medical Association and Oregon Associated Industries.
“Oregon Associated Industries was concerned that this would increase the cost of health care,” Dr. Perkins said. “We maintained that patients with these problems are going to see somebody. These aren’t the kind of problems that just go away.”
Dr. Perkins said the opposition was able to generate some concern over the bill among the legislators. “Ophthalmology tried to create some doubt as far as the accountability of the Board of Optometry and its ability to regulate these medications,” Dr. Perkins said.
Dr. Perkins added that the legislators may have been uncomfortable rendering a medical decision. “I don’t think legislators like to make these decisions,” Dr. Perkins said. “They’d rather not get involved in the technicalities of health care professionals. It typically isn’t their area of expertise.”
The legislators then suggested the idea of the Formulary Council.
A compromise
“In order to get the legislation passed, we had to compromise somewhat,” said Scott Walters, OD, past president of the Oregon Optometric Association. “This Formulary Council was our compromise.”
Dr. Walters said the council representatives will be appointed by the Oregon Boards of Optometry, Medicine and Pharmacy. The council will not be permitted to meet until Jan. 1, 2002.
Dr. Walters said he is hoping that the spirit of cooperation will prevail. But even if the council reaches an impasse, the bill will be revisited. “Sen. (Bill) Fisher, who is chairman of the Health and Human Services Committee, has made it clear that he wants to see some change on this issue,” Dr. Walters said. “So if there is no cooperation on the Formulary Council, he is ready to look at the legislation again next session.”
Dr. Perkins said if the medical doctors on the council try to nullify the law by unreasonably restricting the medications, they could be excluded from the proceedings altogether.
He recalled a similar situation a few years ago, when Oregon’s therapeutic law was passed. The specifics were initially to be decided by the Board of Medicine, he said. “The board of medicine came up with a few over-the-counter drugs and a few antiquated antibiotics and said that was what optometry could use,” he said. “We told the legislature that they were not cooperating in the spirit of the law. And so the legislature took it away from medicine and put it in the hands of the Board of Optometry.”
Dr. Perkins said he hopes this scenario does not repeat itself. “We hope they have learned from that experience,” he said. “The intention of the law was to allow us to use these medications, and if they try to limit it in such a way that it is ineffective, it doesn’t really meet the spirit of the law.”
Relationships remain strong
Dr. Walters emphasized that, although political conflict persists in Oregon, everyday working relationships between optometrists and ophthalmologists are generally positive. “When it comes to politics, the associations and the academies are usually going to be at odds,” he said. “But I think personal, individual relationships are still quite strong.”
For Your Information:
- Jack Perkins, OD, is president of the Oregon Optometric Association. He can be reached at 1471 Pearl St., Eugene, OR 97401; (541) 686-1237; fax: (541) 484-2026; e-mail: JEPOD@home.com.
- Scott Walters, OD, is the past president of the Oregon Optometric Association. He can be reached at 1022 NW 6th St., Grants Pass, OR 97526; (541) 476-4545; fax: (541) 479-5985; e-mail: drw@eyecaregroup.net.