Ophthalmologists could perform laser-assisted surgery under controversial bill | Policy

ByMartha R. Camara

Jan 27, 2020


BOISE — Despite the slight irony in his voice, Speaker Fred Wood was pretty serious Thursday when he opened the House Health and Welfare Committee.

“The next order of business is the epic first optometric physician licensing law battle,” said Wood, a Republican from Burley.

The committee heard more than two hours of testimony on the bill that would expand the scope of practice for ophthalmologists and allow them to perform some laser-assisted procedures.

The issue boiled down to general disagreement: the ophthalmologists said they were trained to perform the procedures; eye surgeons said the doctors weren’t trained enough.

Several speakers referred to the issue as a “turf war” and the testimonies were often stormy. Wood repeatedly cut speakers off, telling them to “be careful” when their comments started to get combative.

“Nobody really likes battles over the range of practice,” Wood said. “You’re asking the Legislature to choose between friends and we don’t like to choose between friends.”

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A vote is expected to take place this week.

Doctors versus surgeons

Optometrists, often called ophthalmologists, provide vision and eye care, perform examinations, and prescribe eyeglasses and a variety of other treatments. Ophthalmologists, or eye surgeons, are doctors who diagnose eye diseases and perform several types of procedures and surgeries.

The code governing optometrists in Idaho hasn’t changed much since the 1980s, and an executive order signed last year by Governor Brad Little required an update. The proposed bill would update laws, add definitions, remove outdated language and revamp the law.

But a controversial section of the bill expands the scope of practice to allow optometrists to perform certain laser-assisted procedures.

Advocates singled out the six states that have approved similar scope-of-practice extensions — some for up to 20 years without incident. Opponents pointed to more than a dozen states that have rejected similar bills in recent years over public health concerns.

Aaron Warner, president of the State Board of Optometry, said optometrists have performed a wide range of minimally invasive procedures for years in Idaho, and this bill would allow them to perform three more. Opposition to the bill comes from national eye care advocacy groups, Warner said.

“Optometrists are not trying to say at all that we have the equivalent training as an ophthalmologist,” he said, “but optometrists are properly trained to perform the procedures that we ask to be performed.”

The bill would save money for patients and improve access to care statewide, said Jack Zarybnisky of the Idaho Optometric Association.

Zrybnisky, who has practiced in Burley since 1972, pointed out that optometrists encounter resistance whenever their scope of practice expands to allow them to dilate eyes or prescribe medications or do many of the procedures they do. can do now. Each time he did, he said, they took “great steps to gain the training and experience required to perform these procedures effectively,” and as a result, “the citizens of the Idaho have received further scrutiny”.

But allowing non-physicians to perform surgery isn’t safe, said Idaho Ophthalmological Society President Nathan Welch. Optometrists lack the years of training and experience necessary to operate with potentially dangerous instruments, Welch said.

“These procedures can and will lead to blindness for some of our fellow Idahoers,” he said. “This bill is not safe for Idahoans and it is not necessary for Idaho.”

Welch, who practices in Twin Falls, pushed against the idea that residents don’t have access to care in the state. There is no backlog of people waiting for surgery and most procedures take place the same day a patient is diagnosed, he said. And although eye doctors only exist in about a quarter of Idaho counties, people are generally willing to drive from Jerome to Twin Falls for eye surgery performed by a qualified surgeon, he said.

The most controversial aspect of the bill is that instead of listing specific procedures optometrists can perform, it includes a list of 32 procedures they cannot perform.

Jason Halverson, an ophthalmologist from Twin Falls, said the exclusion list doesn’t go far enough and could allow optometrists to perform several hundred procedures for which they are not trained.

“The sheer number of procedures that fall outside this exclusion list makes the whole bill impractical and would, in my view, be unenforceable,” Halverson said. “The logic of approaching a scope expansion in this way is unclear.”

If the legislature were to pass the bill?

“May God protect us all,” he said.

Kelley Packer, bureau chief for the Idaho Office of Professional Licensing, said the exclusion list was a compromise for ophthalmologists and normally outside the scope of the law. It was “insulting and condescending” to suggest that optometrists would do procedures they weren’t trained in and that the board wouldn’t provide proper oversight, Packer said.

Scope of practice laws already prevent doctors from performing procedures that are not part of their training, and they should be allowed to practice to the fullest extent of their ability, she said.

“We create licenses to keep people in their lane,” she said. “We provide licenses so they can be taken away if they do something wrong.”

Robert Ford, an eye doctor who supports the bill, said optometrists are professionals and have good judgment.

“I don’t think we should try to micromanage scope of practice in legislation,” Ford said. “Legislation would allow me to do brain surgery, but I wouldn’t do it because I’m not qualified.”

Pending vote

The committee chose to suspend voting on the bill until Thursday to consider a recent report from the Vermont Office of Professional Regulation.

The report ultimately recommends against expanding the scope of practice in Vermont.

“The Bureau cannot conclude that optometrists have the education and training to perform these procedures safely,” the report said. “Nor can it conclude that there is a need to broaden access to the proposed advanced procedures or to reduce the costs associated with expanding scope.”

Five Republicans on the committee opposed the motion to delay the vote until Thursday to approve the bill at the initial hearing.

Rep. Laurie Lickley, R-Jerome, moved a failed motion to keep the bill permanently in committee, which would have effectively killed it.

Wood acknowledged that many committee members had likely already made up their minds on the matter, but none had access to hard data to back up their views. It took a week to review the report, he said.

“The Legislature has always tried to facilitate, to ensure that everyone can practice to the fullest extent of their training and license,” he said. “I think we understand that it’s not necessarily a hard and fast line in any profession.”