BOISE — Despite the hint wryness in his voice, Chairman Fred Wood was mostly serious Thursday when he opened the House Health and Welfare Committee.
“Next order of business is the first epic battle of the Optometric Physician Licensing Act,” said Wood, a Republican from Burley.
The committee took more than two hours of testimony on the bill that would expand the scope of practice for eye doctors and allow them to do a few laser-assisted procedures.
The issue boiled down to a general disagreement: eye doctors said they’re trained to do the procedures; eye surgeons said the doctors aren’t trained enough.
Several speakers referred to the issue as a “turf war” and testimony was often heated. Wood cut speakers off on multiple occasions, telling them to “be careful” when their comments started to get combative.
“Nobody likes scope of practice battles at all,” Wood said. “You’re requiring the Legislature to choose among friends and we don’t like to choose among friends.”
A vote is expected to take place this week.
Doctors vs. surgeons
Optometrists, often referred to as eye doctors, provide vision and eye care, perform examinations, and prescribe glasses and a variety of other treatments. Ophthalmologists, or eye surgeons, are medical doctors who diagnose eye diseases and perform several types of procedures and surgeries.
The code governing Idaho’s optometrists hasn’t substantially changed since the 1980s, and an executive order signed last year by Gov. Brad Little required an update. The proposed bill would update laws, add definitions, remove outdated language and reorganize the statute.
But a controversial section of the bill expands the scope of practice to allow optometrists to perform certain laser-assisted procedures.
Advocates held up the six states that have approved similar scope of practice expansions — some for as many as 20 years without incident. Opponents pointed to more than a dozen states that have rejected similar bills in recent years over concern for public health.
Aaron Warner, chair 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 ophthalmology advocacy groups, Warner said.
“Optometrists are not trying to say that we have the equivalent training to ophthalmologist at all,” he said, “but optometrists are properly trained to perform the procedures that we’re asking to perform.”
The bill would save money for patients and increase access to care across the state, said Jack Zarybnisky of the Idaho Optometric Association.
Zrybnisky, who has practiced in Burley since 1972, pointed out optometrists faced resistance each time their scope of practice expanded to allow them to dilate eyes or prescribe medicine or do many of the procedures they can do now. Each time it did, he said, they went “to great measures to get the required education and experience to do these procedures effectively,” and as a result, “the Idaho citizens received a more thorough examination.”
But allowing non-medical doctors to perform surgery is unsafe, Idaho Society of Ophthalmology President Nathan Welch said. Optometrists don’t have the years of training and experience necessary to do surgery with potentially dangerous instruments, Welch said.
“These procedures can and will lead to blindness for some of our fellow Idahoans,” he said. “This bill is not safe for Idahoans and it’s not necessary for Idaho.”
Welch, who practices in Twin Falls, pushed against the notion that residents lack access to care in the state. There isn’t a backlog of people waiting for surgery and most procedures take place on the same day a patient is diagnosed, he said. And while ophthalmologists might only be in about a quarter of Idaho’s counties, people are generally willing to drive from Jerome to Twin Falls for eye surgery done by a qualified surgeon, he said.
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The most contentious aspect of the bill is that instead of listing specific procedures optometrists can do, it includes a list of 32 procedures they cannot do.
Jason Halverson, a Twin Falls ophthalmologist, said the exclusion list doesn’t go far enough, and could allow optometrists to perform several hundred procedures they aren’t trained for.
“The sheer number of procedures that fall outside this exclusionary list renders the whole bill impractical and would, in my opinion, be impossible to enforce,” Halverson said. “The logic of approaching a scope expansion in this manner is unclear.”
If the Legislature were to pass the bill?
“God save us all,” he said.
Kelley Packer, the bureau chief for the Idaho Bureau of Occupational Licenses, said the exclusion list was a compromise for the ophthalmologists and isn’t normally part of scope of practice law. It was “insulting and condescending” to suggest optometrists would ever do procedures they weren’t trained for, and that the board wouldn’t provide proper oversight, Packer said.
Scope of practice laws already prevent doctors from doing procedures that aren’t part of their training, and they should be allowed to practice to the full extent of their abilities, she said.
“We create licenses to keep people in their proper lane,” she said. “We provide licenses so we can take them away if they do something wrong.”
Robert Ford, an ophthalmologist who supports the bill, said optometrists are professionals and have good judgement.
“I don’t think we should be trying to micromanage scope of practice in the legislation,” Ford said. “The legislation would permit me to do brain surgery, but I wouldn’t do it because I’m not qualified.”
The committee opted to withhold a vote on the bill until Thursday in order to consider a recent report from the Vermont Office of Professional Regulation.
The report ultimately recommends against expanding scope of practice in Vermont.
“The Office cannot conclude that optometrists have the education and training to safely provide these procedures,” the report says. “Nor can it find that there is a need for expanded access to the proposed advanced procedures or a reduction in costs associated with scope expansion.”
Five Republicans on the committee opposed the motion to delay the vote until Thursday in order to approve the bill at the original hearing.
Rep. Laurie Lickley, R-Jerome, made a failed motion to permanently hold the bill in committee, which would have effectively killed it.
Wood acknowledged many on the committee had likely already made up their minds on the issue, but none had access to hard data to support their view. A week was needed to review the report, he said.
“The Legislature has always tried to facilitate, to make sure that everybody gets to practice to the full extent of their training and their licensure,” he said. “I think we understand that’s not necessarily a hard and fast line in any profession.”