An abrupt about-face by the Florida Medical Association is helping to keep malpractice reform legislation alive, but at least one group of physicians is calling the move "irresponsible."
After years of staunchly opposing broader prescription authority for optometrists, the FMA has agreed to recognize their "full scope" privileges. As recently as last November, the FMA declared: "Expanding optometrists' scope of practice would be dangerous for patients."
In return for seeing things the optometrists' way, the FMA garnered support for medical malpractice legislation the association has proposed this session.
"A commitment was made that any compromise reached on the eye-care issue would be placed in a legislative package that also included significant medical liability reforms that would help all physicians," said a source familiar with the negotiations.
The med-mal bills -- Senate Bill 1316 and SB 1506 -- include three reforms long sought by the FMA:
- Allowing a prospective defendant or his or her legal representative to interview the claimants treating health-care providers without the presence of the claimant or the claimants legal representative.
- Increasing the burden of proof in medical liability cases involving diagnostic testing to a clear and convincing standard.
- Permitting physicians and patients to enter into an arbitration agreement that includes a limitation on damages.
FMA President Miguel A. Machado hailed the legislation, saying, "Advancing medical liability reforms will encourage more physicians to locate in Florida, which will increase patients access to care."
But the FMA's deal with the optometrists has angered some ophthalmologists, who are licensed physicians and belong to the 20,000-member medical association.
Ophthalmologists critical of the agreement worry that medical standards will be sacrificed and that the distinction between them and optometrists, who are not doctors, will be blurred further.
The Florida Society of Ophthalmologists is opposed to the tradeoff with optometrists.
"This is absolutely one of the worst things to happen to health care in this state. It is irresponsible," said William J. Mallon, president of the FSO.
"We all support tort reform, but to give in on this is patently wrong. Optometrists have given $700,000 to state legislators and this shows that the votes are for sale," Mallon charged.
The FMA, which maintains that patient care is its foremost concern, says several safeguards have been agreed to. Among them:
- A strict prohibition of surgery by optometrists.
- A requirement that optometrists report any adverse incidents related to prescribing a limited number of oral medications.
- A requirement that optometrists complete a pharmacology certification process jointly developed and administered by the FMA and the Florida Optometric Association (including passing an examination).
- New requirements that optometrists refer any patients who experience progressive glaucoma due to failed pharmaceutical intervention to an ophthalmologist in a timely manner.
- "Co-management" of post-operative care to be conducted pursuant to an established protocol that governs the relationship between the operating surgeon and the optometrist. This includes a provision requiring patients' written consent to the co-management relationship.
- Optometrists are prohibited from administering or prescribing Schedule I or Schedule II pharmaceutical agents.
Mallon said ophthalmologists who support the optometrist provisions are already engaging in co-management schemes that he calls "unethical" and "illegal."
"This has divided the profession because some ophthalmologists are in bed with optometrists. Just follow the money," said Mallon, who practices in Vero Beach.
As for the pharmacology training, Mallon said 50 hours of online coursework is hardly sufficient for optometrists, who, as the FMA has previously noted, have considerably less education than ophthalmologists.
"Pharmacists are eminently more qualified to write prescriptions," he said.
Furious that no ophthalmologists were included in the FMA's discussions over optometry, Mallon said the association should have stood by its original position and "not be worn down by the money given by the other side."
Ken Lawson, an optometrist and spokesman for the Florida Optometric Association, said there is no "quid pro quo" for the med-mal legislation. He said in a statement:
"We work as much as possible with other health-care associations to create more access, affordability and quality in terms of health care for Florida's patients. Oftentimes, many or all of the health-care associations will be in support of the same, or similar pieces of legislation.
"We are very glad to be working closely this year with the FMA on some regulatory reform which we feel will improve eye care in general, and we are delighted to be working with them in bringing about meaningful lawsuit reform, a key policy initiative that will lower costs and improve affordability of quality care for everyone."
According to new state data, in addition to the $700,000 already given, the Florida Optometric Association spent $354,993.50 to lobby legislators ahead of this current session.
Contact Kenric Ward at kward@sunshinestatenews.com or (772) 801-5341.
