Recently, two pieces of proposed legislation Senate Bill, SB 1506 and SB 1316 were amended to include dangerous provisions that would allow nonmedical doctors, specifically optometrists, to prescribe and administer systemic oral drugs for the first time in the state's history.
The Florida Medical Association has repeatedly advised the Legislature that a patient who requires an oral drug should be under the treatment of a medical doctor to ensure the condition is properly diagnosed and treated. Up until now, the Florida Legislature has agreed, and has consistently recognized that it would be irresponsible to expand the scope of optometric practice and authorize optometrists to prescribe oral drugs.
Through the testimony of the FMA and other medical experts, the Legislature has been made keenly aware that the education and training requirements for optometrists pale in comparison to that of medical doctors. Medical doctors typically spend seven to 11 years in rigorous hospital-based training after college. On the other hand, optometrists spend only four years in optometry school and this education does not include surgery, hospital-based training or prescription writing. In fact, a few optometry schools in the United States do not even require a college degree for admission.
Unfortunately, SB 1506 and SB 1316 would authorize an optometrist to prescribe oral drugs after completing minimal coursework that can be accomplished in less than one week, primarily online, without any patient contact. Furthermore, there would be no required supervision of prescription writing. Medical doctors are under direct supervision for years while training, and write thousands of prescriptions under close supervision before they are ever allowed to prescribe independently.
Medical doctors also complete many hours of continuing medical education annually to remain current with the constantly changing drugs and their potential side effects. Because oral drugs affect the entire human system, side effects can be devastating. These risks are even more acute in our state, which has a large population of senior citizens, many of whom are on multiple medications that can have adverse interactions.
This dangerous legislation would allow optometrists to prescribe a broad list of oral drugs, including a habit-forming narcotic and an antibiotic with such serious side effects that it has a "black box" warning from the Federal Drug Administration. It would also allow optometrists to prescribe and administer oral anti-glaucoma drugs, which are used almost exclusively by medical doctors in serious emergency and pre-surgical cases. Optometrists are currently prohibited from prescribing these oral anti-glaucoma drugs in almost all 50 states.
This is not a new issue for Florida. Indeed, optometrists have asked for this same list of oral drugs in the past and the Legislature has steadfastly refused because of patient safety concerns.
Then why has this legislation resurfaced?
According to a recent letter sent by FMA leadership to FMA members, the legislation resurfaced because of the intense efforts of the optometric lobby, which raised $668,499 in political contributions during the past year. Some legislators once opposed because of serious safety concerns are now urging that optometrists be allowed to prescribe the same drugs that the Legislature previously deemed dangerous.
FMA leadership suggests that because of these campaign contributions, it is inevitable that scope of practice for optometrists will be expanded. I respectfully, but strongly, disagree with the FMA's assessment.
Some believe that I am politically naive, but I still respect the legislative process and the legislators who participate in the process. Until proven wrong, I believe Senate leaders will recognize and be guided by the same patient dangers that caused them to vote against this proposal countless times in the past. I also believe that legislators will not let campaign contributions blind them from the importance of protecting patient safety. For the sake of all patients, lets hope that I am correct.
William J. Mallon, M.D., is president of the Florida Society of Ophthalmology.
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