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NC Scope of Practice

Discussion in 'Optometry' started by canuck_OD, Nov 22, 2005.

  1. canuck_OD

    canuck_OD Member
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    Here's a read for those that are interested. As you can see optometry is a thirving profession. It's a reminder to be involved with your association when you graduate!!



    N.C. board empowered to credential injections
    The Board of Optometry must observe an 18-month moratorium before addressing these privileges.

    --------------------------------------------------------------------------------


    Following years of negotiations – and litigation that began in 2003 – a dispute between the North Carolina Board of Optometry and the North Carolina Medical Board regarding injection privileges has been resolved.

    “This is a very important event,” John D. Robinson, OD, executive director of the state optometry board, told Primary Care Optometry News. “Not only does this Settlement Agreement clear the way for the board of optometry to begin credentialing properly trained and licensed optometrists to perform certain injection procedures including fluorescein angiography, it also terminates all prior agreements between the two parties.”

    Communication, collaboration on injections
    The story begins in 1977, Dr. Robinson said, when North Carolina passed a therapeutic drug law, soon after West Virginia passed similar legislation. “They were the first, and we were the second, only our scope of practice was much broader,” he said.

    The North Carolina legislation included a clause providing that when prescribing medication other than topical, the optometrist should “communicate and collaborate with a physician licensed to practice medicine.”

    Dr. Robinson said the board interpreted the clause through the adoption of a board rule. The rule stated that if communication with a physician were not possible at the time of prescribing, the physician agreed to by the patient would be notified verbally or in writing within 72 hours. During this period, the only other restriction in the state’s optometry law was that optometrists could not perform surgery, he said.

    “It was the board’s position from 1977 forward that if an optometrist performed an injection, it was not considered surgery,” he said. “It would fall within the ‘communication and collaboration clause.’ The law went unchallenged this way for 20 years.”

    In 1997, the optometry law was amended to remove the “communication and collaboration” provision.

    A second dispute
    Prior to the change in the law in 1997, Dr. Robinson said the state board had become involved in a dispute with the North Carolina Society of Ophthalmology and the North Carolina Medical Society concerning the scope of optometric practice. The North Carolina Board of Medical Examiners also eventually joined the dispute.

    “They disputed the codes that optometrists submitted to Medicaid,” he said. “Some of those codes represented injection procedures.”

    The North Carolina Society of Ophthalmology and the North Carolina Medical Society filed a petition in Superior Court for an injunction to prevent optometrists from performing these procedures. At the hearing, the presiding judge refused to issue an injunction until the medical board joined the litigation. But the court issued a temporary restraining order preventing optometrists from using a number of the codes.

    “After several months of negotiations the ‘Infamous 1997 Agreement’ was signed,” Dr. Robinson said. “That agreement set forth three categories of codes: one category included those procedures that optometrists could clearly do, one category included those that optometrists would not do and a third category included those that could not be agreed upon.”

    For example, corneal foreign bodies could be removed, rust rings could not be removed and injections were not agreed upon. After about a year and a half, Dr. Robinson said rust ring removal and punctal plugs were moved from the category of “can’t do” to “can do.” Among the signators on that agreement were the optometry board, the medical board, North Carolina Optometric Society, the state medical society and the state ophthalmology society.

    “Soon after signing the agreement we began to negotiate the performing of six injection procedures with the board of medical examiners under the provisions of the agreement,” Dr. Robinson said. “In June 2000, the medical board voted to approve all of those codes.”

    Immediate opposition
    The North Carolina Medical Board immediately met with fierce opposition to its decision, especially from the North Carolina Society of Ophthalmology, Dr. Robinson said. In September 2000, the board rescinded its action to approve the codes and recommended instead that a study committee be formed to resolve the issue. This committee would include optometrists and ophthalmologists and would be overseen by the medical board.

    “This went on for more than a year and went nowhere,” Dr. Robinson said. “So the optometry board decided there was no use in proceeding further, and the committee was dissolved.”

    After reviewing its options with its attorney, the board of optometry decided to file suit against the medical board. This litigation, filed 2 years ago, was ended by this Settlement Agreement, Dr. Robinson said.

    Shortly after the lawsuit was filed, the ophthalmology society, by this time known as the Society of Eye Physicians and Surgeons (SEPS), filed a motion to intervene, as did the North Carolina Medical Society.

    When both of their appeals were denied by the Superior Court the denials were appealed to the Court of Appeals, where they sat until the lawsuit was dismissed following the Settlement Agreement Dr. Robinson said.

    “In the meantime, SEPS had asked the medical board to issue a declaratory ruling on the billing codes,” he said. “They argued that the responsibility of the medical board went beyond regulating the practice of medicine. They also had a responsibility to ‘protect the citizens of North Carolina from those who would perform procedures for which they were not properly trained.’”

    The optometry board then went back to the Superior Court and sought a Temporary Restraining Order to prevent the medical board from issuing a declaratory ruling in a matter that was already before the courts. The court issued the order, in which the medical board could conduct hearings on the matter, but could not issue a ruling.

    Eventual resolution
    With several matters pending before the courts, the medical board expressed a desire to attempt settlement through mediation. Representatives of the board of optometry, the medical board and their respective attorneys met with a court-approved mediator.

    “We started at 8 a.m., and by 9 p.m., we had an agreement,” Dr. Robinson said. “We are now ready to begin the process of credentialing optometrists to perform the procedures as set forth in the Settlement Agreement.”

    As part of the agreement, the optometry board will heed an 18-month moratorium before further addressing those codes that were classified “undecided.” The 18-month moratorium includes indocyanine-green angiography, subconjunctival injections and injection of therapeutic agents into Tenon’s capsule.

    The Settlement Agreement stipulates that the optometry board “will have the right to credential optometrists to perform fluorescein angiography, as well as therapeutic or diagnostic injections, subcutaneous or intramuscular.”

    The board will also have the authority to credential ODs to perform injections for chalazion, according to the settlement statement.

    For Your Information:

    John D. Robinson, OD, executive director of the North Carolina Board of Optometry, can be reached at 109 North Graham St., Wallace, NC 28466; (910) 285-3160; e-mail: [email protected]
     
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