HomeMy WebLinkAboutMINUTES - 07131993 - 1.148 ®. ..:;:
CALIFORNIA:OPTOMETRIC ASSOCIATION
��� ���=. 801'12TH STREET, SUITE.2020�b P.O.Box 2591 .:SACRAMENTO, CnuFoPN1A.95812-2591
• ( 6) 441-3990 FAUivE::(916)-448-1423
RECEIVED . :'
:: • June •30, ..1993
luI _ .
993
Contr.a..CoStBI COUnty Board 'of;;•Superv.isorS
C/o .County, Cldrk.,, CLERK BOARDOF.SUPFRVISORS
65i Pine 'Street, 1•1th Floor Z._ :CONTRACOSTA'CO.
Martinez•, CA 94553`
Dear::B'oard of 'Supervisors
The Calif ornia .Optometric. As sociat'ion. .(COA) is sponsoring Assembly
Bill 2020. by y. Assemblyman Phil Isenberg, which would .,allow:
opt6metri8ts . to:..utilize.-Therapeutic- Pha" maceutical• Agents..,(TPAs:) ,
some pre sCrlption: and :other �over=the-counter medicines,. .excluding..
all.. dangerous:-or controlled substances: COA respectfully asks for
the. Board ::Of-`:Supervisors' review dnd ,:cons.ideration:'Of' support. .for
1 'thi:s legislation'-_;on the basis': that, AB- 2020 offers the: citizens. of `
rural`,countles,greater ,access to.quality, eye care. (particularly the
elderly. and handicapped•.,:who have difficulty traveling)., eliminates
unnecessary Of fice' 'Visits . .(.and :therefore .cuts:.; down.•,On lOSt-.:time. :.:.
from work) , anil lowers medical. costs..
AB' 2020°• 6h,-
passed. the Assembly. Health. Committee ..by, an ._11=1 vote on• ::.
Tuesday', April', '13th ' ,, and passed ' the: Assembly Ways and Means
Committee.`by.a.'.16-2 vote •on May ,12 AB 2020 ' d the. Assembly.;
Y
P , '
Floor, by.a vote.'of 61-4 on•Thursday May 27th and will be.•heard..next
in' the Senate:.:'
Tle •benefits` ,to,: Calif.ornia's.:';consumers a.r.e•.evident in a number of
ways: It :will lower California's . health .,care expenditures 'by.. .
- ' eliminating :costly referrals and .unnecessary office :visits,; and ..
will, increase a, client=,s access'to. care by ,allowing optometrists .to ;
provide the ..needed TPAs at . ,the`. same'.;;time ' that" client'.s. are
rec6ivin4.; other vision and .eye care. services:
.It ':is Our,conVictio_ n; •thcit •:oiDtometrists •can. provide-tre'atment: in..a
more. expedient and cost:effective manner Optometrists have;. been:,
using;: therapeutic. medications,; including eye drops "and; ointments
and :many .,over-the-counter' drugs - . in •.,36; :states; ::the .District- .of
Columbia; Federal Ve'terans! ' Hospitals•. and . Indian . Health. Service
facilities. with t any significant or Preva ling:.problems:"and. with,
no -change.. in the.malpraetice' rates.
(�... �3oQ�d
Pa a ,2'
. g -
AB, .,.2020, `-does , not .; elevate the::".profession•::::; of : optometry :.'by
1'egislation •., The, ;schools and :colleges of ''optometry currently
educate and' ;cl nicall -
train'--their ,'students., with these skirls
. :.
however,,_ previous: graduates. ;.will-; ;'need to `.com fete : additional
P.
.-training :.:and ., pass. independent, testing.'.:; :No.: `one will bet.
~ raridfathere'd in
':Optometrists ;`using::: .TPAs wi11• be'. required :' to. •accept. I'Medi-Cal .;
:patients: and ,; 4il.1 '-be- prohibited from dispen"sing • medications :•for:
charge _in. ;their; offices. `•: The 'fact is;. optometrists;;.provide: :92 . ,
percent `of ,vision care services ;in;the Medi-ca'l• program. ,An :"the
wa tometrsts must-: refer .
Y: <:law :.works . 'now;: ..op. patients
"specialists" ;for minor ::treatments:: This. not only costs more;'.but
= delays•."care.
AB :202.0 :wil;l,.increase =,thea_ agailablty. of services 'in=under-serve
d'
counties (11 counties; in ;.California; -have'::. no , ophthalmologists
' . providing eye ,'care , services)- The::situation ,for'.;- our:'; urban: and ;.
,rural "poor is .:compounded.: by:',;,a ;severe shortage •:of health care
:. = -
•resources;; often overlooked. in their°communt;ies . :.;de rivin these
P g
citizens of, what most of Ais.-coiis.ider a .basic;`.necessity :of life.
Such ' is.�:thii�� case', iri the;.;delivery': of_ eye: care for ; this:'-.group::.:
Conditions .:'such: :as conjunctivitis;. :.readily cured by simple
:pharmaceutical .agent's are too;'often;' left °untreated,:liecause. of `cost: =
and theinadequate •distribution "of services:: 'An ;individual, whose;,,.
onTy,.recourse s';an emergency: room ;at :a county;hea•lih: facility may
turn their , back,: on .such: an ".option: The failure to treat. simple
Condit oiis;";:such; :as- .,this.• Ah :, a. tiaielji.:-manner .can:- Iead`: to;::a :- more;
complicated scenario wit2i _the>possibilty=:of permanent:visual :Toss
The ,support ,we-have xdceived: from,:.6ther_public health. associations
labor unions; ana' ': business•; leaders further • 'demonstrates the
credibility- of ourlegislation.:`: :; : There;.-.are. several .,,-compel'ling>:
reasons,why: Assemblyman;Isenberg.:dec�.ded: to carry:this legislation,
and: why the' Ariierican:,'Public: .Health' Association- the 'Northern and
Southern. .:Calif iornia 'Public-- -Heaith : Associations; Indian Health
Services, ...the.,;Californi'a, Te:acliers! ;Association ':`California Vision; -:...:. :
.._
Service;:•.Plan, numerous •union ;groups, . ,and, local .governments-.have
i
g ven,-their;:support.'t'o this legislation:
Please.call: me at .:(916) 41 ..399 .. 1- y. have :'.any::-fur her questions. .: ::,;;.; :
Thank; you for your;time sand -I look forward.-to hearing from you
sincere' 1
_ y.
.. :. :.. ..:.
any.
c I
• J 'Am t ou
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Pro ect Coordinator .:`
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ctor 6
COMPREHENSIVE VISIONrAREACTOF1993
AB 2020
By Assemblyman Phillip Isenberg
Sponsored by the California Optometric Association,AB 2020:
- Allows optometrists to use 12 classes of therapeutic medications (therapeutic pharma-
ceutical agents, or TPAs) for the treatment of ocular disease. These 12 classes of
medications include 489 brand name medications; of which 227 (such as aspirin,eye
lubricants,Tylenol,Advil,Dristan,etc.)are available without a prescription at grocery
and drug stores. The list of drugs does not include any controlled substances (such as
barbiturates or narcotics).
- Adds one class of medication for additional optometric diagnostic purposes.
- Mandates establishment of tough educational and examination requirements for all
optometrists seeking TPA privileges. (Does not allow "grandfathering" of practicing
optometrists.)
- Requires all optometrists to pass a national board certification examination, adminis-
tered by the California State Board of Optometry,before they are allowed to administer
TPAs.
- Establishes a pharmaceutical advisory committee—including pharmacists and ophthal-
mologists as well as optometrists—to assist the State Board of Optometry in establishing
regulations for the use of medications by optometrists.
- Allows optometrists to remove only superficial irritants from the eye.
- Prohibits optometrists from dispensing medications other than samples to patients.
- Makes it a crime for any optometrist to refer a patient to a pharmacy in which the
optometrist has any financial interest.
- Sunsets a California Medical Board advisory panel that has notmet for more than a dozen
years.
- Requires optometrists,if they choose to use TPAs, to accept MediCal patients.
Principal co-authors of AB 2020 include: Assemblymembers Dan Hauser,Richard
Polanco and Stan Statham. Coauthors Assemblymembers Joe Baca,Robert Campbell,
Tim Costa. Martha Escutia. Diane Martinez, Willard Murray and Ray Haynes.
irDoctor Of Optometry
OPTOUMICEDUCAnON
A=editation
* Graduates of California's optometry schools--U.C.Berkeley School of Optometry
and Southern California College of Optometry--optometrists currently are
permitted to administer medications in 36 states.
• Nationwide.there are 16 accredited health care schools of optometry. U C.Bedr-Irl -
Schooi of Optomeu i is the number-one ranked school of optometry in the nation. Ia
a ratio;of colleges it scored 4.94,the same mark given to Harvard University School
of Medicine.
CmTicnimn
* Optometric students receive more than 100 class hours in pharmacology. Tharis
-more tan is offe ed in medical schools and dental schools.
• Curricula in each of the schools includes extensive instruction in the use of
pharmac'xuticais,bands-on clinical training using medications and a colnPrehes
sive continuing education program.
* Optometrists have more pharmacological training than family pradltlohaers,
dentists and podiatrists--all of whom regulariy prescribe medicines.
M h3in nterMhipS
* Optometrists have more training in diagnosis and treatment of eye disease than
do medical students.Yet,optometrists are required by law to refer patients to a.
physician--even when treatment is the use of an over-the-counter medication.
* Optometric education includes more than 500 class hours related to the diagnosis
and treatment of ocular disease.
* Optometry students must perform extensive clinical braining during a IO-weds
rotation in settings such as Veteran Hospitals,Indian reservation health clinics or
military hospitals.
* During an internship,an optometry student makes an average of 1,300 patient
contacts.
Certification
• Graduates must pass both an extensive national licensing exon and a
California clinical evaluation prior to practicing optometry.
* Optometrists will be required to pass a certification examination,administered by
the California State Board of Optometry,that incorporates the use ofTPAs and dwir
systemic and ocular effects on the body.
Fatuity
•
The same educators for medical schools and dental schools typically to:ch at optometry
• "'Will► .
Doctor of Optometry
i ACCESS TO EYECARE
•Access to eye care is a simple numbers game. Nationwide,optaomettists oumumber
ophthalmologists nearly four to one.
i Optomettistsarelocatedin6,800 communities throughoutthe U.S.andare theoniy eye
care provider in more than 4,140 of those communities.
* Eleven California counties do not have any ophthalmologists at all and three have
only one. Fach of these counties is served by optometrists.
A recent study reports that a patient waits an average of three weelm m see an
ophthalmologist and only one week for an optometrist.
In the same survey,only 25 percent of the ophthalmologists responded thattheyworked
weekends,versus 75 percent of optometrists.
* Optometrists normally are the fust point of contact for patients suffering from optical
health problems. 651'5 percent of primary diagnostic en-mm are done by optom-
eirists.
Optometrists are the only health professionals f illyedncatedandtrainedintherarpea-
tic pharmacology who are unable to prescribe medications.
* Optometrists are bi#iy recruited by the U.S.Army,Navy and Air Force to provide
treatment(using TPAs)for service personnel.
Doctor of Optometry
COSTOFOPTOMETRIC CARE
•According to areport by Audits&Surveys,optometrists nationally chargec onsider-
ably less than ophthalmologists for routine eye exams. A routine eaatu performed
by an optometrist costs on the average S41 (nationally)while the average for an
ophthalmologist providing a similar etamiaatioa is$61—50 percent more.
In comparing char es of optomeuists and ophthalmologists under the Medicate Pro-
m.average optometric charges were lowerfor every service code for office visits
for new and established patients. Comprehensive service visit charges were 26 percent
higher when billed by ophthalmologists for new patients.
•
Allowing optometrists to treat conditions they now diagnose will save the public
money by eliminating unnecessary referrals and duplicative exams. Many of the
referrals--forprocedures thatthe optomenxstis trained andqualiffedto perform—are
unnecessary in most other states.
• Optometrists are now required to referpatients to specialists so the parientcan be treated
with over-the-counter medicines.
• M=yCalifornia#rainedoptometristsareleavingtitestatetopracdceinswmtbat
allow them to use the fall scope of their education and clinical training to diagnose and
treat patients utilizing common medications.
•Allowing optometrists to tress the conditions they now are liable to diagnose,the comber
of patients requiring care for eye infections,inflammations and disease will not increase,
Rathe,the number*of referral office visits will det�^ease.Increased competiton and
accessibility results m reduced costs to patients and the Medi-Cal program.
• Authorizing doctors of optometry to prescribe medications will resultin costsavings for
government funded and private health care programs alike.
Doctor of
OPTOAJffRIC SAFEGUARDS
• Optometrists only want to tareatthe patients'primary needs. They wM continue to
me referrals for additional consultation and treatment in cases of serious eye disease.
• Optometrists will not be allowed to atilize TPAs without firstmcrossfully completing
a rigorous course of classroom and ciinical instruction.
_ •Opmmet rists wdl be required to pass state fic tion examinations titatincarpor=
diagnosis and use of TPAs and their effects on the body.
• NL o optometrists will be"grandfathered"by this legislation. All optometrists in
California will have to receive groper training and certification to administer medica-
dons.
• Optometrists in the milliary uttiize TPAs and have a proven safety record. Overthe past
five year,7.00 military(Air Force)optometrists treated 3 million patients,31)09000
within California.
• An impartial gauge of the safety of health care is the rate of ma4nacsice insurance.
Optometrists rates are the lowest of any major health care profession.
•There is no difference in malpractice rates for optometrists m sues allowing TPAs
versus states not allowing,their use. 'There has been no increm in malpractice rates in
any state due to the passage and optometric use of TPAs.
THE BOARD OF SUPERVISORS OF THE COUNTY OF STANISLAUS
STATE OF CALIFORNIA
Date: May 25 , 1993 No. 93-543
On motion of Supervisor Si
.........................mon..................................... Seconded by Supervisor.............Ma .y.�leld...................,
and approved by the following vote,
Ayes: Supervisors: ..............................Paul . Mayfield - Simon-, Caruso and Chairman-_Blom .••••••.
Noes: Supervisors- ---------------- clone. ......... ......... . .. .................
Excused or Absent: Supervisors: ....None.........................................................................................................................................
Abstaining: Supervisor: --••---••--------••-•None..........................................................................................................................................
Q rz ea......2...
THE FOLLOWING RESOLUTION WAS ADOPTED:
IN RE: SUPPORTING AB 2020 (ISENBERG) — ALLOWING
OPTOMETRISTS TO UTILIZE THERAPEUTIC PHARMACEUTICAL
AGENTS (TPAS)
WHEREAS, AB 2020 allows optometrists to use 12 classes of
therapeutic medications for the treatment of ocular disease and
adds one class of medication for additional optometric diagnostic
purposes; and
WHEREAS, this bill also mandates establishment of tough
educational and examination requirements for all optometrists
seeking TPA privileges, and also requires optometrists, if they
chose to use TPAs, to accept Medical patients; and
. WHEREAS, it also requires all optometrists to pass a national
board certification examination, administered by the California
State Board of Optometry, before they are allowed to administer
TPAs,
WHEREAS, AB 2020 offers greater access to quality eye care
(particularly in rural areas) , eliminates unnecessary office visits
(and therefore cuts down on lost time from work) , and lower%,
r
medical costs, ,,,.••••�-••.,.2
•.
I hereby certify that the foregoing is a full, ''•Og pc
�-.�•
NOW, THEREFORE, BE IT trtRBSftVRDcc0zhQite ifhginal f sl prrPS;9`
in the Minutes of the Board of Supervisors. `'j'•��;\�.'!fl, !:
1 .:.
Board of Supervisors does hereby support AB 2020 andsges_,_it � �'
CHRISTINE D. FERRARO
passage in the Legislature. Clerk to the Board of Supervisors '� `�• '
ATTEST: CHRISTINE t sora of the � ,�., .
Ci $ E D. FERRARO, Clerk unty of Stanislaus, State of California ry'
Stanislaus County Board of Supervisors,
State of California,
By: PATRICIA A. MINTON, Assistant Clerk File No. M-20-0-24
sero—se
D`OARD OF SUPERVISORS C
520 W. Main Street
a K
P.O. Box 10201, Quincy, California 95971 (916) 283-631S FAX (916) 284-6415 n� tie
��FO$fi
tPANC95 J.AOUMBUM. aS-MICT
800E$'T A.MBA=FA. OLTMI T 3
PAUL C SIMPSON, DIWMICT 3
PHIWP A.CAE80"L DMTAICT•
BILL COAM. OWNICT S
JIIOITII waL1.8. CLIA
May 14, 1993
Assemblyman Phil Isenberg
State Capitol, Room 6005
Sacramento, CA 95814
SUBJECT: Support of AB2020 (Isenberg)
Dear Assemblyman Isenberg:
The Plumas County Board of Supervisors considered your AB2020 at it's meeting of
May 11, 1993 and adopted a position of support on the bill.
For neral county's such as Plumas, with a population of 20„000, where approximately 8090,
of the County is National Forest and in a remote area of California, we do not have an
Opthomologist in the community to administer therapeutic pharmaceutical agents for the
treatment of eye diseases. Its our understanding there are at least 10 other counties in
California that also do not Have Optbomologist's eye care services. Most of the residents
in this community who need this type of service have to drive to Reno, NV, a trip of
approximately 1 hour and 45 minutes one way.
Thank you for your sponsorship of this good government bill and we will work with our
delegation for its passage.
Sincerely,
41k
Bill Coates
Chairman
BC:It
cc: Senator Leslie
Assemblyman Richter
John Vasconcellos, Chair
Assembly Ways and Means Committee
CSAC
RCRC
NORCAL
ZO' d t00' oN ZS: OZ 26, VT ,lHW QI
oy,;saco� BOUNTY OF COLUSA
PUBLIC HEALTH DEPARTMENT
❑ Public Health ❑ Emvlrunmental Health
(9161458-5177 9461458--17 gL�04rtiP.O. Box 610 251 E. Webster Street • Colusa,CA 95932
Child Health&Dia,bility ❑ animal Control Fax: (916) -158-}136
Program(CHDPI(916145R-517', 1916)4584500
aCalifornia Children Sen ice,iCCS1 ❑ Tobacco Cunuol
19161458.5177 19161458-?N11 April 29, 1992
To: The Honorable John Vasconcellos
Chair, Assembly Ways and Means
State Capitol, Room 6026
Sacramento, CA 95814
Re: AB 2020 SUPPORT
Dear Assemblymember Vasconcellos,
I am writing to ask that you support AB 2020 authored by
Assemblyman Isenberg.
I live and work in a rural Northern California area. As
administrator of the Colusa County Public Health Department,
I must coordinate health care with other providers . As the
Director of Nursing, I work with the clients . Most Health
Department clients are uninsured, underinsured, or MediCal
recipients . Referral for their care is almost impossible for
all but the most threatening conditions .
There are no ophthalmologists in Colusa County, or in some of
our neighboring counties . We do have optometrists . Our
physician ratio is 1 : 3000 . The California ratio is 1: 1000 .
This lack of physician accessibility is repeated throughout
rural California. The situation becomes more grave when a
specialist is required.
Passage of AB2020 will give all our residents increased
access to care of certain uncomplicated ophthalmic
conditions .
The bill requires additional education and examination of all
optometrists, no "grandfathering" , and national board
certification of those seeking to be Therapeutic
Pharmaceutical Agents (TPA) .
I urge your support of AB 2020 .
Sincerely,
Marilyn Elliott
Administrator/Director of Nursing
a
OFFICE OF
BOARD OF SUPERVISORS -�
108 COURT STREET • JACKSON. CA 95642-2379 • PHONE(209) 223.6470
o +�
May 26, 1993
The Honorable David Knowles
California State Assembly
Post Office Box 942849
Sacramento, CA 95249-0001
Dear Assemblyman Knowles:
At our May 25, 1993, meeting, the Board of Supervisors of the County of Amador voted
unanimously to support AB 2020 (Isenberg) authorizing California licensed optometrists to use
therapeutic pharmaceutical agents (TPAs) in their treatment of diseases of the human eye. This
would lessen the necessity for referrals to ophthalmologists who are not as available in rural
areas.
On behalf of the Board of Supervisors, I strongly urge you to support AB 2020, which will offer
citizens of rural counties, such as Amador County, greater access to quality eye care,
particularly those who have trouble traveling, such as the elderly and the handicapped. It will
eliminate unnecessary office visits, and therefore, cut down on loss of time from work, as well
as lower medical costs.
Yours very truly,
ter::.'(;/'--[Lt�
I �-
tephanie D'Agostini
Chairman
Ad
cc: The Honorable Phil Isenberg
California State Assembly
State Capitol, Room 6005
Sacramento, CA 95814
Nancy Armentrout
Project Coordinator
California Optometric Association
P.O. Box 2591
Sacramento, CA 95812-2591
FAX (916) 448-1423
OFFICE OF THE COUNTY ADMINISTRATIVE OFFICER
C O U N T Y O F' M O N O
P.O. BOX 696 • BRIDGEPORT, CALIFORNIA • 93517 • (619)932-5228 FAX (619) 932-7145
BILL MAYER
County Administrative Officer
May 19, 1993
Norma J. Dillon, Director
California Optometric Association
Government Affairs Center
801 12th Street, Suite 2020
P.O. Box 2591
Sacramento, CA 95812-2591
Dear Ms. Dillon:
Upon the recommendation of Supervisor Michael Jarvis on May 18, 1993.
the Mono County Board of Supervisors voted to support AB 2020, which
would allow optometrists to utilize Therapeutic Pharmaceutical Agents
(TPA's).
The Board of Supervisors' position in support of AB 2020 has been sent to
Mono County's representatives in the State Senate and State Assembly.
AB 2020 would clearly offer the residents of rural counties greater access to
quality eye care, should eliminate unnecessary office visits, and should lower
medical costs.
Thank you for bringing this bill to our attention.
Sincerely,
� I� P(kV
Bill Mayer
County Administrative Officer
County of Mono
WTM:mkr
cc: Michael T. Jarvis, District # 1
u my MONTOYA
GARY E.BOYLES Ct l L• C CITY Ct;6nx
MAVOA O ,.,,,,, y DR.CHARLES A.KOEHt.ER I
JOHN a.MA�R Ppm ROBERTS '', O Gr TREASUP"R
CARL B.COLE=MAN,JR. City o f Fontana
CO""Q`Mewee` = C A L I F O R N I A JAY ht COREY
DAVID R.ESHLEMAN rt1 �� Cirr MAMMER
COUNM ME►aER 4`,4
BEATRICE WATSON
COUNCL Mann
The Honorable Ruben S.Ayala
Member,C,ullfornia State Ser1;LtC
State Capitol
Sacramento, California 95811 June 23, 1993
Dear Ruben,
I am writing to urge your support for A132020 which is due to conic before your Senate
Business and Professions Committee soon. !
A332020 provides for the retraining,relicensing,and recertification of optoinetrisb;in this state
to Utilize therapeutic drugs in the complete care and treatment of their patients.
Recertification will be mandatory for all optometrists who wish to practice in this modality.
AB2020 aisomandatm thcacccptancc of Mcdi-Cal patients for treatment by qualified doctors.
Medical treatment of eye-related problems are at times difficult to obtain through some
medical practitioners,as many of them now do not accept Medi-Cal paticntt-even when they !
are directly referred to theta by optometrist.
Tharp are about clevert(tl) counties in California wiverc there are no apthah"olagists in
practice and availabie to the public. Even here in Montana, where we have the Kaiser
Permanente Ilospital and the population close to 100,000, there is no ophthalmologist
available to the patient that is not a member on the Kaiser plan.
I feel shat AD2020 is good for the people of California in terms of eye care and cost
effectiveness for the Medi-Cal program. Bath of these considerations are in line with the
Clinton Administration's concepts of health care for the future of America. California should
be ready to manifest its leaderxhip role in the health care of lits citizens. I again urge your
support for the passage of AB207.(1. t Thank you for your time.
Sincerely,
Dr. Charles A. Koehler,
City Treasurer
8353 SIERRA AVENUE(F.O.BOX 518) - FONTANA.CALIFOSNIA 9233a-0518 • (909)350.7600
SISTER CITY-KAMLOOPS,B.C.CANADA
rrtni(PnNn&rAraPPrrn
BOARD OF SUPERVISORS
P.O. Drawer 1258 (916) 623-1217
. WEAVERVILLE, CALIFORNIA 96093
n,
Barbara M. Rhodes, Clerk
Donald E.Benedetti,Administrative Officer
June 4, 1993
Assemblyman' Phil Isenberg
State Capitol, Room 6005
P. O. Box 942848
Sacramento, CA 94248-0001
Dear Assemblyman Isenberg,
At our meeting of June 1, 1993 the Trinity County Board of
Supervisors voted to support AB 2020 which would allow optometrists
to utilize Therapeutic Pharmaceutical Agents (TPA's) .
Thank you for your efforts to allow access to low cost quality eye
care which is of particular benefit in rural areas such a Trinity
County.
Sincerely,
TRINITY COUNTY BOARD OF SUPERVISORS
.By LISA BALLARD
Matthew Leffler, Chairman
cc Nancy Armentrout, Government Affairs Center
STAN PLOWMAN RORF•RT SS'.IIUDDLF.STON ARNOLD WIIITRIDGF. MATTIIF.W T.I.F,FFI.F.R ROSS RURGFSS
District 1 District 2 District 3 District 4 District 5
Groups Supporting Assembly =
Bill 2020 (Isenberg
Associations:
American Public Health Association
Representing a combined national membership of over 52,000 public health professionals(both Medical and non-Medical professions)and community
health leaders,promoting high standards in public health.
Public Health Association,Northern California
An organization representing over 800 public health professionals throughout Northern California.
Southern California Public Health Association
An organization representing over 1,000 public health providers in Southern California.
California Teacher Association
Representing 180,000 California teachers.
American Association of Retired Persons(AARP)
Represents three million members in California.
California Health Federation
Representing over 200 public health clinics in California.
Indian Health Services,Department of Health And Human Services
Over 75 optometrists (distributed in over 80 facilities) and 10 ophthalmologists (distributed in 4 medical centers) provide eye care services to
approximately 1.5 million Native Americans and Alaskan Indians.
California Rural Indian Health Board,Inc.
Representing 10 Indian Health clinics and over 30 tribes in California.
California Urban Indian Health.Council,Inc.
Representing Indian Health clinics in California,which provide training and support.
Associated California Health Centers,Inc.
Approximately 95 not-for-profit clinic sites.
Sacramento County Commission on Aging
Representing the needs of seniors in Sacramento.
Health Maintenance Organizations:
Vision Service Plan
The oldest and largest HMO providing vision care services to over 13 million people,including over 6 million in California,with over 19,000 doctor
(optometrists and ophthalmologists)locations nationwide.
Friendly Hills HealthCare Network
A managed care organization which serves over 100,000 California patients. AB 2020 has received support from 65 practicing physicians at Friendly
Hills,including ophthalmologists,internists,dermatologists,family practitioners,gynecologists,cardiologists and radiologists.
Golden West Dental&Vision
An HMO providing health care benefits in California.
Labor Groups:
California Teamsters Public Affairs Council
Representing the health care interests of over 250,000 union workers in California.
Sacramento Central Labor Council,AFL-CIO
The Sacramento Central Labor Council and the Sacramento-Sierra's Building&Construction Trades Council jointly represent building trades and
services trades union members.
Laborers'International Union of North America
Represents over 65,000 members,their friends and families in the State of California in such diverse occupations as Education,Federal,State,and public
Employees,Utility and Maintenance,and Construction.
California State Council of Laborers
An organization representing construction and maintenance workers in California.
(More)
California/Nevada Conference of Operating Engineers
Representing over 80,000 operating engineers in California.
United Food and Commercial Workers,Region 15
Representing over 110,000 members in Southern California.
United Food and Commercial Workers,Local 1036
A labor union representing 11,000 members in Central California.
United Food and Commercial Workers,Local 770
A 30,000 member local covering the greater Los Angeles area.
Engineers and Scientists,.MEBA,AFL-CIO
Representing approximately 3,000 members in California.
California Optical Laboratories Association
Representing 29 optical laboratories statewide,with approximately 1,000 members.
Northern California Millwrights Union,Local 102
A division of the Carpenters Union representing over 35,000 Carpenters in Northern California.
California Organization of Police and Sheriffs
Representing peace officers in California.
Brotherhood of Maintenance of Way Employes
An affiliate of AFL-CIO and C.L.C.
United Brotherhood of Carpenters&Joiners of America,Local 713
Approximately 1.000 members in Alameda County.
Grocery,Bakery,and Construction Drivers And Helpers,Local 559
A Connecticut local representing over 6,000 members,who were able to cut costs by 30%after TPAs were enacted.
Connecticut Laborers'District Council
Representing 10 affiliated Local Unions of the Laborers'International Union of North America with 8,500 members statewide.
Business Community:
Vision West Services
An ophthalmic management group.
Future Diagnostics,Inc.
A P.P.O.of MRI and CAT Scan Network Imaging facilities,offering cost-savings and cost-containment to the diagnostic imaging market.
.HOYA Lens of America,Inc.
Westminster Chamber of Commerce
Fortuna Chamber of Commerce
Hermosa Beach Chamber of Commerce
Westside Chamber of Commerce
La Palma Lions Club
Local Government:
County of Colusa,Public Health Department
Accessibility of health care is the issue for this rural California County.
Amador County Board of Supervisors
Mono County,Board of Supervisors
Plumas County,Board of Supervisors
Representing needs of citizens in rural areas.
Stanislaus County Board of Supervisors
Trinity County Board of Supervisors
City of Fontana
Marin Sanitary Service
Garbage and rubbish collectors in the city of Marin.
**Any letters may be obtained by contacting the Government Affairs Division of the California Optometric Association at(916)441-3990.
6/30/93
POLICY
•
State University
of New York
College of Optometry
CENTER FOR VISION CARE POLICY Issued April 5, 1993
Cost Control Benefit of Therapeutic Drug Authority for Optometrists
Barry J. Barresi, O.D., Ph.D. and Mort Soroka, M.P.A., Ph.D.
Research Paper of the Center for Vision Care Policy
State College of Optometry, State University of New.York
INTRODUCTION
Optometry has been legally recognized as an independent experience with the professional services of optometrists per-
health profession in the United States since the turn of the mits an assessment of the public health effects of therapeutic
century. In recent decades the scope of optometric licensure pharmaceutical agent (TPA) use by optometrists.
has expanded in multiple jurisdictions.State legislatures,regu- Of specific interest in this analysis is to determine howTPA
latory bodies and agencies of the federal government have use by optometrists has influenced the costs for eye care
concluded that the ability to use pharmaceutical agents for services. We approached the cost question from several
diagnostic and therapeutic purposes by doctors of optometry perspectives evaluating access to primary care, provider mar-
enhances the quality of care and is in the best interest of their ket share,service levels,and out of pocket spending.The study
constituencies. All 50 states, the District of Columbia, and finds that TPA authority for optometrists improves cost effi-
Guam authorize the use of diagnostic pharmaceutical agents ciency in the delivery of eye care. We conclude that more
(DPAs)by optometrists.As of this writing,thirty three states,the efficient functioning of the market lowers the public costs for
Indian Health Service of the US Public Health Service, the quality eye and vision health care.
Veterans Health Administration, and the Military Services Extending TPA authority to optometrists helps control
authorize the use of therapeutic pharmaceutical agents(TPAs) health care costs. Since cost control is a driving force in our
by qualified doctors of optometry.' nation's effort,atthestateand federal level,to reformthe health
Thus there is considerable clinical experience,in a variety care system, it seems prudent to regard TPA authority for
of jurisdictions, with the diagnosis and treatment of medical optometrists as state policy consistent with national goals in
conditions by optometrists.The extent and diversity of clinical health care reform.
OPTOMETRISTS ARE THE MOST ACCESSIBLE PRIMARY
EYE CARE PROVIDER
The American public chooses optometrists for their primary eye care needs. More than two-thirds of primary eye care services
in the United States are provided by doctors of optometry.= Across the country, optometrists are geographically more broadly
distributed than ophthalmologists. Optometric services are available in 6,830 communities throughout the United States. The
27,600 practicing doctors of optometry(nearly twice the number of practicing ophthalmologists)are the only primary eye care
providers in more than 4,100 communities.' In rural areas,there are proportionately more optometrists than ophthalmologists.'
For patients residing in those communities without a practicing ophthalmologist, access to"therapeutic eye care" is impractical
as well as costly. Patients, devoid of access to an ophthalmologist, may risk foregoing needed care entirely.
The geographic maldistribution of ophthalmological care across communities is part of the larger problem of uneven access
to medical subspecialists. Optometrists are more evenly distributed and many practice in smaller communities and inner city
neighborhoods, affording accessible care to residents who otherwise would be without any eye care.
National and regional studies also show that optometrists are more readily accessible than ophthalmologists when it comes
to promptness of care. Waiting time for a primary care appointment to see an optometrist averages less than one week,while the
corresponding wait for an ophthalmologist is more than three weeks.' Moreover,three-fourths of optometrists offer primary eye
care services on week-ends or evenings while only one-fourth of ophthalmologists do.'
OPTOMETRISTS AND OPHTHALMOLOGISTS ARE MARKET
EQUIVALENTS IN EYE CARE
As optometrists increase their scope of services, provider has been of interest in health economics for some time. Paul
market share shifts from office based and emergency room Feldstein,the University of California health economist,noted
physicians to community based optometric practices.Optom- in the 1970sthat"Optometrists function independentlythereby
etrists able to treat eye disease provide more comprehensive cutting into the demand for ophthalmology services". " Thus,
care at the primary entry level. Consequently, TPA optom- Feldstein identified optometrists as market equivalents to phy-
etrists reduce the need for referrals to office and hospital based sicians and highlights how care by optometrists benefits the
physicians for unnecessary diagnostic services. public by reducing duplication of service and increasing
The changing provider supply characteristics in eye care market efficiency.
FIRST CONTACT TREATMENT OF.EYE DISEASE REDUCES
COSTLY DUPLICATION
Improved market productivity occurs when optometrists from physicians to optometrists. With TPAs, eye disease
treat conditions that they currently diagnose in first contact treatment by physicians, especially ophthalmologists, can be
primary visits. Treatment at the time of diagnosis during the expected to decrease as more patients are retained for care in
optometric patient encounter would help reduce health costs optometric practices that can now manage eye disease at the
by eliminating the expense of an additional visit to a physician initial visit. In Wisconsin,of 12,702 administrations of TPAs by
'. Further cost control is expected from subsequent treatment optometrists,only one percent of these cases required second-
visitswhich are provided at a lower average fee by optometrists ary referrals to other health care practitioners.' Prior to TPAs,
than by ophthalmologists. all of these eye disease cases would have required referral to a
Reduced duplication is the prime market productivity physician, thus duplicating charges for an initial office visit.
enhancement from TPAs. In those states that do not allow the An analysis of Medicare claims data underscores the shift
use of TPAs, optometrists must diagnose and refer patients to in market share from ophthalmologists to optometrists repre-
various medical specialists for the treatment of even minor eye senting the most important cost containment impact of the TPA
ailments. This results in many costly inefficiencies such as laws.`,"' With TPA authority in place,some increase in patient
duplication of care, delay in receiving care, discontinuity of preference for optometric services is observed. More impor-
care, and additional time lost from work. The extra fees are tantly, however, this increase in demand for optometric ser-
additional costs that must be borne by the patient,private third vices concomitantly reduces demand for some
party payers, Medicare or Medicaid. ophthalmological services.Under TPA authority,HCFAclaims
Reports at the state level and with the Medicare program data show a significant shift of patient demand from ophthal-
show that optometric authority to use TPAs shifts some patients mologists to optometrists for entry level exams and office
procedures.
OPTOMETRISTS CHARGE LOWER FEES THAN OPHTHALMOLOGISTS
AND EMERGENCY ROOMS
Elimination of duplication of diagnostic services is not the Lower fees by optometrists have persisted since changes in
only cost control benefit from market share shifting to optom- the Medicare Payment Schedule. The RBRVS Medicare Fee
etrists. Office fees and charges for visits associated with the Schedule sets the same ceiling on fees for both ophthalmolo-
treatment of eye disease are on average lower for an optom- gists and optometrists in a given market butdoes not determine
etrist than for an ophthalmologist. National and regional actual allowed charges for providers. Doctors can not bill
surveys of professional fees and analysis of public health Medicare patients fees that are higher than the usual and
programs present significant evidence of the lower cost of eye customary fee they charge other patients.On average,optom-
care when provided by doctors of optometry. etrists charge lower usual and customary fees than ophthal-
Ophthalmology is a surgical medical specialty.'," As a mologists. '=
result, ophthalmologist charges for eye care significantly ex- Furthermore there is no evidence that the enactment of
teed charges by optometrists for similar services. For example optometric TPA authority stimulates an increase in optometric
in 1989 the national average cost of a routine eye examination fees. In fact, a study of eye care fee levels in Ohio shows no
was 45% higher for ophthalmologists than for optometrists.' statistically significant difference in fee trends for TPA as
Payments to ophthalmologists under governmental programs compared to non-TPA authorized optometrists." In this study
such as Medicaid far exceed the fee schedules for optom- all licensed optometrists in the state of Ohio were surveyed to
etrists.'•'' Thus, significant savings to the public are realized compare the annual percentage change in fees between TPA
with the increased use of optometrists. and non-TPA optometrists. Thus, the Ohio study concludes
Similarly, in the Medicare Program,a higher proportion of that for the eye care market, TPA authority has no significant
eye care rendered by optometrists means that average allowed impact on professional fee increases by optometrists.
charges will decline because optometrists charge a lower fee For eye care offered in emergency rooms the contrasting
than ophthalmologists for the same procedure code. The of fee levels and the cost control benefit of TPA optometrists is
Medicare"and office fee studies" al I show consistently lower particularly dramatic. States without TPAs for optometrists
fees from optometrists than ophthalmologists for the same demonstrates the high cost for emergency eye care as noted by
procedure or visit. a recent study in Massachusetts. Extending TPA authority to
optometrists could greatly reduce the use of expensive emer- $6,800,000 in health care costs.", The Massachusetts study
gency room care. For 1989 in Massachusetts, 74,554 cases of suggests that for non-TPA states, three percent (3%) of emer-
superficial eye problems were treated in emergency rooms at gency room visits are for superficial eye problems treatable by
a cost of$9,800,000. optometrists able to prescribe therapeutic pharmaceutical
While the actual effect of a shift of care to the optometrists agents. Lowering reliance on emergency room use by autho-
office is not known, if these services had been provided by rizing TPA services by optometrists could yield significant
optometrists able to use TPAs, the people of Massachusetts reductions in health care spending.
would have spent only $3,000,000, resulting in a saving of
PROMPT TREATMENT OFTEN LOWERS TOTAL COST OF
TREATING AN ILLNESS
Increased accessibility for eye care from optometrists infectious diseases,the initiation of pharmaceutical treatment
makes it easier for patients with eye disease in TPA states to early in the course of the disease greatly improves the likeli-
receive prompt diagnosis and treatment. Prompt treatment of hood of effective treatment and lowers the risk of complica-
disease afforded byTPA availability at the patient's first contact tions. Thus, total cost of care for an episode of illness can be
with the health care system assures patients of immediate lower when TPA related care is offered at the primary care visit
symptomatic relief from pain. For many inflammatory and in the optometrist's office.
TPA USE BY OPTOMETRISTS LOWERS THE PATIENT'S COST OF
OUT-OF-POCKET EXPENSES
According to a 1990 US Government report,the average billing when the provider does not accept assignment of
travel time for patients of ophthalmologists in rural areas is 70 insurance benefits as payment in full. Low income patients,
minutes, which is the highest travel time for all types of often at high health risk,are very dependent on optometristsfor
physicians except radiologists/oncologists; and the average their primary eye care services. These patients may be
travel time to ophthalmologists' offices for persons below the particularly inconvenienced in seeking eye disease treatment
poverty level is 53 minutes, the highest for all types of physi- because of low Medicaid participation rates for ophthalmolo-
cians.' Patients may incur additional direct costs due to extra gists. In Oregon,a 1991 report found that 70%of optometrists
travel time and distance. A study conducted by the Kansas were Medicaid providers,.whereas only 1 1%,of ophthalmolo-
Optometric Association of its members 18 months following gists accepted Medicaid payment for serving this high health
implementation of its therapeutic law indicated that 128,000 risk population." Historically, as a profession, optometrists
miles in travel weresaved by patientstreated byoptometrists.17 have demonstrated a high participation rate in government
Often patients face the out of pocket expense of balance programs serving the disadvantaged.
MANAGED CARE SYSTEMS RECOGNIZE OPTOMETRISTS AS
COST EFFECTIVE
Health Maintenance Organizations and other managed effective models are those where optometrists perform all
care entities recognize the cost savings of optometrists. routine examinations and also manage certain eye diseases
InterStudy,a nationally recognized research firm,documented and conditions ." '" A report published by the Group Health
a potential 36% savings when optometrists are utilized to the Association of America,documents the cost control benefit of
full extent of their training and competence. "The most cost optometrists as primary care providers in integrated managed
care networks.
CONCLUSION
This study found that TPA authority for optometrists improves cost efficiency in the delivery of eye care.The analysis outlines
the observed cost control benefits of the optometric clinical use of therapeutic drugs to treat eye disease.
Our findings are consistent with the policy position of the American Public Health Association(APHA). In 1990,the APHA,
a national organization of 77 health professions and 32,000 members, adopted a policy statement urging state legislatures to
update their state optometric practice acts to allow optometric use of diagnostic and therapeutic agents. The APHA has
traditionally encouraged health care practitioners of all types to practice to the fullest scope allowed by their education as a means
of increasing the public's access to cost effective and high quality health care.21
We find that therapeutic drug use by optometrists benefits Americans with more accessible, lower cost, and high quality
primary care for diseases of the eye and related structures. Extending TPA authority to optometrists in the remaining states will
help address the goal of national health reform to provide affordable and quality care to all Americans.
REFERENCES
1. American Optometric Association Map-Status of Pharmaceutical Legislation,June 11, 1992.
2. Bennett I.Aron F.State of the Profession- 1992. Optometric Economics,October 1992.
3. Aron F. Unpublished data. The number of cities in each state with optometrists and ophthalmologists based on hand counts from
the Blue Book of Optometrists, 1991 and the Red Book of Ophthalmology, 1990.
4. Health Care in Rural America, U.S.Office of Technology Assessment,Washington, D.C., 1990.
5. Soroka M.Comparison of Examination Fees and Availability of Routine Vision Care by Optometrists and Ophthalmologists,Public
Health Reports,Vol. 106, No.4,July-August 1991.
6. Feldstein PJ. Health Care Economics. 1988. Delmar Publishers,Albany. New York.
7. Barlow M. DPAs and TPAs: An Argument for Their Use in Optometric Practice,Clin. Eye Vision Care, Vol. 3, No. 2, 1991.
. 8. Warden.Memorandum from Ramona Weakland Warden,Director Bureau of Health Service Professions,"Final Summary of 1991
Use of Therapeutic Pharmaceutical Agents by Optometrists in Wisconsin",July 14, 1992.
9. Soroka M, Barresi BJ. The Medicare Optometry Parity Amendment: predicted and actual payments to optometrists and
ophthalmologists.J Am Optom Assoc.September 1991;62:699-703.
10. Barresi BJ:Substitution Effect of Extending Medicare Coverage to Optometrists. Published Abstract.Am J Optometry. Dec 1992.
11. Seventh Report of the President and Congress on the Status of Health Personnel in the United States,March 1990.
12. Gauer,Bonnie B., Erickson,Todd S.,and Ulland, Robert L.,Cost and Availability of Routine Eye Care: A Comparison of Oregon
Optometrists and Ophthalmologists,Presented to Pacific University College of Optometry,.April 1991.Submitted for publication
J American Optometric Association.
13. Lee P,et.al. Physician Payment Review Commission,Annual Report to Congress.1991.Washington DC.
14. Soroka M.A Comparison of Charges by Optometrists and Ophthalmologists Under the Medicare Program.J American Optometric
Association. 1991.62:372-75.
15. Barresi BJ.Soroka M. Impact of Therapeutic Pharmaceutical Agent Authority for Optometrists on Eye Care Fees.Study of Center
for Vision Care Policy.In preparation March 1993.
16. Cohn M.Kurtz D.Frequency of certain urgent eye problems in an emergency room in Massachusetts. J.Am.Opt.Assoc.,Vol.63,
No.9,September 1992.
17. The Impact of the Use by Kansas Optometrists of Therapeutic Pharmaceutical Agents,Kansas Optometric Journal,Nov-Dec 1989.
18. InterStudy-Eye care in the HMO setting Current Status and Potential cost Savings of Alternative Arrangements
19. Barresi BJ, Rosenthal J.Managed eye and vision care,options for IPA model HMOs. Group Health Institute.June 1987.
20. APHA: Yes to therapeutics for optometrists,Am.Opt.Assoc. News,Vol. 29, No.8,October 15, 1990. (Resolution 9004).
ABOUT THE AUTHORS
Dr. Barry Barresi is the Vice President and Dean for Academic Affairs of the State College of Optometry,State University of
New York. He is a senior research associate of the Center for Vision Care Policy. Dr. Barresi is the editor of a clinical textbook,
and numerous clinical and research articles.He is a frequent presenter on topics of health care policy and academic administration.
A graduate of Holy Cross College and the New England College of Optometry, Dr. Barresi completed his PH.D. in public
administration with specializations in health, policy analysis and finance from the Wagner Graduate School of Public Service of
New York University.
Dr. Mort Soroka is the Director for the Center for Vision Care Policy of the State College of Optometry, State University of
New York. He holds the rank of Associate Professor at the State College of Optometry State University of New York and teaches
courses in health systems and care delivery. From 1979 to 1987 he was the Associate Director for the University Optometric
Center, the clinical facility for the College of Optometry. He received a M.P.A. degree from the Graduate School of Public
Administration of New York University and went on to receive a PH.D.degree from New York University Graduate School of Arts
and Sciences. Dr. Soroka has authored some 40 articles that have appeared in the optometric and public health literature.
THE CENTER FOR VISION CARE POLICY
The Center for Vision Care Policy is a research unit of the State College of Optometry,State University of
New York and conducts policy studies and health services research. Established in 1985, the Center has
completed numerous descriptive and evaluative studies on regional and national issues related to the
organization,personnel needs and economics of vision care services.Its publications and position papers serve
to inform policy makers in government,business and labor as well as leaders in optometry about vision care
policy issues.
CENTER FOR POLICY INSIGHT is published by the Center for Vision Care Policy.Comments and inquires are welcome
VISION CARE POLICY and appreciated. Address correspondence to the Center for Vision Care Policy, SUNY/State College of
100 East 24th Street Optometry, 100 East 24 Street, New York New York 10010.
New York, NY 10010 The content of this publication does not necessarily reflect the opinions of the State College of Optometry
or the State University of New York. It is solely the work of the authors.
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Abandoned 9
Mei Cal Pati
eats .
Ophthalmologists are not adequately participating in the Medi-Cal progranL The-number
of eye exams provided by Ophthalmologists to Medi-Cal patients is steadily declining.
According to the State Department of Health Services, Ophthalmologists provided only
8% of the Medi-Cal vision care services in 1991. This compares with 92% provided by
Optometrists.
ON 92%* 1991
NDS 8% 1991
ODs 82% 1989
UDS 18% 1989
Despite the decreasing involvement of Ophthalmologists in the Medi-Cal progz~am, they
_ still seek to prevent optometrists from practicing to the full level of their education and
clinical training.
*There has been no provider rate increase since 1985.
OVERLAPPING SCOPE: OPTOMETRY SERVICES
ARE EQUIVALENT TO OPHTHALMOLOGY SERVICES
The Federal Government has REJECTED OPHTHALMOLOGY CLAIIi IS that Optometric
services are not equivalent. Recent Medicare regulations state that there is NO CONVINCING
EVIDENCE TO SUPPORT MD CLAIIi LS that services provided by an optometrist are differ-
ent from the same service when provided by an ophthalmologist!Federal Rester. Vol. 56, No.
227, Nov. 1991). Medicare reimbursements for optometry are now similar to ophthalmology
because Medicare greatly reduced ophthalmology allowable charges. Ophthalmology was
overcharging.
For more information, contact the California Opcometric Association at (916) 441-3990.
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Better fonis" c e � care
Let optometrists order patients often see two doctors instead
of one and pay considerably mom
limited therapeutic drug A02020 would end such inconve-
aiiforni*a optometrists.the tuenc a by allowing optometrists who
medical professionals most are properly trained to administer
people Soto for their vision some therapeutic drugs to treat fron-
problems.are seeking authority to ad- tai eye diseases.About half of the i
minister a limited number of there drugs wouldbe
over-the-counter i
pwdc drugs to treat eyeAiseases, medicati
Southern California College of Optometry
NO D T 3575 Yorba Linda Boulevard • Fullerton • California • 92631-1699 • (714) 449-7455 • FAX (714) 526-3907
*o�90&�'d �
F0 TOM���
DR. MORRIS S. BERMAN
Dean of Academic Affair
June 4, 1993
Mr. Peter Shilla
Western Center on Law and Poverty
2000 "0" Street
Suite 230
Sacramento, CA 95814
Dear Mr. Shilla:
I have been requested by the California Optometric Association to provide you with
some details regarding the clinical services provided by the Southern California
College of Optometry.
By way of background, the Southern California College of Optometry (SCCO) was
founded in 1904. SCCO, the nation's third oldest college of optometry, and the oldest
of the two California schools of Optometry is a non-profit, independent, fully
professional and regionally accredited institution. SCCO is the major supplier of
optometric manpower for California as well as the majority of the western states.
SCCO's graduates are qualified to meet the specific educational requirements in
each of the states which already license optometrist to use ocular therapeutic
agents in rendering eye-vision care to their patients. As an institution which has
graduates in all of the states in our nation, our graduates are educated and
clinically trained to fulfill their role in the public as independent primary health
care providers of vision and eye care services. The rigorous pre-optometry
requirements emphasize the biological sciences and are comparable to the
prerequisites of medicine, dentistry and podiatry. Required didactic and laboratory
coursework in general anatomy and physiology form a sound foundation for the
clinical tracks in pharmacology, clinical medicine as well as ocular 'disease
diagnosis and treatment. ►
The didactic, laboratory preparation of optometry students for clinical practice has
carefully been structured to provide opportunities for students to examine,
diagnose, manage and treat a diverse patient population within a variety of health
delivery systems in widely distributed geographical locations.
The primary clinical facility is based on the main campus in Fullerton and
administers over 40,000 patients visits annually. In addition, there is an extensive
off campus optometric clinical progyram consisting of over eighty facilities in
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June 4, 1993
twenty-four states. Fourth year optometry students spend one half to two thirds of
their clinical training in the external clinical sites that include:
College owned and operated clinical facilities
United States Indian Health Services
Military clinical facilities
Independent external clinical facilities
These clinical sites are listed in the attachment.
Each clinical site is different and the following narrative briefly highlights the
unique opportunities and challenges of the following representative samples.
COLLEGE OWNED AND OPERATED CLINICAL FACILITIES:
Optometric Center of Los Angeles
The Optometric Center of Los Angeles (OCLA) is a satellite clinic of the Southern
California College of Optometry which operates in South Central Los Angeles. This
clinic provides fourth year clinicians an inner city experience, exposing these
young clinicians to the realities of an urban community and to the special health
concerns associated with lower socio-ecomonic populations. OCLA is subsidized by
the college as well as a number of foundations, their financial involvement allows
OCLA to provide services not commonly found in most privately owned facilities.
Through the involvement and assistance of the Lions Club of District 423 we are
able to provide complete eye care to many of the indigent residents who are
attempting to work their way back into the mainstream of working society.
This is a-. community where many of the people struggle to acquire the basic
necessities of life, where there is no room for the luxuries that the rest of society
takes for granted. Here, much of what society would call a necessity is viewed as
luxury. Unfortunately, health care often falls into this category. The severe
shortage of health resources compounds this abysmal situation. Health care
resources in the surrounding communities commonly shut out residents of this
area through their fees and by their failure to accept Medi-Cal. In order to fulfill
our responsibilities to our patients, we are thereby forced to add to the woes of the
County Hospital Emergency system by sending them the bulk of our referrals.
Baldwin Park Optometric Center (BPOC)
The Baldwin Park Optometric Center is the second satellite clinic of the Southern
California College of Optometry which operates in the city of Baldwin Park, twenty
miles east of Los Angeles. This clinic is also subsidized by the College with
community grant support to meet the needs of our undeserved, low income and
largely Hispanic population of the area.
UNITED STATES INDIAN HEALTH SERVICE:
There are several clinics are located in remote regions in the western states located
within various Indian Reservations. The population served presents optometry
students with unique experiences in examining, diagnosing, treating and
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June 4, 1993
managing health and vision problems. The socio-economic, environmental and
cultural conditions of this patient population provides unique supervised learning
experiences in ocular therapeutics for optometry students.
MILITARY CLINICAL FACILITIES:
The needs of servicemen and their families in the US military differs from
population groups in other external clinical facilities. In addition to the basic eye
vision and ocular therapeutic needs, this population often requires optometric
expertise for addressing environmental/occupational vision problems that occur in
military training and combat.
VETERANS ADMINISTRATION FACILITIES:
The vast federal network of Veteran Administration outpatient centers and
hospitals is heavily dependent on optometry for administering to the eye vision care
needs of the nation's veterans. Extensive clinical experience in Veteran
Administration facilities are enjoyed by optometry students and residents who
obtain a high volume experience in diagnosing, managing and treating patients
with complex ocular and systemic health problems which may be chronic or acute
in nature.
The College has owned and operated the clinics in Fullerton, Los Angeles (OCLA)
and Baldwin Park (BPOC) for over twenty years and is committed to subsidizing the
operations of these clinics in the interest of community service, patient care and
student education. In the current difficult economic climate, this choice has been
made despite the availability of clinical training sites that would benefit our
students without placing fiscal constraints on the College.
I hope that the Western Center for Law and Poverty will recognize our sincere
efforts to serve the public by lending your support to the passage of AB 2020. With
the legislation, the clinical training of our students will be greatly enhanced as
these inner city clinics serve population groups who have a very high incidence of
ocular and systemic health problems.
Sincerely,
AorrisBerman, O.D., M.S.
Dean of Academic Affairs
MSB:gn
cc: Dr. Gordon
Norma Dillon
�r,AUFO/?,y�9
Optometric Center of Los Angeles
'•* 0 D r an affiliated clinical facility of
O G) Southern California College of Optometry
*O� 190 �i* 3916 South Broadway • Los Angeles • California 90037 • (213) 234-9137 • (818) 308.1628
OPTOM�
April 26, 1993
Mr. Peter S. Schilla
Western Center on Law and Poverty, Inc.
2000 "u" St., Suite 230
Sacramento, CA 95814
Dear Mr. Schilla,
The Optometric Center of Los. Angeles (OCLA) is a satellite clinic of the Souther
California College of Optometry which operates in South Central Los Angeles. This clinic
provides an inner city experience for the fourth year clinicians assigned here, exposing
these young men and women to the realities of this plagued urban community and to the
special health concerns which poverty entails. Because OCLA is subsidized through the
resources of our parent institution, we are able to offer this community a level of health
services not commonly found in most privately owned facilities. Through the involvement
of the Lions Club we are able to provide complete eye care to many of the indigent
residents of skid row attempting to work their way back into the mainstream of working
society.
This is a community where people struggle to acquire the basic necessities of life, where
there is no room for the luxuries that the rest of society takes for granted. Here, much of
what society would call a necessity is viewed as luxury. Unfloitunataljr, healUh carp o"tan
falls into this category. The severe shortage of health resources compounds this abysmal
situation. Health care resources in the surrounding communities commonly shut out
residents of this area through their fees and by their failure to accept Medi-Cal. In order
to fulfill our responsibilities to our patients, we are thereby forced to add to the woes of
our County Hospital. Emergency system by sending them the bulk of our referrals.
Our clinic is on the front lines in dealing with the problems of the uninsured and
underinsured in securing quality eyecare. Th-- current assembly bill AB 2020 is a step in
the right direction. By enabling our clinic to overate to the level of care which our
clinicians are capable of offering,this bill would mean greater and more affordable access
to the treatment of eye disease for the poor in areas such as this. Although this bill does
not have the power to affect great change, it is a small and logical step which will relieve
pressure on the system and on the ranks of the needy. Such small steps can help our
society move from the inertia of its current state towards a-more humane and healthy
future.
Sincerly,
Dr. Donaldo R. Figueroa
Clinic Director
cc: California Optometric Association