Governor vetoes bill expanding optometrists' drug authority

Posted: Thursday, May 11, 2000

JUNEAU (AP) -- Gov. Tony Knowles has vetoed a bill that would have allowed optometrists to prescribe oral and injectable pharmaceutical drugs, a move the sponsor is calling politically motivated.

Knowles said he vetoed Senate Bill 78 because it would have expanded optometrists' drug practices without adequate training and education.

''Without a regulation change, under the language of this law, a licensee with a current endorsement to administer topical drugs would automatically be licensed to prescribe oral drugs and administer injected drugs,'' Knowles wrote.

He said the Legislature never sought the opinion of the medical community and the Alaska State Medical Board when considering the bill.

''This was a failure to recognize this as a medical and health issue,'' Knowles said.

Knowles requested the board's opinion after the bill reached his desk. The Medical Board, made up of five physicians and two public members, unanimously voted to oppose the bill.

''The board believes that the potential for harm to Alaskans from optometrists prescribing and administering nontopical medications greatly exceed the benefits,'' wrote Dr. Sarah Isto, a Juneau physician and chairwoman of the board, to Knowles.

''Optometrists do not have the clinical experience to safely administer eye injections, intravenous and intramuscular injections and oral medications, including some narcotics,'' Isto wrote.

She said reading about the effect and side effects of medications or attending seminars does not prepare an optometrist for complications related to patients' other medical problems and chronic medications.

''The board's charge is to protect Alaskan patients,'' Isto said. ''We believe that this legislation would endanger patients.

The bill was sponsored by the Senate Labor and Commerce Committee, and Chairman Jerry Mackie did not restrain his anger when he received word of the veto.

''There was no opposition to it through the process,'' said Mackie, R-Craig. ''The governor's veto is simply protection of the monopoly of the few ophthalmologists and doctors in the state. That's all this is about.''

Mackie said 37 states allow optometrists to prescribe oral medications. He said no additional training is necessary.

''This won't allow optometrists to do anything more than what they're qualified and trained to do,'' Mackie said.

Ophthalmologists are medical doctors licensed to perform eye surgery. Optometrist Dr. Jeff Gonnason, the former president of the Alaska Optometric Association, and the former president of the state Optometry Board, said the opposition is less about patient care than about money.

''There's not enough surgery to go around so they have to compete with us for glasses and contacts,'' Gonnason said.

All states west of the Mississippi River allow optometrists to prescribe oral drugs, he said, except for Washington, Oregon and Alaska. The need is especially critical in rural states, he said, where patients have access to fewer health professionals.

Both Mackie and Gonnason said it's absurd that physicians assistants and nurse practitioners can prescribe drugs for eye care when eye experts such as optometrists with eight years of education cannot. Mackie said optometrists travel to Alaska villages, diagnose infections or eye scratches, and must defer to a physician's assistant.

''How much sense does that make?'' Mackie said.

The Senate approved the bill 18-2 on March 7. The House approved the bill 34-2 on April 11. Gonnason said he attended every hearing on the bill and no one testified against it.

The Medical Board sent its letter after a meeting April 27.

Gonnason said optometrists would only rarely use injections but much of the debate focused there. He said the Board of Optometry was willing to ban injectable drugs except in cases of emergencies to address the concerns of critics.

Alaska's law is discouraging optometrists from practicing here, he said.

''These kids getting out of school don't want to come to Alaska,'' Gonnason said. ''Their hands are tied. They can't practice.''

Gonnason said he has worked to change the law for 24 years but scare tactics by medical doctors trying to protect their turf have been effective.

''Nobody believes Marcus Welby would lie to you,'' Gonnason said.

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