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Patient fights for optometrists

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By Mary Jo Melone
2/24/2010 © Health News Florida

Karen Thompson, a 59-year-old grandmother in rural LaBelle, never set out to be a poster girl for a cause. 

But with help from a public-relations consultant, she’s filling that role for Florida’s optometrists in their quest to win the right to prescribe drugs to their patients that now can be given only by ophthalmologists and other MDs.

That turf battle is expected to be one of the hardest-fought in the upcoming session, which starts next week. Current law allows optometrists only to prescribe topical medications.

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Thompson before  and after

The optometrists say Thompson suffered a permanent eye injury that could have been avoided if the law were different. 

On a Friday afternoon In October 2008, Thompson went to her optometrist complaining that something felt wrong with her eye. He said he thought she had shingles, but since she had no obvious symptoms, he sent her home. When she felt worse the next day, she called him. 

The optometrist tried to reach Thompson’s family doctor to write the prescription for an antiviral. The doctor was out of town. 

Her optometrist, Lamar Youmans, said he didn’t know of an ophthalmologist who would take Thompson, who is disabled and on Medicaid. And it was a Saturday. 

Thompson drove to the emergency room at the nearest hospital, Lehigh Regional Medical Center in Lehigh Acres, 30 miles away. Youmans said to tell doctors she had shingles, but the ER physicians told her she had pink eye.

She challenged them, left and called Youmans, who told her to go back in and tell them again of his diagnosis. When she tried to return, she says, she was blocked at the door.
A spokesman at Lehigh Regional Medical Center would not comment on her case. 

So Karen Thompson didn’t get the medication for shingles that she needed until the following Monday---three days after she first went to the doctor. 

By then, she said, it was too late to prevent damage. She said the eye aches constantly and she no longer sees very well out of it. She has had her eye stitched partially shut because it is irritated by sunlight. 

“It will get worse as she gets older,” Youmans said. 

Karen Thompson’s wrong-place, wrong-time story would have remained her personal burden, but Youmans and his partner shared it with their colleagues in the Florida Optometric Association.

The group has long been trying to change the state law that permits optometrists to prescribe only topical medications. They want to prescribe oral medications, as well. 

The optometrists hired a Tallahassee publicist, Brett Doster, to ghostwrite Karen Thompson’s story. He shopped it around to some Florida newspapers. It appeared Feb. 13 in the St. Petersburg Times as a guest column.

“Although my injury has taken some of my sight, I am not bitter,” the column read. “It has enabled me to have the opportunity to speak out in favor of something that may save others from even more significant eye injury.” 

The optometrists are behind a bill, SB 330, introduced by State Sen. Mike Bennett (R-Bradenton) that would permit optometrists to prescribe 13 oral medications: analgesics, antibiotics, antivirals -- including the one eventually given Karen Thompson -- and anti-glaucoma agents.

A companion bill, HB 135, has been filed by Rep. Ron Reagan, R-Bradenton. 

Most states do give optometrists broader prescribing privileges. Only two others, New York and Massachusetts, bar optometrists from prescribing anything but topical medications, according to a legislative analysis of Bennett’s bill. 

It is a scaled-back version of a measure that would have permitted optometrists to prescribe all eye-related oral medications. It died in committee last year. 

But the change has done nothing to soften the opposition of medical doctors. Optometrists simply aren’t trained to understand and properly prescribe the medications, said Bradley Fouraker of Tampa, president of the Florida Society of Ophthalmology. “It’s a safety risk to the citizens of Florida.” 

“Most of these drugs are rarely used by ophthalmologists. Oral drugs are rarely used unless you have a very significant infection or you are preparing a patient for surgery.”
According to Fouraker, two of the 13 drugs carry FDA “black box” warnings, the sternest the agency issues. One drug, an analgesic, carries the risk of death by suppressing respiration. One of the antibiotics can rupture tendons, he said. 

“Optometrists simply aren’t trained to understand the interactions of the drugs,” Fouraker said. “They are trained in the eye, not in the rest of the body.” 

The bill is also opposed by the Florida Medical Association. “Optometrists are not medical doctors,” spokeswoman Lynn Tackas said. 

On the other side, Ken Lawson, legislative co-chairman of the Florida Optometric Association, said he regularly hears from patients who want to know why they have to pay another doctor to get the medication they need.

“’Why can’t you do it? Why do I have to pay more?’” are the objections Lawson said he hears patients make. 

“We’re a valuable resource that is being underutilized, and we need to do the best to advocate for our patients,” said Lawson, from Sarasota. 

Not all ophthalmologists disagree. Dr. William Soscia of Bradenton said he had seen cases in which patients’ eyes worsened as a result of the delay involved in having their optometrist see them, and then having to refer them to him for medication—precisely what happened to Karen Thompson. 

“If I thought there was a potential danger to patients," Soscia said, "I’d be the first one leading the charge against optometrists.” 

Optometrists have a committed ally in Thompson, who said she is willing to go to Tallahassee to tell her story to lawmakers. She doesn’t blame her optometrist and hasn’t sued the hospital; she’s angry about the law. 

“If only I would have had two pills,” she said, “I would have been all right.”

--Mary Jo Melone, an independent journalist in Tampa, can be reached by e-mail.