Physicians’ assistants with the proper training and licensing will be able to write prescriptions and optometrists will be able to apply therapeutic and diagnostic eye drops and ointments, non-invasively treating pinkeye and other minor problems, if two bills approved in committee Wednesday become law.
Sen. Usie Richards sponsored both measures, which he said were designed to get the most benefit and patient care for the public from the territory’s existing medical resources.
Optometrist Lisa Adams and others testified to the Committee on Health and Hospitals on St. Thomas in support of expanding the ability of optometrists to use pharmaceutical agents. "All 50 states have therapeutic drug laws," Adams said. "In 49 states, D.C., and Guam optometrists can treat glaucoma," she said. Thirty-four states, D.C., and Guam go further than the proposed V.I. law and allow optometrists to give injections as well, Adams said.
Dr. Kidabe Assefa, an ophthalmologist, testified against granting optometrists the authority to provide medical care, arguing that ophthalmologists complete medical school, and then complete medical residencies, putting in several more years of school and practical medical experience. In comparison, optometrists spend less time in school and focus more exclusively on vision rather than medical care, he said. Assefa also suggested the territory did not have a shortage of ophthalmologists.
Dr. Byron Biscoe, a St. Thomas ophthalmologist, also testified against the measure for similar reasons.
"Optometrists’ training is not comparable to ophthalmologists’ training, so who would you trust your or your loved ones’ eyes to?" Biscoe said.
St. Croix District Health Officer Dr. Marc Jerome testified the V.I. Health Department supported the thrust of the legislation, but had concerns both about the resources available to enforce compliance and about the details and scope of the particular bill.
"The proposed legislation includes questionable scope of services for optometry assistants and technicians that warrant further research and discussion," Jerome said. Based on population and the recommendations of the Optometry Board, a single ophthalmologist would be sufficient for an area with a population of 250,000, he said, suggesting that Assefa was correct about the lack of a shortage. But "the expansion would increase access to care and speed of service," Jerome said.
Dr. Robert Centeno, chief medical officer at Gov. Juan F. Luis Hospital on St. Croix, joined several other doctors and hospital administrators in support of the measure allowing physicians’ assistants to prescribe medication.
Dr. Frank Odlum testified against allowing physicians assistants to dispense as well as prescribe medicine, and urged that if any prescribing authority is granted, it be limited to drugs on the federal Schedule’s III through V- excluding powerful and addictive narcotic painkillers that are classified in Schedule II.
Odlum, Centeno, and every other testifier raised concerns over a section in the bill that would allow physicians’ assistants to perform tasks that are not within the scope of the supervising physician. They argued this would mean there was not always effective oversight, which could lead to risks for patients and potential liability problems.
Richards asked Centeno, Odlum, and the other testifiers to email him with detailed concerns and proposed alternate language in order to craft amendments to the bill when it is considered next in the Rules and Judiciary Committee.
Voting to send the bill expanding treatment authority for optometrists on to Rules for further consideration were Richards, Sens. Shawn-Michael Malone, Nereida "Nellie" Rivera-O’Reilly and Sammuel Sanes. Sen. Alvin Williams voted nay and Sen. Craig Barshinger was absent.
Every senator present voted to send the bill giving physicians’ assistants prescribing powers on to Rules, with Barshinger absent.