Two groups are facing off over Arkansas Act 579 of 2019, which allows optometrists to use lasers and scalpels for certain procedures.
The proponents, the optometrists and patients that make up Arkansans for Healthy Eyes, say the new law increases access and will help the state recruit and retain optometrists.
The opponents, ophthalmologists and other medical doctors that make up Safe Surgery Arkansas, say patient safety is at stake and call the law a “slippery slope” that could lead to other non-medical doctors performing surgeries.
The people behind Arkansans for Healthy Eyes announced the formation of their group on Wednesday, just days after Safe Surgery Arkansas announced a ballot question committee to coordinate a rare referendum challenging the new law.
Alex Gray is an attorney for the Steel Wright Gray law firm in Little Rock, which drafted and filed the Safe Surgery referendum. He said the group has until July 23 to collect about 54,000 signatures to get the referendum on the November 2020 ballot.
If the group can collect enough valid signatures, Act 579 would not go into effect until after the vote, if it at all.
“The people … don’t vote to repeal the act. …[I]t’s essentially a ratification,” Gray said.
That means that if the majority of people vote for the act, it will go into effect, he said. If the majority of people vote against the act, it will not go into effect.
Gray said the group could have tried to amend the law. But that option requires more signatures, and Act 579 would have been in effect in the interim.
Gray said the referendum process hasn’t been used in decades — probably because people aren’t aware of it.
Access, Retention
Vicki Farmer, executive director of the Arkansas Optometric Association, is part of the group fighting to retain the law.
Farmer said Act 579 is a “scope of practice” law that’s already been through a process including public comment, study and months of conversations with lawmakers before passing in this year’s legislative session.
Several patients testified about “how they had to wait to see a specialist when they wanted to use the doctors of optometry that they trusted and that they were comfortable with.”
Lawmakers also heard from opposition, including ophthalmologists and other medical doctors, and both state and national organizations, she said.
The scope of practice for optometrists in Arkansas hadn’t been updated in more than 20 years, Farmer said, and some of the procedures the new law allows have been taught in optometry schools for 10 years. They are also allowed in Oklahoma and Louisiana, she said.
According to the proponents’ Wednesday announcement, 18 states have a wider scope of practice for optometrists, and Kentucky and Alaska both allow the same procedures as Act 579.
Farmer said proponents want to emphasize that these procedures are “minimally invasive, in-office procedures.”
“That’s one thing we definitely want to point out,” she said. “These are things that are done in the office … they are never done in an operating room.”
Her case for the act is two-fold: access, and recruitment and retention of optometrists.
According to Farmer, there are full-time optometric practices in more than 80 percent of Arkansas’ counties, while ophthalmologists have full-time practices in only about 30 percent.
“This is about providing patients all over Arkansas with enhanced access to quality care,” she said, noting that patients across the state may have to drive hours to see an ophthalmologist, and they may not get a needed procedure because they’re unable to go, Farmer said.
Referring patients to a specialist, an ophthalmologist, also results in higher health care costs, she said.
Farmer said being prohibited from procedures they know how to safely perform is frustrating to optometrists who want to serve their patients.
“It really got to the point where we were having students that were coming out of school that we were trying to recruit to Arkansas, that were looking at our state, that were from our state, but they were like, ‘I am trained and educated to provide this scope of practice, this is how I should be treating my patients, this is what they deserve from me, but I’m not allowed to do it in Arkansas,'” Farmer said.
She said that last year, 20% of new graduates went to other states where they could provide more services.
Bigger Picture
Those pushing for the referendum see things differently. Gray said his clients are concerned about patient safety being compromised.
Only a few states allow optometrists to perform the procedures, he said, adding that optometrists are non-medical doctors who have gone to school for four years, while ophthalmologists have four years of medical school, three years of residency and one year of fellowship under their belts.
Gray also disputes that there is “a pressing need” to expand Arkansas optometrists scope of practice.
Opponents are also looking at the bigger picture, Gray said.
“… [I]f you start letting one non-medical doctor class of individuals perform surgeries, it’s a slippery slope,” he said. “Who knows what will be permitted next? … It sets a dangerous precedent.”
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