Page 24


representation on the board, which had dwindled from three members to one under Governor Clements’ appointment policies. By informal agreement, three board positions have traditionally gone medical education is substantially the same as that of M.D.’s, but also includes training in skeletal manipulation. Clements, in a move one senator characterized as political vengeance against osteopaths for their support of his 1978 gubernatorial opponent John Hill, has ignored tradition and filled two osteopath vacancies with M.D.’s. During the session the Texas Osteopathic Medicine ing to get three positions designated by law for osteopaths. When this effort failed, TOMA sought legislation establishing a separate regulatory board. TMA opposed the bill, saying it would create an artificial distinction between the two medical disciplines, but the measure, sponsored by Sen. Lloyd Doggett of Austin, narrowly cleared the Senate late in March. The TOMA found a more sympathetic reception in the House. The governmental organizations committee rendered the separate board bill unnecessary by restoring D.O.’s to the board and went a step further, adding a clause to prohibit discrimination based on “academic medical degree, school, or system of medical practice.” TOMA pushed the measure to protect osteopaths from what it considers discriminatory hiring practices by M.D.-dominated hospital hiring committees. As TOMA lobbyist Bob Gammage put it, “If we’re all equal, all be no objection to this clause.” While apparently ready to concede on the board representation issue, TMA refused to budge on the non-discrimination provision. The wording was vague, they said; it would deprive hospitals of the authority to hire physicians based on skill and would generate lawsuits by disgruntled osteopaths. Gammage said July 9 that his organization and the Texas Hospital Association had stood ready to negotiate on wording, but TMA had refused to discuss the issue. TMA and TOMA board members talked informally, he said later, but no statutory language was ever offered to resolve the dispute. The conference committee appointed to iron out differences between House and Senate versions of the bill removed the non-discrimination clause and reinserted it several times during the negotiations. In the end, though, it stayed in, the bill died with the session, and the matter remains to be settled in special session. Eye Exam Drugs The battle to authorize optometrists’ use of diagnostic drugs was politically more intricate and medically more significant than the skirmish with the osteopaths. Currently, only physicians may use the disputed “diagnostic pharmadrugs to anesthetize the eye and dilate and constrict the pupil during an eye exam. Optometrists say the DPA’s would allow them to use more precise measuring instruments and perform a more thorough exam. They point out that people who wouldn’t think of seeing a medical specialist for a routine eye exam will often go to an optometrist, who might discover and refer to an ophthalmologist more serious problems, such as glaucoma. Optometrists thus provide patients with entry into the health care system. If DPA’s would improve screening procedures, optometrists say, they should be made available. The medical profession counters that optometrists are untrained in the use of DPA’s and would be unprepared to cope with the severe reactions patients can have to the drugs. In rare instances, DPA’s can precipitate epileptic seizures Or acute glaucoma, conditions requiring the immediate attention of a physician. Doctors say that patient safety would be sacrificed if optometrists could use DPA’s. Twenty-eight states currently allow optometrists to use DPA’s. The Wisconsin law, passed in 1977, approved DPA use for a four-year trial period and required optometrists to report each use to the state’s department of regulation and licensing. A department survey of nearly 100,000 patients revealed no serious adverse reactions to the DPA’s and only 20 moderate adverse reactions, such as eye stinging or allergy. Responding to this report, the Wisconsin legislature made the DPA provision permanent in June, 1981. Citing other states’ positive experience, Texas Optometric Association lobbyist Fred Niemann dismisses ophthalmologists’ claims that optometrists using DPA’s would jeopardize patients’ safety. “The overall strategy of the TMA,” he said, “has been to prevent any other health care provider from encroaching on what is traditionally considered the practice of medicine. There’s an element of economics behind it.” Texas Ophthalmological Association president Dr. Alan Baum denies that economic competition is behind his organization’s opposition. “In general the low,” he said, “but if you’re that one person who has a seizure, you want the person taking care of you to know how to deal with the problem.” He says optometrists already can do adequate screening without the drugs, and the increased precision of the testing which DPA’s would afford does not justify increasing the risk to patients. A ‘Stranglehold’? If the arguments sound familiar it is because they occur repeatedly in territorial battles within the health care community. Doctors are unwilling to cede authority to practitioners they consider less qualified than themselves. The practitioners nurses, physician assistants, and now optometrists charge the medical profession with maintaining a stranglehold on health care delivery that deprives many people, particularly those in rural or medically underserved areas, of access to any medical care whatsoever. If the legislature decides to approve the use of DPA’s by optometrists, the move will loosen the medical profession’s nearly absolute control over health care in the state. State lawmakers have already rejected the DPA proposal once, though, and its revival this session took both optometrists and the TMA by surprise. In 1977, the Texas Optometric Association introduced a bill that would have authorized optometrists to use DPA’s once certain training and licensing requirements had been satisfied. The TMA defeated the bill and elicited from the optometrists a promise not to revive the issue until the 1983 legislative session. In exchange for this two-session silence, the optometrists got TMA cooperation on two important 1979 bills, one requiring insurance companies to reimburse optometrists for eye exams, the other establishing a visual screening program for schoolchildren. Since both the Texas Optometry Board and the Board of Medical Examiners were scheduled for Sunset review in 1981, the professional associations agreed it would be wise to postpone a fight over DPA’s until both boards had cleared the Sunset hurdle. Neither group, however, anticipated House Speaker Billy Clayton’s unexpected position on the DPA issue this session. At the request of his campaign treasurer, optometrist Bill Armistead, Clayton had the House committee amend the Medical Practice Act to permit DPA use by optometrists and then fended off all TMA efforts to remove the language. Some read the Speaker’s fierce defense of the House amendments as a signal to the TMA that their overbearing lobby tactics had gotten out of hand and THE TEXAS OBSERVER 5