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Greed is behind bill on post-op eye care


© St. Petersburg Times, published April 12, 2001

TALLAHASSEE -- If religions made laws like politicians do, here's how it might have gone in the Sinai Desert some 3,300 years ago.

TALLAHASSEE -- If religions made laws like politicians do, here's how it might have gone in the Sinai Desert some 3,300 years ago.

Aaron: Bubba, the sheepherders are lobbying us like crazy. They say the competition's too tough and they've gotta have help. By the way, they've been very generous to the Ark Fund lately.

Moses: Okay, from now on, no one eats pork. Pigs smell bad anyhow.

There's a donnybrook going on here over a bill (SB 924, HB 553) to discipline any Florida-licensed medical or osteopathic physician who delegates "ocular post-operative responsibilities" to someone who isn't one of the above.

In plain language, that means that the eye surgeon either does post-op checkups himself or supervises whoever else does. He can't send the patient to an optometrist for followup care, as many ophthalmologists do.

Outwardly, this might look like another food fight between featherbedding MDs and their non-MD rivals, the optometrists. It is that, but it is also a lot more.

One group of ophthalmologists is after another. The one group envies the assembly-line incomes of some of their more entrepreneurial colleagues and figure there'll be more wealth to share if the high-volume guys, some of whom allegedly fly in from other states to cut Florida cataracts, have to stay around for their own post-ops.

The optometrists are caught in a typical Tallahassee power play.

The Florida Medical Association and the Florida Society of Ophthalmology are pushing the bill to the dismay of many of their own members.

"I've had my own ophthalmologist call me and say this is a terrible bill," said Senate Minority Leader Jim King, R-Jacksonville. But even he hasn't been able to stop it.

Ordinarily, the medical lobbies would regard as far left of communism any attempt by the Legislature to micromanage their practices. But what's a little principle when there's a chance to make a lot of money?

Their side of it is that Florida eye patients are vulnerable to "rogue" ophthalmologists from other states who fly home with the money, "dumping" their patients on emergency rooms for any problems that might arise.

They might have a point if it weren't so hypothetical. They haven't named any patient who was hurt by being left to an optometrist's care. What's more, liability insurance premiums for optometrists have been going down. That hardly makes a case why Florida should become the first state to cosset ophthalmologists so kindly, or why patients in rural counties without ophthalmologists should have to make multiple day trips for routine post-op care.

Definitive complaint data is, of course, impossible to obtain. Florida law makes state secrets out of complaints that health regulators refuse to pursue, however poor the reason. There are no more powerful black holes in outer space. This is how the medical lobbies like it. With them, it's hard to tell when patient safety is a principle and when it's a pretext.

The real grease in the eye doc issue is as rank as the odor of a pigsty, except that this time it's the sickly sweet smell of money. Since 1996, according to state election records, the FMA has given more than $530,000 to various political committees, including $129,500 to the Republican Party for the 2000 campaign. The optometrists gave not quite half as much overall, and only $20,500 to the Republicans last year. The FMA and the ophthalmologists between them have at least 31 lobbyists in the fight (including Michelle McKay, the Senate president's wife, who lobbies House members) to fewer than 10 for the optometrists.

The ophthalmologists' flag-bearer, Alan Mendelsohn of Hollywood, is a leading fund-raiser for both the FMA and the Republican Party, and is also one of the organizers of People for a Better Florida, a secretive committee that spent heavily on "independent" advertising for and against candidates last year.

He's backed influential Democrats as well. One of them is Sen. Debbie Wasserman Schultz of Weston, a co-sponsor of his bill, who told the Miami Herald: "He's a novice who learned the game very quickly and he plays to win. . . . He's raised me thousands and thousands of dollars. He basically is the architect of the FMA's rebirth in terms of being a political player."

Why do you suppose the FMA isn't lobbying to punish obstetricians who let nurse-midwives provide post-partum care? Is it only because there isn't enough money in it? Or will that be next?

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