Improving the Scope of Practice for Optometry

Irving Bennett, O.D.

The very first concerted attempt to increase the scope of practice of optometry by passing a state law that would permit optometrists to use both diagnostic and therapeutic pharmaceutical agents occurred in 1937 in Pennsylvania.  Yes, 1937, some 39 years before the State of West Virginia passed its therapeutic pharmaceutical agent (TPA) law and 34 years before the State of Rhode Island passed its diagnostic pharmaceutical agent (DPA) legislation. It should be noted that the first successful efforts to get DPA and TPA laws for optometry were those adopted in Rhode Island and in West Virginia.

The effort to increase the profession’s scope of practice in 1937 was headed by Albert Fitch, the founder and first president of the Pennsylvania State College of Optometry, later named the Pennsylvania College of Optometry.  Fitch was a forceful, dynamic and enthusiastic advocate for extended privileges for optometrists and, according to many of his contemporaries, the most outstanding visionary for the profession of optometry.

Fitch’s efforts with getting House Bill No. 1119 adopted by the Pennsylvania Legislature were chronicled in his autobiography (My Fifty Years in Optometry, volume 2, 1959, pages 337-55).  Fitch had arranged to get the expanded privileges bill introduced by the administration, giving it a better chance for adoption.  It was only through chicanery that the bill was defeated; the vote was 90 to 88, a margin of one vote.

The salient features of the legislation and the virtues of it were that it increased the required education of optometric students (as termed in the bill “specialized education”) so that licensed optometrists would be fully trained to handle the diagnosis and treatment of eye diseases and conditions.  Supporters of the legislation openly compared it with dentistry’s struggle to separate itself from medicine some hundred years before.

As the path for adoption seemed clear, a last minute maneuver by the opposition did it in.  In Fitch’s words it went like this:

“After hearing our talks and those of the medical side, the Committee endorsed Bill No. 1119 and recommended its passage. The bill passed its first two readings almost unanimously in spite of the opposition of the medical group. On the third reading, when it appeared certain that the bill was destined to pass, the medical group resorted to a reprensible trick to cause the defeat of the bill. A physician, a member of the Health and Sanitation Committee of the Legislature, posing as its chairman, made a sobbing appeal to have the bill referred to his committee.  He asked that this be done as a favor because otherwise it would appear as if a reflection were being cast on his committee.  He said that this bill should have come to his committee in the first place instead of to the Committee on Education where it had been sent originally.

“He also said it would be different if his committee was opposed to the bill, but as a matter of fact this committee had been in favor of it from the very beginning.  The physician made a solemn promise that if the bill was referred to his committee, it would be reported back the next day with a recommendation for its passage. He said all this knowing full well that his committee, which contained more physicians than any other committee in the legislature, was not in favor of the bill and that his promise would never be kept.

“This whole procedure was highly unusual; the most seasoned legislators could not recall anything like this ever happening before.  We were told that some of our best friends among the legislators would vote to have the bill referred to the Health and Sanitation Committee because of the solemn promise of this physician member to report it back the following day.  It so happened that this physician told a deliberate falsehood, as he really had no authority to speak for his committee. He was simply following orders of the medical lobby which would stoop to any dishonesty to defeat a bill which they oppose.

“However, in spite of the sobbing appeal, the untruthful statements and the false promise, the vote was close, ninety in favor of referring the bill eighty-eight opposed. As the reader can well imagine, this bill never came back to the floor for a final vote.  Unfortunately, this was an administration bill, and since almost all such bills are sent to the floor for action late in the session, it was now too late for us to reintroduce the bill in this session of the Legislature.”

Melvin D. Wolfberg, OD in March 1999 wrote a comprehensive historical review of optometry essentially picking up where James Gregg, OD left off in his 1972 book, “The American Optometric Association – A History”  Wolfberg, whose work appeared in Journal of the American Optometric Association (vol. 70; no. 3, March 1990), referred to the Fitch efforts in 1937 and noted that this “this attempt to broaden the scope of optometric practice” continued after the defeat of the expanded scope of practice legislation.

Wolfberg writes: “For the two decades after the defeat of HB 1119 in Pennsylvania, Fitch continued his commitment to optometric education by expanding and improving bio-medical subjects such as anatomy, pathology, and pharmacology in the college’s curriculum, and leading the country’s academic community in lengthening the amount of time required to receive an O.D. degree. The success of those actions created a ripple effect; PCO graduates became increasingly frustrated, since they were licensed under antiquated practice acts and could not render professional services they had been educated and trained to provide. The impact these graduates had in many states in subsequent years was great.”

As an aside, it took until June 1958 for the Pennsylvania Optometric Association to vote in convention assembled to “institute the effort to amend the optometry act to permit the examination of the human eye without restriction as to method of procedure.”  The surprising events that transpired after that will be covered in a later “Gem.”

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