When Bradley Pratt's eye pain didn't go away one night in March 1987, he decided to visit Tooele optometrist Kris Hill, an acquaintance, who discovered a small particle of metal in Pratt's eye.
Hill used standard medical equipment to remove the particle, as well as a ring of rust that had begun to form around the particle. Hill then put eye drops in Pratt's eye and sent him on his way, never charging him a cent.Despite the fact that Pratt suffered no ill effects from the treatment, the Utah Division of Occupational and Professional Licensing Tuesday placed Hill on one year's probation.
Even though Hill's diagnosis and treatment of the injury was correct, it is illegal under Utah law for optometrists, like Hill, to do something as simple as removing a metal particle or administering eye drops.
It's a law many Utah lawmakers want to see changed. "Your mother can prescribe more drugs than your optometrist," said Rep. Jerrold Jensen, R-Salt Lake, one of 26 co-sponsors of HB168, a broad-sweeping and controversial measure that will go before the full House on Monday or Tuesday.
The bill, which would give authority to properly trained optometrists to administer prescription eye drops and repair minor eye injuries, has appeared on Capitol Hill almost every session for years. But it has been vigorously opposed by the Utah Medical Association and the Utah Ophthalmological Association.
It has evolved into one of the most animated annual feuds on Capitol Hill. This year alone, the ophthalmologists' PAC spent more than $17,700 in contributions to lawmakers. Optometrists have countered with $12,500 of their own contributions.
Similar bills have passed the House in past years but have bogged down in the Senate, due in large part to the efforts of Sen. Winn Richards, D-Ogden, an ophthalmologist.
At the heart of the issue is whether or not optometrists should be allowed to treat minor eye ailments. Traditionally, Utah optometrists are allowed primarily to prescribe corrective lenses.
Twenty-five other states allow optometrists to administer limited medications and repair minor eye damage for which they are trained. But in Utah, eye injuries and diseases have traditionally been the realm of ophthalmologists - eye doctors with medical training.
"The ophthalmologists say they oppose the legislation on public health grounds, but it's really an economic battle," Jensen said. "They don't want optometrists pulling their business away."
But many of the bill's co-sponsors are rural lawmakers, who say most areas of rural Utah do not have ophthalmologists, forcing rural residents to drive two to four hours to get treated for simple problems that a local optometrist could have treated easily and properly.
"I am breaking the law with 60 to 70 percent of the patients I see every day," admitted one rural Utah optometrist. "The Utah law is incredibly restrictive. I can't even tell a patient to go put Visine in his eye."
Ironically, it is not against Utah law for nurses or doctors' assistants, none of whom have received specialized training in eye disease or treatment, to treat the same eye conditions prohibited to optometrists, who have received four years of such training.
"We already have a health-care crisis in rural Utah," said optometrist Ron Kirk, owner of the San Juan Vision Clinic in Blanding. "If the law isn't changed, optometrists in some areas of Utah may have to leave. I may move back to Colorado. We just can't function in Utah the way the law is now."
For Kirk's patients, the closest ophthalmologist is two hours away in Durango, Colo., or even farther in Price. "To get an appointment, most have to go all the way to Provo (about four hours away)," he said.
There are 80 ophthalmologists in Utah, almost all on the Wasatch Front. There are 180 optometrists, many scattered throughout rural Utah. Rural optometrists say local medical doctors often consult them on proper eye treatment - knowing full well it it against Utah law for optometrists to diagnose or treat such ailments.
But most of the medical community is lobbying hard to defeat the bill. They say optometrists are not properly trained in medical procedure or pharmaceutical practices, and that they don't adhere to the same ethical standards as the medical community.
"The issue is one of training," said Dr. Merrill Oaks, a Provo ophthalmologist. "They see less than 100 patients with eye disease during the course of their training, and you can't learn about eye disease from textbooks. Their lack of experience shows."
Oaks also cited a case he treated where a woman lost her eye due to an incorrect diagnosis by an optometrist.
But that raised the ire of Rep. Haze Hunter, R-Cedar City, who also cited examples of two family members who have lost eyes due to incorrect treatment by ophthalmologists.
When questioned by lawmakers about a possible compromise, both sides admit any compromise is unlikely, assuring the bill will remain one of the most controversial before the 1991 Legislature.