The AMA is applauding New Mexico Gov. Michelle Lujan Grisham for safeguarding the vision of patients by recently vetoing legislation that would have allowed optometrists to perform a wide range of complex surgical procedures.
In her veto message, Lujan Grisham reiterated concerns raised by the AMA and other physician organizations, stating: “I am vetoing this bill because it sets a dangerous precedent for allowing nonsurgeons to perform surgical procedures.”
The governor’s message says “there is no persuasive evidence that this bill would increase access to care. Data shows that expansion of laser authority for optometrists has not resulted in a statistically significant increase in access to these procedures for patients.”
Lujan Grisham added that the bill’s change in scope of practice would not “increase or even maintain the current standard of care.” She noted that the “bill allows nonsurgeons to perform procedures that are currently performed by medical doctors with significantly more educational and hands-on training requirements to receive their degrees.”
Those “are not abstract concerns,” the governor added, citing a case that happened in March. “An optometrist in a neighboring state performed an unauthorized surgical procedure that this statute would legalize, resulting in complications so severe that the patient had to be transferred to the University of New Mexico for intervention by an ophthalmologist.” Learn more with the AMA about the risks of letting optometrists do eyelid surgery.
Stopping the bill was an important win for patients in need of eye surgery. This legislation was strongly opposed by the New Mexico Medical Society, American Academy of Ophthalmology, New Mexico Academy of Ophthalmology and the AMA.
The AMA sent a series of letters to lawmakers expressing opposition to the legislation and a letter (PDF) to the governor urging her veto. In that letter, AMA Executive Vice President and CEO James L. Madara, MD, highlighted the differences in education and training between optometrists and ophthalmologists and the inherent complexity of eye surgery which “requires medical supervision during surgical preparation, performance of the procedure, and postoperative patient care,” as well as the medical knowledge to determine whether surgery is necessary.
The New Mexico Medical Society also received a grant from the AMA Scope of Practice Partnership to help defeat this legislation.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
3 scope of practice bills in Maine
Maine is another state considering this type of legislation. The Maine Society of Eye Surgeons and Physicians has led the charge against this scope of practice expansion and partnered with many, including the AMA, American Academy of Ophthalmology, the Maine Medical Association (MMA), and the Maine Osteopathic Association (MOA). The MMA and MOA also received a grant from the AMA Scope of Practice Partnership to help defeat this legislation.
Legislative Document (LD) 1803, which would allow optometrists to perform a wide range of complex surgical procedures,” says a letter (PDF) to the state House and Senate chairs of the Joint Standing Committee on Health Coverage, Insurance and Financial Services.
Stay up to date on fight against scope creep
See how the AMA defends against scope of practice expansions that threaten patient safety.
“Patient safety and quality of care demand that patients be assured that individuals who perform invasive procedures, including eye surgery, have the appropriate medical education and training to do so,” wrote Dr. Madara. “Optometrists are important members of the health care team, but they do not have the education, training or experience to perform any type of surgery, including scalpel or laser surgery involving the eye or tissues surrounding the eye. Allowing optometrists to perform the procedures described in LD 1803 would pose a serious threat to the safety of patients in Maine.”
The committee carried this bill to the next session, which starts in January, and asked stakeholders to attempt to compromise in the meantime.
The AMA also has recently weighed in on two other scope of practice expansion bills in Maine. One bill, LD 961, would grant nurse practitioners the ability to independently provide medical care without an initial two-year supervisory period. In a letter, the AMA argued that this legislation compromises patient safety, citing significant disparities in the education and clinical training between physicians and nurse practitioners. This bill has been carried over to the next session, and MMA will continue to work to educate stakeholders about the concerns.
Another bill, LD 1166, would change the title of “physician assistants” to “physician associates.” In a letter voicing strong opposition, the AMA questioned the need for such legislation, which “does not improve the cost of or quality of health care for patients in Maine, nor … improve access to health care.” The committee did not heed the concerns and voted 11–1 to approve the change.
The bill will increase patient confusion as the current title “physician assistant” is common in today’s health care lexicon and well understood by patients. The term “physician assistant” is also ingrained in the existing health care infrastructure, including federal statutes and regulations, as well as the laws and regulations of 49 states and the District of Columbia.
Learn more with the AMA about what sets apart physicians and nonphysicians. Also, visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
