Optometry in the News - Minnesota Reformer

June 17, 2024
"Minnesota optometrists get thumb in the eye from big donors, House speaker"

By Michelle Griffith, Minnesota Reformer

Dozens of lawmakers from both parties, eye doctors and the Minnesota Board of Optometry wanted Minnesotans to be able to receive expanded services from their eye doctors this past legislative session.

Minnesota optometrists currently can’t prescribe oral antiviral medications to treat shingles in the eyes, for example, for longer than 10 days, or glaucoma medication for longer than seven — unlike dozens of other states.

Instead, Minnesotans have to see ophthalmologists, who are licensed physicians who went to medical school. Optometrists typically complete a four-year optometry program after undergraduate school. 

The problem: Optometrists outnumber ophthalmologists in Minnesota about 4-to-1, so wait times are long and availability scarce.

For about a decade, optometrists have been lobbying state lawmakers to expand their scope of practice.

This year, they were inches from the legislative finish line when they ran into a powerful opponent: House Speaker Melissa Hortman, DFL-Brooklyn Park, who pulled the optometry provision even after House and Senate negotiators had signed off on a watered-down version.

“I think that there’s a very big difference between a medical doctor’s training and other medical professionals’ training, and there’s a lot of things that other medical professionals can do, but there are things that should be reserved for those who have the extensive training that a physician has,” Hortman told the Reformer.

The optometrists faced another key adversary: Dr. Mary Lawrence, an ophthalmologist, and her husband Jim Lawrence, who together are prominent donors to the Democratic-Farmer-Labor Party and longtime opponents of allowing optometrists to broaden their care.  

Mary Lawrence serves on the board of the Minnesota Academy of Ophthalmology; Jim Lawrence is the chairman of a private investment firm and a board member on the Metropolitan Airports Commission after Gov. Tim Walz appointed him to the role in 2021.

From 2016 to 2023, the Minneapolis couple has collectively donated nearly $750,000 to the House DFL and Senate DFL caucuses, the DFL Party, Walz, the Alliance for a Better Minnesota, Hortman and former Senate Majority Leader Kari Dziedzic, according to a Reformer review of campaign finance reports.

Mary Lawrence has publicly boasted about holding political fundraisers and about her relationship with legislative leaders while prevailing in previous optometry scope of practice fights. In a blog post published by the Minnesota Medical Association, Mary Lawrence said she believes optometrists are seeking to expand their scope of practice “for commercial reasons.”

“Over the past several years, my husband, Jim, and I have hosted dozens of political fundraisers, including a fundraiser for … the MMA’s political action committee,” Mary Lawrence says in the post. “Together, Jim and I have developed personal relationships with legislative leaders in Minnesota, and as a result, we hope that ‘excellent physician-led health care’ is at the forefront of legislative decision making.”

A message left with Mary Lawrence was not returned.

Asked about the political giving, Hortman cut off the question.

“Let me be very, very clear … There is absolutely no tie between campaign contributions and the positions that the Minnesota House DFL or its members take on any issue,” Hortman said. “It’s super offensive to suggest that there would be.”

Hortman said donors give to Democrats because they agree with their position on issues. Hortman said over the years she’s had people call and threaten to pull future donations if Democrats voted a certain way on an issue, and she’s said, “Fine, see you later.”

A Hortman aide later emphasized that political action committees for both optometrists and ophthalmologists have donated thousands to Democrats and Republicans over the years. Last year, the Optometry PAC donated over $25,000 to lawmakers from both parties and caucuses. The MN Eye PAC — representing ophthalmologists — gave about $13,000 to lawmakers and caucuses.

‘A turf war between professions’

The optometrists have never come closer to expanding their scope of practice than during the recently ended legislative session. Lawmakers, including House and Senate health committee chairs Rep. Tina Liebling, DFL-Rochester, and Sen. Melissa Wiklund, DFL-Bloomington, signed off on a compromise — known as a conference committee report — on May 18. It included scope of practice expansions for various professions, including social workers, dentists and optometrists. 

The optometry scope of practice expansion wasn’t everything the eye doctors were seeking; it only allowed optometrists to administer steroids for up to 14 days and allowed them to issue a glaucoma prescription without a cap.

At the Legislature, conference committee reports are rarely amended, and if they are it’s usually for small technical issues.

After the scope of practice conference committee report was finalized and agreed to, Hortman said she told Liebling to cut the optometry expanded scope of practice, otherwise the bill would not be heard on the House floor. 

Bills in the Minnesota House can have a maximum of 35 co-authors. This year’s optometry scope of practice bill had so many lawmakers of both parties sign on that a clone bill was created to accommodate all the bill’s supporters. 

Rep. Robert Bierman, DFL-Apple Valley and a chief author, said he proposed the bill because many eye doctors are going to other states where they can practice all the procedures they were taught in school.

Bierman said he believes there’s a “turf war between professions,” even though in the real world optometrists and ophthalmologists work well together.

“(Optometrists) are not trying to move into the turf that’s ophthalmology, in my opinion, but I think the ophthalmologists see it very differently,’” Bierman said.

In response to an interview request, the Minnesota Academy of Ophthalmology referred the Reformer to a letter it sent to the Senate during the legislative session. In written testimony against expanding the scope of practice for optometrists, the group said that patient safety would be jeopardized.

In a January letter to the Senate Health and Human Services Committee, Minnesota Academy of Ophthalmology President Timothy Olsen wrote that optometrists don’t have the required expertise to safely inject around the eye, and he said the restrictions on prescription medications are needed.

“Allowing unlimited duration prescribing for certain oral medications by optometrists is not necessary, increases health care costs due to delayed diagnoses of and inexperienced care for serious medical conditions, and most importantly, raises serious safety concerns for the quality of eye care for all Minnesotans,” Olsen wrote.

The Minnesota Board of Optometry — the state’s regulatory board that licenses optometrists — for the first time in the decade-long battle submitted written testimony in favor of expanding the scope of practice. The board said the state’s current laws are “antiquated.”

“Minnesota is lagging behind other states and needs to catch up in its ability to deliver timely, quality care to Minnesotans. Slightly expanding our scope of practice — to fall more closely in line with neighboring states — will help attract new graduates to our state, ensuring better access to care throughout the state,” the Minnesota Board of Optometry wrote in its letter to the Senate committee.

Tina McCarty, chair of the Minnesota Board of Optometry’s policy and planning committee, said in an interview that the regulatory board decided to get involved in the scope battle because it believed the debate at the Capitol had gone awry. 

McCarty said after the bill failed, the board examined campaign contributions — including from the Lawrences — and grew alarmed at the end-of-session lobbying and legislative legerdemain.

“The bill was very bipartisan, very well supported, and to see things change at the last minute — in a way that was unprofessional and unproductive — is really disappointing,” McCarty said. “The activity that happened the last weekend of the session was particularly disturbing, and as a result we’ve started to reach out to elected officials.”

The Minnesota Optometric Association also pushed back against the ophthalmologists’ assertions that eye doctor’s aren’t properly trained to take on the new responsibilities, and that Minnesota should maintain a higher standard of care for injections around the eye.

Beth Coleman-Jensen, executive director of the association, noted that while optometrists are banned from injecting anesthesia around the eye for some procedures, another group of professionals has been given the legal right to use a needle around the eye: tattoo artists, who might be drawing a tattooed eyeliner, for instance.

“It seems unfair to the patients of Minnesota that (legislators) won’t allow optometrists to do something that they’ve been trained to do and would be better for the patients,” Coleman-Jensen said.

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