Political deal let optometrists do eye injections, records show

Six years ago, Andrew Watry sought legislation to help the N.C. Medical Board do a better job of policing bad doctors. Watry, the medical board's executive director, wanted tougher regulations and a fee increase to hire more staff.

But correspondence released to The News & Observer shows that Watry could not get his legislation through the state House until the board gave the state's roughly 1,000 optometrists something in return -- the right to perform five kinds of eye-care procedures that included injections into and near the eyes.

The correspondence shows that House Speaker Jim Black, a Mecklenburg Democrat and an optometrist, was kept aware of negotiations on the issue and sought to help the optometrists.

Black, through a spokeswoman, said he did nothing to hold back the medical board's legislation.

Deal-making occurs all the time in the General Assembly, and is an important part of how the legislature works. But the correspondence about the deal with the optometrists is unusual for its candor and offers a look into the practice of North Carolina politics that the public rarely sees.

The correspondence was merely part of a long turf battle between physicians and optometrists over who could perform the potentially lucrative procedures.

In most states, the procedures are typically done by ophthalmologists, who are medical doctors; optometrists are not.

The fight did not end until last year, on terms that generally favored the optometrists.

The N.C. Board of Optometry first requested approval for the procedures in 1998.

Watry discussed the concession on June 28, 2000, in a voice mail to the optometry board's lawyer, Johnny Loper, which Loper's secretary transcribed. The News & Observer obtained the transcription and other correspondence from the optometry board.

"As you know, we're in the throes of trying to get some legislation down there, and of course the optometry issue is key to all this," Watry said.

The transcription goes on to refer to the procedures by their "CPT codes," a medical shorthand for Current Procedural Terminology codes, which practices use to bill for their work. It refers to then-Rep. George Miller of Durham, sponsor of the bill the medical board wanted, and to a consent agreement, a proposed treaty that would settle the dispute.

"I'm demonstrating to Mr. Miller that we are not [vacillating] in our approval of the CPT codes and for that purpose am producing a copy of a modified consent agreement."

The consent agreement would have given the optometry board authority over the five injections -- including one in the outer layer of the eye and another in the eyelids.

Watry was eager to get Loper's signature on the agreement so he could bring it to the legislature. "I hate to put you on the spot like this, but you know how things get in the frenetic last few minutes of legislation," Watry said in the voice mail. Loper signed the agreement.

The House passed the medical board bill 12 days later. The agreement fell apart, however, after the state Senate declined to pass the legislation. Soon afterward, the medical board backed out of its agreement with the optometry board.

But the agreement continued to haunt the medical board.

The optometry board sued the medical board in November 2003, saying it had made a valid agreement three years before. Last year, after a judge made a key preliminary ruling in favor of the optometrists, the two boards reached a settlement. It allowed optometrists to perform three of the injections immediately. Two others are subject to further discussion.