The Medical Board and eye care issues

Your Sept. 6 editorial "Black eyes" and Dr. Cynthia A. Hampton's Sept. 8 Point of View article "Injecting politics into delicate eye care" blurred the difference between the N.C. Medical Board's efforts to achieve a fee increase in 2000, the board's work in 2005 and the board's efforts to enhance its regulatory powers. In this regard, your editorial failed the people of North Carolina.

As we made clear to your reporter, we made sure the 2005 legislation moved forward on its own merits without consideration of any other factors, including the litigation initiated by the Optometry Board. Unfortunately, your editorial glanced over this fact by noting that what resulted was "complicated" [referring to the process that had included a consent agreement signed in 2000 by the medical board and optometrists]. The "complications" consisted of hundreds of hours devoted by the board to resolve the litigation in a manner consistent with present standards of medicine, science and law. These efforts included numerous motions in Superior Court, two appeals to the state Court of Appeals, two mediations and a declaratory ruling proceeding.

Your editorial ignored the question of when an injection becomes "surgery." This point is critical because, under North Carolina law, optometrists can perform any procedure and deliver any pharmaceutical in treating the eye so long as the procedure does not constitute "surgery." What is and is not surgery was the critical issue in the 2005 lawsuit. Yet your editorial and Hampton [a former president of the N.C. Society of Eye Physicians and Surgeons] glossed over this "complicated" and essential distinction.

Neither your editorial nor Hampton mentioned that flourescein angiography is presently administered by non-physicians. Moreover, nowhere in her description of the procedures at issue did Hampton assert that they are surgery. Similarly, your editorial and Hampton failed to mention that in the 1990s optometrists began to perform rust ring removal and foreign body debris removal with the full agreement of ophthalmologists and that these procedures are more invasive and riskier than the procedures allowed under the 2005 agreement.

Your editorial also omitted that the 2005 settlement was the result of a state Court of Appeals-ordered mediation, not some back room, last-minute deal. We also find it unfortunate that nobody from your staff contacted the mediator, a well-respected attorney, or the president of the Medical Board at the time of the settlement.

The settlement between the medical and optometry boards was reached with public protection and existing laws being the Medical Board's only considerations. It had no relationship to any legislative activity, directly or indirectly. Any suggestion to the contrary is not only unfounded and untrue, it insults the good work and integrity of the Medical Board and its staff who worked extremely hard to make sure this dispute was resolved in a manner that did justice to medicine and the law.

The Medical Board will always be ready to work with concerned members of the legislature to further its efforts to protect the people of this state. And the people can be assured it will do so openly, transparently, and with integrity.

Robert C. Moffatt, M.D.

President

N.C. Medical Board

Raleigh

(The length limit on letters was waived to permit a fuller response.)