Health bill blind to open slather

By ANDREW SANGSTER*

Proposed changes to health laws will result in many people suffering from avoidable blindness, and otherwise detectable health conditions going untreated.

As is stands, the Health Practitioners Competence Assurance Bill, introduced to ensure higher and more consistent standards among health professionals, will unintentionally promote suffering among people with eye and visual disorders.

Once it is passed, almost certainly before Christmas, restrictions on eye examination will cease and a new market in informal, and unwanted, medicine will take off.

This is scandalous, and optometrists are gearing up to knock firmly on the Minister of Health's door to put the case for the public interest.

Their action stems from the reluctance of the previous Government to listen to the commonsense view that those who deliver primary health services should be qualified, competent and subject to monitoring and discipline.

The central issue is whether eye examinations and prescriptions should be provided by properly trained optometrists and medical practitioners, or whether they should be opened up to all and sundry.

At present the Medicines Act rightly controls the prescribing of medicines, and the Optometrists and Dispensing Opticians Act restricts eye examinations and the prescribing of spectacles and contact lenses to optometrists - professionals who examine eyes for visual disorders and underlying pathology. Dispensing opticians order and fit spectacles.

The sensible principle behind these laws is that an appropriate diagnosis must be made before treatment can be safely prescribed. But in the passing of the new bill, these controls will disappear and unacceptable levels of risk will be introduced. In fact, no part of the profession of optometry will be restricted to optometrists. Anyone will be able to examine and prescribe spectacles and contact lenses.

The previous Government's response was specious. It said that optometrists and dispensing opticians should negotiate who did what through scopes of practice under the bill. Scopes of practice are effectively job descriptions based on clinical qualifications and experience.

Optometrists will be a minority on the Optometrists Board, the registering authority which will control optometry and develop scopes of practice. So the clinical interests of optometrists will be dominated by lay people and the commercial interests of opticians and others who want just to sell spectacles and contact lenses.

Officials from the Ministry of Health are pushing the line that the right to examine, diagnose and prescribe may be controlled through their inclusion on a restricted tasks list. But that is not going to happen unless the minister can be persuaded that to do so is in the interest of the public.

These views, and those of the previous Government on the value of optometry, are astonishingly short-sighted. They simply miss the key point: an eye examination is a complex medical procedure that aims to analyse both diseases and problems with the eye, and underlying medical conditions.

So what is the best approach: use an optometrist who has undergone a four-year, degree-level course of training to detect undiagnosed diseases such as diabetes, glaucoma, brain tumours, hypertension, temporal arteritis, multiple sclerosis and ocular melanoma; or use an untrained or lightly trained examiner whose sole purpose is to sell you spectacles? Draw your own conclusions.

What we conclude is that the health of New Zealanders will decline, the personal cost of quality eye health will increase, as will the health bill to the nation.

In New Zealand, 20 per cent of blind people are needlessly blind; some 12 per cent of unnecessarily blind people have type 2 diabetes; and a further 50,000 people have undiagnosed diabetes.

Professional eye examinations by optometrists have a key role to play in early detection and treatment that will minimise harm. It is only going to get worse as Maori and Pacific Island people face an explosion in rates of diabetes.

With existing legislation 3500 cases of glaucoma are diagnosed each year, conditions which will not be picked up through lay examinations. As the population ages, so will the rates of glaucoma increase. What we are potentially facing is unnecessary personal suffering on a significant scale.

The long-run financial cost to the nation will be huge. According to American figures, the annual cost of every blind person is an additional $30,000 in treatment and assistance; preventing blindness from diabetic retinopathy provides net annual savings of $35,000 a person.

If the bill is not changed, a market will develop for cheap eye examinations, which will lead eventually to higher personal costs for many people. These costs are both monetary and quality of life.

New providers will enter the market, offering eye examinations using auto refractors to test vision, as they do in Hong Kong.

This will encourage people to bypass professional eye examinations and go straight to spectacles to correct vision problems that may be related to undetected health issues.

These services try to convert 90 per cent of their customers to spectacles or contact lenses. People will end up paying needlessly for spectacles, and once they have started they will not stop.

Clearly, none of this is good for people affected by health issues or for the economy of the nation. Yet it is so easy to prevent. All the incoming Government has to do is amend the law to ensure that eye examination (including auto refraction), diagnosis and the writing of prescriptions remains in the hands of optometrists and medical professionals.

Anybody can then buy their spectacles or contact lenses from wherever they like, provided they have a valid prescription from an authorised prescriber.

* Andrew Sangster is the president of the Association of Optometrists.