Some vets lose sight, may trigger Calif. probe

(MILITARY TIMES)   A Veterans Administration probe that found eight veterans suffered potentially preventable vision loss while under the care of optometrists at a Northern California VA facility is prompting medical groups to call for a state investigation.

The groups sent a petition Wednesday to the California Department of Consumer Affairs seeking an evaluation of the care received by the veterans at VA Palo Alto. The patients had glaucoma, a class of eye diseases that can lead to blindness.

The California Medical Association, California Academy of Eye Physicians & Surgeons and American Glaucoma Society want the state to suspend a new state law set to take effect in January that would expand optometrists’ ability to care for glaucoma patients.

It’s the latest salvo in an ongoing dispute between optometrists, who have four years of training, and opthamologists, who are medical doctors, over who should be allowed to treat the disease.

“This illustrates what can happen when people who aren’t qualified treat glaucoma,” said James Ruben, a pediatric opthamologist who is president of the Academy of Eye Physicians & Surgeons.

The Department of Consumer Affairs has received the petition and has 30 days to respond, spokesman Russ Heimerich said.

The VA Palo Alto Health Care System conducted an internal probe after physicians discovered in January that a 62-year-old male patient treated at the optometry unit suffered severe damage to his eyesight due to poorly controlled glaucoma.

During the next three months, officials reviewed the records of all the patients at the optometry clinic.

They found that, contrary to policy, 381 patients had been treated by optometrists alone, without support from an opthamologist. Of those, 23 were identified with progressive vision loss, and 87 were deemed to be at high risk for losing eyesight.

Investigators found that the vision loss of eight veterans might have been mitigated if they had been seen by an opthamologist, said Stephen Ezeji-Okoye, deputy chief of staff at VA Palo Alto, who took part in the probe.

The optometrists appeared to have been practicing beyond their scope, in violation of VA policy, he said.

VA Palo Alto officials moved quickly to contact the patients, inform them of the problem and let them know their legal options, Ezeji-Okoye said. Hospital guidelines have since been rewritten to ensure that optometrists and opthamologists work closely together.

Three patients sued. One settled for $87,000, and two other claims are pending.

“It appears to be a wholesale failure internally at the VA, and it’s sad because these individuals have lost eyesight in a situation where it could have been prevented,” said Kim David Staskus, an attorney representing the veterans.

The hospital also removed the chief of optometry, Curtis Keswick, from his administrative and clinical duties. Keswick, who has since retired, did not return phone and e-mail messages seeking comment.

Another optometrist was removed from clinical duties pending a review by the VA’s Human Resources and Regional Counsel.

Ezeji-Okoye said the best glaucoma care relies on both types of providers — the optometrist in the early screening and the opthamologists to further treat the complex disease.

The medical groups calling for an outside investigation are citing the VA cases as examples of what can go wrong if optometrists’ scope is expanded.

The law’s intent was to make it easier for patients in poor and rural areas to get the care they need, since optometrists are more widely available and generally less expensive to see than opthamologists.

The California State Board of Optometry hopes to enact new guidelines for certifying optometrists to treat glaucoma by January.

California already has certified 475 of the state’s 7,000 licensed optometrists to treat glaucoma. Most of those certified are post-2008 graduates. The new law would allow other optometrists to seek certification.

Mona Maggio, executive officer of the California State Board of Optometry, said she knew of no problems resulting from certified optometrists treating patients. She noted the optometrists at the VA facility were not certified.

Many medical doctors are protesting the expanded role of optometrists, saying the new training guidelines don’t give the doctors enough direct contact with patients.

“Glaucoma is a very difficult disease to diagnose and manage,” Ruben said. “We had to draw a line in the sand and say if you’re going to treat glaucoma, you’ve got to have proper training.”

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