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Copyright 2009 Palo Alto Daily News

Palo Alto Daily News (California) 

Distributed by McClatchy-Tribune Business News 

November 14, 2009 Saturday 


ACC-NO: 20091114-PL-VA-hospital-1114 

LENGTH: 820 words 

HEADLINE: VA hospital: State requests probe of VA hospital \\?? 23 glaucoma patients suffered serious vision loss 

BYLINE: Jessica Bernstein, Palo Alto Daily News, Calif. 


   Nov. 14--The state consumer affairs department has formally requested an investigation into the VA Palo Alto Health Care System, where 23 glaucoma patients experienced significant vision loss while receiving treatment.

   California Department of Consumer Affairs Director Brian Stiger made the request in response to an administrative petition the California Academy of Eye Surgeons and Physicians, the American Glaucoma Society and the California Medical Association filed in September with his agency.

   "As the events at the VA hospital do concern consumers, I am formally requesting that the Board of Optometry, together with the Medical Board of California, investigate the occurrences at the Palo Alto Veterans Affairs Hospital regarding the eye

   care provided to veterans, including the role of optometrists and physicians in that care," Stiger wrote in a Nov. 10 letter addressed to Dr. James Ruben, president of the California Academy of Eye Surgeons and Physicians.

   "To the extent permitted by existing state and federal law, I am also requesting that those boards make public the findings of the investigation," Stiger said.


   However, Stiger rejected the medical groups' request that a new state law expanding optometrists' ability to treat glaucoma and prescribe medication be put on hold until the investigation concludes.

   The VA initiated a probe earlier this year after ophthalmologists reported that a 62-year-old male veteran with glaucoma went blind while being treated in the optometry department.

   At issue is whether the optometry department failed to follow VA policy requiring it to consult with medical doctors on glaucoma cases, possibly costing the 23 patients their vision, VA officials said at the time.

   As part of the probe, the VA informed seven patients that doctors might have mismanaged their treatment. The VA has since made a similar disclosure to an eighth patient and has ordered the optometry department to report to ophthalmology, spokeswoman Kerri Childress said in September.

   "It is understandable that people are concerned -- we certainly were," Childress said in an e-mail Friday. "However, VA Palo Alto has made all the changes necessary to ensure our veterans with glaucoma receive the best care possible."

   Ophthalmologists are physicians and medical school graduates, while optometrists earn their degrees after completing four years of optometry school and, in some cases, a residency. The two groups of eye doctors have been fighting over glaucoma certification requirements for California optometrists for years.

   While ophthalmologists have historically treated glaucoma, optometrists now can do so in most states.

   The latest California certification requirements, set in motion by the 2008 state Senate bill 1406, are still in the works, but the California Board of Optometry will likely enact them in January, Mona Maggio, executive officer of the board, said earlier this year. Ophthalmologists have complained that the requirements are "watered down," a charge the optometrists deny.

   "It would be premature at this time to withdraw the department's findings in the absence of sufficient evidence establishing that the events at the VA hospital are substantially linked to the implementation of SB 1406," Stiger said in the letter.

   However, Stiger later said he would ask the optometry board, which is part of his department, to "re-evaluate its decision to proceed with these regulations."

   No one from the consumer affairs department could be reached for comment Friday because of a state-imposed furlough day.

   Dr. Ruben, of the California Academy of Eye Surgeons and Physicians, said he is heartened by Stiger's request that the optometry "re-evaluate" its process in adopting clinical training regulations.

   "I'm concerned about what happened at the VA but, moving forward, I'm more concerned about what the future holds for people with glaucoma in California," Ruben said. "The whole process needs to be revisited. We're not against optometrists treating glaucoma, but we do think there are certain minimum requirements that are necessary."

   William Gould, an attorney for the California Optometric Association, described the petition as "an attempt by ophthalmology to derail the regulatory process" and noted that Stiger rejected most of the petitioners' requests.

   Gould added that his group would welcome an investigation of the VA's optometry department.

   "It would be helpful given the fact that we're not aware of adverse findings against the doctors," Gould said.