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job, if they had not detected the pathology, it would not have been on that form and they would have never picked up this error.
In the listing of the pathology they saw indicated, or suspected, they were following the letter of the original instruction of 1960, February instructions.
Mr. Sisk. If the gentleman would yield, I would appreciate it if I could put this in the record. My understanding, if you read that, I don't think there is a real difference there?
Mr. WHITENER. No. As I understand it, not the original, but the optometric practitioners in North Carolina have been given guidelines by the State Commission on the Blind.
Dr. Ephraim. Yes, sir.
Mr. WHITENER. Apparently some dispute arose as to whether the optometrists were complying with those instructions and this may, have been as a result of this report that was gotten up by Dr. Grant, MD. and Dr. Costabile, who is Executive Secretary of the North Carolina Optometric Society, wrote to Mr. Henry Wood, Executive Secretary of the North Carolina State Commission for the Blind and propounded certain specific questions. Then Mr. Wood, on August 23, 1961, replied to Dr. Constable's
, letter and answered each of those questions seriatim. I think the procedures were then made clear.
In that connection, Mr. Chairman, I have a letter here from a good friend in North Carolina, Dr. G. L. Lang, Jr., dated May 19, 1966, in which he sent photocopies of the correspondence that we have just referred to. These gentlemen referred to that.
I believe it would be a good idea, if it is agreeable to the Chairman and the subcommittee, to make Dr. Lang's letter and the attachments a part of the record immediately following the testimony of these gentlemen.
Mr. Dowdy. It will be done.
CONCORD, N.C., May 19, 1966.
DEAR MR. WHITENER: I appreciate very much the time that you took with me on the telephone last Saturday. For many years I have served the North Carolina State Optometric Society in official capacity including that of President. At present I am a member of the Board of Examiners and appointed by Governor Moore. You will recall that I informed you that I had just received a copy of the “hearing” on the D. C. Optometry Bill. I was appalled at some of the information contained in the transcript. The testimony that Dr. Dryden gave is indeed shocking as it relates to visual examination performed by North Carolina optometrists.
The record shows information inserted therein concerning the North Carolina State Commission for the Blind, Dr. R. B. Rankin, Jr., and the profession of optometry.
Dr. Rankin inferred, according to the record, that the optometrist had been negligent in referring cases with suspected pathology to ophthalmologists.
Mr. H. A. Wood, Executive Secretary of the North Carolina State Commission for the Blind, wrote a letter to Dr. John Costabile, Executive Secretary of the North Carolina State Optometric Society, on August 23, 1961. This letter contained the procedure to be followed in referring patients to ophthalmologists. Please read carefully this whole letter and especially note paragraphs 3 and 4 on page 2
The optometrists listed what they found on the BA-2 forms and sent these in according to their instruction. Now Dr. Rankin, in his zest for notoriety,
probably didn't know of the instructions given. Dr. Rankin is not too happy with the optometrists in this area because we stopped referring patients to him-and for good reasons. We refer our patients to other ophthalmologists in the area.
It is extremely doubtful that the lay members of the State Commission for the Blind were aware of the letter of instructions.
We have copies of letters written prior to this so called "survey" which would make me think of the word “conspiracy”.
The optometrists of North Carolina on finding a disturbance in the eye sent the BA-2 forms directly to the district office and it was up to the district office to refer the patient to a co-operating ophthalmologist. That is what we were instructed to do. We do not think this is a good procedure. Normally, an optometrist calls the office of an ophthalmologist in referring a patient, and he writes a report to the ophthalmologist as to the reason for the referral. In this way optometrists can be assured that the patient reaches the ophthalmologist in the shortest possible time.
The officers of the North Carolina State Optometric Society met in emergency session on Wednesday, May 18, in Raleigh with the legal staff of the Society. The same group also met with the Assistant Attorney General for the State of North Carolina. Representatives of the North Carolina Optometric Society have been advised by legal counsel that our rights have been infringed upon and that information has gone out which is not true. We further have been advised that there is a remedy via the courts of the land.
The attached letter from Mr. Wood to Dr. Costabile was in my file. I was an officer of the North Carolina State Optometric Society at the time and I kept the files. The letter of instruction proves beyond a shadow of a doubt that the same records that Dr. Rankin pulled should have been used for administrative referral of these pathological cases by the district offices instead of being used to slander the optometrists of North Carolina.
Mr. Whitener, the officers of the Association feel that we should be allowed to have a hearing on this subject. You have informed me that the hearings would be closed but that you would see to it that this material was presented to this committee and put into the record.
We do not have unethical practice in North Carolina. We feel that the practice of optometry is an honorable profession and that the “tinge of money should not enter in the delicate relationship between an optometrist and his patient. The ethical minded optometrists in the City of Washington want to practice like we do. Even though the D.C. Bill probably contained features that neither you nor I like, then I would ask that the committee come up with a good bill. A Doctor of Optometry is a Doctor of Optometry, no more-no less. He is important in the American society. By working with competent and honest ophthalmologists (we all have our ophthalmological friends and referral contracts), we do provide excellent eye service. Of the practicing optometrists in North Carolina, 96.2% belong to the North Carolina State Optometric Society, according to our President.
Our representative will be happy to appear at a hearing if you will allow us, and let me assure you of our sincere thanks for your fairness. With kindest personal regards, I am Sincerely yours,
G. L. LANG, Jr., 0.D. (Enclosure: Photostat of Mr. Wood's letter to Dr. Costabile.)
North CAROLINA OPTOMETRIC SOCIETY, INC.,
Wilson, N.C., June 13, 1961. Mr. HENRY A. Wood, Executive Secretary, North Carolina State Commission for the Blind, Raleigh, N.C.
DEAR MR. Wood: I wish to express the appreciation of Dr. Rowland, Mr. Johnson, and myself for the courtesies extended during our visit with you June 7. We believe that our visit was of mutual benefit and sincerely hope that all our meetings may be as cordial.
As we stated during our conversation, The North Carolina State Optometric Society believes the 1609 patients of the Commission seen by optometrists throughout North Carolina indicates that gross discrimination against the use of optometrists in the commission's program still exists. However, in view of the
fact that this was the first year in which optometrists were utilized in the commission's program, perhaps this small number should have been expected.
Our conversation revealed that after a year some flaws in the procedure and understanding between the optometrists and the commission exists.
Your files will show that on March 14, 1960 a letter sent out under the name of Dr. John Robinson was mailed to all optometrists in North Carolina along with your administrative memorandum No. 107 and the list of various offices and personnel. Paragraph 3 of Dr. Robinson's letter stated, “In the event that a patient seeking your services under this program should be found by you to be one in need of services other than optometric, then that patient should be referred, along with all forms, to a medical practitioner cooperating with this program and no bill rendered by you to the commission for this patient.”. Since our conversation revealed that the above procedure does not provide the results desired we wish to have clarified the procedure to be used by optometrists when this situation presents itself. We wish instructions and procedures from the Commission on the following questions:
1. What procedure should be followed by an optometrist when he sees a patient certified for Commission services and finds the patient in need other than optometric care?
2. Is the method and the information provided by the optometrists to the Commission on its forms being written in a manner satisfactory to the Commission for the Blind?
3. When an optometrist sees a patient in need of referral for treatment and refers that patient, should he fill in the forms provided and send these forms to the Commission's office? If the answer is yes should the optometrist submit a bill to the Commission for $2.00 secretarial fee for filling out the forms?
4. If a patient is in need of referral for medical treatment, to whom does the optometrist refer the patient? The individual optometrist does not have a list of the ophthalmologists cooperating with the Commission's program. Would the Commission supply me with the list of cooperating ophthalmologists so that I may send this list to the optometrists in North Carolina? The list that we have obtained shows less than 25% of the eye physicians cooperating with the Commission's program. However, I am sure that your list would be more valid.
It is our sincere hope that you will provide us with the answers to the above questions as soon as possible. We believe that if the procedure relative to these matters can become uniform that many problems may be prevented.
You stated that you had paid the $2.00 fee to optometrists for referrals they made to physicians. If we had been advised that these optometrists were not following the uniform procedure set forth in Dr. Robinson's letter, we may have been able to find out sooner that this was the procedure you desired, rather than the one we agreed to in the beginning.
There may be other areas which need a review as to procedures, rather than the ones mentioned in this letter. If our conversation brought any other problems to your attention, please advise us so that we may cooperate with the Commission in straightening out any of these problems.
May I again thank you for the courtesies extended and again offer our fullest cooperation to the Commission. It is out sincere hope that you continue to recover from your recent illness and that you will suffer no lasting effects on your health. I shall be waiting for your reply. With kindest personal regards, I am. Sincerely,
John D. COSTABLE, 0.D.,
NORTH CAROLINA STATE COMMISSION FOR THE BLIND,
Raleigh, N.C., August 23, 1961. Dr. John D. COSTABILE, Executive Secretary, North Carolina Optometric Society, Inc., Wilson, N.C.
DEAR DR. COSTABILE: Reference is made to your letter of June 26, 1961, concerning the conference we had with Dr. Rowland and Mr. Johnson. I am sorry that I have been so long in replying to the letter; but as I explained to you during the conference, I would have to discuss these matters with persons charged with the responsibility of eye care on the Commission Staff. Last week we had a Staff Conference and the matter was discussed thoroughly.
Specifically I will answer your questions set forth on page 2 of your letter of June 26:
1. If, in the opinion of the examining optometrist, a patient is found to be in need of other than optometric care, this information should be indicated on the Commission's form, BA-2 and the form sent to the nearest District Office of the Commission for the Blind in accordance with the procedures set forth in paragraph 3 of my Memorandum No. 107, dated February 26, 1960. This Memorandum is reproduced in your bulletin issued March 14, 1960.
2. The information provided by optometrists on Form BA-2 has been generally satisfactory. Of course, there have been instances where we have had to write the examining optometrist for additional information which had been omitted. We request that the BA-2 be completely filled out including frame measurements and pupillary distance. This is the same procedure we require of all other practitioners except in instances where the examining practitioner and an optical company that dispenses glasses, with which the Commission has a contract, are both located in the same place. Under these circumstances, the patient is referred by the examining practitioner to the optical company with the second copy of the Need Slip. If the examining optometrist, under these circumstances, refers the patient directly to the optical company, he must indicate this on the BA-2 by stating that “glasses have been ordered from
(and fill in the name of the optical company). This will prevent the Commission from ordering two pairs of glasses on the same prescription and for the same patient. Equally important is the requirement that the examining optometrist must recommend only those frames and lenses approved by the Commission. The Commission has contracts with co-operating optical companies and these contracts specify the type of frames, lenses, and the price range that has been approved.
We should appreciate it if the examining optometrists would use the side of the BA-2 which carries the caption Optometrist's Report on Eye Examination. A large percentage of the optometrists use the side of the BA-2 carrying the caption Physician's Report on Eye Examination, and then sign the report at the bottom over the space entitled-“signature of examining physician.”
3. When an optometrist sees a patient in need of referral for treatment, he should fill in the Form BA-2 and send this form to the nearest District Office of the Commission for the Blind along with his bill in duplicate and both copies of the Need Slip (CR-2). The Commission for the Blind is perfectly willing to pay the examining optometrist the going rate for an examination in cases where he determines that a patient is in need of referral for treatment-providing the referral is made in accordance with the preceding statement.
4. You asked the question: "If a patient is in need of referral for medical treatment, to whom does the optometrist refer the patient?” The optometrist, in cases of this type, should complete the BA-2 and send this to the nearest District Office of the Commission for the Blind in accordance with the above procedure.
We are attaching a list of the North Carolina Eye, Ear, Nose and Throat Specialists and Ophthalmologists as a matter of information for you. You realize that it is not possible for the State Office of the Commission for the Blind to keep current a list of co-operating eye physicians. For various reasons, an eye physician may be in a position to co-operate with the Commission one week” and not be able to do so the next week-and so on. Please remember that the attached list is sent to you as a matter of information and not for referral purposes.
The matter of a referral of patients for medical services is a procedure that must be handled by the Medical Worker of the Commission in the District Office. Many years of experience has shown that this is the only satisfactory way that the Commission can maintain its Medical Eye Program.
Let me add this statement on this point: if the examining optometrist finds a patient with an acute eye condition, or thinks that the patient should be seen by an eye physician immediately, he is authorized to call the Medical Worker in the proper District Office of the Commission for the Blind so that the matter can be handled cooperatively. He is further authorized to make this a collect call and the Medical Worker for the Commission for the Blind will authorize the acceptance of this collect call. The examining optometrist also, in cases of emergency, may call the local Department of Public Welfare and the local Department of Public Welfare will co-operate in handling the case. We do not have any authority to authorize collect calls made to County Departments of Public Welfare. I hope that the above information clears up the matters we discussed. Sincerely yours,
H. A. Wood, Executive Secretary.
North CAROLINA Eye, Ear, Nose & Throat SPECIALISTS & OPHTHALMOLOGISTS,
SEPTEMBER 1, 1961
Dr. James F. Layton, P.O. Box 147
*Dr. Jack Thurmond Asheboro:
Dr. John 0. Redding, 147 McArthur Street
Dr. R. M. Wilhoit, 1203 Fayetteville Street
*Dr. Henry Harrison Briggs, 611 City Bldg.
*Dr. M. Wayne Woodard, Flat Iron Bldg. (607)
*Dr. Paul M. Abernathy, Medical Village
Dr. Charles W. McPherson, 323 W. Front Street
Dr. G. T. Kiffney, N.C. Memorial Hospital
*Dr. Sam D. McPherson, N.C. Memorial Hospital (P.T.) Charlotte:
*Dr. E. Reed Gaskin, 1012 King's Drive
Dr. Robert B. Yudell, Hawthorne Medical Center
Dr. R. B. Rankin, Sr., Cabarrus Bank Bldg.
*Dr. R. B. Rankin, Jr., Cabarrus Bank Bldg. Dunn:
Dr. H. A. Eldridge, 111 N. Wilson Street
Dr. John F. Martin, Box 186
*Dr. W. Banks Anderson, Duke Hospital
Dr. G. W. Meyer, 906 Broad Street * American Board Diplomates.