THE MISSISSIPPI LEGISLATURE

The Joint Committee on
Performance Evaluation and Expenditure Review

Report # 377

A Program Evaluation of the State Board of Optometry

July 14, 1998

Introduction

The Legislature created the Board of Optometry to meet the public's need for protection from incompetent or negligent optometric practice. With the highest incidence of visual impairment in the nation, Mississippi has an unusually high level of need for competent eye care services. The PEER Committee's evaluation of the Board of Optometry sought to answer specific questions concerning the board's operations.

Conclusions

Following are the primary questions PEER pursued in the review, along with summary conclusions:

How should the State Board of Optometry regulate the practice of optometry to ensure adequate protection of the public?

The State Board of Optometry should protect the public through licensure and disciplinary procedures.

Do state statutes protect the public and ensure accountability by providing the Board of Optometry with the authority needed to fulfill its regulatory responsibility and by ensuring public involvement in regulation?

Although the statutes provide the Board of Optometry the necessary authority to license optometrists and offer a wide range of disciplinary options for use by the board against optometrists, the statutes provide limited options for use by the board against the unlicensed practice of optometry. Also, the statutes do not require involvement of the public in the regulatory process.

Has the board regulated the licensure of optometrists in a way that ensures that optometrists meet and maintain all necessary qualifications and competency requirements without imposing needless restrictions?

Although the Board of Optometry has ensured that licensed optometrists meet the minimum standards of competence in areas central to the practice of optometry, the board has not adequately regulated the initial licensure of optometrists to ensure that optometrists meet necessary qualifications and other board competency requirements without imposing needless restrictions. Specifically, the board has not ensured that optometrists can apply the board's rules and regulations to practice-related situations or that optometrists have demonstrated the necessary skills needed for permanent licensure. Also, the board has imposed unnecessary requirements in the licensure application process and in the use of the pharmacology exam which may deny qualified optometrists the opportunity to practice in Mississippi, an underserved state.

Are the board's disciplinary procedures and practices adequate to protect the public from harm associated with incompetent or unlicensed practice?

The Board of Optometry's disciplinary processes are inadequate to protect the public from harm. The board relies on complaints as its primary source of information on incompetent or improper optometric practice, but it has not developed procedures for ensuring that the public can contact the board. Also, the board has relied on another state agency for legal assistance in protecting the public from unlicensed practice of optometry, but that agency has not consistently provided the investigative and prosecution services needed by the board.

Do the board's administrative practices, including planning, budgeting, and reporting, support its licensure and discipline regulatory functions?

The Board of Optometry has not maximized use of its limited resources to support its licensure and discipline functions.

PEER gives details on each of these conclusions in pages 18 through 49 of the report.

Recommendations

The following summarize PEER's legislative and administrative recommendations concerning the Board of Optometry. Appendix K, page 68 of the report, contains proposed legislation concerning the board.

• 1.The Legislature should amend MISS. CODE ANN. Section 73-19-105 to eliminate the requirement for the board to prepare and administer the pharmacology examination. The statute should require the board to administer examinations that measure job competency and are based upon professional testing standards.

• 2.To address the risk of injury to the consuming public due to opticians' unlicensed practice of optometry, the Legislature should consider either licensure, registration, or certification of opticians. (See page 50 of the report for details on these three options.)

• 3.The Legislature should amend state law to allow the board to suspend immediately the license of any optometrist who poses a clear and present danger to the public.

• 4.The Legislature should amend state law to require that the membership of the Board of Optometry include a member of the consuming public. The board should provide orientation and training to newly appointed non-optometrist members in order to emphasize their role on the board-to serve the public and ensure competent practice.

• 5.The Board of Optometry should revise the optometry licensure application form to eliminate the requirement for applicants to submit a letter of recommendation by a Mississippi licensed optometrist.

• 6.The Board of Optometry should require documentation of the knowledge and skills needed for the Phase II mentoring process and interview and establish standards for assessing the passage of Phase II for permanent licensure.

• 7.The Board of Optometry should revise its law examination procedures to comply with professional testing standards, such as those promulgated by the Council on Licensure, Enforcement, and Regulation (CLEAR).

• 8.The Board of Optometry should improve the public's access to the complaint process by establishing procedures to ensure that the public is aware of the complaint resolution process. The board should maintain a listing in local telephone directories and make information available to the public which describes the complaint process.

• 9.The Board of Optometry should comply with MISS. CODE ANN. Sections 73-19-33 through 73-19-45 by ensuring that complaint files are complete and well-organized. The board should develop procedures for training board members on how to conduct investigations and maintain complete files that include a sufficient level of evidence, prioritizing and timely processing of complaints, and receiving information from other state agencies or entities on violations of the Optometry Act and for referring complaints outside the board's jurisdiction to the proper entity for action. The board should also publish information on disciplinary actions taken against optometrists in a medium such as a newsletter.

• 10.The Board of Optometry and the Attorney General's Office should jointly develop a procedure for determining when the board should act on an allegation of unlicensed practice or when a case regarding unlicensed practice should be referred to the Attorney General's Office for investigation and prosecution. By January 1999, the board and the Attorney General's Office should report to the Legislature on their progress in developing and implementing procedures related to unlicensed practice.

• 11.The Board of Optometry should establish a procedure to update its regulations routinely to remain consistent with state law and current board practices.

• 12.In preparing its FY 2000 budget request, the Board of Optometry should transfer a portion of the funds currently in the contractual major object into the salaries and fringe benefits major object in order to hire administrative personnel for assisting the board in its regulatory responsibilities.

• 13.The Board of Optometry should request assistance from the Department of Finance and Administration in developing administrative policies and procedures related to long- and short-term planning, preparing and submitting budget requests, maintaining accounts, receiving and depositing funds in the state Treasury, hiring and compensating employees, and collecting and reporting financial and performance data.

• 14.The Board of Optometry should request assistance from the State Department of Health's Division of Professional Licensure and Certification in developing procedures and material for training new board members.

• 15.The Board of Optometry should submit a report to the Legislature in January 1999 describing its progress in implementing the above recommendations related to developing administrative policies and procedures with the assistance of the Department of Finance and Administration and the Department of Health.

• 16.The House and Senate Public Health and Welfare committees should consider studying, or should ask the PEER Committee to study, the need for technical assistance to small regulatory bodies (e.g., the Board of Optometry and other boards with few licensees and low revenue) which might experience difficulty in collecting revenue needed to carry out their regulatory responsibilities effectively. The study should develop alternative arrangements through which state agencies would provide free or affordable technical assistance services to small boards. These arrangements could include assistance related to planning and budgeting; office and meeting facilities; staff and board training; and, litigation.

• 17.The Board of Optometry and Board of Medical Licensure should jointly develop written recommendations for presentation to the Legislature in January 1999. These recommendations should specify how the boards plan to work together to: (a) determine the causes for the shortage of optometrists and ophthalmologists in Mississippi; and, (b) develop a plan for providing eye care services that meets the state's needs.

• 18.The Executive Director of the PEER Committee should refer copies of this report to the directors of the Department of Finance and Administration, the Department of Health, and the Board of Medical Licensure.

The report contains detailed recommendations on pages 50 through 55.

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