Representative Chris Crawford
Dr. Copeland
(Opposition Testimony)
DR. COPELAND: Good afternoon Madam Chairman and Representatives Guillard, Chalk, and the rest of the committee here.
I am not from Oklahoma. I am from Washington, D.C. and I practice ophthalmology at Howard University Hospital where I am the Chairman for the past fifteen years. In that time, I have trained forty-four board certified ophthalmologists. During that time, I have trained, and they have trained and performed, 1,400 hours of coursework in medical school, four years in training which includes one year of general medical and surgical internship, three years of ophthalmology training, with 66% of these individuals going into fellowship training.
Our accrediting body, which is the ACGME, requires that ophthalmologists do approximately 3,000 outpatient visits. And we have to do an additional 612 hours of academic sessions. And this is over a 3-6 year period. Our surgical requirements are over a 6-year period. And we have bare minimal requirements that you have to do. Now, we have two classes of surgery. We have class I, which the individual resident does with the primary surgeon. We have class III where they assist with surgeries. Our class I requirements are that we do 86 cataracts, we do 10 strabismus surgeries, which is surgery around your eye (muscle surgery), corneal surgeries – 3 cases, glaucoma filtering cases – 5 cases, glaucoma lasers – 9. We do retinal vitreous cases which were inside the eye – 1 case. And we do about 25 lasers and other assortments of procedures in retina. We do 38 oculoplastic surgeries and we do at least 4 trauma cases during our residency. During that whole period, we have to do at least 364 cases. This is the minimal requirements that we have. This is not something that you get on a weekend course. It starts with theory and didactic lectures…lectures in which we disseminate scientific information. These lectures are not only proctor, but we have proctor surgical lab times, so we don’t come in on the weekends and do courses. We actually have labs in which we do videotaping of the individuals learning these surgical procedures to make sure that they are proficient. Finally, when they are at the point where they have persisted on surgeries, we have a fellowship-trained mentor with written and video examinations of these individuals as they perform surgery. So, you can’t learn these things on the weekend.
Now, our core competencies include six things: Patient care, medical knowledge, practice space learnings and improvement, interpersonal and communication skills, professionalism and systemic-based practice. Now I must say, every board-certified ophthalmologist must maintain a state license, they must be board certified by the United States Medical Licensing Examination. There are three parts: There is part I in which we look at anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology. The second part: We look at clinical efficiency and
Dr. Copeland
(Opposition Testimony)
Page Two
knowledge. We look at clinical skills in which we actually have actors look at us to make sure we are efficient in this. And then the last thing we have here is the American Board, which we have to pass. And we have two parts; we have a written and an oral. And this was started in 1915. And if you have been board certified in ophthalmology after 1992, every 10 years you have to be recertified.
I gave this abbreviated background synopsis to you so you could see why I’m expressing my strong opposition as an academician and clinician to Bill H-3303 that would expand the scope of practice for optometry, to allow optometrists to perform laser surgery, which I think is a big mistake, to perform incisional and scalpel surgery, to place injections inside the eye, diagnose and treat serious conditions with drugs and narcotics which I have not used in the last 2 years. This bill would also allow optometrists to prescribe therapeutic drugs, determined solely by the prescribing optometrist. I believe that you are setting a new precedent. These catastrophic changes come without any governance, testing of one’s comprehensions, aptitude, skill level and certification. It’s a blank check to do anything and it determines that they are experimenting on the patients of South Carolina. This bill negates strenuous step-by-step accretion of a life-long learning process that medical students have to go through.
In closing, I’d like to say, remember that patient care is first. You must ask yourself one important question, and I only ask this one question: Would you like to have someone who is not properly trained to perform surgery on you or one of your loved ones? The answer should be “No.” It is, in my estimation, to accept this bill in any form is dangerous and reckless.
Thank you.
MALE PARTICIPANT #1: Thank you. I assume that you have read the bill? And, in reading the bill, what, in your assessment, would be the required training for the items that are listed that they are asking to do?
DR. COPELAND: I would say, simply, go to medical school. Get the training that we do in ophthalmology. I am not trying to be funny here, but this is a pyramid system. This is not something that you do a course on one weekend. We build blocks. We don’t have someone going to do intricate surgery with scalpels. We are talking about minute structures inside the eye.
And I would just say this to you: To get this bill okayed, I think, sends a very, very bad message to the citizens of South Carolina.
Dr. Copeland
(Opposition Testimony)
Page Three
And that would be my answer to your question.
MALE PARTICIPANT #1: So you are saying that the training that they presently have…how many more years or hours would it be added on… I guess is my question… to be able to perform the procedures that they are asking to be?
DR. COPELAND: Well, I can only answer this…I’ll give you the number here. They need approximately 17,000 hours more of training to be able to do what we do.
(Laughter)
DR. COPELAND: Yes sir?
MALE PARTICIPANT #2: Yes. You ever been to Oklahoma?
DR. COPELAND: Uh…. (Laughter)
MALE PARTICIPANT #2: Ya’ll threw me off.
DR. COPELAND: Representative Guillard…we have somebody from Oklahoma that will answer…
MALE PARTICIPANT #2: Are you familiar with the program in Oklahoma?
DR. COPELAND: I am going to let the person that is the professor of ophthalmology, Oklahoma, speak on that.
MALE PARTICIPANT #2: Surely.
DR. COPELAND: I would not let you down. (Laughter) Thank you.
MALE PARTICIPANT #3: Doctor?
DR. COPELAND: Yes.
MALE PARTICIPANT #3: Thank you very much. I didn’t catch all the different types of procedures that you were talking about, but I did catch the bottom line…364 different actual surgeries….
Dr. Copeland
(Opposition Testimony)
Page Four
DR. COPELAND: That’s correct sir.
MALE PARTICIPANT #3: To be board certified?
DR. COPELAND: That’s right.
MALE PARTICIPANT #3: How many of those are with the optometrist training?
DR. COPELAND: I don’t have a clue. I have never looked at… I don’t think they even come close to doing the type of surgeries we do. They don’t…
MALE PARTICIPANT #3: They aren’t asking for that, are they?
DR. COPELAND: No. I’m just saying….(Applause)…I will ask you a question, but you…
(Inaudible)
DR. COPELAND: They are asking for the scalpel…to use a scalpel. And I’d like to say this to you: You can start off saying that you just want to do something benign and the next thing it blows up and they want to do surgery inside your eye, so I think…
MALE PARTICIPANT #3: I don’t mean to cut you off…
DR. COPELAND: Okay, I’m sorry.
MALE PARTICIPANT #3: But there are a lot of speakers upcoming. I think the bill is very focused. Is that right? And…
DR. COPELAND: I’ve read the bill…
MALE PARTICIPANT #3: And all the procedures you talked about, they are not talking about at this time.
DR. COPELAND: Some of the procedures they are asking for, sir. Yes they are. They are asking for lasers…they are asking to do lasers. They are asking to do injections
Dr. Copeland
(Opposition Testimony)
Page Four
inside the eye, sir. They are asking for a lot of things that don’t….
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