Help Improve Optometry, Help Puerto Rico

By: Dr. O. A. Negrón

The U.S. Commonwealth of Puerto Rico is the last and only jurisdiction of the United States of America where licensed Doctors of Optometry are not allowed to use therapeutic pharmaceutical agents for the treatment of ocular health conditions in their patients.

Imagine yourself graduating from Optometry School and passing all parts of the National Boards. Imagine getting that letter from your state board congratulating you for completing all the state’s requirements and for the first time seeing what it will be your license number for your entire career in that state. Now imagine that your state told you that your practice would be confined and limited to just refraction and contact lenses fitting. That you will be prohibited to use any pharmaceutical agents for the diagnostics and treatment of ocular diseases in your patients. You review your National Board scores and your performance in the TMODs. You see your classmates, with the same qualifications that you, prescribing to their patients. You then would think that you decided to practice in a third world nation instead of in a modern U.S. Territory. Regretfully we optometrists in Puerto Rico, a Commonwealth of the United States of America, do not have to “imagine” that scenario. It is a reality for us.

The U.S. Commonwealth of Puerto Rico is the last and only jurisdiction of the United States of America where licensed Doctors of Optometry are not allowed to use therapeutic pharmaceutical agents for the treatment of ocular health conditions in their patients. Optometrists in Puerto Rico are educated with the same rigorous U.S. accredited didactic and clinical training as all the optometrists in the United States, and are required to complete and successfully pass all parts of the National Board of Examiners in Optometry examinations to be allowed to practice in the Island. The National Board is a requirement for a license to practice as an optometrist in all the 50 United States.

Up until recently, Doctors of Optometry trained in Puerto Rico were successfully engaged in practices with full therapeutic privileges at this moment in many states, as commissioned officers in the U.S. Armed Forces Medical Services, as well as the Veterans Administration, The U.S. Public Health Service and other federal and state medical departments. Organized optometry in Puerto Rico has unsuccessfully presented legislation in the past, leaving the more than 4 million citizens of the Island with only about 100 ophthalmologists to care for their ocular health. This situation is not acceptable under the basic standard of care that the rest of the citizens of the United States enjoy in their particular jurisdictions by certified Doctors of Optometry. As a matter of fact, many practicing optometrists in Puerto Rico hold also therapeutic licenses in states, to maintain and uphold their proficiency and clinical expertise’s at par with the regular practice of the profession in the United States.

It was with deep anger and embarrassment that we were informed not long ago that the U.S. Army would no longer be accepting Doctors of Optometry with licenses that will not allow the practitioners to prescribe therapeutic pharmaceutical agents. The U.S. Army was very clear in stating that: “We do not accept any providers who do not meet the necessary criteria for practicing at the highest level of our profession. It does not matter what license you hold. If you are not licensed to practice therapeutics, your credentialing in our Military Treatment Facilities is extremely limited and you are not able to perform your duties at the level necessary to carry out the mission in a combat zone or other deployments.” Its expected that the Navy, Air Force and the rest of the federalmedical services will go along with the Army soon.

The government of Puerto Rico, by not allowing Optometrists in Puerto Rico to prescribe, is systematically discriminating against their own citizens and purposely allowing a substandard of care. This is an injustice and discrimination toward the 4.5 million residents of this U.S. Commonwealth, and now to the Doctors of Optometry licensed in Puerto Rico that are now not allowed to serve as officers and healthcare providers in the U.S. Armed Forces.

We had played the “political game” before and did everything we could to get these privileges, unsuccessfully. Now we are accusing our government of having our privileges “sequestered for ransom” at the legislature and allowing a “discriminatory” standard of ocular healthcare in this island, in comparison with the rest of the jurisdiction of the United States.

You could help enormously by signing our petition at Change.org, pasting the petition in your facebook page, Tweet account or just having your friends and colleagues know about it and encourage them to sign it too.

A Message From U.S. Congressman José Serrano (D-NY):

“Osvaldo, Thank you for bringing this issue to my attention. I will look into it. As a former Army Medical Corpsman, this issue is of special interest to me. Thanks again.”

A Message from a consultant to one of the Armed Forces Surgeon General:

“The restriction you are forced to practice under is unfair and goes against Congressional and Health and Human Services initiatives to reduce health care costs and expand access for primary eye health care.”

If only the government of Puerto Rico would be so reasonable and understanding, this issue could be resolved in a second. Regretfully the government is still ignoring our pleads.

Perhaps an U.S. Congressional inquiry, as everything “federal”, would help change their mind!

Thank you all again for your support.

Dr. O. A. Negrón