[Congressional Record Volume 150, Number 103 (Thursday, July 22, 2004)]
[Senate]
[Pages S8728-S8729]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FITZGERALD (for himself, Ms. Cantwell, Mr. Hollings, Mrs. 
        Feinstein, and Mr. Sessions):
  S. 2743. A bill to amend title 38, United States Code, to provide 
that only licensed medical doctors, licensed doctors of osteopathy, and 
certain licensed dentists may perform eye surgery at Department of 
Veterans Affairs facilities or under contract with the Department; to 
the Committee on Veterans' Affairs.
  Mr. FITZGERALD. Mr. President, I rise today to introduce the Veterans 
Eye Treatment Safety Act of 2004, or VETS Act, which will protect the 
eye care of our veterans by providing that only licensed physicians may 
perform eye surgery at Department of Veterans Affairs (VA) facilities 
or under contract with the VA.
  Presently, 49 out of 50 States prohibit optometrists from performing 
surgery. Oklahoma is the only State that allows optometrists to perform 
laser surgical procedures. Recently, Oklahoma enacted a law expanding 
existing law to allow optometrists to perform nonlaser surgical 
procedures such as cataract surgery.
  Under the VA credentialing practice, optometrists have been granted 
laser surgery clinical privileges within the VA Medical Center. The 
VA's credentialing practice allows medical practitioners to be granted 
privileges to perform procedures within the VA system that they are 
authorized to perform in the State in which they are licensed. Thus, an 
optometrist licensed in Oklahoma can be granted clinical privileges to 
perform laser surgery at the VA. In 2003, the VA allowed at least three 
optometrists to perform laser eye surgery at multiple VA hospitals 
throughout the Nation.
  This practice is inconsistent with the policies of the Army, Navy, 
and Air Force, which do not allow optometrists to perform eye surgery. 
The VA, which also treats TRICARE beneficiaries, is the outlier. If a 
military retiree, a TRICARE beneficiary, needs laser eye surgery, only 
a licensed medical doctor or doctor of osteopathy could perform it, as 
required by the Army, Navy, and Air Force. However, if that same 
TRICARE beneficiary seeks treatment at a VA facility--as is his or her 
right--it is possible that an optometrist could perform the surgery. In 
this case, such person would receive a lower standard of care than the 
Department of Defense would allow in a military treatment facility. 
This VA credentialing practice regarding eye surgery creates two 
standards of care: a high standard of care for active duty personnel, 
dependents, and TRICARE beneficiaries when seen in a military treatment 
facility, and a lower standard of care for TRICARE beneficiaries and 
veterans if treated in the VA system.
  The VA's practice is questionable. Optometrists typically do not have 
the requisite training and experience to perform eye surgery. Only one 
school of optometry in the United States offers courses in laser eye 
surgery. To become certified, optometrists must complete two courses at 
this school, with less than 40 hours of training, and perform only four 
supervised surgeries. In contrast, ophthalmologists during medical 
school, internship, and residency complete between 9,000 to 12,000 
hours of training and education before practicing without supervision.
  The Veterans Eye Treatment Safety Act of 2004 provides that only 
licensed medical doctors, licensed doctors of osteopathy, or licensed 
dentists whose practice is limited to oral or maxillofacial surgery may 
perform eye surgery at Department of Veterans Affairs facilities or 
under contract with the department. This legislation is narrowly 
targeted and does not prevent optometrists from performing noninvasive, 
nonsurgical procedures--the procedures that optometrists are trained 
and qualified to perform. The bill simply ensures that only licensed 
physicians can perform invasive, surgical procedures on our veterans.
  The VETS Act has been endorsed by the Vietnam Veterans of America, 
the National Gulf War Resource Center, the American Medical 
Association, the American Academy of Ophthalmology, the American 
Osteopathic Association, and the American College of Surgeons. 
Additionally, the Veterans of Foreign Wars and the Blinded Veterans 
Association have written letters to the Department of Veterans Affairs 
opposing allowing optometrists to perform surgery.
  This bill is a patient safety measure that protects our veterans. It 
protects the law of 49 States, preventing the will of one from becoming 
the law of the land. We must send a clear message to the VA that 
veterans should receive the same quality eye care that ordinary 
citizens receive.
  I would like to thank Senator Cantwell, Senator Hollings, Senator 
Feinstein, and Senator Sessions for cosponsoring this important 
legislation. I urge all of my colleagues to join me in supporting this 
bill that will protect the ocular safety of our veterans--ensuring that 
they receive the same high level of care that almost all Americans and 
members of the armed forces receive.
  I ask unanimous consent that the text of bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2743

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veterans Eye Treatment 
     Safety (VETS) Act of 2004''.

     SEC. 2. LIMITATION AS TO PERSONS WHO MAY PERFORM EYE SURGERY 
                   FOR DEPARTMENT OF VETERANS AFFAIRS.

       Section 1707 of title 38, United States Code, is amended by 
     adding at the end the following new subsection:
       ``(c)(1) Eye surgery at a Department facility or under 
     contract with the Department may be performed only by an 
     individual who is a licensed medical doctor, a licensed 
     doctor of osteopathy, or a licensed dentist whose practice is 
     limited to the specialty of oral or maxillofacial surgery.

[[Page S8729]]

       ``(2) For purposes of this subsection, the term `eye 
     surgery' means any procedure involving the eye or the adnexa 
     in which human tissue is cut, burned, frozen, vaporized, 
     ablated, probed, or otherwise altered or penetrated by 
     incision, injection, laser, ultrasound, ionizing radiation, 
     or by other means, in order to treat eye disease, alter or 
     correct refractive error, or alter or enhance cosmetic 
     appearance. Such term does not include the following 
     noninvasive, nonsurgical procedures: removal of superficial 
     ocular foreign bodies from the conjunctival surface, from the 
     eyelid epidermis, or from the corneal epithelium; corneal 
     debridement and scraping; forceps epilation of misaligned 
     eyelashes; the prescription and fitting of contact lenses; 
     insertion of punctal plugs, diagnostic dilation or irrigation 
     of the lacrimal system; the use of diagnostic ultrasound; 
     orthokeratology; or the treatment of emergency cases of 
     anaphylactic shock (with subcutaneous epinephrine, such as 
     that included in a bee sting kit).''.
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