The business model is heavy advertising that promises eyeglasses with the convenience of one-stop shopping. Owned by a conglomerate, the chain-store operates as a place to drop in for an eye examination and purchase eyeglasses and contact lenses all in one place. It seems like a convenient option. The attorney general of California has spent 10 years saying that it isn’t.
Currently, the California state Legislature is discussing a piece of legislation, AB 778, that will legitimize in statute a particular chain-store business practice that is in danger of being put to rest through litigation. The bill is a bad idea.
The issue centers on consumer protections that have been part of California law for 90 years.
You see, this chain-store model allows a corporation to own both the business which sells a product, eyewear; and a managed vision care organization that employs doctors. The attorney general concludes that such a business model is clearly different from a traditional optometric practice and violates California consumer protection statues.
In a declaration obtained by the attorney general on April 19, 2010 for the U.S. District Court for the Eastern District of California the reasons become clear.
The declaration reads, “Even though independent optometrists sell eye glasses and profit from the sale of those glasses, their sale of eyewear is incidental to their practice and not their primary focus. Independent optometrists are free to concentrate on patient health care and are under no external pressure to see a certain number of patients or prescribe a certain number of glasses. Chain optical stores on the other hand have as their primary purpose the selling of eyewear. There is an inherent conflict of interest between the professional’s duty to the patient, and the chain store’s duty to its shareholders.”
Yes, such stores have been in operation for years. However, they have paid a king’s ransom in legal fees in a battle to sustain a business plan that critics contend allows too much corporate control over the personal care of a patient.
While one chain store steadfastly declares that there have been no problems with their business model, they settled a class action law suit for $20 million, believed to be among the largest medical privacy settlements in California history. The lawsuit discusses withholding the patients’ prescriptions in violation of federal law and also forcing optometrists to divulge their patients’ confidential medical information for marketing purposes.
AB 778 is an effort to bypass consumer protection litigation and seek a legislative remedy for the corporations. The filings with the courts suggest that this particular remedy has negative consequences for patients.
For example, a declaration by Dr. Phillip M. Parker, an expert in the quality of examinations for patients in different settings, detailed that the problem with chain stores, is that on average, they offer lower quality care. Private practice optometrists, free of corporate pressures, perform more procedures, are more likely to diagnose eye conditions, are less likely to skip procedures, and spend more time performing each procedure. Essentially, Dr. Parker is warning patients that retail sales pressure, as found in chain stores, provide less thorough eye exams, resulting in a less accurate diagnosis and missing serious health issues.
In yet another deposition conducted by the California attorney general, Dr. Randall McPherran said that all of his staff were employees of the chain store and he had no control over them. Furthermore, the sales employees were required to be in the examination room, yet they lacked the skills necessary to properly act as a scribe and often interfered with the eye exam. Furthermore, the chain store controlled Dr. McPherran’s appointment book and computer records and essentially took over his entire practice, which he feels led to a situation where patient care suffered.
As late as April 29, 2011, a California optometrist wrote of her deep concern with AB 778 and said that the problem with corporate control over doctors is that they “dictate how many patients are to be seen every hour, regardless of the patient’s condition.”
She further stated, “I am not given the time to examine and treat the patient properly. I am questioned when patients with ocular infections, who should not be wearing contact lens, don’t walk out of the office without a contact lens prescription. I am told to recommend anti-reflective coatings, transition lens and other extra options for their eyeglasses to get patients to spend more money. The Patients Privacy Act [HIPPA] is violated every day. The sales associates are allowed full access to patients’ charts in the doctor’s office, and dispense contact lens without doctor approval, which compromises the patient’s ocular health.”
No one wants to drive the chain stores from California. It can work. It does work for those stores that allow the doctor total autonomy. However, it makes no sense to bypass years of consumer protection by allowing a sweetheart deal to corporations on AB 778. The eye health care of Californians is at risk. Let’s trust the courts as they complete 10 years of work and not jam this bill through the Legislature.