His statement is misguided and incorrect. John D. Wright, Jr. M.D.
(pediatric ophthalmologist in a letter to the News & Observer, Jan., 26, 2006, responding to Jim Black’s assertion that the new comprehensive eye exams prevent learning disabilities)
I usually trust my pediatrician to tell me if there’s a problem or not. That’s what they’re there for. North Carolina parent
I own a hair salon and think all kids should get a haircut before they start school — so where do I send my campaign contribution to Jim Black? Anonymous to the Charlotte Observer Jan. 27, 2006
The Issue: Vision Screening for School Children
The cost to North Carolina families beginning fall of 2006:
• Per child entering kindergarten: $100-$120 per exam
• Estimated total cost to N.C. taxpayers: $25,000,000.00
NC Gen Stat. § 130A-440 — Health Assessments for Kindergarten Children
NC Gen Stat. § 130A-440.1 — Comprehensive eye examination required
NC Gen Stat. § 143B-216.67 — Governor’s Commission on Early Childhood Vision Care
Summary: During the 2005 legislative session, a provision requiring the 111,000 kindergarteners entering public school in the fall to have a comprehensive eye examination (costing $100-$120 per exam) passed into law. Two million dollars in taxpayer money has been set aside for those who are unable to pay for the exam. The exam can be performed only by a licensed optometrist or opthomologist. Everyone, except the optometrists, the group that stands to benefit most from this new law, is opposed to this new law.
Explanation of the issue:
In 1985, lawmakers passed a law (NC Gen Stat. § 130A-440) requiring every child entering kindergarten to have a complete health assessment, which includes a medical history and physical examination with screening for vision and hearing, and if appropriate, testing for anemia and tuberculosis. The current law allows a physician, a physician’s assistant, a certified nurse practitioner, or a public health nurse to perform the health assessment.
North Carolina currently has a prototype vision screening program, the largest non-profit screening program and one that other states use as a model. Through the Kenneth Royall Vision Screening Program and the Preschool Vision Screening Program, over 500,000 children are screened annually for vision problems. Of those, about 35,000 are referred to eye doctors for follow-up treatment. For children whose families cannot pay for vision screenings, funding is available through N.C. Health Choice, Headstart, Medicaid, DHHS Commission for the Blind, VSP’s Sight for Students and the Lions Club Foundation. The National Eye Institute and the U.S. Preventive Services Task Force both endorse the screening process as effective, especially in catching serious eye problems like “lazy eye”.
During the 2005 legislative session, a new law (the Black Eye Bill) requiring a comprehensive vision screening examination (in addition to the Health Assessment already required for children entering kindergarten) was slipped into the massive budget bill (Sec. 0.59F(a)-(h) of S.L. 2005-276; Senate Bill 622). The law has two provisions:
1. The law requires all children entering kindergarten to have a comprehensive eye exam before they can enter a North Carolina school. The comprehensive exam is far more extensive than the vision screening now required. The law requires that the exam can be performed only by a N.C. licensed optometrist or ophthalmologist.
2. The law also establishes the Governor’s Vision Care Program. The purpose of this program is to provide tax subsidized funding to reimburse optometrists and ophthalmologists for the exams for all children enrolling and already enrolled in kindergarten, first, second and third grades. This new program would provide taxpayers’ money to pay for exams for children whose own health insurance doesn’t cover the exam, for families that make below a certain income level (a family of four — below $48,375 a year), or don’t already qualify for some kind of public aid. This provision also clarifies requirements for children to qualify and sets up a commission to oversee the program.
Although the requirement in the first provision is only for children entering kindergarten to have the $100-$120 exam, funding is established in the second provision to pay for children in first, second and third grades as well. Language later appeared that would include children not only enrolling but those who are already enrolled (see Legislative history later in this paper). It appears the groundwork has been laid to include more children in the program, which, of course would require additional funding.
This is the birth of another entitlement program. A program that many say is unnecessary and a waste of healthcare dollars. It is a program that benefits a special interest group, whose members include Speaker of the House Jim Black.
Recently, there has been extensive press coverage on this new comprehensive eye examination requirement, that has been fueled by widespread opposition from various associations, including: North Carolina Education Alliance, Covenant with North Carolina’s Children, North Carolina Justice Center, North Carolina Pediatric Society, North Carolina Society of Eye Physicians & Surgeons, North Carolina Association of School Administrators, North Carolina Principals & Assistant Principals Association, North Carolina School Boards Association, and the North Carolina School Superintendents Association. Many parents and small business owners have written to the editors of newspapers across the state voicing their opposition as well.
It is important to note who can perform these examinations under the new law. The law states, “the comprehensive eye examination … shall be conducted by an optometrist or ophthalmologist licensed to practice in this state.” An optometrist is not a medical doctor, but is a doctor of optometry who can diagnose vision problems and eye disease, prescribe eyeglasses and contact lenses, and prescribe drugs to treat eye disorders. Speaker Jim Black is a practicing optometrist who has been licensed in North Carolina since 1962. An ophthalmologist is a physician who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury. Ophthalmologists in this state strongly oppose this new law and argue that the exams are medically unnecessary.
Only an optometrist or ophthalmologist (not a nurse, a health department official, not even a child’s own pediatrician) could perform the newly required comprehensive eye exam. Speaker Black, a practicing optometrist who received almost $60,000 in campaign funds from other North Carolina optometrists, is among the few authorized to perform these $100-$120 examation.
Speaker Black has adamantly denied that he made sure the provision was inserted into the budget bill to personally benefit himself and fellow optometrists. He claimed it was the Governor Mike Easley’s idea. The Governor’s office has said they didn’t instigate it.
HERE’S HOW IT UNFOLDED: When the Governor’s proposed budget was sent to the General Assembly in February 2005, the eye examation provision was not included. When the Senate formulated its budget proposal during May 2005, it wasn’t there either. When the Senate’s final version passed on May 5, 2005, it wasn’t there either. When the budget bill was introduced in the House, it wasn’t there either. When the budget bill made its first appearance in the House, the eye exam provision suddenly appeared in the House Finance Committee version on June 14, 2005. It remained part of the bill throughout the House negotiations and the conference committee reports. With very little time to review the voluminous budget document and even less time for debate, the eye exam requirement became law, with hundreds of other provisions on August 11, 2005.
Civitas can not confirm how the provision got in the House budget bill, but it is common knowledge that Speaker Black controls what goes on in the House, and that is where the eye exam language was slipped into the bill.
Civitas believes that a change like this, which affects all North Carolina kindergarteners, and probably all first, second and third graders soon, should stand alone to be thoroughly reviewed, debated and voted on. Pediatricians, eye doctors, school administrators, health department officials, parents, and taxpayers should participate in the debate. If it’s a good and wise use of taxpayer money, then it should become law. If it is not a good idea, unnecessary, and not a wise use of taxpayer money, then it should not become the law.
With the outpouring of opposition to this law, Speaker Black has made assurances that he will propose changes when the General Assembly reconvenes in May. He has suggested changes that allow a longer time period for children to be examined, allow out-of-state licensed optometrists or ophthalmologists to conduct examinations, and make some allowances for counties that don’t have optometrists or ophthalmologists.
Speaker Black can’t make changes to a law by himself. Our legislative system requires public hearings, open debate and participation by the entire General Assembly. The Black Eye Bill doesn’t need to be amended. It was a bad and self serving idea from the start. It needs to be repealed.
Legislative History Appendix:
I. Session Law 2005-276; Senate Bill 622: An Act to make Base Budget Appropriations for current Operations of State Departments, Institutions and Agencies and for Other Purposes. Ratified on August 11, 2005.
Section 10.59F(d) Establishes the Governor’s Commission on Early Childhood Vision Care
II. Session Law 2005-345; House Bill 320: An Act to make Technical, Clarifying, and other Modifications to the Current Operations and Capital Improvements Appropriations Act of 2005. Ratified on August 30, 2005.
The bill expands the Black Eye Bill described above.
Section 20.(a) adds children who are enrolling in grades K-3 as well as those who are already enrolled to be covered under the Governor’s Vision Care.
Section 20.(b) includes those children whose health insurance does not cover vision exams to receive funds under the Governor’s Vision Care Program
Section 20.(c) requires DHHS to submit a preliminary report by January 15, 2006 rather than May 1, 2006.
Section 20.(d) makes the requirement for the eye exams effective for the 2006-2007 school year and makes the
Governor’s Vision Care Program effective July 1, 2005.