Optometrists and Dispensing Opticians Board

July 2013 Newsletter

In this issue:

  • Election/re-election of Chair and Deputy Chair of the Board
  • APC Renewals Update
  • Update on consultation on draft guidelines for optometrists on prescribing for glaucoma
  • Update on consultation on Optometrist Scopes of Practice
  • Discipline case outcome – A Buckingham
  • Steps to take when closing a practice
  • Discipline case outcome – D White
  • Update on review of  HPCA Act
  • Update on Possible Move to Health Regulatory Authority Single Shared Secretariat
  • Update on Medicines Act Amendments
  • Administration of Tropicamide
  • How to terminate a patient/client relationship
  • Feedback welcomed

 

 

Election/re-election of Chair and Deputy Chair of the Board

At the Board’s first meeting of 2013, held on 8 February 2013, optometrist Damian Koppens was elected as Chair of the Board, and lay member Ruth Spelman was re-elected as Deputy Chair of the Board. Both look forward to leading the Board through what promises to be an interesting and challenging year.

You can view profiles for the Chair and Deputy Chair, as well as other Board Members, by visiting the ‘About the Board’ page of the Board’s website located at www.odob.health.nz or by clicking here.

The Board would like to thank Board member, Richard Lobb, for his service as Chair of the Board for the last 2 years. His strong leadership and considered and objective approach to decision-making has proved very valuable to the Board. While not wishing to continue in the position of Chair, Richard remains a current member of the Board.

As noted in previous Board communication, there are four positions on the Board up for re/appointment this year – one lay position, one dispensing optician position and two optometrist positions. Applications have now closed for these positions and the Board expects to hear the outcome of this round of appointments from the Minister of Health in due course.

APC Renewals Update

The 2013/14 APC renewal period has now closed. The Board was very impressed with the timeliness of renewals this year, with all but a few getting their applications in on time.

Those not intending to practise between 1 April 2013 and 31 March 2014 still need to let the Board know what their intentions are for the current practising year. If you have not yet renewed your status, please contact the Deputy Registrar on 04 474 0704 to discuss your options.

Consultation on draft guidelines for optometrists on prescribing for glaucoma

The Board received 8 submissions on the Board’s recent consultation on draft guidelines for optometrists for prescribing in glaucoma; six from interested organisations and two from individual practitioners. Thank you to those who made a submission. A summary of these submissions can be found by clicking here.

After careful consideration of the submissions received, the Board has revised the draft guidelines and now seeks further comment from practitioners and stakeholders on these revisions. Please click here to view the revised guidelines. We would appreciate receiving your feedback by 2 September 2013.

Update on consultation on Optometrist Scopes of Practice

The Board received 12 submissions on its recent consultation on possible changes to the optometrist scopes of practice; five from interested organisations and seven from individual practitioners. The Board thanks those who made a submission. A summary of these submissions can be found by clicking here.

No substantive decisions on changes have yet been made.  The Board intends to take its time with the decision-making in respect of possible changes to the Optometrist scopes of practice. 

The Board has resolved to maintain the status quo regarding the existing scopes of practice for Educators.  The views of submitters were considered carefully before coming to this decision. 

The Board’s next step is to commission a review of the place of TPAs in contemporary optometry training and practice in New Zealand, Australia and elsewhere.  The Board expects to receive a report on the outcome of this review at its November 2013 meeting. 

Further consultation on proposals for change to the Optometrist and Optometrist (TPA Endorsement) scopes of practice is likely to take place once the review report has been received. 

Discipline case outcome – A Buckingham

On 20 and 21 November 2012, the Health Practitioners Disciplinary Tribunal considered a charge of professional misconduct laid by a Professional Conduct Committee (PCC) appointed by the Optometrists and Dispensing Opticians Board against optometrist, Ms Andrea Buckingham.

In summary, the charge alleged that in the period before 20 May 2011, when Eyezone Limited (a company which Ms Buckingham is alleged at all material times to have been the sole director and shareholder) was placed into liquidation, until the date when the charge was laid – 5 July 2012, Ms Buckingham failed to make appropriate arrangements to ensure the continuity of Eyezone’s patients’ optometric care and/or ensure that the patients’ care would not be compromised after her business went into liquidation.

Ms Buckingham disputed the charge on the basis that she did not have the means to make records available to patients at the time of liquidation due to cost, that she believed she was no longer registered with the Board and therefore had no obligation to Eyezone patients, and that the records were not necessary for continuity of care.

The Tribunal found the charge established and made the following orders:

  • That Ms Buckingham’s registration is cancelled, effective from 21 February 2013.
  • That Ms Buckingham is censured. The Tribunal expressed its strong disapproval of the conduct it had been required to review.
  • That Ms Buckingham contribute $17,500.00 (exclusive of GST which is not payable) in respect of the costs of the PCC.
  • That Ms Buckingham contribute $9,800.00 (exclusive of GST which is not payable) in respect of the costs of the Tribunal.
  • That a copy of the decision, and a summary of it, be placed on the Tribunal and Board websites, and in the Board’s newsletter.

The full decision of the Tribunal can be viewed by clicking here.

Steps to take when closing a practice

The above case has highlighted the importance of practices taking the necessary steps to ensure continuity of care for patients when closing a practice.

The Board recommends that the following steps be taken when closing a practice –

  1. A letter or email should be sent to patients advising them of the upcoming closure of the practice and what is to happen to their patient records.
  2. Notice of the closure needs to be placed in local publications, indicating where patients may gain access to and/or request transfer of their records.
  3. Notice of the closure should be left at the practice address for as long as possible after the closure of the practice, informing patients where they may gain access to and/or request transfer of their records.
  4. The practice owner should attempt to negotiate transfer of the records to another local practice, where they can be stored securely and be readily accessed as necessary by patients who may or may not decide to become a patient of that practice.
  5. Notification of the practice closure and where records have been transferred or are being stored should be lodged with the Board, in the event that patient enquiries about the closure are received.

Health providers have a legal responsibility under the Privacy Act 1993 and Health Information Privacy Code 1994 to ensure that health records are securely stored and are also able to be readily accessed, on written request, by health consumers. If you are not familiar with these responsibilities or wish to refresh your memory, please visit the website of the Privacy Commissioner located at http://www.privacy.org.nz/

Discipline case outcome – D White

On 25 March 2013, the Health Practitioners Disciplinary Tribunal considered a charge of professional misconduct laid by a Professional Conduct Committee (PCC) appointed by the Optometrists and Dispensing Opticians Board against optometrist, Desmond White.

In summary, the charge alleged that on or about 16 December 2010 and/or in the period between 16 December 2010 and 7 February 2011, Mr White failed to refer his patient in a timely manner to an ophthalmologist for the assessment and/or treatment of an abnormality (subsequently found to be a retinal detachment) which he had identified in the Patient’s right eye. The optometrist did not refer the patient to an ophthalmologist until 7 February 2011.

The patient was diagnosed with a right retinal detachment by an ophthalmologist on 16 February 2011 and referral for surgery was arranged for the following week.  The patient underwent a number of subsequent surgeries and on 3 December had his right eye removed and replaced with an artificial eye. 

Mr White admitted his failure to refer the patient in a timely manner and that he did not refer the patient until 7 February 2011.

The Tribunal was satisfied that Mr White was guilty of professional misconduct as it considered the photographs taken during initial consultations with Mr White clearly showed a retinal detachment.  The Tribunal considered that the failure to make a diagnosis of retinal detachment and then not to refer that urgently for an ophthalmologist’s opinion were significant departures from the standards to be expected of a reasonably competent optometrist.  The failures illustrated a lack of competence and the delay in referral was serious and detrimental and well below the expected standard.  It could not be dismissed as an administrative error.

The Tribunal recognised that Mr White was not currently practising as an optometrist but considered a 6 month suspension from practice to be appropriate given the seriousness of the conduct and to recognise that Mr White should be rehabilitated. 

Conditions were also imposed on resumption of practice that Mr White:

  • Practice under supervision for a period of 18 months by an Optometrist and Dispensing Opticians’ Board appointed supervisor;
  • Satisfy the Board that he can demonstrate competence in fundamental eye assessments, examinations and diagnostics;
  • Not practice as a sole practitioner for a period of three years.

Mr White was ordered to pay $10,000 towards the costs of the PCC investigation and Tribunal hearing.  The Tribunal also lifted the interim order for name suppression and directed that the decision and a summary of the decision be published on the Tribunal’s website and a notice be published in the Board’s newsletter and the New Zealand Optics monthly magazine.

The full decision of the Tribunal can be viewed by clicking here. 

Update on review of HPCA Act

The review of the Health Practitioners Competence Assurance Act 2003 (HPCA Act) being undertaken by the Ministry of Health is still in progress. Submissions on the first round of consultation have now been considered and a summary of these can be found on the Health Workforce New Zealand website located at http://www.healthworkforce.govt.nz/.

The Board has recently been advised by the Ministry of Health that a decision has been made not to undertake further consultation on the review of the HPCA Act, as was previously planned. The reason for this decision is that submissions received on the first consultation indicate that the HPCA Act is working well and as intended for the most part, and therefore, major changes are not required at this time. Instead, only minor changes are to be made to the HPCA Act, and the Ministry does not, therefore, believe that further consultation is needed.

The Ministry will inform the health regulatory authorities about these minor changes in the near future. The Board will keep practitioners and stakeholders informed of these and on what impact these may have on registered practitioners.

Update on Possible Health Regulatory Authority Single Shared Secretariat

The Board has been exploring the benefits of establishing a shared secretariat with the other 15 health regulatory authorities (RAs) in order to deliver improved regulatory outcomes.

The Steering Group for this work appointed PricewaterhouseCoopers to work on a Detailed Business Case (DBC) to spell out the case for change and to identify the benefits and costs that would be involved in establishing a single shared secretariat. This work is now complete and the DBC has now been considered by the 16 RAs.

The Board considered the DBC at its May meeting and agreed to participate in further enquiries into implementing a single shared secretariat and to progress to consultation with staff and stakeholders. The consultation document, when ready, will be published widely and reasonable time given for stakeholders and staff to make submissions.

Any stakeholder and staff feedback will be an important contribution to the Board’s further consideration of the proposal.

Update on Medicines Act Amendments

On 20 March 2013, the Medicines Amendment Bill had its second reading in Parliament. At this time, the Bill is waiting to go to Committee of the whole House which is where it will be debated by Parliament and any Supplementary Order Papers (additional changes) will be introduced.  It may still take a few months for this to progress or it may happen quickly. The Ministry of Health is keeping the Board informed of progress on this, so we will notify practitioners and stakeholders as soon as we hear more.

Administration of Tropicamide

The Board received an enquiry earlier in the year about whether it was legal for an optometrist to delegate the administration of Tropicamide to a dispensing optician or other staff member. To seek clarity on this issue the Board sought legal advice, which confirmed the following –

  • It is lawful for an optometrist to delegate the administration of Tropicamide to registered or unregistered staff, provided that the optometrist takes appropriate steps to ensure that the staff member administers the medicine in accordance with a direction given by the optometrist.
  • Any health care provider administering a prescription medicine is subject to the requirements of the Code of Health and Disability Services Consumers’ Rights. In particular, the duty to provide services with reasonable care and skill and in a manner that minimises potential harm (Right 4).
  • Where an optometrist delegates the administration of Tropicamide, the optometrist retains overall responsibility for the use/administration of the Tropicamide.

How to terminate a patient/client relationship

When communication lines breaks down with a client or patient beyond repair, it can sometimes become necessary to advise the client or patient that it would be best for them to transfer their care/custom to another practice. To follow are recommended steps for managing this situation in a professional manner –

  1. Be clear about your reasons for seeking to transfer the patient’s care to another practice.  Find a colleague or fellow health practitioner with whom you can talk through what you want to say.  Take the time to become confident that you can express your reasons clearly.  Make a note of what you will tell the patient. 
  2. If constructive verbal communication is possible, phone the client and advise them of the decision you have reached that it would be best for their care/custom to be transferred to another practice, including the reason/s for this decision.  
  3. Follow this phone call up in writing to the client (or start with this step if the above step is not possible), advising them that you would be happy to transfer their records to the new practice once they have selected one and confirmed where the records should be transferred to, or alternatively, advise the client that they may uplift their records themselves.
  4. If transferring the records, make contact with the practice and ensure that the records are transferred to the new practice securely and let the client know that the transfer has taken place.
  5. If the client wishes to uplift their records themselves, ensure that the patient understands that you are providing them with their original records and that care should be taken to store them securely as you have not retained a copy for future reference (unless you decide to retain a copy for a short while in the event of loss or a possible need to discuss the client with the new practice).

Due to the nature of human behaviour, the above steps will not fit perfectly for all situations so are intended as a guide only. If you need assistance in managing a difficult client relationship and are concerned that the situation may escalate to a formal complaint, please contact the Board for advice on how best to manage the situation for all parties involved. Contact information for the Board’s Registrar can be found below.

Your feedback welcomed

The Board welcomes feedback and enquiries on its standards, policies, and processes at any time. If you would like to make an enquiry or submit feedback, please feel free to email the Board’s Registrar, Lindsey Riley, at [email protected] at any time. 

Contact Us

Optometrists and Dispensing Opticians Board

Level 5, 22 Willeston Street,
Wellington 6011
PO Box 9644, Wellington 6141
Tel: +64 4 474 0705, Fax +64 4 474 0709

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