Can material or lens type be made part of the legal Rx? The indepenent OD that I work with in AL says I can be disciplined by the state optometric board if I don't follow the Rx to a "T". I always took material or lens type as a recommendation. Am I wrong?
This is something that gets my goat!
Here in Oz, anything written above the prescribers signature is an integral part of the prescription including lens type, material etc.
Really though the optometrists should stick to prescribing, and let us dispensers who are trained and have the product knowledge, dispense that prescription. That is why we are dispensers!
There's my two cents worth!
I've never gotten a straight answer on this questions either. Some say everything above the signature needs to be in the final pair of eyewear, others say that the only thing a dispenser can't change are the actual prescription (sph, cyl, axis, prism, add) and has free reign to change lens design and/or materials.
So, to make everyone happy....If a patient and I are discussing different lens materials or styles than what is listed on his/her prescription (which around here isn't very often), then I would call the prescribing doctor. Inform the doctor that the patient is interested in a different lens option, xyz lens, and feels he/she will get more benefit from it because..... do you mind if we change it? MOST of the doctors appreciate the call and don't mind changing it if the patient gets a benefit from it.
(I've seen Rx's for a monocular patients in Glass PGX.....obviously NOT in the patients best interest, not to mention you will also be liable if that glass lens shatters and ruins the patients only good eye.) So call!
Michele
In virtually every state where prescriptions are written that I have had exposure to, the law requires compliance with the "by order of the prescribing doctor" provision.
Substitutions or other changes without the prescribing doctor's concurrence violate that law. It has nothing to do with whether the doctor is right, wrong, should consult, should change, or other.
I am not aware that concurrence means "in writing" or by phone, or a simple nod or gesture. However, if NOT in writing, and the doctor wishes to protest, you have a problem.
A big one.
My wife bakes pies suitable to house miniature tools! The tools are placed in little plastic frame bags, so you can safely eat the pie before you . . .
Some of the docs around here add "dispense as written" to the lower part of the rx form and then they checkmark that line, adding lens name and seg style, as well as anything else they want to include, taking away any doubt as to who is in charge of the final product.
This leaves the doc or tech free to direct the patient to the house dispensary when the patient calls back or returns saying no one carries that lens! And then, of course, doc can modify the rx if his/her "optician" feels that that lens would take too long to get or doesn't come in that add power. Now I don't have actual proof that this is the rationale, but I have my suspicions...
jP (So glad I can access the board again this morning!!!)
Jenny,
I agree with you completely! I have seen cases where I would strongly agree with it (i.e. Poly for children and adults with vision in only one eye). Then there are other instances where the doctor is doing so to keep his business (prescribing a private label brand which is only available to OD's).
I, when explaining to the patient that we are unable to help them, (because the OD won't change the recommendation) why they will HAVE to get it from the OD. In all but one case they return with the recommendation removed or the OD's office calls to acknowledge they can have the lens they choose.
In this case I win. The OD almost always loses and I inherit a patient for life!
I have always been of the school that it has to be filled as written unless I get verbal approval.
~Cindy
Howdy folks,
There is no straight answer to this question as it is dependant on how touchy the OD's are about it. A few OD's would drag an independant optician into court for breathing wrong if they felt it would add to their business, but those are a small number of OD's that would do that.
Here is some intresting information though:
Most of the state laws which govern OD's are unconstitutional. At least in the state of Texas, the States Attorney General said that many of the laws in the TOB Acts are unconstitutional. You can get into semantics with a written Rx if the doctor specifies a lens material or manufacturer. It could, in a vague way, constitute anti trust. If a doctor can specify a material or manufacturer he could be intentionally cutting out other companies (or at least courts could construe it that way.) This would fall under restraint of trade. Or they could be in league with Lucifer :)
The TOB has Acts which negate others in the same statutes, but they enforce them all, unless of course you're Wal Mart, Sears, EyeMasters, Lenscrafter or any of the other big guys. This also falls into the catagory of unconstitutional because they are selective as to when they will enforce these Acts. If you do it for one you have to do it for all, but they know that these big companies have enough money to put a real hurt on them in legal fees, so they only go after those that can't afford to fight them. Not to mention that if they did, these big boys would bring out the unconstitutionality of their regulatory Acts and the TOB would be sunk.
As an example the TOB has the Texas Two Door Law which is completely stupid and outdated in it's usefulness. This law was repealed, but low and behold is resurfaced and was codified in the Texas Occupation Codes. Anyone want to guess why? That's right because they had to seperate it from the new amendment that says that MD's and OD's can form partnerships. You may be asking yourself why the two would have anything to do with the other? Well, MD's are not governed by the TOB so by forming a professional corporation between and MD and an OD you have an umbrella that covers the OD under the unrestricted license of the MD. In otherwords if an OD and an MD set up this type of corporation the OD could practice anywhere that the MD had office space i.e. in an optical owned by an opticians sans wall ;)
The ruling negates the Two Door Law so the TOB had it codified in the Occupation Codes. That way they can keep it seperate and apart from the new Act. Then it isn't immediately apparent that the new Act negates the old one unless someone does some digging. Pretty sneaky huh? :)
The second thing that I find interesting is that most of the Acts set forth by the TOB work "against" Optometrists and yet Optometrists support them. Is that goofy or what? Amendments have to be made just so that Optometrist "can" do things. It's truly amazing.
In short to answer the original question: At present an OD can do whatever with regard to written prescriptions and it not be legally binding, BUT are you going to push it and do you have the money to fight it out in court? The OD's have more money than the average Optician and could bancrupt an independent just by having thier lawyers play legal games.
It boils down to "What are you prepared to do?"
Take care,
Darris C.
Hello out there in Optiboard land. The Doctor can make brand and lens type a part of the Rx if the material and brand is available to every Optical outlet in the area. If it is not available to every outlet, then the signer of the Rx is in violation of the law. Check around and see if every Optical shop in your town can get the product. If not, then do what you must do. Jim Seebach
I haven't been on the dispensing side in a while, but I always tried to do what was best for the customer/patient. Some docs made it easy by saying "no substitutions permitted", or specified that lens material, etc. were just recommendations. If neither was specified, I'd usually call the doctor's office. Of course, this usually results in being put on hold for at least 30 minutes, not to mention being transferred to three different places. Sometimes it was easier to just tell myself "it's easier to beg forgiveness than it is to ask for permission". But ALWAYS in the best interest of the customer.
With that said, I wouldn't encourage anyone to violate the law in their state. But here in Alabama, I haven't been able to find such legal guidance, so I'm not even sure there is such a law.
Most of the stuff I've seen has actually been helpful, like recommendations for UV or AR coating. Still, I imagine if a monocular patient presented a prescription mandating glass lenses, I would have to send them back to their doc to get it changed, preferably after he was done smoking whatever he was smoking when he wrote the original Rx.
(On the other hand, why not go ahead and let the doc pick out the frame, too - and take out all the guesswork for us?)
Blake
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