Opinion ID: 2454965
Heading Depth: 1
Heading Rank: 1

Heading: Prescription of lenses

Text: That Curteman engaged and engages in [t]he prescription    of lenses   to correct defects and abnormal conditions of the human eye is clear under all accepted definitions of the term prescription. To prescribe means to write or give medical prescriptions (for a patient)   to give advice in the manner of a doctor giving a medical prescription    to lay down authoritatively as a guide, direction, or rule of action: impose as a peremptory order: dictate, direct, ordain    to direct, designate, or order the use of as a remedy (the doctor prescribed quinine). Webster's New International Dictionary, Third Edition. A prescription for a contact lens is a written direction for the preparation of such a lens to be fabricated in conformance with certain specifications calculated to meet the refractive needs of the human eye, and includes both the device and the instructions given by the prescriber as to the use of the device. Without doubt the form which Curteman prepares, issues and presents to the laboratory for fabrication of contact lenses is a prescription within the wording of subsection (3). One basic factor contained in the prescription (the correction of the refractive error) is derived from a prescription issued by an ophthalmologist, but it is not possible to fabricate a contact lens from a prescription for ordinary spectacles. Ten other additional operations, measurements, judgments and decisions must necessarily be made by someone before the converted prescription may be issued in form sufficient to enable a laboratory worker to fabricate the lens. Curteman performs these ten additional necessary operations, measurements, etc., determines and prescribes the final specifications, and issues the prescription used by the fabricator. Thereafter Curteman instructs the patient as to the use of the devices. Under the wording of subsection (3) as written, the only reasonable and realistic conclusion is that Curteman is engaging in the prescription of lenses to correct defects or abnormal conditions of the human eye. It does not militate against this conclusion that one ingredient of the final prescription comes from a physician or that after Curteman performs these services to the best of Curteman's ability the result is subject to review and approval or disapproval by the physician, who inspects the lenses and re-examines the eyes of the patient. It is no defense that Reiss processed a doctor's prescription and that his work had been pronounced satisfactory by the ophthalmologist after a wearing time of three weeks. The crucial period requiring professional supervision was at the time of the adaptation of the lenses, their initial adjustments and the early stages of wearing. New Jersey State Board of Optometrists v. Reiss, (1963) 83 N.J.Super. 47, 198 A.2d 816, l. c. 822. Appellant's contention that he would have referred the patient back to the prescribing doctor does not excuse his practice of optometry at the time of fitting. Fields v. District of Columbia, (1967) D.C.Ct.App., 232 A.2d 300, l. c. 306. Nor is Curteman exempted from the operation of Chapter 336 on Optometrists under § 336.120, V.A.M.S., exempting Physicians or surgeons of any school lawfully entitled to practice in this state. This exemption is granted to physicians and surgeons and does not in terms or by necessary implication extend to lay technicians. In this connection it is significant that our statutes make provision for one and only one classification of persons authorized to assist those empowered by § 336.010 to prescribe or adapt lenses for the human eye, namely, registered apprentices assisting registered optometrists. Chapter 336 on Optometrists recognizes such apprentices and authorizes them to assist registered optometrists in the practice of optometry, provided they have a certificate of registration as an apprentice and work under the immediate personal supervision of a registered optometrist. § 336.010. No corresponding statute recognizes lay technicians, provides for their licensure or authorizes such assistants to work under the immediate personal supervision of licensed physicians practicing ophthalmology. This court may not by judicial fiat create such a class, prescribe their qualifications, provide for their licensure and authorize them to perform this function. Nor have physicians or optometrists been authorized by statute, in the practice of their professions, to utilize the services of unlicensed and unregistered lay technicians in the performance of acts constituting the practice of optometry (no matter how convenient and satisfactory such an arrangement may be to the physician or optometrist, and no matter how adequately such a system may serve the public need). Nor do Curteman's activities and practices fall within the exemption on the theory that Curteman is but the alter ego or extension of the hands and fingers of the ophthalmologist. Pointing to the invaluable services rendered by other trained technicians and allied health personnel (laboratory and X-ray technicians, nurses, physiotherapists, etc.) as assistants to physicians and surgeons, respondents claim that as trained technicians working as subordinate assistants under the supervision, direction and control of ophthalmologists they are capable of performing and should be permitted to perform the routine, mechanical tasks involved in filling prescriptions of ophthalmologists and fitting contact lenses for their patients; and that the use by ophthalmologists of such technicians' services should be recognized as lawful. This argument overlooks the fact, which we find from contested evidence, that the activities and practices of Curteman do not involve mere routine, mechanical acts; that the several decisions and judgments which necessarily must be made in preparing a contact lens prescription and in fitting contact lenses require a considerable degree of professional skill and judgment. State ex rel. Reed v. Kuzirian, (1961), 228 Or. 619, 365 P.2d 1046, l. c. 1047, 88 A.L.R.2d 1284; Fields v. District of Columbia, supra, 232 A.2d l. c. 304-305. It overlooks the fact that Curteman does not fill the ophthalmologist's prescription. Curteman completes, prepares and issues the prescription from which contact lenses are fabricated by another. Furthermore, this argument ignores the conclusive fact that Chapter 336, which dictates who may practice optometry, does not accord that privilege to trained technicians or allied health personnel. In its wisdom, by the passage of Chapter 336, the General Assembly has restricted and confined the class of persons authorized to perform these acts and make these decisions to registered optometrists, registered apprentices of optometrists, and physicians and surgeons exempted from the operation of Chapter 336 by § 336.120, V.A.M.S. As we have seen that exemption does not extend to lay technicians such as Dale Curteman, the Curteman corporation or its employees, and ophthalmologists have no right to set aside statutory provisions regulating the practice of optometry, delegate their privilege to practice optometry to others, or authorize unlicensed and unregistered laymen to perform functions which constitute the practice of optometry (no matter how proficient or well trained such laymen may be). Pennsylvania Optometric Ass'n, Inc. v. DiGiovanni, (1968) 45 Pa.D. & C.2d 245, l. c. 269-270.