SQ 793 is about corporate control of a medical profession (Guest Post: Joel Robison)

Of the five state questions on the ballot in November, only SQ 793, which would allow optometrists and opticians to operate in retail establishments, is the subject of intense, well-funded campaigns from both supporters and opponents. We asked both campaigns on SQ 793 to submit guest posts explaining their position. This post by Joel Robison explains why his group opposes the measure.  A post in support can be found here


Joel Robison serves as executive director for the Oklahoma Association of Optometric Physicians.

State Question 793 is a November 2018 ballot initiative that would allow big retailers like Walmart to open corporate-run optometry clinics inside their stores. It was put on the ballot after a successful signature gathering drive led by Oklahomans for Consumer Freedom, a group created by and paid for by Walmart. The “yes” campaign is being funded by Walmart, with some help from other big retailers like Costco.

Optometric physicians in Oklahoma and across the country are opposing State Question 793 because it would give non-medical companies control over their medical profession and lower the quality of vision care. Eye doctors are particularly concerned with language in SQ 793 that would give corporations like Walmart the ability to control their doctors’ scope of practice by limiting the procedures they can perform or directing them to practice in a certain way. Because SQ 793 is a constitutional amendment that trumps all other laws and regulations regarding optometry, it also creates a special class of doctors – a.k.a. “Walmart Doctors” or “Big Box Store Doctors” – who are not beholden to the standards of care and patient protections mandated by the Oklahoma Board of Examiners in Optometry. Essentially, Walmart would be able to tell its doctors to take shortcuts regarding the diagnosis and management of vision diseases and would be explicitly protected by the Oklahoma Constitution when it does so.

Understanding Optometry’s Unique Position in Oklahoma

Optometrists in Oklahoma have the broadest scope of practice in the nation. They perform procedures that are only administered by ophthalmologists in other states. Oklahoma optometrists diagnose and manage many types of eye conditions and diseases, including bacterial and viral eye infections, diabetic retinopathy, macular degeneration, glaucoma, and cataract, as well as refractive conditions like myopia, hyperopia, and astigmatism. 

Because of that broad scope of practice, Oklahoma is one of the best places in the country (and the world) for optometrists to train. Northeastern State University’s Oklahoma College of Optometry is considered one of the finest optometry schools in the nation.   

Before 1971, when Oklahoma’s modern optometry laws were put into place, optometrists had a much more limited scope of practice and many worked helping to sell frames and lenses at large retailers and jewelry stores.

A concerted effort was made to elevate the practice in two ways: first, by dramatically expanding scope of practice to emphasize medical care over sales; second, by establishing a much higher bar for quality of care, overseen by the State Board of Examiners in Optometry.

Finally, optometrists removed themselves from retail establishments like Walmart, where the pressure to assist in non-medical sales could corrupt the integrity of their medical practice and damage the doctor-patient relationship.

Undoing Five Decades of Improvement in Vision Care

Today, Walmart wants to undo that progress by asking voters to pass State Question 793 in November. Not only would this initiative put optometric physicians back in the Walmarts of the world, it has also been deliberately crafted to give those corporate entities almost total control over their doctors.

For example: an independently practicing optometric physician is required by the Board of Examiners in Optometry to diagnose and manage conditions like glaucoma, which can eventually cause blindness. If SQ 793 were to pass, a Walmart optometrist in Oklahoma could be contractually obligated to discard every part of their medical training that does not lead to maximal sales of frames and lenses. While such a practice would be obviously and directly harmful to patients (whose glaucoma could now go untreated and continue to degrade their vision), the medical community would be powerless to object because SQ 793 was crafted as a constitutional amendment that overrules all other conflicting statutes.

State Question 793 is being marketed by its supporters as a free market proposition; in reality, it is a corporate takeover of a medical profession. All voters – regardless of their ideology or their immediate need for vision care – should be disturbed by this attempt to change the state’s constitution to benefit large corporations at the expense of good health care and patient safety.  

The opinions stated above are not necessarily those of OK Policy, its staff, or its board. This blog is a venue to help promote the discussion of ideas from various points of view and we invite your comments and contributions. To see our guidelines for blog submissions, click here.

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The opinions stated in guest articles are not necessarily those of OK Policy, its staff, or its board. To see our guidelines for blog submissions, click here.

5 thoughts on “SQ 793 is about corporate control of a medical profession (Guest Post: Joel Robison)

  1. Your comments and concerns seem reasonable. I just wonder what has actually happened in the 47 states that already have this. We should be able to obtain some data and learn from the experience of those states, rather than base our decision on speculation.

  2. The major concern I see from the “No on 793” crowd is that it would somehow lower the quality of eye care in Oklahoma. Every regular eye doctor visit I have had here in Oklahoma has already been limited solely to the machine that checks for glaucoma and then the actual check of what prescription I would need. When I was tested to have signs of glaucoma I was referred to a specialist.
    How would eye care get worse/lesser under the new state question? Current eye doctor visits are already extremely limited in scope so how would big box retailers be able to reduce the quality of care when someone with a serious problem would already be referred to a specialist?

  3. I agree with the earlier comment that raises the question of how can this be as harmful as the opposition claims when 47 other states already allow these practices in large retail stores? Yet the proponents fail to cite instances of rising prices or other problems that have occurred in those other states. If those claims are real, then citing those supposed problems in other states should be easy.

    The question about why make this a constitutional amendment seems to address why our legislature has failed to act on behalf of eye care consumers in this state, and the real threat that a petition to simply change the law would be quickly watered down or overturned in the next legislature.

    Without citations of specific problems that have occurred in the 47 other states, then the opposition is resorting to speculative scare tactics, not facts.

  4. 47 other states do not allow this. NO other state allows for this, where a retail corporation can limit the scope of an optometrist. It’s specifically written in there: both things. 1. That the retail corporation may limit the scope of practice and 2. That all the laws will be null and void. The state constitution trumps state statute which regulates Optometry and other health professions with state boards. This will explicitly allow the retail corporation to override curent state law legislated for public welfare because Wal-Mart doesn’t want to play by the rules that other OK already has in place like other states with a “2 Door” policy allowing “independent doctors of Optometry” to practice next to an optical in a retail establishment. These 2 door policies allow for doctors to practice to the level of the license with state oversight. This constitutional amendment overrides the ethical oversight of a state Board. Walmart, Sams, Target, Costco, etc could play within the rules like LensCrafters, Eyemart Express and VisionWorks (formerly EyeMasters) but they have chosen to attempt to amend the state constitution to allow literal control of the Doctor. This is bad for Oklahoma.

  5. I think the language ‘limit scope of practice’ leans more to the side of ‘no surgical procedures, etc’ in the office within the retail establishment. In other words, should anything requiring a specialist be noted, a referral will be done. Having lived in numerous other states with optometrist’s in retail establishments, I would tell you that SQ793 is a good thing, and I agree with the above statement Sam; without proof this is simply speculative scare tactics by a group of folks that don’t want price competition. PBTW, the cost of just a simple optometry check up here in OK is ridiculous as compared to other states.

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