COVID-19

Board Communication #9

May 18, 2020

9th ADVISORY

COVID-19 Pandemic and Update

I hope all is going well with reopening to see routine and non-urgent patients in Phase 1 of Governor Cooper’s reopening orders. I hope everyone has reduced your clinic schedules to allow for appropriate safety protocols to be implemented. One source I read reflected that during Phase 1, clinics should be operating at 25% of normal capacity, Phase 2 at 50%, and Phase 3 at 75%. The Board feels that each optometrist should determine his or her own practice capacity, keeping in mind that safety protocols are essential in making such determination.

One question that has been brought to the Board’s attention is “What do you do when a patient refuses to be screened or wear a mask, as both are required under the current safety protocols?” Some patients have cited their civil rights, ADA exemption, and HIPAA issues as making them exempt from the requirement. They have further indicated the optometrist has no right to ask them why or what condition exempts them from this requirement.


Here is the answer:

The safety of other patients as well as you and your staff is paramount. Patient screenings and wearing masks are absolutely essential to that objective. If a patient cannot wear a mask or refuses to do so, tell the patient he or she will need to be rescheduled to a time in the future when these requirements are no longer in place.

Considerations:

1. The optometrist needs to know the patient’s complete medical history. If a patient will not provide that history (i.e., if the patient won’t tell you what the condition is that prevents him/her from wearing a mask), the OD does not have to treat the patient.

2. Even if the patient reveals his or her condition, but still can’t or won’t wear a mask, the OD does not have to treat the patient. Safety of all is the most important consideration here! As an example, a regular face mask can easily be modified to fit a patient on oxygen.

3. If a patient is uncooperative or otherwise is a problem patient who is not willing to follow reasonable rules of the practice, consider whether you as an optometrist would want to sign on to provide care for that patient.

It came to the Board’s attention that some dentists were adding a surcharge for the additional costs of PEE, etc., necessary to provide care in this pandemic environment. One dentist added a surcharge of $10 paid up front indicating this charge would be billed to the patient’s insurance and if covered would be refunded to the patient. So, the question arose, can optometry charge a similar fee.

This is not a question for the Board. This question can be more appropriately answered by the State Society or national association.

For the Board,


Bill



William B. Rafferty, O.D.

Executive Director

North Carolina State Board of Optometry

PO Box 69

Wallace, NC 28466

(910) 285-3160 or (800) 426-4457

Fax: (910) 285-4546

exdir@ncoptometry.org


Board Communication #8

May 5, 2020

8th ADVISORY

COVID-19 Pandemic and Update


I will make this Advisory short and sweet.

Today Governor Cooper announced the state is transitioning to Phase 1 of reopening North Carolina starting this Friday May 8, 2020, at 5:00 p.m. The Board has all along said it would follow the state’s orders and therefore is giving the go head to resume routine and non-urgent care at the date and time above.

As was stated in Advisory #7 and I think needs repeating: this highly contagious virus is still with us and will be for some time. The risk of virus transmission and serious illness or death is also still with us. We must continue to be thoughtful and careful—for our patients, our staff and colleagues, and for ourselves and our families. We cannot let our guard down.

So, with that said, you must follow strict office safety protocols. If you have stayed open, you are already practicing with safety protocols in place. If you are considering reopening, you will need to implement protocols before reopening including engaging your staff in following these safety protocols.

The North Carolina Optometric Society sent out protocols that the Board reviewed.

At a minimum, follow these directions. Patient flow and disinfection between patients is essential. Every office is different and it is important your practice adapt so your next patient is not exposed to the previous patient.

I have included other links for resources in developing or modifying your existing protocol. These are being provided to you solely as a reference if you choose to use them. Additionally, I have included a protocol from a long-time friend and colleague that he developed using several of these resources.

https://www.aoa.org/coronavirus

https://www.aaopt.org/

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/

Anonymous OD’s protocols


Go forth; stay healthy.


For the Board,

Bill


William B. Rafferty, O.D.

Executive Director

North Carolina State Board of Optometry

PO Box 69

Wallace, NC 28466

(910) 285-3160 or (800) 426-4457

Fax: (910) 285-4546

exdir@ncoptometry.org

Board Communication #7

May 4, 2020

7th ADVISORY

COVID-19 Pandemic and Update


The Board wants to thank North Carolina optometrists for taking this pandemic seriously and doing their part to curb the progression of this highly contagious disease. The Board has a single responsibility and that is of public protection. Therefore, public protection weighs first and foremost in all the decisions the Board renders. With rare exception many optometrists have expressed appreciation and understanding for the difficult job the Board has had to play in the pandemic. I think everyone will agree, this is an unprecedented time in our professional careers and the Board understands and appreciates the sacrifices everyone has had to make.


Last Friday our nation experienced the highest single day death toll with over 2,900 deaths related to the COVID-19 pandemic. Unfortunately, North Carolina is one of 20 states where cases are continuing to climb and therefore, we have not hit the downside of the curve. As we contemplate returning to full service optometry, make no mistake, COVID-19 is still with us and will be for some time. The risk of virus transmission and serious illness or death is also still with us. We must continue to be thoughtful and careful—for our patients, our staff and colleagues, and for ourselves and our families. We cannot let our guard down.

If you read carefully the Board's 6th Advisory you will see the CDC did not actually lift the guideline advising postponing routine eye care. In fact, it is still posted on the CDC's website. What the CDC did was to transfer that responsibility to individual state governments and agencies through the CMS.

The Board is aware that many ophthalmological practices have announced they will be restarting comprehensive care and surgery scheduling this week. The Board is also aware some optometry practices have also decided to return to routine and nonurgent care this week. As of today, the Board's position has not changed—the Board is waiting to see if Governor Cooper suspends the Stay at Home Order that ends this coming Friday, May 8 and progresses to Phase 1 of the state’s plan to reopen North Carolina. This will be when the Board would recommend practices return to full service care observing office protection protocols.


The Board is not out driving around looking for practices that are not following the Board’s Advisories. As mentioned above, the Board’s single responsibility is that of public protection and as such we are mandated to respond and investigate complaints filed to our office.Seeing routine and non-urgent care prior to the Board's advisory to do so would likely only adversely impact you and your practice if someone were to file a complaint against you.

The state society will be emailing office safety protocols to all licensees today. The Board provided input into these protocols and would be happy to address any questions about them. If you have stayed open, likely you are already practicing with these protocols in place. If you are considering reopening, you will need to put these into place before doing so.

For the Board,

Bill

William B. Rafferty, O.D.

Executive Director

North Carolina State Board of Optometry

PO Box 69

Wallace, NC 28466

(910) 285-3160 or (800) 426-4457

Cell: (336) 816-3459

Fax: (910) 285-4546

exdir@ncoptometry.org

Board Communication #6

April 26, 2020

6th Advisory

COVID-19 Pandemic and Update


The Board has heard from several optometrists referencing the AOA’s recent announcement that the CDC is no longer recommending limiting routine eye care. I have also heard that a few North Carolina ODs mentioned on social media sites that this Monday they were resuming comprehensive care including routine exams based on the AOA’s announcement.

The Board thinks it important for you to understand the AOA’s statement and where the North Carolina Board stands on reopening practices for nonurgent and routine care and why.

If you read only the first half of the AOA’s first sentence on this announcement, it would be very misleading. The full announcement says, "The AOA has confirmed with Centers for Disease Control and Prevention (CDC) officials that the agency's March 17 nationwide recommendation to postpone routine eye care is no longer in effect, and that CMS's specific guidance on reopening facilities to provide nonemergent and non-COVID-19 health care is in force. Under this framework, state-by-state decisions will guide when and how doctors and practices can resume delivery of complete, comprehensive care."

Further, "the AOA recommends that clinical judgment and practice operations should be informed by the U.S. Centers for Medicare and Medicaid Services (CMS) reopening guidance of April 19 and the Opening Up America Again plan, as well as all state, state board and local health directives."

Now, looking at the CMS statement referred to in both of the AOA statements above:

CMS recognizes that at this time many areas have a low, or relatively low and stable incidence of COVID-19, and that it is important to be flexible and allow facilities to provide care for patients needing non-emergent, non-COVID-19 healthcare. In addition, as states and localities begin to stabilize, it is important to restart care that is currently being postponed, such as certain procedural care (surgeries and procedures), chronic disease care, and, ultimately, preventive care. Patients continue to have ongoing healthcare needs that are currently being deferred. Therefore, if states or regions have passed the Gating Criteria (symptoms, cases, and hospitals) announced on April 16, 2020, then they may proceed to Phase I.

Governor Cooper's April 23rd statement, extended North Carolina's Stay at Home Executive Order to May 8th. He said, "it is clear that we are flattening the curve, but our state is not ready to lift restrictions yet. We need more time to slow the spread of the virus before we can ease the social restrictions.”

In this statement Governor Cooper is referring to the fact that North Carolina has not met the gating criteria metrics that CMS references and is appropriate to initiate Phase 1 strategy of reopening. Additionally, if you look at the IHME site that I referenced in the Board’s 5th Advisory for comparison, they are sticking with May 11th to start "containment strategy."

The Board is aware several surrounding states have either started to reopen offices for nonurgent and routine care or have set early May dates to reopen. The Board and State Society are preparing a state-wide protocol to present to the Governor for his Phase 1 consideration. This protocol will include office disinfection products, hand sanitizer, and PPE to include standard face masks (N-95 when available), medical gloves and eye protection. Now is the time to secure these resources if you have not done so already.

I know most optometrists want to get back to full comprehensive care. And to remind you, all of the optometrists on the Board are practicing ODs and share that same sentiment. However, the Board will only act in a manner that conforms to the prevailing environment considering all relevant federal and state agencies and authorities. We are close to reopening and when the Board gets the word we will announce the date immediately. Additionally, the Board will soon be sending out specific requirements for offices to be prepared for reopening. Those offices who have stayed open for urgent and emergent care, have adopted most of these requirements.

Let’s be clear this virus is still with us and will be for some time. As I am sure you have heard, as we reopen our country, we will open to a “new normal.” Please try to understand and be patient.

For the Board,

Bill

William B. Rafferty, O.D.

Executive Director

PO Box 69

Wallace, NC 28466

(910) 285-3160

Cell: (336) 816-3459



Board Communication #5

April 20, 2020

5th Advisory

COVID-19 Pandemic and Update


The Board is receiving multiple inquiries regarding when it will give the go ahead for its licensees to return to seeing routine and nonurgent patients. (as well defined in Advisory #4.)


The answer to that question is that the Board will continue to follow the CDC and US Surgeon General’s Guidelines along with federal directives and state executive orders. Governor Cooper’s current “Stay at Home” Executive Order No. 121 remains in effect until April 29, 2020. There is a lot of discussion regarding when and how such Orders may be relaxed or withdrawn. President Trump has indicated these decisions will largely be determined by the governor of each state. The Board’s understanding is that the North Carolina General Assembly is working on a COVID-19 bill that will address “release” issues and would likely go into effect on or before the expiration of the current executive order #121.


Now, to help you understand what most likely will be the science behind these decisions, I will reference the “IHME website. This site is sponsored by Bill Gates and is widely used and quoted by scientists and federal agencies.


This site uses state by state data to predict the expected trend of COVID-19 morbidity and mortality. This model as of April 17, 2020 predicts that if North Carolina continues its current social distancing practices until infections minimized and containment implemented, after May 11, 2020 the following “Containment Strategy” could be implemented: “relaxing social distancing may be possible with containment strategies that include testing, contact isolation, and limiting gathering size.” To view this information, click on the link below.

(Containment Strategy Definition. “The beginning of this timeframe is determined by our estimate of when COVID-19 infections drop below 1 per 1 million people in a given location, and is also influenced by each location's available public health funding to implement new containment strategies. Infection rates are derived from our forecast of deaths.”)


http://www.healthdata.org/covid/updates

Click on “View the COVID-19 projections”

Then click on, “United States of America”

Scroll down and click on “North Carolina” and view the interactive graph.


There are several variables to consider regarding this model:

  • This like any other model can change as data changes (for the better or worse)
  • This model may not be used or may be used along with other strategies by those making the decisions (CDC and US Surgeon General Guidelines along with the federal directives and state executive orders)
  • Will resources be available to implement the “containment strategies” that include testing, contact tracking and isolation.
  • Medical practices including optometry regarding seeing routine and non urgent cases could be implemented using a totally different methodology than the “Containment Strategy” above. In any case, the following protocols should include:
    • Continue to follow rigorous screening protocols
      • Body temperature screening
      • Potential exposure
      • Change in or loss of taste or smell
      • Body chills, aches or pains
      • Shortness of breath
      • New onset or worsening cough
      • GI disturbances such as nausea or diarrhea
    • Social distancing, limiting patients in the office (some practices ask patients to wait in their car until called)
    • Office hygiene protocols (disinfection wipes, hand sanitizer, etc.)
    • Wearing PPE by optometrist and staff (start now by looking for resources for PPE to be prepared (primarily N95 masks and gloves, face shields could be considered) The North Carolina Optometric Society along with the AOA is researching possible resources.
    • Employment of protective shields/devices where possible to limit exposure


  • So, the Board, like you, is waiting to hear what the next step(s) will be going forward. We are communicating with other boards and government agencies and will let you know immediately when we have something to report and can provide guidance in implementation.


Again, as things now stand you are not required to keep your practice open or reopen your practice at any given time; you should make that decision based upon your individual circumstances. However, let me make it clear that you are required to take call for your practice and fulfill the needs of your patients that do not require examination or when appropriate, guide your patients in a manner where their needs can be addressed.


If you have remained open for urgent and emergent patient care needs as defined in Board Advisory #4 please stay safe, protect your patients, staff and yourself as defined above. For now, stay the course: if in your professional judgement, an exam can be postponed without threat to the patient’s vision or welfare, that remains the current directive.


Board Continuing Education Requirements


Earlier this year, the Board increased the allowed number of online CE to 8 hours (from 6).


In addition, COPE has modified their policy regarding live-interactive courses:

https://www.arbo.org/COPE_temporary_rules_modification.3.16.2020.pdf

CE courses would be considered "live" and eligible for certified credit.

To find courses available, you would go to the ARBO website and search "COPE Qualified Courses". Under "Format" select "online-inter". Please keep in mind, the type of credit (general or certified) is still determined by this Board's CE policy:

https://www.ncoptometry.org/board-policies/continuing-education.


Courses that are ACCME approved and are interactive, also meet the Board's CE requirements.


There are multiple courses currently available on-line that meet the Board’s CE requirements and more are being planned. Hopefully, this should help relieve concerns over meeting re-licensure requirements for 2021.


The Board will continue to monitor the pandemic situation and post updates to its website. In the meantime, if you have other questions or need information, please do not hesitate to contact this office.


For the Board,

Bill


William B. Rafferty, O.D.

Executive Director

PO Box 69

Wallace, NC 28466

(910) 285-3160

Cell: (336) 816-3459

Board Communication #4

NORTH CAROLINA STATE BOARD OF

EXAMINERS IN OPTOMETRY


03/31/2020

4th Advisory


Who would have imagined on New Year’s Eve as we welcomed in 2020, that only a few months later we would be hunkered down in our homes, our practices closed or open for only limited services. Our economy was booming and 2020 (20/20), in some way symbolized our excitement for the future. To say we are having to regroup and adjust is an understatement.


Some NC optometrists have expressed they would like additional clarification regarding the Board’s advice/directives provided during this COVID-19 pandemic and the current “Stay At Home” executive order. Other optometrists have complained that while they are following the CDC Guidelines and the Board’s directive, some of their colleagues are not, continuing to provide routine care. I am writing this fourth email to hopefully clear up any remaining confusion and to set the path for the next 30 days.


  • Optometry is considered “essential.” (Governor Cooper’s Executive Order No. 121 - Stay at Home Order - “eye care centers, including those that sell glasses and contact lenses” are considered essential.)


  • If you decide to keep your practice open to see urgent or emergent cases (defined below), you may do so. No one is suggesting you close your practice.
    • Remember to screen patients before they are seen in your practice. (Current screening questions include: body temperature, new onset or worsening cough, GI symptoms/diarrhea/nausea or shortness of breath.)
    • If a patient screens positive, the patient should be sent home and told to contact the patient’s PCP for advice and probable testing.
  • If you decide to close your practice, that is totally your prerogative. However, the Board expects that you will continue to take patient calls and make arrangements for those patients to be seen by someone who has not closed unless you can address their questions/needs by phone or telemedicine. It is not OK to say “Our practice is closed, go to your emergency room or another practice” unless you have made prior arrangements with that practice to see your patients.

  • The Board did not generate the terms routine, urgent, or emergent. Rather, they were terms provided to us from federal and state government and used by our national organizations. So, I will continue to use these terms but think I can explain them in a manner that hopefully clears any confusion. (Please forget any formal dictionary definitions, etc.)
    • Routine – bread and butter optometry – vision care – glasses and contact lens exams – periodic rechecks for conditions that are not vision threatening – conditions that can be postponed without threat to the patient’s vision or welfare. The CDC guidelines remain in place and that means routine patient should not be seen.
    • Emergent – obvious conditions that require treatment or evaluation to rule out vision threatening conditions
    • Urgent – in your professional judgement, if you think a patient needs to be seen, then see that patient. If you think putting off their appointment for weeks or months could lead to issues, then see the patient.
      • If a -2.00 D breaks his or her glasses and can’t drive and needs to drive, repair the glasses or order a new pair.
      • If you have concern from your last visit, a glaucoma patient is not under control or concern for a diabetic patient that had retinopathy that could be progressive, then see the patient.
      • Clear and simple, do what you think is in the best interest of the patient, considering risks to benefits. As doctors, we make these decisions on a daily basis, this is no different!


  • President Trump (3/30/2020) and Governor Cooper (effective 3/30/2020), formally extended the “Stay at Home” and social distancing guidelines for 30 more days, essentially through the end of April. Therefore, continue following the CDC Guidelines by postponing and rescheduling routine patients, through the end of April. Following these Guidelines can help make a difference and curb the spread of this disease.


  • The optometry members of the Board; Drs. Philippe, Johnson, Ellington, Haines, and Sikes as well as myself are all practicing and are going through this trying time with you. So, when I say, we are all in this together, I mean just that. Stay safe, protect yourself, your family and your patients.


  • A famous Dalai Lama saying: “There is no benefit in worrying whatsoever.” Something to at least keep in mind.


Thank you,


Bill

William B. Rafferty, O.D., Executive Director

North Carolina Board of Optometry

PO Box 69

Wallace, NC 28466-2713

(910) 285-3160

info@ncoptometry.org



Board Communication #3

COVID-19 Board Communication #3

Board Communication #2

To: All North Carolina Licensed Optometrists

From: North Carolina State Board of Examiners in Optometry

Date: March 19, 2020

Subject: COVID-19 Advisory Following 3/18/2020 Announcement


The Board released its announcement regarding COVID-19 on 3/18/2020 (below). This announcement included the Centers for Disease Control and Prevention (CDC) recommendations that were released on 3/17/2020.

One of these CDC recommendations specifically states, "postpone routine dental and eye care visits". It is obvious that this recommendation is specifically directed to dentists, optometrists, and ophthalmologists.

Since the Board's announcement, the Board has received multiple questions asking if the Board is mandating that optometrists follow the CDC recommendations. Optometrists are also reporting that while they are following these recommendations, other optometrists in their communities are not.

The CDC recommendations are issued as a result of a world-wide crisis the likes (and potential ramifications) of which are unprecedented. Strong measures and a level of sacrifice clearly are called for on the part of our licensees in order for optometry to do its part in bringing this pandemic under control.

If the Board is called on to decide whether one of its licensees has acted appropriately under these circumstances, compliance with CDC guidelines and other prudent measures may well be the yardstick the Board uses in determining whether there has been a breach of the standard of care or whether unprofessional conduct has occurred.


Additionally, it is possible that those involved in any adverse event---patient, patient’s family member or caregiver, or even the optometrist’s professional staff---might well use an optometrist’s failure to comply with CDC guidelines as presumptive evidence of negligence in litigation against the optometrist.

The government is asking for all to practice social distancing, etc. for a minimum of 15 days. The Board strongly advises following the CDC recommendations.


With questions or concerns, please feel free to contact me by phone or email at the information below.


William Rafferty, O.D., Executive Director

North Carolina State Board of Examiners in Optometry

PO Box 69

Wallace, NC 28466

(910) 285-3160

(800) 426-4457

Fax: (910) 285-4546

https://www.ncoptometry.org

Board Communication #1

NCSBEO COVID-19