DeSantis decision delivers historic win for Florida optometrists and patients

When Florida Gov. Ron DeSantis vetoed SB 230 nearly a week ago, it was a victory for the thousands of practicing doctors of optometry and the public in the state.

And it ended, at least for now, a renewed attack backed by ophthalmology extremists and allied groups aiming to block growing momentum in state legislatures to further expand optometry’s role in the delivery of essential health care services.

“We are very relieved and very grateful that the governor saw the discriminatory language for what it was, vetoed the bill and protected the profession of optometry,” says Mark Marciano, O.D., president of the Florida Optometric Association (FOA). “We executed our plan to the best of our abilities and are grateful we got the bill vetoed.

“We felt good about it,” Dr. Marciano says, noting the thousands and thousands of calls, emails and letters sent to the governor’s office in support of doctors of optometry and against the bill there. “But you never know. You never know what somebody is going to do.”

The AOA issued a statement in support of the veto.

“Gov. DeSantis’ decisive action today is a powerful message of support for and recognition of optometry’s essential and expanding role in health care,” AOA President Ronald L. Benner, O.D., said. “The FOA fought and prevailed in a challenging battle and did so by remaining confident in the knowledge that truth, fairness and the needs of patients across the Sunshine State would prevail. I’m proud to say thank you to Gov. DeSantis, the FOA and colleagues from across the country who helped ensure that our profession was heard loud and clear.” 

The statement added that the AOA is prepared to take any and all necessary steps up to and including legal action against any effort to discriminate against the profession of optometry or to infringe on optometry’s essential and expanding role in health care.

About SB 230

In its original form, the bill addressed health care practitioners’ titles and abbreviations used in their advertisements, communications and personal identification. It requires health care practitioners to identify themselves in a specific manner, disclosing the type of license under which an individual practitioner is authorized to provide services and the title and abbreviations specified by the bill when treating patients, and further, it states the grounds for disciplinary action, which include a felony charge punishable by a $10,000 fine per occurrence and denial of licensure by practitioners’ regulatory boards. “Only physicians may include titles and abbreviations or medical specialties in their advertisements,” it reads.

The bill does not specifically reference optometry, but there is concern that the restrictions on titles could later be used to attack the qualifications of doctors of optometry, in particular those who specialize in certain areas of optometry. In addition, the proposed ban on the use of the term “physician” in any capacity potentially conflicts with the recognition of physician status for optometrists under federal law.

Doctors of optometry have long been recognized by federal agencies as physicians. The Centers for Medicare & Medicaid did so in 1986. They also are referred to as physicians under Federal Employees Workers Compensation, as they are at rural health clinics and federally qualified health centers.

Despite that recognition, organized medicine and ophthalmology have opposed expansion of scope to doctors of optometry. Since January, for instance, a scattering of targeted states have seen “not-a-doctor” legislation pop up, including Connecticut, California, Massachusetts, Texas, Wisconsin, North Carolina and Florida.

The bills are reminiscent of the American Medical Association’s (AMA’s) years-old campaign to build support for the “Sullivan Bill,” which was rejected in successive sessions of Congress. According to the AOA’s analysis, there are indications that the AMA also is resurfacing its “truth in advertising” campaign, which the AOA successfully challenged.

Most of the recent bills have been stymied by the valiant efforts of doctors’ state optometric associations. Anti-optometry language has been stripped out or a bill’s progress stalled in committee.

On June 1, doctors of optometry received a notification from the California Optometric Association, titled “Doctor title bill temporarily defeated.”

“Several states have introduced legislation to limit the use of the term ‘doctor’ or ‘physician,” the notification read. “The California bill came under heavy opposition from several provider organizations and didn't pass the Assembly Appropriations Committee. However, it can be heard again next year. AB 765 would make it a misdemeanor for a person who does not have a MD license to use any term implying that the person is a licensed physician, including the word ‘doctor’ or ‘physician.’” 

“The California Optometric Association (COA) opposed the bill and secured amendments that make clear an optometrist can still use the term ‘doctor,’” it added. “The amendments also allow an optometrist to make ‘any truthful statement that they specialize in a service or field that is within their licensed scope of practice.’ COA remains opposed because we are seeking additional clarifying amendments to make certain an optometrist in California will continue to be able to use all terms in use now. The bill includes vague language, and we are concerned how it will be interpreted.”

In Florida, a battle over its bill had continued to brew. In response, the FOA has been mobilizing doctors, optometry students, staff and concerned patients and fought back with equal intensity.

Plan of attack

The FOA quickly mobilized to respond to the bill; the attack had not been unexpected. Asked to what the FOA owed its success, Dr. Marciano says “There were a number of factors that came into play.”

Among them:

• Knowing the key players. “We were well aware of the Senate president’s agenda early on, so we were able to prepare for it and try to educate our doctors,” Dr. Marciano says. “Our legislative chair, Dr. Ken Lawson, has been engaged with the Florida legislators and our lobbying team for over a decade. His intimate knowledge of those in a leadership position in the Florida Senate and House was invaluable in allowing us to prepare for what ultimately became SB 230.”
• Being strategic at every turn. Dr. Marciano notes that the FOA had anticipated her “ramming” the legislation through the senate. “And she did. So, we really focused our energy on the House. We worked on the grassroots early on to make sure House members knew it was not good public policy and that the discrimination against optometry was blatant and uncalled for. By doing that, we were able to get House members to change the bill and, in doing so, it forced the bill to extend all the way to the second to last day of the legislative session.”
• Engaging the grassroots. They were preparing for every contingency. Getting the bill to the last week allowed the FOA to really work on the approach to their veto. It gave the FOA time to continue educating its doctors, refining its messages and encouraging the grassroots—to call or email. “Our doctors in the state of Florida responded in such a positive way. Our doctors understood the issue. They understood and believed in the leadership’s message and strategy. They called every single day. We literally had thousands of contacts (calls and emails) with the governor asking him to veto (between the time the bill passed out of the Senate and landed on the governor’s desk). That was a ton.”

Their campaign against the legislation garnered tremendous support. Doctors, in state and out of state, donated thousands of dollars and contacted the governor’s office, and almost every AOA state affiliate had reached out as did the AOA.

“Many local ophthalmologists wrote letters, called and emailed the governor’s office in opposition to the bill, even though organized medicine and the Florida Society of Ophthalmology were supportive of the bill,” he says. “That was a good thing for us.”

Their efforts paid off, though not without great effort expended:

“The emotion was very raw,” Dr. Marciano says. “People were frustrated, upset and were downright scared, as was I. You could have lost your ability to call yourself a physician. You don’t know how that impacts patient access, insurance reimbursements et cetera and future initiatives to grow a practice.”

According to Carl Spear, O.D., MBA, an active FOA legislative keyperson and Essilor Luxottica senior vice president for eyecare, the FOA has been aggressively laying the groundwork for strong grassroots advocacy in Florida for years. “Led by FOA Legislative Chair, Kenneth Lawson, O.D., doctors of optometry from across the state have been preparing for this threat—and any attack—for years,” Dr. Spear says. “The FOA Legislative team and the FOA leadership met with Gov. DeSantis multiple times, even before he was elected, to ensure that he understood the critical role optometry plays in the health and welfare of the citizens of Florida. In early 2023, we doubled down on our efforts as we got word that the bill was being proposed in the state legislature in Tallahassee. The FOA’s and all of optometry’s ultimate victory was the result of clear-headed planning and a full strategic mobilization of doctors, patients and industry partners, all rooted in years and years of doing the hard advocacy work. I want to extend a special thanks to FOA President Mark Marciano and the FOA Board of Trustees, and all colleagues across Florida and around the country who supported the effort to defeat this legislation. We also learned who our true industry partners were in their support and recognition from the beginning that this was a battle our profession needed to win.”   

What’s next?

The past several weeks had been an emotional rollercoaster ride for FOA members. When the FOA’s board got word of the governor’s veto, Dr. Marciano recalled a bundle of emotions in the moment—there was relief, exuberance and exhaustion “because you’d worked so hard for something for so long and then you win and you’re like, ‘wow we actually did it, despite all the odds.’ Fortunately, it worked out. I guess when you love something enough and you work hard enough at something, it means more.”

That’s the thrill and now there is the reality. Dr. Marciano will end his tenure as president of the FOA this July and Peter Santisi, O.D., will step up as its next president.

There are about 4,000 doctors of optometry in Florida, with about 3,300 actively practicing in the state.

 “We don’t expect this will be the end of these efforts,” Dr. Marciano says. “Dr. Santisi has been a close partner through all of this, as has the entire board. He is well prepared to work with Dr. Lawson and our legislative team and will carry forward the positive message of what optometry can provide our residents.”

“I think this is one of those wake-up calls that brought us together as a profession,” Dr. Marciano says. “I think we all get lulled into a sense of calm and complacency, so membership drops off a little bit and commitment to our PACs drops off a little bit. But every once in a while, you get a slap in the face, and it wakes you up.

“This issue certainly slapped us in the face and woke up a lot of people,” he says. “We now have support growing for our initiatives. We really hope the next generation of optometrists sees that our profession may never be safe; that we may always have to fend off these attacks. But the people and our patients see the value in optometry and hopefully, we will be able to parlay this into a stronger membership and a better future.”