‘Enough is Enough’
Thank you for the coverage Review of Optometry has done over the years of the Puerto Rico TPA issue.

Osvaldo A. Negrón, O.D., and Rafael Toro Landron, O.D., are each relocating outside of Puerto Rico in order to practice with TPA privileges.

As you know, I dedicated most of my career to enhance the profession of optometry in Puerto Rico. [Editor’s note: Dr. Negrón began a nationwide petition that called for therapeutic privileges for optometrists in Puerto Rico. The petition has garnered more than 1,400 electronic signatures.]

But you may not be familiar with the story of Dr. Rafael Toro Landron, who has been on the front lines of the fight as well. Dr. Toro Landron was elected president-elect of the Colegio de Optometras de Puerto Rico. But as an Army Reserve optometrist, he is now obligated to seek a TPA license from another U.S. jurisdiction to keep his commission. [Editor’s note: The U.S. military now requires all optometrists who work in military treatment facilities to have therapeutic prescriptive authority.]

In other words, after 15 years as an optometrist in Puerto Rico, Dr. Toro Landron is obligated by an archaic Puerto Rico practice law to seek a practice license outside of Puerto Rico to continue his military career.

Dr. Toro Landron’s unit is in Puerto Rico and is now scheduled to deploy to Afghanistan this December. If he were able to stay in Puerto Rico after his deployment, he would become the president of our association in 2014.

For my part, after 18 years of practice in Puerto Rico, I decided to relocate to Maryland in a quest to practice perhaps the last years of my career under a system that appreciates and recognizes our preparation and clinical skills as doctors of optometry.

As I’m now close to Washington, D.C., I am committed to continue the fight for TPAs for Puerto Rico. At this time, Dr. Toro Landron is considering relocating also to the mainland after his Afghanistan tour. Both of us love our profession and have dedicated many years trying to enhance the practice of it in Puerto Rico. But in the end, we decided that “enough is enough” and that we need to continue the fight outside of Puerto Rico.

—Osvaldo A. Negrón, O.D.
Baltimore

Give Patients Respect
Having respect for people is paramount in forming relationships, and this includes the bond between health care providers and their patients. Our patients treat us with utmost courtesy and hold us in high regard. After all, we hold the keys to diagnosing and treating their problems.

Sight Gags by Scott Lee, O.D.

One of the ways we show respect is how we address each other. Patients being treated in examination rooms typically address their health care provider by calling them “Dr. Smith,” and the doctor will do what is comfortable for both when in private with the patient.

In many offices’ greeting and waiting areas, patients are called by their first names, many times at a first visit. Typically, a patient will sign in, or be greeted and told to have a seat. After that, a staff member will enter the waiting area and call a patient by his/her first name to escort them to an examination room. The same thing happens in laboratory testing offices.

When asked why they call patients by their first names, staff members usually respond that it’s because of “privacy issues” or “HIPAA,” thinking that the Health Insurance Portability and Accountability Act’s Privacy Rule requires that patients be addressed by their first names. Nothing could be further from the truth. HIPAA requires that we implement reasonable safeguards and the minimum necessary standard to prevent medical information from being communicated and does not prevent us from addressing patients in a polite and respectful manner.

This is from the U.S. Department of Health and Human Services website:
“May physicians’ offices use patient sign-in sheets or call out the names of their patients in their waiting rooms? Yes. Covered entities, such as physicians’ offices, may use patient sign-in sheets or call out patient names in waiting rooms, so long as the information disclosed is appropriately limited. The HIPAA Privacy Rule explicitly permits the incidental disclosures that may result from this practice; for example, when other patients in a waiting room hear the identity of the person whose name is called, or see other patient names on a sign-in sheet. However, these incidental disclosures are permitted only when the covered entity has implemented reasonable safeguards and the minimum necessary standard, where appropriate. For example, the sign-in sheet may not display medical information that is not necessary for the purpose of signing in (e.g., the medical problem for which the patient is seeing the physician).”

Our patients choose us as their health care providers because they trust and respect us. They are often anxious when visiting us. We owe them the excellent customer service they deserve by addressing them in a respectful and courteous manner.

—Errol Daniels, O.D.
Buffalo, N.Y.

For the Record

In September’s article, “Lawsuit Ends: Judge Rules Against ‘Falsity’ of Board Certification,” Dr. Art Epstein’s affiliation with the American Optometric Society was incorrectly stated. Although Dr. Epstein resigned from the AOS board (to avoid possible conflicts with his role with the American Board of Clinical Optometry), he continues to be an AOS member. Review regrets the error.