State lawmakers are scheduled to vote Thursday on whether to repeal education rules for ophthalmologists that mention diversity training and whether to rewrite the licensing rules for Wisconsin’s newest licensed profession.
The Legislature’s Joint Committee on Review of Administrative Regulations (JCRAR) will vote on paper ballots without meeting.
Both rules submitted to the committee were submitted by the Department of Safety and Professional Services (DSPS), which oversees professional licenses and licensing boards.
The voting motion presented to JCRAR members on Thursday is to “indefinitely oppose” rules that would revise continuing education requirements for optometrists, health care professionals licensed to provide basic vision care, including testing people’s eyesight and prescribing corrective lenses and other treatments.
Optometrists must complete 30 hours of approved continuing education every two years. In March, the state Board of Optometry proposed revised rules. (CR-23-040) This allows for one hour of “cultural competency or diversity training” out of the 30 hours, but does not require it.
The opposition cites that provision.
In testimony submitted at a Assembly Health Committee hearing on the rule in May, Mike Tierney, legislative liaison for DSPS, said it is essential for health professionals to “know about a patient’s culture, religion, traditions, beliefs, and ancestry in order to identify patients who are at risk for or suffering from a genetic disease, identify issues and potential underlying causes, and make appropriate treatment decisions or referrals to genetic counselors or other health professionals.”
Genetic differences can mean medical problems affect people from different ethnic groups differently, while religious and cultural differences also “influence how people respond to proposed treatment courses”, Tierney added.
He said the Optometry Board initially intended to make cultural competency training mandatory but decided to make it optional instead.
“Literally everything the Board is doing in this rule [is] “For optometrists who want to be at the top of their profession and provide the best possible patient care, taking the course signals that it matters,” Tierney testified.
The revised rules would also require optometrists to complete one hour of training every two years on responsible prescribing of controlled substances, and would add an exemption to this requirement for optometrists who do not have a federal license to prescribe controlled substances.
Current optometric continuing education regulations have no training requirement for prescribing controlled substances. The two-hour training requirement began in December 2019 and expired two years later in December 2021.
Tierney testified that of the 1,286 optometrists practicing in Wisconsin, only 184 are licensed to prescribe medications. Licensed physicians rarely prescribe controlled substances, Tierney said. For those physicians who are not licensed to prescribe medications, the change “eliminates the requirement for them to undergo completely unnecessary continuing education on prescribing practices.”
The only speaker at the May 22 hearing was Cicero Action, the lobbying arm of the right-leaning Texas policy group Cicero Institute. In written testimony, the group said “cultural competency” and “diversity training” are “highly loaded ideological terms” and “divisive concepts” that the state should not include in its optometrist training standards.
After the hearing, Republicans on the Assembly Health Committee passed a motion to oppose the rule changes. All of the committee’s Democrats voted against them.
“Continuing education should focus on improving practitioner skills and knowledge, not training on political diversity, equity and inclusion,” Rep. Clint Moses (R-Menomonie), chairman of the House Health Committee, said in a letter circulated Wednesday along with a motion to suspend JCRAR’s new rules.
Moses also wrote that the cuts to training on prescribing controlled substances “demonstrates that DSPS is not taking the opioid abuse problem seriously.”
Cameron O’Connell, a legislative staffer for Moses, said in a phone interview Wednesday that Moses isn’t opposed to training that directly educates people about ethnic differences in health risks and treatment, but he doesn’t think the training mandated in the rule is relevant to the skills needed for health care workers.
Licensed Naturopathic Doctor
The other rule to be voted on by the Administrative Rules Committee on Thursday concerns a newly created license for naturopathic doctors, with Wisconsin creating one for the first time during the 2021-22 legislative session.
The proposed licensing rules are: CR 23-074 states that applicants in 10 different circumstances may be required to take an oral examination during the application process.
The JCRAR motion cites as a ground for objection the situation in which the applicant “has been convicted of a crime substantially related to the practice of naturopathic medicine.”
Mike Mikalsen, chief of staff to Sen. Steve Nass (R-Whitewater), co-chair of the Administrative Rules Committee, said Nass and co-chair Rep. Adam Neylon (R-Pewaukee) oppose the oral exam, saying it goes beyond what state law requires.
The state Code of Administrative Regulation requires the same oral examination process. State medical licensing regulations But for over 20 years.
The framework set out in the naturopathic physician licensing rules follows that of medical licensing rules, Tierney said in a June 11 memo to Nass’ office, a copy of which was obtained by the Wisconsin Examiner through a public records request.
“The provisions referenced are not new provisions but are provisions that have been used by other technical committees to carry out legislative intent,” Tierney wrote.
Under a law enacted in 2018 under former Gov. Scott Walker, when a license applicant has been convicted of a crime, DSPS must investigate whether the crime was substantially related to the occupation and whether the applicant has demonstrated sufficient rehabilitation to be granted a license. The oral exam is part of that analysis, Tierney wrote.
State records also show no indication that anyone challenged the oral exam language during the public hearings or comment period on the naturopathic rule or the emergency rule that preceded it.
The motion calls for the new Naturopathic Medical Examining Board to change licensing rules. by Friday afternoon, though it may be difficult for the board to meet that deadline given the time required to notify a public meeting.
Sen. Kelda Royce, D-Madison, said Wednesday that Democrats on the committee had not been informed of the complaints raised by the co-chairs and had not had a chance to discuss the issues before a vote scheduled for Thursday.
Royce also said opposition to the cultural competency clause in the optometric continuing education rules shows a “fundamental misunderstanding of what cultural competency is.”
The aim, she argued, is to ensure that all patients from diverse backgrounds are represented, “to make sure people get what they need, especially in settings like healthcare and optometry.”
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