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JAMA study shows research not on optometrists’ side in Eyeball Wars

As Florida’s “Eyeball Wars” start up again, research in the Journal of the American Medical Association gives new insight on what is at stake in the struggle between ophthalmologists and optometrists.

In October 2016, a team of medical professionals, mostly from the University of Michigan, issued a report examining the difference in treatment outcomes between optometrists and ophthalmologists in Oklahoma. Since 1998, both types of practitioners in Oklahoma have been allowed surgical privileges to perform laser trabeculoplasty (LTP).

Laser trabeculoplasty is a procedure where doctors use lasers to treat certain types of glaucoma by burning areas of the trabecular meshwork, located near the base of the iris, to increase fluid flow.

Through a health care claim database of Medicare enrollees with glaucoma, the study examined patients undergoing the procedure from Jan. 1, 2008, through Dec. 31, 2013 – covering nearly 1,400 eyeballs.

For optometrists, the results are less than encouraging.

After accounting for potentially “confounding factors,” the report finds that eyes receiving LTP by optometrists had a 189 percent greater hazard for a follow-up procedure in the same eye, as opposed to those LTPs by an ophthalmologist.

For Florida, a state with a much higher population than Oklahoma, more than double the risk to the eye may not be a risk worth taking.

“Considerable differences exist among the proportions of patients requiring additional LTPs, comparing those who were initially treated by ophthalmologists with those initially treated by optometrists,” the report says.

In conclusion, the study offers an ominous warning: “Health policy makers should be cautious about approving laser privileges for optometrists practicing in other states until the reasons for these differences are better understood.”

In the case of the Eyeball Wars, the suggestion is far from insignificant, since the authors note that “recently, optometrists have been lobbying state legislatures for expanded privileges so they may perform LTP.”

As FloridaPolitics.com noted in November, optometrists have indeed begun lobbying up for the upcoming Legislative Session, reheating a debate that, by all accounts, was settled nearly four years ago.

After years of lobbying and struggles between optometrists and ophthalmologists over authority to prescribe certain medications and medical procedures, a compromise was reached in 2013.

HB 239 allowed optometrists to prescribe a specific and limited number of oral medications, under certain conditions. However, it also expressly prohibited them from performing surgery. Optometrists are required to carry the same level of malpractice coverage as medical doctors; they cannot prescribe Schedule I and II controlled substances and must refer patients with severe glaucoma within 72 hours to an ophthalmologist.

At the time, then-Senate President Don Gaetz praised the truce. The “Eyeball Wars have ended,” the Niceville Republican proclaimed.

Not so fast.

As FloridaPolitics.com reported in August, the Florida Optometric Association — as well as several associated organizations – have given more than $2.1 million to committees and candidates statewide.

And facing a clear difference in treatment outcomes there is little surprise that optometrists have taken on lobbyists at a rate four times that of ophthalmologists. As the JAMA article shows, optometrists will more than likely have an uphill battle.

Optometrists are gearing up for a return to the Eyeball Wars, a war where scientific research is not on their side.

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Florida Democrats to propose “The Helen Gordon Davis Fair Pay Act” aimed at closing gender pay gap

House Democratic Leader Janet Cruz and two of her colleagues have filed the Helen Gordon Davis Fair Pay Act, aimed at closing the gender pay gap in Florida.

Lantana Democrat Lori Berman is co-filing the legislation with Cruz in the House (HB 319), and Orlando Democrat Linda Stewart is filing the bill in the Senate (SB 410).

“It is unconscionable that in America today women continue to be paid less for the same amount of work as men,” declared Cruz in a statement issued on Friday. “Our nation was founded on the ideal that all of us are created equal and that ought to hold in all facets of our lives. Paying people fairly for the work they do shouldn’t depend on their gender, but rather on the quality of their work.”

The Democratic lawmakers say the two bills delineate which reasons that employers can use to pay employees differently, such as based on education, skill-set and experience. They say that by clarifying those reasons, employers can avoid litigation and be clear about which attributes are valued.

The bills would also bar employers from inquiring about or screening employees based on their prior salary history, and it would also increase civil penalties for a violation.

“While I feel this legislation should be unnecessary, the reality is that in 2017 women are still not earning the same pay as men in the same position,” said Berman.”Paying women equally is good for the economy and good for business. It is simply a no-brainer and I invite my colleagues on both sides of the aisle to write this into statute once and for all.”

“Those groups most affected by this – the single mother; a family stricken by illness or unemployment or tragedy that relies on a female breadwinner; those Floridians whose gender identity isn’t even recognized anywhere in our state laws; they deserve policies and protections that reflect the reality of their everyday existence. That’s why we need this bill. That’s why we were elected to serve,” said Stewart.

Helen Gordon Davis was a Tampa icon who passed away last May at the age of 88. She was the first woman from Hillsborough County elected to serve in the Florida Legislature back in 1974. She  was reelected for six consecutive terms and, in 1988, was elected to the Florida Senate. Her political career ended in 1992 when she lost that state Senate seat that comprised parts of Hillsborough and Pinellas County to Charlie Crist.

According to the American Association of University Women (AAUW) of Florida, over a lifetime of work (47 years), the total estimated loss of earnings of women compared with men is $700,000 for a high school graduate, $1.2 million for a college graduate and $2 million for a professional school graduate.

The odds of the bill passing in the Legislature would appear to be slim, as Cruz has offered it up in previous sessions without much success.

The three Democrats will speak about their bill next Tuesday at a press conference in Tallahassee.

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Latest on the legislative staffing merry-go-round

With a tip of the hat to LobbyTools, here are the latest movements – both on and off – of the legislative merry-go-round.

On and off: Charles Smith, previously district secretary for Broward County Republican Rep. George Moraitis, is now his legislative assistant.

On: Dennis Ragosta is the new district secretary for Ocala Republican Rep. Charlie Stone.

On: Mikhail Scott has become the legislative assistant for Miami-Dade Democratic Rep. Kionne McGhee.

On: Nancy Bowers a new district secretary for The Villages Republican Rep. Don Hahnfeldt.

On: Rebecca Zizzo is district secretary for House Speaker Richard Corcoran.

On: Jack Harrington is the new legislative assistant for Miami-Dade Republican Rep. Michael Bileca.

Off: Janine Kiray is no longer legislative assistant to Clearwater Republican Rep. Chris Latvala.

Off: Constance Baker has stepped down as district secretary for Jacksonville Democratic Rep. Kim Daniels.

On: Leota Wilkinson is district secretary for Palatka Republican Rep. Bobby Payne.

Off and on: John Love is no longer House administrative assistant for the Joint Select Committee on Collective Bargaining. Lisa Larson has replaced Love.

On and off: Lindsey Locke is the new House administrative assistant for the Joint Committee on Public Counsel Oversight. Locke replaced Michelle McCloskey.

On and off: Patricia Gosney is the new legislative assistant in the Tallahassee office of Broward Democratic Sen. Lauren Book. Joel Ramos has stepped down.

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FanDuel calls on Florida fans to support fantasy sports

FanDuel, the national fantasy sports website, has sent a “call to action” email to its Florida users, asking them to contact lawmakers in support of their hobby.

“With the Big Game just around the corner, we have an important message to share with every Florida fantasy sports player,” the email says.

“A new bill has been introduced that would update Florida’s laws to recognize what we all know to be true—that fantasy sports are games of skill and should be kept legal for all eligible Floridians to enjoy,” it says.

A Senate committee on Wednesday is set to discuss a major gambling overhaul bill (SB 8) that, among other things, would expressly legalize fantasy sports play.

“The fact is that current laws have not kept pace with technology,” the FanDuel email says. “Unless legislators are willing to deny millions of Floridians the right to play America’s newest national pastime, they must act quickly to update the law by passing legislation that protects your right to play.”

A 2006 federal law banned online gambling but specifically exempted fantasy sports.

In Florida, however, a 1991 opinion by then-Attorney General Bob Butterworth says “operation of a fantasy sports league” violates state gambling law. Such opinions don’t have the force of law, but can be used to persuade judges.

The FanDuel email includes a link to a site where users can send a message to their state legislators to urge them to vote for this year’s bill.

Florida struggled with fantasy sports last legislative session, ultimately letting die a measure that would have explicitly legalized online fantasy play.

FanDuel and its rival, DraftKings, agreed late last year to merge amid increasing regulatory scrutiny. The merger requires federal approval.

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Richard Corcoran: House won’t OK legal money for DEP

House Speaker Richard Corcoran late Monday said his chamber won’t agree to hand over any more money for the Department of Environmental Protection to pay its legal bills until the agency gives a full accounting of what’s already been spent.

Corcoran was reacting to the DEP’s request to the Joint Legislative Budget Commission for an additional $13 million to pay outside legal counsel in an ongoing court fight between Georgia and Florida over water use. (Earlier story here.)

The commission is scheduled to take up the request Tuesday.

Coincidentally, DEP Secretary Jon Steverson resigned Friday and is going to work for one of the law firms, Foley & Lardner, that’s representing the state in the matter. Steverson is an attorney.

“We won’t approve the money until an audit is done and we will pass legislation barring the revolving door from agency head to lobbyist/lawyer,” Corcoran said in a statement.

The Joint Legislative Budget Commission acts as a joint committee of the Legislature, charged with reviewing and approving the equivalent of mid-course corrections to the current year’s state spending plan.

It’s made up of seven members of the state House and seven of the Senate. Of those House members, five belong to the House’s controlling Republican caucus, including commission co-chair Carlos Trujillo, who also heads the House Appropriations committee.

Earlier Monday, Trujillo told FloridaPolitics.com he would “need additional information before we can even consider approval,” noting the state will have dedicated over $100 million to legal and related fees in the water use case if the latest dollars are OK’d.

The nearly two-decade dispute centers around upstream water use from the Chattahoochee and Flint rivers in Georgia. They meet at the Florida border to form the Apalachicola River, which empties into the Apalachicola Bay.

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Tampon tax exemption clears Senate committee

Members of the Senate Committee on Commerce and Tourism couldn’t resist hazing Sen. Kathleen Passidomo before approving her bill to exempt female sanitary products from the sales tax.

“I think this is Sen. Passidomo’s first bill” as a member of the committee, Sen. Jack Latvala said of his colleague, a Naples Republican elected to the Senate last year following service in the House. “What an interesting bill this is!”

He asked what SB 176 — her tampon tax exemption — would cost state government.

About $15 million annually, Passidomo said.

Latvala: “Would that be an annual figure or a monthly figure?”

Passidomo: “Let me look at my pad and see if I can calculate that.”

Latvala: “Does the committee attorney, can they offer an opinion as to whether there’s any conflicts of interest from any members of the committee voting on this? We can’t vote on things where we have a personal financial impact.”

Passidomo, cracking up laughing: “I can answer that for me. It wouldn’t affect me at all.”

“I believe we’ve exhausted those questions,” chairman Bill Montford said at that point.

The committee voted, 8-0, in favor of the bill.

The panel also voted unanimously in favor of SB 68 by Sen. Denise Grimsley, which would clarify that tourist development tax dollars may flow to facilities, like Clearwater’s Eckerd Hall, that are publicly owned but managed by nonprofit organizations.

Existing law allows tourism tax money to be spent only on convention centers, sports stadiums or arenas, or coliseums that are publicly owned and operated.

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Bill to expand juvenile civil citations raises questions on officer discretion

A bill to set up a civil citation program for juveniles statewide advanced Monday through a Florida Senate committee.

However, questions about removing officer discretion may need to be addressed before the proposal gets widespread support from lawmakers later this Session.

Miami Republican Senator Anitere Flores’ bill (SB 196) would mandate law enforcement officers to offer a civil citation for youths admitting to one of 11 separate misdemeanors: possession of alcohol beverages; battery; criminal mischief; trespassing; theft; retail and farm theft; riots; disorderly conduct; possession of cannabis or controlled substances; possession, manufacture, delivery, transportation, advertisement or retail sale of drug paraphernalia and resisting an officer without violence.

Flores introduce the bill to the Senate Committee on Criminal Justice Monday.

“The reason why I find this bill to be very important is that it brings uniformity to the Civil Citation Program,” Flores said, “so that ability to get a second chance doesn’t depend on where you live or what the color of your skin is, and that it just be something that in the state of Florida we prioritize for all members of our state.”

Although civil citations are already an option for all law enforcement agencies to write up, there is a huge discrepancy in the percentages of actual use among various police and sheriff departments.

For example, in the most recent fiscal year, Pinellas County used civil citations 94 percent of the time they were available. However, across the bay, Sheriff David Gee’s agency in Hillsborough used them only 34 percent of the time.

Currently, Florida law states that law enforcement officers may issue a civil citation. Flores bill would make civil citations a requirement for law enforcement in particular cases.

Although each person in the seven-member committee indicated general support for the bill, some resistance came from St. Petersburg Republican Jeff Brandes, who said that while 94 percent of Pinellas County Sheriff Deputies did write up civil citations, 6 percent believed placing the juvenile under arrest was the best thing to do.

“Why shouldn’t they be allowed to exercise their discretion?” he asked.

Barney Bishop, with the Florida Smart Justice Alliance, said he had been advocating such a bill since his time with Associated Industries of Florida. Nevertheless, Bishop said he had several issues with the bill as currently written.

Like Brandes, Bishop said law enforcement should not be mandated to issue civil citations; he instead suggested incentivizing police chiefs and sheriffs to create department policies to encourage the maximum use of civil citations.

Bishop also disputed the staff summary of the bill saying it will have no fiscal impact. Small counties like Taylor or Washington — ones which currently do not have any civil citation programs in place — must spend money to create such a program, he said.

Bishop then suggested small counties could work together, or with a nonprofit agency, to come up with their own program.

While Flores’ bill would only mandate a civil citation for first-time offenses, Pinellas County Sheriff Bob Gualtieri said, currently, there is no statewide database system to allow his deputies to know if a youth found guilty of one of the offenses listed in the legislation hadn’t already received such a citation in a different county.

And though Flores emphasized that the misdemeanors requiring the offer of a civil citation were all nonviolent, Fernandina Beach Republican Aaron Bean questioned the inclusion of battery on the list.

“Battery stands out. That one might be an issue,” Flores admitted, adding that part of the problem is how expansive its definition is, including unwanted touching.

“I’m open to suggestions on how we walk that line,” she said.

The bill passed out of committee by a 5-2 vote. Brandes and Orange Park Republican Rob Bradley opposed it.

After the vote, Senate President Joe Negron issued a statement: “Instead of helping our youth to learn positively from their mistakes like we once did, they may be put in the juvenile justice system, which then creates a criminal record that could potentially follow them for their rest of their lives.”

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Enterprise Florida’s new chief defends the economic development program

The new head of Enterprise Florida Inc. defended the organization Monday against complaints that it doesn’t raise enough private-sector money, saying a required one-to-one match of public and private dollars applies only to operating expenses.

Chris Hart, who became president and CEO just weeks ago, cited the statute that created the economic development organization in 1996 during a meeting of the Senate Committee on Commerce and Tourism.

“We do meet our private sector match,” Hart said. “That one-to-one match that’s been required since 1996 is met, as you look at the statutory guidelines.”

The match does not apply to economic incentives paid to lure out-of-state businesses to Florida, Hart said — only to the organization’s core functions — international trade and development, including promoting the state as a place to do business; business development; and marketing.

Sen. Jack Latvala said he served in the Legislature at the time and could verify that Hart was correct.

“My memory agrees with Mr. Hart’s that it was anticipated that that (match) would be based on operating dollars,” Latvala said.

Gov. Rick Scott has asked the Legislature for $85 million for Enterprise Florida this year. House Speaker Richard Corcoran opposes such spending as “corporate welfare,” but Scott points to public support for the program.

Sen. Jose Javier Rodriguez cited news reports suggesting that the taxpayers pick up as much as 90 percent of the Enterprise Florida budget.

“This is the first time I’m hearing that economic-development incentives are not operating costs,” he said. “It seems like a new argument.”

“There have been a lot of misperceptions, misconceptions,“ Hart said. In practice, most economic incentives have contained a private match — for example, an employer drawing a job-training grant would be expected to contribute its own money, too.

But it doesn’t count toward the required operations match, he said.

The contrary interpretation has emerged during the past year or two, Hart said.

“That’s new. That’s why I think we all need to talk to you as policymakers,” he said — to clarify the situation.

The meeting flared up somewhat when Rodriguez — who has filed legislation to boost oversight of the organization — asked that Enterprise Florida was doing to avoid conflicts of interest.

“Some of the criticisms have been about EFI doing business with some of its board members,” he said.

Latvala objected.

“Can we get Sen. Rodriguez to be a little more specific about what specific examples he’s referring to here?” Latvala said. “That’s a broad and accusatory statement.”

Rodriguez started to mention some examples, including that Publix has a board seat and has received incentives and “six or seven” companies “that I could identify.”

“I don’t think it would be necessary to identify any particular company,” committee chairman Bill Montford interjected. “We don’t want this to be a dog and pony show.”

Hart said Enterprise Florida is committed to reviewing its governance process — and that board members have no say in awarding incentives. The organization does that with the Department of Economic Opportunity, he said.

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Bill Galvano’s higher-ed reform bills sail through Senate committee

Two bills that would increase Bright Future scholarship benefits and rework how colleges and universities measure progress and deal with top professors sailed through the Florida Senate Education Committee Monday.

Senate Bills 2 and 4, both introduced by Sen. Bill Galvano, drew some concerns about how they might affect nontraditional and working students but little opposition, as Galvano assured committee members, he shared and would be addressing those concerns.

“The thrust of this bill is not to somehow put additional pressure on a student, or mess with the opportunities they have by putting additional requirements on what the students achieve,” Galvano, a Bradenton Republican, said of SB 2, which took up the bulk of the committee’s discussion and drew the most concern. “The thrust of this bill is to make sure the institutions that they attend are achieving the highest levels of excellence. and within the definition of excellence is the ability to attend and achieve regardless of your financial background.”

That bill would do several things, most notably:

— Re-establish the Bright Futures Academic Scholars Awards to a level that would pay 100 percent of tuition and certain fees;

— Expand eligibility to the Benacquisto Scholarship Program for eligible out-of-state students;

— Double the state match to the First Generation (in college) Matching Grant Program to two dollars for every dollar the student pays;

— Strengthen the program that has two-year state colleges sign automatic matriculation programs with four-year universities; and,

— Modify the state accountability metrics and standards to reward universities for getting more students to graduate in four years.

That latter point was the only one drawing much concern. Galvano’s overall intention was to encourage students to not waste time in graduating, which could run up additional student debts and cost additional money. And no one on the committee seemed to have a problem with that.

But several public speakers and committee members, notably Democrats Gary Farmer and Perry Thurston Jr. and Republican Tom Lee, raised concerns about unintended consequences of pressuring the schools — with funding formulas — to push for four-year graduations. That, they argued, could lead the schools to start reducing opportunities to nontraditional students, many of whom are lower-income, and can only attend while working at the same time, or must take semesters or years off to earn money.

“It’s a pipe dream that they could ever finish college in four years,” said Lee, of Brandon.

Thurston, of Fort Lauderdale, cautioned that some schools such as Florida A&M University specialize in such nontraditional students, and those schools could be hurt for doing so.

Galvano assured he would work with them to prevent those concerns from playing out.

Farmer, of Fort Lauderdale, said he appreciated and accepted Galvano’s intentions.

“There are so many great things in this bill I will be ultimately voting for this bill today,” Farmer said. “I share the goal of making our university system a great university system …. We’re tired of hearing people talking about North Carolina or Virginia or Michigan, and Florida should be mentioned right up there with them, and Florida State.”

The companion measure, SB 4, would create a program for universities to identify, hire and retain star faculty members, and establishes programs to improve quality and prominence of graduate programs including those for medicine, law and business. It drew little discussion before being approved.

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Senate companion filed for controversial kratom ban bill

One of the more controversial bills filed in the Florida House this session, a proposed ban of constituent elements for kratom, saw a Florida Senate companion emerge Monday.

Senate Bill 424, filed by Democrat Darryl Rouson, mirrors the House bill.

Both bills would add Mitragynine and Hydroxymitragynine, constituents of Kratom, to the schedule of controlled substances, offering an exception for any FDA approved substance containing these chemicals.

Selling, delivering, manufacturing, or importing these Kratom chemical constituents into Florida would be considered a misdemeanor of the first degree under either bill.

Even before Rouson’s version was filed, the House bill filed by Rep. Kristin Jacobs, a Democrat from Coconut Creek, got national scrutiny.

Jacobs, in a no-holds-barred interview with FloridaPolitics.com, compared kratom advocates to one of history’s greatest villains.

“They have a story,” Jacobs told us via phone. “Just like Hitler believed if you tell a lie over and over again, it becomes the truth.”

Contrary to the many assertions from kratom users that the herbal remedy helps them manage pain, anxiety, and other debilitating conditions, Jacobs brought forth a “kratom madness” style of rhetoric when dismissing those who use the substance.

Jacobs described kratom users as “addicts with glassy eyes and shaky hands.”

Kratom advocates forcefully countered such descriptions soon after that.

Rouson received campaign contributions in 2016 from at least one party with a vested interest in a kratom ban.

Mark Fontaine, the former executive director of the Florida Alcohol and Drug Abuse Association, gave Rouson $400.

“Caremark Rx,” a division of the CVS drugstore chain, gave Rouson $1,000.

ABC Fine Wine and Spirits, which sells liquor, gave $1,000 on two occasions during the 2016 cycle. Meanwhile, the Beer Distributors Committee, Wine and Spirits Distributors, and Southern Wine and Spirits all gave $1,000 once.

Betty Sembler, the wife of anti-cannabis crusader Mel Sembler, gave Rouson $500.

We’ve reached out to Sen. Rouson to ask if he aligns with Rep. Jacobs’ comments, and whether or not his campaign’s financial backing factored into his decision to file companion legislation to a bill bounced out of the Florida Legislature in each of the last two sessions.

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