News-Record.com

The reason why they're requiring it now is because it's in a master's interest to keep his slaves as healthy as possible.

Please do take the home-school route and try to persuade as many other people as possible to do so.

I would agree with the writer's observations save the fact that the eye exam given by the physician is merely cursory. Full eye exams, like those given by a specialist, include tests for things such as color blindness, disease, etc. A full eye exam provides the patient with the opportunity to receive a prescription for corrective lenses. That is something the family physician cannot accomplish. The eye exam provided by the family physician is similar to the one provided by the DMV. It can only tell you if you need glasses, not what kind you need.

The reason this is such an important thing for children is that there are many out there who are like I was as a youth. I did poorly because I could not see the board or read without getting a headache. It wasn't until I was sixteen and about to get my DL that I was told I needed glasses. What a difference! Once I had the glasses I could see the board and my grades skyrocketed. Success in education is worth the extra money you spend to take your child to an eye doctor.

As a preschooler I went to one of Greensboro's finest pediatricians, but when I got to first grade, I had trouble learning to read. Neither my parents nor my teacher recognized the signs that, in retrospect, pointed to the source of my reading dificulty. It wasn't until the second grade that my teacher, the daughter of an optician, discovered that I had extreme myopia (nearsightedness) and recommended a proper eye exam.
An eye exam by a dedicated professional is essential. Not getting this simple and realatively inexpensive exam nearly amounts to parental neglect.

There is a very good story on the News & Observer's website on this very subject:
http://www.newsobserver.com/150/story/393597.html

It addresses all of the points raised thus far in this blog - including the fact that the very common problm of nearsightedness usually does not present until the ages of 6-12 . . . long after Speaker Black's new kindergarten mandate. In many cases, teachers ARE the first to recognize and report a problem - because that's how the problem presents - headaches and difficulty seeing the blackboard. I know. I was a "four-eyes" too.

Hearing and vision screening is something that is done at ALL good well-child checks. From asking parents if they notice any problems, to the little things the doctor does during the exam (that the parent doesn't even notice), to the actual formal hearing & vision screening at ages 4 & 5 when the little ones are entering school. If a problem is discovered, it is referred for a "full exam". And if a referral is made, I tend to refer children to opthalmologists - preferrably with some pediatric subspecialty training.

Of course, that really depends on where you are and what resources you have to work with. In some of North Carolina's more rural areas (like where I am now), this eye-exam mandate is going to impose unnessessary hardship . . . I already have parents complaining about time and cost and distance. And I certainly do not think that their legitimate concerns in any way constitute "neglect". "Simple and relatively inexpensive" is in the eye of the beholder.

If you want to talk about mandates, maybe we should be talking about mandatory dental exams - because that is the area in preschoolers where I am seeing some pretty awful stuff.

The state's time and money would better spent making sure that all children get regular healthcare exams after the age of five (when many children fall off the medical radar) . . . rather than paying back Speaker Black's professional and political base. Because that's EXACTLY what this particular "mandate" is about.

*&^%! Hit the post before I caught the typos. Guess I need to get my prescription checked:):):)

I wonder if the Speaker is taking new patients?

I agree with Easley except I think ALL children should be required to have a full eye examination regardless of whether they attend public school or not.

If parents can't afford one, the government should provide it. I can think of a lot worse things to spend our money on than this.

Parents who don't get their kids eyes checked, in my opinion, are guilty of neglect.

More on the mandatory eye exams from the N&O: http://www.newsobserver.com/114/story/394528.html

I've seen REAL neglect, yellowdog. Parents and doctors and school administrators who disagree with this new eye exam mandate are NOT guilty of it.

Governor Easley likes to spend our tax dollars. He and his adminstration were asleep during the rabid plundering of Medicaid's "disproportionate share" program. I dunno, yellowdog, but the nearly-billion dollars that got diverted to the coffers of the big hospitals like CMC (in Mecklenburg County - Jim Black country) might have come in handy for child healthcare.

The Democrats always claim that they are for "working families", but this, once again, proves otherwise. It is estimated that each family will have to fork out an extra $150 per child for such exams. When you combine that with the recent law concerning child car seats (where parents will have to purchase extra seats as their child grows/gets older) and the sky-rocketing new/higher taxes under the Easley Administration and Democrat controlled General Assembly, the working families in NC are taking a hit. I just filed my state tax return for 2005 and noticed that even though my salary remained the same ($30,000/year), my NC income taxes were $191 more than last year. I'm sure that families across NC are enduring this same higher tax burden.

We had a chance to correct this assault on the family budget by the state of North Carolina in November 2004, but NC voters returned "tax and spend" Easley and his Democrat cohorts to office by large numbers, so I find it hard to feel sorry about North Carolinians being over-taxed. At least when the Republicans had control of the state house and senate in the late 1990s, we did enjoy a budget surplus and, as a result, the GOP-controlled legislature returned these savings to the taxpayers through rebates and tax cuts. Remember that the next time you cast your ballot.

I don't get it. I'd make sure my children got a thorough eye exam because I loved them and wouldn't want them going through life suffering from eye problems. I'd also make sure they were safely restrained in an automobile because I loved them.

The government may have their own ulterior motives but it's a damn shame that people are too sorry to do these things on their own without the government forcing them to do it. And for those who are too poor to do it on their own, you'd think they'd like to have somebody do it for them.

I am for child restraints and eye care, as any concerned, decent parent would be, but why does the government have to become more involved? There were already laws on the books concerning child restraints and they were being enforced by local police and the Highway Patrol at license/DWI checkpoints through fines and citations. The eye exam law was sponsored by Speaker of the House Jim Black, who himself is an optometrist, thus this creates the appearance of a conflict of interests. We hear the Democrats whining about GW Bush, Dick Cheney and all their buddies in the oil industry, but this seems to be no different, as Black is looking after his fellow optometrists and not the welfare of the children. Sure, the state will step in to "foot the bill" if poor families cannot afford these exams, but the poor working families will ultimately pay for it through higher taxes as such wasteful spending will create another call for tax increases by the Democrats in Raleigh. We already pay dearly in higher taxes and higher state fees, plus the state will have more money rolling in with the lottery and the proposed toll roads, so the eye exams should be free to ALL NC families, if the law-makers are REALLY concerned about the welfare of the children.

Yellowdog, I honestly don't get why you don't get it - especially if you bothered to read the first link (to a News & Observer story, quoting eye-care specialists) I posted on this subject.

This eye-exam mandate is a prime example of the arrogant "good-ole-boy", "we rule the world" attitude that so many of our legislators in Raleigh have embodied for years. When the Dems are in power, they do it . . . and when the Republicans in power, they do it. Boys and girls, it's not about what is "best" for your children, it's a political whizzing contest. This time the little ones, and their parents, got wet.

According to inquiries I made with the News & Observer, this "law" was quietly slipped into a bill with virtually no discussion or input from healthcare experts (other than Speaker Black - an optometrist) or school officials . . . and the bill passed quickly without floor debate. The NC Medical Society and NC Pediatric Society reportedly had little or no time to react. Black, even under federal investigation, wields a lot of power (by virtue of his political warche$t) and no one was going to rock his boat.

Questions? Please see all of news reports on this subject now catalogued on http://www.jimblackmustgo.com. This eye-exam mandate was political payback that Big Jim hoped he could fly in under the radar.

It's not a matter of parents not "loving" their children - or doctors and school officials not caring. It's not a matter of "neglect" (although that's the line Black would love to sell). There is a right way and a wrong way to conduct "the people's business". Laws (especially laws affecting so many young families - often with limited financial resources) should not get passed without discussion or debate. Public records ARE public record - the information therein is not "highly confidential" or "secret". This cloak & dagger garbage . . . the conflicted interests and downright lying so long the hallmark of the "business" of local, state and federal government (not to mention all of the big "non-profits" rolling in public dough) has got to STOP.

For the record, the News & Observer reported today that Governor Easley is backing off from his "support" for the mandate - if he ever really "supported" it at all. Of course, Mike Easley's history is one of draping the things he wants under the mantle of "education" (as was done with the eye exams) and hoping that the plebes will swallow it hook, line and sinker. Never mind the medical evidence and plain old common sense. The Governor's "support" probably amounted to a wink and a nod - something he can backtrack from now.

Easley's history is also one of letting Medicaid take some horrific hits - and holding no one accountable. The scam worked on the "disproportionate share" program (right under his DHHS Secretary's nose) cost US only nearly a billion dollars. Who cares?

I am sooooooo sick of the mantra, "the government can do it" . . . or "the government can fix it". Hello? The government did not BEGIN to fix it for me (http://www.asheboropediatrics.com) even when the law was on my side. And WHO do you think PAYS for what the government does - or does not do (like proper oversight of the programs it already has)? Whatever happened to personal responsibility . . . and accountability of those charged/trusted with the public good?

Mary,

You sound like you just don't like the way the law was passed, not necessarily that you feel the law is altogether a bad idea. I understand that as I understood the way the lottery was unethically pushed through.

I'm not arguing that the motives were pure. What I'm saying is that I think ALL children should receive thorough eye exams. I don't think that should be limited to only those who can afford them. And that I think that any parent who doesn't have his child's eyes examined at some point is guilty of neglect. I could care less about the politics.

I don't always think the government should do it either. But in the case of children whose parents are too poor to pay for an eye exam, who SHOULD do it? Do you feel that poor children should suffer with bad vision because they were born into poverty? If the government doesn't do it, in this case, who will?

Yellowdog, you're right. I am VERY UNHAPPY with the way the law was passed. For this mandate would not have stood up to even routine medical, educational and legislative scrutiny - that's the reason the Speaker had to sneak it in (giving legislators the impression that they were appeasing the Governor - by approving his "vision plan"). That's also the reason the law is under fire now - and Dems are now retreating & calling for its repeal.

Like the lottery (which no one is backing away from), the way this thing went down literally stank. And the fact that stuff like this does not pass the smell test is a big reason Speaker Black is on the hot seat with federal investigators. Likewise, the way the lottery was passed did NOT set a great example of "ethics" for the children we're trying to teach to behave ethically. But in politics, the end always justifies the means. Nice lesson for the kiddies.

You still miss the point. Again, I refer you to the links. The "full eye exam" mandated by the Speaker's smooth moves is expensive and unnecessary (I spelled it right that time) for the vast majority of healthy children (rich or poor) - at least at the time the Speaker's new law mandates it. Speaker Black has been quoted in the press that lowly vision "screeners" miss vision problems that can be confused with ADHD and other behavioral issues. Well excuse me (on behalf of my medical colleagues and myself, I'm trying not to sound too indignant here), but the screeners the Speaker is DISSING are Pediatricians and Family Practioners - who, in my experience, conduct very adequate hearing & vision screening tests at the kindergarten check (if not sooner). As per American of Academy Pediatrics (AAP) policy statements & practice guidelines, most offices/doctors at least try an eye screen at age 3 (my nurses and I stand on our heads trying to get one . . . before you pontificate on "neglect" and the depth of a parent's love or doctor's caring, have YOU ever tried to get a three-year-old to cooperate with something like that?).

Children who fail their routine screens, and who need to see the eye doctor ARE REFERRED to the eye doctor. That's why the test is called a screen. And I think most of us in general practice are pretty well-versed on ADD and ADHD (in my case because, in addition to being nearsighted, I have it) . . . at least enough to discern the difference between that and an eye disorder.

All children who enter public school in this state - rich and poor - are required by law to have a thorough physical exam upon entrance into the system - which includes a complete medical & developmental history, as well as labaratory work, and hearing & vision screening. Unless they qualify for an exemption, children must be fully immunized. There's a very detailed form that parents and healthcare providers complete and return to the school. But I'm not telling you anything you don't already know.

So the government is already THERE, yellowdog. Do some kids (especially poor ones) fall through the cracks? You betcha. Is this new mandate going to "catch" those children? Not likely. From a public health standpoint, is it cost-effective? NO!!! Could the public's money and time be better spent on other things that might be more successful in providing better overall pediatric healthcare - and maybe catching those children who do fall through the cracks? Yes.

I previously brought up dental care. Do you think that a child whose teeth are rotten and sore is going to have trouble concentrating in school?

Maybe the state government should be talking about how to improve universal access to healthcare for all children - not just those that Mike Easley can pass off to Medicaid. According to the ProCare website, at least one representative has been trying to get universal care on the table for over five years. People like Jim Black weren't listening. As I have pointed out on multiple occasions in these blogs, Medicaid's "disproportionate share" safety net (a program designed to compensate hospitals for the care of the poor & "underserved") was plundered to the tune of nearly a billion dollars. A lot of "suits" (some with very close ties to the Easley adminstration - some the Speaker literally represents) got rich on that one. You and I footed the bill - and I don't see anybody going to jail. How many poor people have fallen through the cracks - and will continue to fall through the cracks - BECAUSE THAT BILLION GOT GONE - because our state government was asleep at the wheel when it came to healthcare?

It's my opinion that all children should get check-ups once a year - just like their adult counterparts. What's good for us should be good for them. And if I were lucky enough to be blessed with children, they would get them. If I ruled the world (or at least our part of it), they would get them. But I don't. And the fact is that many kids fall off the radar after the 5-year exam . . . sometimes not even coming back in until they need a sports exam years later. We doctors cannot go out into the street and drag them in. Do the parents of these children not love their kids? Are they neglectful? I mean, we're talking about routine checkups here (where someone could do a vision screen and probably catch that nearsightedness) . . not the more specialized eye exams. Should the state start mandating something just because one person thinks it is so? Because that's essentially what happened with this new mandate. Speaker Black wanted it. Speaker Black got it.

As for "neglect", DSS these days has very limited powers in terms of what it can do about REAL medical neglect - the life threatening kind. And you're worried about an eye exam that was passed so that one segment of the medical population has a steady income? Part of the reason I don't care for this law is because it makes "doctors" look greedy.

I'm all for making sure that the "poor and underserved" should get good healthcare. In fact, I got crucified in Asheboro because I trusted the government to help me come home (and be around) to do that . . . but the government officials that should have - and could have - helped me when the system went askew hid under their desks. Been there done that. Got a lawyer's closet full of tee-shirts. The, "Do you feel that poor children should suffer with bad vision because they were born into poverty" line is an all too transparent and self-serving play to the Speaker's game plan. The answer is NO. But we're NOT talking about just poor children are we? We're talking about a public health initiative that affects ALL children. I DO care about the politics. And you should too.

It's not just about bad politics, yellowdog. It's about a bad law - a public health mandate that did not get properly scrutinized by educational and medical professionals before it was railroaded through the legislature by an powerful lawmaker trying to pay back his political base.

That's just my opinion. From the fracas and the political backtracking - it does not look like I'm alone. Here's a thought. Wouldn't it be nice if all the ethics hoopla were about MORE than just lip service?

Thomas, as with many other things it is good to shop around. Fox eye care at Friendly Shopping Center only charges 75.00 for a eye exam and also have coupons for 10% off that on their web site. A small price to pay to make sure your child can see properly.

Also, a booster seat (no car seat is required after a certain age) can be purchased at Babies R Us and Sears for a mere 20.00. A childs safety in a motor vehicle is paramount and 20.00 is nothing!

Yes littlebuddababy, it IS important to shop around. As you shop, make sure that the eye doctor is comfortable and experienced in seeing children. And as you "shop" in Greensboro, remember that many parents in our state's rural areas do not have the options you do.

From the Speaker Black's own lips, "The eye docs got their cut":

http://www.newsobserver.com/114/story/395483.html

And from a NC Pediatric Society newsletter yesterday:

". . . medical organizations that are on record as opposing the mandated eye exam include the NCPS, the NC Medical Society and the NC Society of Eye Physicians and Surgeons. The NC School Boards Association, the School Superintendents Association and the Association of School Principals and Assistant Principals are also on record in opposition along with several of the state’s influential advocacy groups including the NC Child Advocacy Institute and the NC Center for Justice and Community Development."

Bottom line, if you care about your child's vision, make sure your child gets regular checkups. Listen carefully to your child's teachers about problems they might be having in school. And, by all means, take your child to see an eye specialist if you want the full exam. But this mandate is unnecessary and costly.

Dr. Mary, while I do "shop" in Greensboro, you have no idea where I live, or how far I dirve to get there. I go where what I need to get is where I can afford it. There is a very simple solution here. If you can't afford proper care for your children then you should not have them. The Dr. I recomended is in fact qualified to deal with children and has done so for many years. I find it hard to believe that these people in your so called "rural areas" do not have access to a phone and a phone book to do their shopping. This is not the 1800's. It makes me very angry when people make excuses for not taking care of their children, and madder when other people make those excuses for them.

Littlebuddababy, it makes me VERY ANGRY when legislators snow the general public about the true motivation for some of their political smooth moves . . . (as Ruth Sheehan pointed out in her N&O OpEd) hiding behind the veneer of protecting little children. And I HATE IT when well-meaning, good people (like yourself) fall for the ruse.

If this law had been such a good idea - and could stand on its own merits, why didn't Speaker Black open it up for legislative debate - rather than sneak it into a bill?

I have lived and worked in some of these rural areas (in both far Eastern and Western NC) . . . with patient populations that can barely eek out a living - and little in the way of subspecialty resources (particularly doctors "comfortable" seeing children). It's not just a matter of having a phone book (by the way, does the phone company publish one in Spanish?). It's a matter of a parent taking time off from work (when some of these jobs/bosses will fire you for that), driving to God knows where (gas isn't cheap these days), and paying money you don't have or cannot spare for an exam that most experts agree is not necessary to ensure the good health of your child.

If you're waiting for people to stop having children just because they don't have the means to raise them without government support, you're going to be waiting a very long time. It's crass and it's cold, but public policy is about getting the biggest bang for the smallest buck. This eye-exam mandate does not do that.

Like I said, if I ruled the world, all children everywhere would have good and comprehensive healthcare. The state of North Carolina has a long way to go in terms of cleaning up its healthcare act - particulary where "poor & underserved" children are concerned. The VERY LEAST our state legislators can do is draft and properly vet a good law - rather than railroad through a bad one.