Seanad Éireann debate -
Wednesday, 7 Mar 1956

Vol. 45 No. 14

Opticians Bill, 1955—Second Stage.

Question proposed: "That the Bill be now read a Second Time."

Minister for Health (Mr. O'Higgins)

The purpose of this Bill is to eradicate the abuses which at present exist in the sale of spectacles and it is proposed to achieve this aim by providing for the registration of opticians and by restricting to registered persons the prescription and sale of spectacles. The Bill will not of course, affect the testing and treatment of eyes and the provision of spectacles by registered medical practitioners.

Opticians may be divided into two classes, ophthalmic opticians and dispensing opticians. Ophthalmic opticians normally test sight and prescribe glasses and many of them are qualified by the possession of diplomas issued either here or in Britain, to carry out these limited functions.

Dispensing opticians do not test sight nor prescribe spectacles, but confine their activities to dispensing the prescriptions of registered medical practitioners or ophthalmic opticians, and for most of them this is a part-time activity.

At present there are no restrictions on the practice of optics and it is open to anyone to describe himself as a "qualified optician" or a "qualified eye specialist" and to go round the country testing, or purporting to test, people's sight and prescribing glasses for them. People without qualifications have for years past been doing this and are still doing it. Unscrupulous persons have taken advantage of the lack of control over prescribing and supplying spectacles and, by trading on the gullibility of the public have made considerable profits for themselves. I am quite certain that considerable harm is being done to people's eyes by these quacks. Persons in need of glasses attend them, attracted perhaps by their flamboyant advertising and extravagant claims, and in due course are given glasses. The customer is led to believe that his eyes have been tested by a fully qualified optician—but in many cases the glasses which he gets are useless or harmful. The assumption of spurious professional titles has not been the only undesirable aspect of these persons' activities. Documentary evidence has been made available to me which shows beyond doubt that these itinerant spectacle vendors have been guilty of other frauds on the public. In a number of cases they have sold spectacles with plain glass lenses to members of the public and charged grossly inflated prices for them. Other cases have also been brought to my notice of persons paying money in good faith to travelling spectacle sellers who failed to forward the glasses for which they had been paid.

I am satisfied that abuses of the type which I have mentioned exist at present and occur in such numbers that it is necessary to take action to eradicate them. The measures which will do so are contained in this Bill. It is proposed to establish a board which will include representatives of medical practitioners and ophthalmic opticians, a dispensing optician and a neutral person. This board will be given power to establish registers for ophthalmic opticians and for dispensing opticians. It will be empowered to recognise optical qualifications awarded both within and outside the State, to organise courses of training or to recognise courses of training organised by other bodies. In this manner it will be ensured that the persons who will in future be registered either as ophthalmic opticians or as dispensing opticians will possess the training and experience necessary to equip them to discharge their respective functions properly.

Initially, of course, arrangements must be made to cover the cases of persons who have been practising as opticians in this country up to the present. A considerable number of those at present practising as ophthalmic opticians have been doing so ethically and satisfactorily for a long time and it is obviously undesirable that they should be prevented by this Bill from continuing to provide a service which has been found satisfactory in the past. There is, therefore, power in the Bill to provide for the registration of persons who at present have not technical qualifications but who, through the experience they have acquired over the years, are capable of satisfactorily working as opticians. Accordingly it is proposed that there will be admitted to the register of ophthalmic opticians, on its establishment, not only persons possessing recognised qualifications, but persons whose principal means of livelihood during the preceding seven years was the business of ophthalmic optician, and persons who, during the five years before the board is set up, will have engaged to a specified extent in prescribing and dispensing spectacles and who pass an examination held by the board in these subjects.

The first register of dispensing opticians will include persons who have recognised qualifications, those whose principal means of livelihood for seven years before the establishment date was the business of dispensing optician and those who, having engaged to a specified extent during the five years before the establishment day in dispensing spectacles pass an examination in that subject. An additional class was added to these by An Dáil, namely opticians who on the date of introduction of the Bill were recognised by the Department of Social Welfare as competent to dispense spectacles under that Department's scheme of optical benefits.

These provisions ensure that persons who were bona fide practising as opticians before this Bill came into operation will not be deprived of their livelihood. I am satisfied that the provisions I have outlined are an adequate safeguard both to the public and to those at present practising optics.

When the Bill comes into operation, the position will be that only registered medical practitioners and registered ophthalmic opticians will be allowed to prescribe spectacles. Only these two classes and dispensing opticians will be entitled to dispense spectacles. It will be an offence for any other person to prescribe or to dispense them, or to hold himself out as being capable of doing so. The board is given power to make rules governing the supply of spectacles by registered opticians and is also given power to make rules governing advertising by them. Standards of prescribing and dispensing will be established by the board and it will be necessary for all registered opticians to conform to these standards.

I am confident that this Bill will achieve the ends for which it is proposed. It will terminate the abuses in the prescription and supply of glasses which are at present occurring and which I am satisfied should not be allowed to continue. It will also ensure that the standard of prescribing and supplying glasses will be considerably improved. It is for these reasons that I recommend it to the Seanad for a Second Reading.

Dr. ffrench O'Carroll

The situation which the Minister has outlined for us here this evening, that anybody at the present time, irrespective of whether he has any technical or professional training, is in a position to prescribe and sell spectacles, is, of course, outrageous, and it is overdue that legislation should be brought forward to prevent it. Despite that situation, I personally do not welcome this Bill, because I imagine that if I had to make the decision which the Minister has had to make, I would have made it in rather a different way. Personally, speaking as a doctor, I cannot see how the Minister can be satisfied that an ophthalmic optician is a suitable person to prescribe and sell spectacles. The Minister, in drawing up this Bill, was in a position that he could decide that in future spectacles would be prescribed only by a doctor who specialised in this work, an oculist, or he could have taken the course he has taken, that the prescribing of spectacles would be left to somebody with a technical rather than a professional training, a man who, as an optician, would have a training course possibly of about three years.

Now let us take the position of the two. On the one side, there is a man who has had three years' training, who is a technician. On the other side, you have a doctor who has spent six years in a university, a further year in a hospital before being even registered as a practitioner, and, if he is to become an oculist, has had to spend over and above that period at least five years and has taken one extra qualification at least, has had special training and experience during that time, and passed very difficult examinations in that work.

I cannot understand how the Minister should decide, he who is responsible, naturally, acting in the best interests of the health of the people of the country, that, in these circumstances, it should be the technician with the three years' training who is to prescribe spectacles for the majority of people in this country. "Prescribe" is an important word, because a man cannot prescribe, unless he can diagnose.

The position is, under this Bill, that in future the majority of the people of this country are to have spectacles prescribed for them by a technician with some three years' training. I think it is a very serious matter indeed. I do not see how the man with limited training can be in a position to decide that failing sight is merely due to a minor error of refraction. I do not see how he can possibly be in a position to decide if there is not present the more serious conditions associated with the pathology of the eye which it takes long training and experience to be able to diagnose. I would suggest to the Minister that there is a very definite relation between technical men and professional men in the field of medicine, and in the field of health in general. There will be many other circumstances where this relationship exists and it has been worked out in an entirely different way.

Let me take for example the question of the pathologist. The pathologist is in charge of the laboratory. The vast majority of the work in the laboratory is done again by a technician—a man with much the same amount of training. It is very probable that, in doing the routine work of the laboratory—what I would call the tests in the laboratory—the technician is probably much more efficient than the pathologist. But there is one important aspect of pathological work which is left entirely to the doctors— the pathologists—and that is diagnosis. A laboratory technician may be a first-class man in doing the tests, in doing the routine work of the laboratory, but he cannot look down a microscope and tell you whether he is looking at a normal tissue or a tissue of cancer. And that is where the ability to diagnose and the training of clinical judgment comes into force.

I believe the same position holds in regard to diseases of the eye. I think it is absolutely wrong that a man with three years' training, who is not a doctor, should be in a position to look at somebody's eyes and tell them: "No; all you need is a simple correction of an error of refraction." I know it is set out in the Bill that the ophthalmic optician is prevented from treating people, but the position of diagnosis cannot be got away from. Diagnosis is the whole point of the lengthy training of a doctor and the specialist training and the special qualifications which the ophthalmic surgeon takes.

Again, we have the same position in regard to the chemist and the doctor. It is perfectly in order for a chemist— he is perfectly competent to do it—to dispense a prescription. But a chemist is not in a position—and a chemist does not do it—to say to somebody who comes into his shop: "You have a cough. I think that for that cough the best thing for you to take is cough mixture X or Y." He may volunteer information on proprietary preparations and tell somebody who comes into his shop that one preparation is used more than another. That is all right, but, when it comes to prescribing treatment, he cannot prescribe unless he is in a position to diagnose. I feel that the proper relationship exists between the chemist and the doctor; the proper relationship exists in medicine between the pathologist and his technician; but the most improper circumstances are going to be created here in so far as the ophthalmic optician is concerned.

Why should the Minister take this course? I expected that he would give us some reason for choosing that the optician rather than the oculist should decide in this matter of spectacles. I could understand it if the case were put forward that people could not afford to have the opinion of an ophthalmic surgeon every time they felt there was something wrong with their eyes. But the Minister, according to his own statement, is in the process of introducing the institutional services under the Health Act and those institutional services will mean that, I suppose, 75 per cent. of the people in this country will be in a position to have free ophthalmic services in so far as a competent oculist's opinion on their eyes is concerned. Why, in those circumstances, when we can give the advantage of a doctor who is a specialist in eye work to so many people in this country, should we pass over this whole question of the prescribing for spectacles to opticians?

I do not say this in any spirit of jealousy as between doctors and technicians. I do not say it out of blind loyalty merely to other doctors or because this attitude has been taken up by the Irish Medical Association. I say it from conviction, because I believe that, so far as diseases of the eye are concerned and so far as preservation of sight is concerned, nothing can be more vital, and it has been shown throughout the field of public health that early expert opinion on eye conditions is absolutely essential and is a basic part of the school medical services, as we have them today in relation to the care of eyes and teeth.

I believe that where we set out in this Bill and give over, not only this work, but the control of the training of ophthalmic opticians to opticians under this Bill, the natural tendency will be for the vast majority of people to consult, in the first instance, an optician, where they have a headache or where they feel their vision is not as good as it might be, rather than a doctor who has specialised in eye work. I would ask the Minister to put before the House what reasons prompted him to make such a choice. I personally cannot see them, and I think it is a retrograde step. It seems to me, too, that the position of the dispensing optician is a very poor one under the Bill. It looks to me as if both the ophthalmic surgeon and the dispensing optician are going to be squeezed entirely by the ophthalmic optician. The constitution of the board is most unsuitable. As I said, it is not a matter of prejudice or mere professional loyalty. My view differs from the majority on both sides of the House. The Minister and his predecessor are apparently quite satisfied with the Bill, but I fail to see why a retrograde step should be taken in this Bill and why services vastly inferior to what could be made available, in so far as the prescribing of spectacles is concerned, are about to be offered to the public.

Mr. Crosbie

I have not got the necessary technical knowledge to follow the line of country of Senator ffrench O'Carroll, although I must say that, as an ordinary lay man, I am greatly impressed indeed by his arguments. That being so, I am also concerned, like Senator ffrench O'Carroll, with the position under this Bill of the dispensing optician, whom we may regard as what Senator ffrench O'Carroll described as a competent and qualified technician who specialises in the dispensing of what is prescribed by the doctor. There is grave cause for anxiety by this body, this professional body of dispensing opticians, on their position under this Bill in view of the constitution of the board.

In the Bill, the Minister does make provision that one member of the board shall be a dispensing optician, in both Section 5 and in the subsequent sub-section (10). However, the method of election, as laid down under Section 10, gives grave cause for fear that, when this form of election comes into operation, the dispensing opticians' profession, in effect, may find themselves squeezed out. It is my intention, therefore, and the intention of some of my colleagues to introduce, on the Committee Stage, an amendment to both Section 5 and Section 10, designed principally to ensure that this one seat should be held by a dispensing optician and by no other member of the three professions named in the Bill. It would, of course, be preferable if the Minister were to see his way to meet us on this and perhaps to introduce a Government amendment to this section. Failing that I give notice that some of my colleagues and myself intend to table such amendment.

Mr. Bergin

I would like to say just one or two words about Section 49 which deals with restrictions on the sale of spectacles. I think the section is far too severe. This is a personal opinion only, and I have not consulted my colleagues on it. I cannot see why it should be made altogether impossible to buy from a shop the type of glasses used by very many of the older and poorer people. To my mind, such glasses should be available to those people. I was consulting some opticians about this Bill, and I noticed that they were all in favour of this section. I asked them what was the minimum price for which they could sell spectacles, and they all said that it was in the region of 25/- to 30/-.

I do not think it is fair to prevent the poor people in the country from buying spectacles where they used to buy them. Those were spectacles which were merely an aid to reading and were, in reality, only magnifying glasses. When a person gets old, there is very little that can be done to improve the eyesight, and I would appeal to the Minister to consider easing this section in some way. I know it might be difficult to alter it in such a way as to enable these people to buy that type of spectacles.

Mr. Cox

It struck me on reading the Bill that Section 48 seems rather difficult to understand. It prescribes that registered opticians shall not do certain things. I thought it would have been more in keeping with the Bill, if it stated that no person shall do those things, but apparently the section leaves it open to people with no qualifications whatever to do the things which a registered optician is forbidden to do.

On quite a different point, the Bill provides for appeal from the disciplinary committee set up and provides that that appeal may be taken either to the High Court or to the Minister. It seems to me to be rather questionable, certainly in view of litigation at present proceeding in the courts, whether an appeal to the Minister would be held to come within the Constitution. I think the principle there, providing for appeals from a professional body to the courts or to the Minister on a matter such as erasure from the register might be a rather dangerous precedent to establish and the Minister should consider that.

I was rather struck by the provision that if, on appeal, it was found that there had not been proper grounds for erasure from the register, the committee might have to pay damages. It would seem to me that that is the introduction of a rather strange principle. Presumably, the people who would try these professional cases would be persons who would be acting in a more or less judicial manner, and it seems to be a rather novel principle that, when a lower court hears a case, it might be called upon to pay damages in the event of its decision being overruled in a superior court.

Another point I would make is that provision is made to register at the outset people who have been for a certain number of years in practice, who are of good character, and that is confined to Irish citizens. There is a provision as regards the new register that they must be citizens, but surely anyone qualified can be registered, if he has the necessary qualifications. It does seem to be rather harsh, if there are persons who would be otherwise qualified, that they should not be admitted merely because by some chance, though they have been resident here for a number of years, and have in that time carried on business, they are not Irish citizens. That seems to be taking away the livelihood of people who might not have expected to be involved in such a matter.

Mr. Murphy

I happen to be a member of a branch of the Labour Party which for years has been advocating that the sale of spectacles should be prohibited, except by properly qualified people. In this respect, you will see that I am in complete disagreement with Senator Bergin. Our view on this matter was that, whilst spectacles could be purchased cheaply in certain shops, it was false economy, and was dangerous and injurious to the eyes of poor people, that they should be able to purchase these spectacles, or so-called spectacles.

In so far as this Bill has prohibited the sale of spectacles by unqualified people, by stores and shops, I welcome it. I do not want to enter into the discussion as to how the representation on the board should be divided, but my interest lies in that one particular aspect, namely, the sale of spectacles by other than properly qualified people.

Mr. O'Higgins

I will not detain the House very long in concluding and in dealing with the points raised by Senators who took part in the debate.

First of all, I thank Senator ffrench O'Carroll for his interesting contribution to the debate. He raised a number of matters with which I would like to deal. First of all, he said he felt that there was a problem involved, but he felt that this was not the way to deal with it. The problem which exists and which affects the public good is the problem created by the peregrinations throughout this country of a group of well-advertised quacks, who, at the moment and for years back have been defrauding innocent people throughout the country. That is the problem. These quacks advertise themselves in the provincial newspapers as being "Dublin's leading eyes specialists" or "Dublin's famous sight testers", or "Belfast's boon to the blind", and down the country they go, well advertised, to meet the unfortunate people in some country town. Before their arrival, they make it clear that their visit is for one day only.

One day only is frequently sufficiently long to collect from these gullible people sufficient money to maintain them until they go to the next town on the circuit.

That is the problem and I think any member of this House who has experience of Irish provincial towns will realise that it is a very real problem. Not only is there wholesale defrauding of innocent people, but there is also considerable harm and injury done, I am advised, to the health of these people.

I mentioned in my speech when introducing the Bill that frequently unfortunate people, instead of getting spectacles, obtaining proper glasses, frequently get plain glass for an eye condition that does need spectacles and often they get spectacles completely unsuited to their condition. That is the problem and I can conceive of no other way of dealing with that problem than establishing some system whereby the prescribing and the dispensing and sale of spectacles will be subject to some supervision. I do not think it would be right that it should be subject to supervision or control by a Department of State. I think it should be supervised and controlled by those who legitimately offer themselves to the public as being experts in this matter, and it is for that reason that it is proposed that this board be established, comprised of members drawn from the medical profession, from ophthalmic opticians and with a member from the dispensing opticians.

I can well appreciate why Senator ffrench O'Carroll says he does not believe that an ophthalmic optician is the most suitable person to prescribe glasses. That is quite an understandable expression of view. Perhaps a number of people would prefer to go to a doctor in order to get glasses prescribed, but the position is at the moment, and has been for years back, that a person can go to anyone and get a prescription for glasses. At the moment, the doctor is only one of many people who, in accordance with our law, is quite entitled to prescribe glasses for any eye condition or complaint, real or imaginary. Under the Bill, no effort is being made to suggest that one can go only to an ophthalmic optician, if one needs a prescription for glasses. All that is being provided is that under the Bill you must go either to a doctor or an ophthalmic optician, and I think that is a fair way of dealing with what is a very serious problem.

Senator ffrench O'Carroll went on to say that the question of diagnosis, the diagnosis of a medical condition of the eyes, was open to grave objection. Under the Bill, care has been taken to ensure that an ophthalmic optician will be prohibited from engaging in the treatment medically of any condition of the eye. These provisions are contained in Section 48 of the Bill. In addition to the prohibitions there contained, there is a specific provision that a registered optician, who is not a doctor, shall not suggest by any written or oral statement, or by any action, that he has made or is capable of making a medical diagnosis of a disease of the eye, or that, in relation to the treatment of the eyes, he has done or is capable of doing anything other than (1) in the case of a registered ophthalmic optician, the prescribing or provision of spectacles, or (2) in the case of a registered dispensing optician, the provision of spectacles. I think that that is a clear indication that it is not the intention, that it is not my intention, as the proposer of the Bill, that ophthalmic opticians or any registered opticians should be entitled to engage—in fact, he is clearly prohibited from engaging —in medical diagnosis. That is a matter entirely for a doctor and I think that the Bill in that connection makes a fair and reasonable provision.

Dr. ffrench O'Carroll

I do not want to interrupt, but the Minister will appreciate it is fair to say a man cannot prescribe without diagnosis.

Mr. O'Higgins

That is one of the difficulties. The Bill as drafted did not contain the express prohibition on medical diagnosis. That was inserted in Committee in the Dáil, but I am advised that there is a clear distinction between deciding the kind of spectacles required for an obvious eye condition and holding oneself out as specifying what that condition is. It is intended to ensure that the ophthalmic optician does not hold himself out as saying what is wrong with the eyes.

Dr. ffrench O'Carroll

I appreciate that.

Mr. O'Higgins

Senator ffrench O'Carroll also mentioned, as did Senator Crosbie, the position of dispensing opticians. I do not want to discuss that in detail, but, as I said in the Dáil and I repeat it here, this Bill would never have been introduced into the Dáil or here were it not for the concern repeatedly expressed over years by the ophthalmic opticians with regard to these grave abuses. The abuses I mentioned frequently were the concern of the Department of Justice and the Garda authorities, but it was the consistent effort by the ophthalmic opticians over the years that eventually induced my predecessor to consider the introduction of this legislation.

After the introduction of this legislation, the dispensing opticians became concerned about it, and I am well aware—at least, I hazard a guess—that most members of this House received billets doux from the dispensing opticians under one guise or another. I have very little sympathy with that. I am concerned that this board should not be used in the cause of any section exclusively, in the interest of the ophthalmic opticians, dispensing opticians or the medical profession.

The board, as constituted, provides that no particular section will have a majority, to the exclusion of other interests, and it will be in the interest of the three sections to work together in order to provide proper standards. The board consists of five ophthalmic opticians, one dispensing optician and four medical practitioners, with a chairman to be nominated. I think that kind of board is best constituted to deal with this problem and to provide proper standards for all those engaged in the prescription and sale of spectacles.

Senator Bergin mentioned the question of the prohibition of the sale of spectacles. I can conceive of no better answer to Senator Bergin than Senator Murphy's contribution. That is one of the problems the Bill is designed to deal with. The purchase of spectacles by poor people just from a frame in a shop or a store at times, I am advised, can cause serious damage to the eye. Poor people now will have available from the health authority a supply of spectacles properly prescribed in accordance with their medical condition. No hardship will be imposed upon them and I do not think that any real disservice is being done. An effort has been made to provide for supervision and for proper standards for something which, after all, is of importance to health.

Senator Cox mentioned a number of matters which, perhaps, we might deal with in Committee in more detail. He mentioned the question of those entitled to come in on the enactment of the Bill as persons already engaged in this business and that that should not be confined merely to Irish citizens. The position with regard to that, of course, is that the provisions in the Bill in relation to Irish citizens apply only to those engaged on the operation of the Bill.

The reason for that, Senators will appreciate, is that there is a possibility that legislation similar to this may be introduced in the British House of Commons and if it is introduced on the information available to me, it will be introduced for precisely the same reason and there is the fear that we would get another invasion from Britain which might be as damaging as the previous one to the welfare of this nation.

I mentioned what Senator Murphy said in relation to Senator Bergin's objection. I think for these reasons the Bill is intended to deal with a pretty obvious public problem, and, while there may be other ways of doing it, I have considered it very carefully. I can see no way of dealing with this problem, except by providing a form of legislation and supervision by people engaged in this business doing it themselves, in the hope that proper standards will be established and that the business will be conducted properly from now on.

Question put and agreed to.

Committee Stage ordered for Wednesday, 14th March.

The Seanad adjourned at 10.20 p.m. until 3 p.m. on Wednesday, 14th March, 1956.