STATE News:

SANTA FE — Local medical students, ophthalmology residents, and doctors provided public comments cautioning policymakers that eye surgery is complex, high-risk medical care that requires physician-led training, supervision, and oversight to protect patient safety. Despite references in committee to a stakeholder compromise, no consensus exists among physicians or professional organizations regarding the expansion of laser eye surgery authority in HB 213.

HB 213 was rolled by the House Health and Human Services Committee and will be heard by the committee on Wednesday with a substitute. The chair indicated that no further public comment will be accepted.

“Laser eye surgery is not an expansion of optometry — it is the practice of medicine, and lowering surgical standards puts patients at risk,” said Dr. Robert Underwood, M.D. board president of New Mexico Medical Society.

HB 213 authorizes non-medical doctors (optometrists) to perform eye surgery using high-hazard FDA-regulated medical lasers—without attending medical school or completing surgical residency. The New Mexico Academy of Ophthalmology, New Mexico Alliance for Patient Protection, New Mexico Medical Society, Greater Albuquerque Medical Association, New Mexico Academy of Family Physicians, New Mexico Society of Anesthesiologists, American Medical Association, American Academy of Ophthalmology, Kentucky Academy of Eye Physicians and Surgeons announced unified opposition to HB 213, which would expand surgical and laser privileges to non-physicians outside of the Medical Practice Act.

HB 213 and the proposed substitute removes statutory guardrails protecting patient safety and places surgical procedures traditionally regulated under the Medical Practice Act to a non-surgical board that is not constituted, trained, or mandated to oversee surgery. The organizations emphasized that eye surgery is not merely “expanded optometry”—it is medicine, requiring physician-level medical education, surgical residency, supervised inpatient training, and competency in managing systemic complications.

Medical Basis for Opposition

1. HB 213 Moves Surgery Outside the Medical Practice Act — HB 213 explicitly authorizes laser procedures on live human eyes yet vests oversight with the Optometry Board rather than the Medical Board. Surgery belongs in the Medical Practice Act with physician-level standards, enforcement authority, and medical oversight.
2. HB 213 Eliminates Guardrails and Broadens Surgical Authority — HB 213 removes the word “minor” from statute and adds new laser procedures on intraocular structures, weakening statutory clarity and allowing scope expansion beyond current understanding, increasing risk to patients and reducing accountability.
3. Insufficient Training and Surgical Competency — Optometrists complete no medical school, no surgical residency, and no rotations in systemic disease management, anesthesia, or perioperative care, yet the HB 213 substitute permits credentialing after short courses and limited proctored cases. In contrast, ophthalmologists complete four years of medical school, one year of internship, three to four years of surgical residency, and hundreds of supervised cases.
4. Surgical Risk and Laser Hazard Classification — The ophthalmic lasers authorized under HB 213 (including YAG and glaucoma laser systems) are medical surgical lasers classified in the highest laser hazard categories, Class 3B and Class 4, because they can cut or photodisrupt ocular tissue and pose permanent vision risks if misused. These are not cosmetic or consumer devices; they are operative medical systems intended for intraocular disease management and historically reserved for medically trained eye surgeons.
5. Complication Management and Continuity of Care — Surgery involves medical decision-making, risk stratification, understanding systemic disease interactions, and managing complications and emergencies. These are core physician competencies, not continuing education add-ons.
6. Evidence From Other States Shows Patient Harm, Not Improved Access — Other states such as Kentucky, that adopted similar laws have documented cases of patient harm, including severe complications, unnecessary surgery, and permanent vision loss. Peer-reviewed research has shown higher rates of secondary surgical interventions when certain laser procedures are performed by non-physicians (JAMA Network).
7. HB 213 Does Not Improve Access — Claims that HB 213 will expand access are not supported by data. Optometrists and ophthalmologists cluster in the same ZIP codes. Utilization of expanded privileges in other states has been extremely low. According to US Census Data, the majority of New Mexicans live within reasonable driving distance of an ophthalmologist, with wait times measured in days rather than months. Evidence from other states demonstrated that similar scope expansions did not improve rural access or utilization, with services remaining concentrated in urban areas.

Additional Concerns

1. Medical Practice Act Statutory Conflict — A legal memorandum dated November 10, 2025 identified potential statutory conflicts arising from HB 213, as it authorizes optometrists to diagnose and treat disease through operative laser procedures that constitute the practice of medicine under the Medical Practice Act. A recent example of statutory and rule conflicts occurred in West Virginia, where the state’s highest court reversed efforts to allow optometrists to perform surgical eye procedures, underscoring the importance of maintaining coherent regulatory structure (NMSA 1978, §§ 61-6-1 et seq.).
2. Medical Malpractice Act — HB 213 creates two different medical malpractice and patient protection systems for the same surgical procedures (NMSA 1978, §§ 41-5-1 through 41-5-29,). Patients injured under HB 213 would not have access to the Patient Compensation Fund, removing a key layer of protection that exists when surgery is regulated under the Medical Practice Act. Medical malpractice lawsuits involving optometric laser surgery are currently active in other states, including a recent Kentucky case alleging permanent vision loss following a laser procedure performed by an optometrist.
3. UNM Medical Doctors, Eye Surgery Expansion, and Rural Outreach — New Mexico’s physician community is already pursuing evidence-based solutions to expand surgical eye care capacity, including UNM Medical School’s ophthalmology workforce expansion initiatives and rural access development efforts. Ophthalmologists are physicians (MD/DO) who complete four years of medical school, a one-year internship, and three or more years of accredited surgical residency training. These initiatives are designed to expand access without compromising surgical standards or patient safety.
4. Evidence Before Expansion — A technical brief titled “Establishing a Pre-Legislative Medical Scope-of-Practice Review Process in New Mexico” describes best practices from other states that require independent, evidence-based review prior to scope-of-practice expansions. Such processes evaluate training alignment, patient safety, statutory conflicts, and access claims before legislatures are asked to adjudicate medical scope issues. This model encourages lawmakers to rely on data, outcomes, and medical evidence—not speculative workforce claims.

Statements from Medical Organizations

New Mexico Medical Society:

“This bill reframes surgery as an expansion of optometry, when it is in fact the practice of medicine. Medical doctors will not negotiate patient safety and wellbeing as HB 213 attempts to do. Surgery belongs in the Medicine Practice Act with oversight of the New Mexico Medical Board,” stated Dr. Robert Underwood, M.D. board president of New Mexico Medical Society.

Greater Albuquerque Medical Association:

“Laser procedures on the eye are complex medical interventions, and expanding surgical authority without appropriate medical residency training introduces unnecessary risk to patients and lowers the standard for surgical competency in New Mexico,” said Dr. Roger Cronk, D.O., President of the Greater Albuquerque Medical Association.

New Mexico Academy of Ophthalmology:

“Laser eye surgery is not a retail procedure—it is delicate intraocular surgery affecting pressure dynamics, visual pathways, and lifelong outcomes. Evidence from other states shows worse outcomes when performed by non-physicians. New Mexicans should not be used as a test case for failed models,” Dr. Rebecca Leenheer, M.D. President of the New Mexico Academy of Ophthalmology.

New Mexico Society of Anesthesiologists:

“On behalf of the New Mexico Society of Anesthesiologists, I oppose House Bill 213. Every member of the healthcare team plays a vital role, but not all roles involve the same depth or scope of training. When it comes to surgical and medical procedures, training matters. Patients deserve care that prioritizes safety, clarity, and transparency about who is providing that care and what qualifications they hold,” said Dr. Natalie Bruno, MD, President-Elect of New Mexico Society of Anesthesiologists.

The signatory organizations urge lawmakers to oppose HB 213 and preserve the regulatory framework that protects patient safety:

• Vote NO on HB 213
• Keep surgery in the Medical Practice Act
• Preserve physician-led standards for invasive procedures