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Backlog leaves people fighting to see

By John Stucke
Staff writer
December 7, 2008

Kiera Williams, age 9, has been waiting months for a new pair of glasses being provided by the state's Medicaid program. Some 1,000 low-income children and adults in Washington state who need glasses don't have them yet.

Thousands of children enrolled in Washington's Medicaid program have waited months for new eyeglasses. The backlog can be traced to new security protocols and computer software at the Airway Heights Corrections Center, where inmates work in a state-run optical lab to make every lens and frame for poor people served by the state's subsidized insurance program.

In November the backlog of eyeglass orders - for both children and adults - peaked at 12,000.

Some kids have been without glasses since the start of the school year, prompting doctors and educators to worry about vision problems and obstacles to learning.

"This entire thing is outrageous," said Lori Williams. Her daughter Kiera, 9, has been waiting since late August for her new oval-shaped glasses with purple-blue frames.

Kiera takes medication for a rare disease that affects her vision. She needs bifocals because she can't see things far away and she can't read things close-up. It makes reading books - which they do a lot of in fourth grade, Kiera said - a struggle. She gets headaches from squinting to read the teacher's lessons written on a whiteboard or trying to see things across the the classroom.

"Sometimes, during recess, I can't really play because I don't feel well," she said. "I'm lucky, though, to have such good friends who sit with me."

Officials with three state agencies that have a hand in the eyeglasses program say they expected changes at the prison to delay deliveries by a few weeks - at most - before returning to the 10-day turnaround time required by contract.

MaryAnne Lindeblad, a division director in the state Department of Social and Health Services who monitors the Medicaid vision benefit, acknowledged that complaints from optometrists have been climbing. DSHS has encouraged the prison program to cut the long delays.

Lindeblad said that as the agency has to keep pressure on the lab, the backlog has become "closer to what they should be able to manage and catch up."

Errors beget errors

Jim Parker, general manager of Correctional Industries, the prison's work program, said the problems have been solved and the wait times drastically cut. As of last Thursday, he said, the Medicaid backlog had been reduced to about 1,800 pairs of glasses for children and adults.

Unfortunately, he said, it's some of the most complicated prescriptions that are ensnared by the wait.

"Murphy's Law seems to attach itself to certain patients," said David Hays, a Tacoma-area optometrist and a liaison for the Optometric Physicians of Washington in its dealings with DSHS.

"It seems in the worst cases that the most delayed jobs, when they finally get them done and shipped, there's a problem with it," he said. "Complaints make the staff tense, and the job tends to jump to the front of the line, and then it gets rushed and a mistake is made and it just compounds."

Hays said he knows DSHS is upset by the backlog and has put Parker's program on notice.

"They truly view the children and adults in the Medicaid program as clients," he said. "And I know they get really ticked off when they hear about a kid that needs glasses and can't get them.

"My feeling is that in January, if the problem isn't solved, DSHS will simply have to find another provider."

Hays is not pushing for that scenario and recalled previous contracts with private providers as riddled with quality problems and delays.

Staffing changes

The prison's optical lab has made glasses since 1997. The state is required by law to contract with the prison program, which employs 65 inmates who earn between 45 cents and $1.50 an hour. They make 700 pairs of glasses every day ¡V or about 150,000 pairs a year. That makes the facility the second-largest optical lab in the state, trailing only Costco, which produces about 5,000 pairs a day.

But earlier this year, Parker and prison officials saw potential problems with inmates having access to limited patient records.

Although names and identifying information from doctors' offices were erased from paperwork that inmates entered into computers, Parker said the decision was made to stop having inmates perform data entry as of June.

"The old adage, ¡¥If it could happen it might' - well, we wanted to get rid of the 'might,' " Parker said.

He emphasized that no patient's privacy was ever breached. And he said the backlog was not the fault of the inmate lab workers.

Temporary staff began typing in order information, but problems ensued and the backlog grew. By August, more than 10,000 orders were backlogged. Parker said he hired more people, but the training curve and rigorous state hiring guidelines took time.

It wasn't until mid-October that Parker had a trained, full staff.

"In hindsight, sure, we would do some things differently." he said, "We would have had a staff in place."

The worst part was the knowledge that most of the backlog affected children already disadvantaged because of low family incomes and associated learning problems.

Inhibited learning

With the situation under control, Parker predicts better service.

"We hope that's the case," said Jim Horn, optical department manager for the three Spokane Eye Clinic offices in Spokane.

The clinics' patients are awaiting delivery of about 400 pairs of glasses from the prison.

Horn called the long waits unacceptable and hoped the state would review the contract and make the changes to prevent such problems from happening again.

Such delays would be "simply unacceptable," he said, if they happened with a child whose parents had private insurance.

That's what upsets Lori Williams.

"My daughter shouldn't have had to be going to school without glasses now three months and counting," Williams said. "We don't have a lot of money, and we're doing the best we can. It has left me thinking maybe it's not important because it's a low-income program. That seems to be the bottom line."

Barbara Hopkins, who handles the billing at Franklin Park Vision Clinic, where Kiera goes for eye care, said some patients have been waiting since June for their eyeglasses.

"It's really too bad," Hopkins said as she counted more than 200 eyeglasses orders that haven't been filled. "We've done everything we can and called everybody we know for help."

Glasses are more important than simply helping a child to read or watch a game. Sometimes they help prevent serious eye damage. And they can help alleviate headaches that deter learning.

Kathe Reed-McKay, health services director for Spokane Public Schools, hadn't heard about the wait for eyeglasses but called the problem serious.

"We consider good vision critically important to learning," she said. Schools are required to conduct vision screenings for children beginning in kindergarten.

"It's not just learning we're concerned with," Reed-McKay said. "It's safety factors," things like being able to see a car coming, or playing on the playground.

Rosalind Knox, a contracts specialist for the Office of State Procurements, said her office has administered the prison contract for 10 years. The latest contract, a two-year pact valued at $6.8 million, expires in October; Knox is confident the problems will be resolved and the contract renewed.

She said the prison optical program has delivered excellent service and held down costs.

The average pair of glasses made by inmates costs $20 rather than the $300 to $400 charged by private labs.

In addition to the big cost savings and satisfactory quality delivered to the state's Medicaid vision program, having prisoners do the work fulfills another good - skills training that could help inmates find jobs upon their release, which lowers recidivism rates.

Hays said he hopes the optical program can rebound from a tough year.

"Things were a mess, and yes it was bad," the optometrist added. "What we need now is to know that it has been fixed and won't happen again."

Contact John Stucke at (509) 459-5419 or johnst@spokesman.com.

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