DR. NORMAN S. BATEH, )
vs. ) CASE NO. 83-1259
Respondent. )
Pursuant to notice, a hearing was held in the above styled case before Arnold H. Pollock, Hearing Officer with the Division of Administrative Hearings, on August 2, 1983, in Jacksonville, Florida. The issue for consideration is whether Petitioner's performance on the July, 1982, optometry examination was properly graded and whether certain questions on the examination were valid.
For Petitioner: Abraham I. Bateh, Esquire
For Respondent: Drucilla E. Bell, Esquire
By letter dated December 30, 1982, Petitioner was notified that as a result of the review process his failing grade of 66.00 on the July, 1983, optometry examination was raised to 68.00, a grade that was still a failing grade. Since that letter ended the review process, Petitioner was advised of his entitlement to a hearing under Section 120.57, Florida Statutes. On February 17, 1983, Petitioner submitted a letter requesting a hearing. At the hearing, he testified in his own behalf and presented the testimony of Dr. Roy H. Schnauss, Dr. Gary M. Akel and Dr. James Lanier, as well as Petitioner's Exhibits 1 through 4. Respondent presented the testimony of David J. Gustafson and Dr.
Charles J. Pappas; and Respondent's Exhibits A, B and C.
Dr. Norman S. Bateh is the Petitioner in this matter and is an unsuccessful candidate on the optometry (theory and practice) licensing examination administered by the Respondent Board of Optometry on July 23 through 25, 1983.
The development of, an examination by this Board reflects careful planning and consideration to ensure it fairly tests an applicant's knowledge of the subject matter. Prior to the preparation of a particular examination, a large pool of questions is developed from numerous professional and academic sources. After the examination is given, an analysis of it is conducted to see how the questions are received by the examinees. Examinees are given the opportunity to contest particular questions after the examination has been administered. Based on the Board's analysis of the test results, any question that was answered correctly by less than 58 percent of the examinees, in addition to those questions contested by the examinees are sent for verification to the Board's consultants, in this case Drs. Pappas and Chrycy. If, upon review by the consultants, it appears a question was incorrectly graded, ambiguous, unclear, or unfair; or if, in the consultant's opinion, there is any sort of problem with the question, all examinees are given credit for it.
Passing grade on the 100-question, multiple-choice examination was 70 percent. Petitioner was initially awarded a grade of 66, but on review, at his request, of several of the questions which were graded as wrong, he was awarded two more points, which brings his grade to 68, still two points below passing. He was ranked 98th out of 103 examinees.
Petitioner challenges four questions at this hearing as being either improperly graded or invalid because the question is incapable of a correct answer. These questions are numbered 8, 31, 73 and 78 and will be discussed individually, infra.
If Petitioner's answer is determined to be correct, he will be awarded one point credit for that question. If any question is determined to be invalid for any reason, Petitioner will be awarded one point credit for that question.
Question 8 on the examination read:
Intraocular lens placement after cateract extraction results in an image magnification of approximately:
0%
4%
9%
D. 25%
Petitioner's answer on the examination was "C. 9%." The Board's correct answer was "B. 4%."
Petitioner presented the testimony of an ophthalmologist, Dr. Schnauss, who has performed the operation to implant intraocular lenses between
500 and 600 times. As an expert who has used the lenses in his practice frequently and as consultant to one .of the major manufacturers of these lenses, e states unequivocally the degree of magnification is less than 1 percent, but not 0 percent. The further away from the location of the original lens of the eye, the greater the magnification. Since the lens implant is close to the plane of the original eye lens, there would be little magnification. Therefore, notwithstanding the conclusions of the Respondent's experts, Dr. Pappas and Dr. Chrycy, both consultants to the Board of Optometry, who cite Duane, Clinical Ophthalmology, Vol. I, as authority, no answer listed as an option on the examination is clinically correct. However, 52 percent of the candidates who took this particular examination gave the Board's correct answer.
Question 31 on the examination read:
Which of the following would you consider a positive scotoma:
the blind spot
Evan's angia-scotomas
Seidel's scotoma
muscae volitantes
Petitioner's answer on the examination was "C. Seidel's scotoma." The Board's correct answer was "D. muscae volitantes."
A scotoma is a blind spot in the patient's vision. Positive scotomas are those which are noticeable by the patient as he sees. Negative scotomas are not noticeable to the patient, but show up under test. A Seidel's scotoma, which is an extension of a blind spot, would not be a positive scotoma because the patient would not see it in the visual field.
The Board's preferred answer, muscae volitantes, was attacked by Petitioner's experts as being inaccurate since they are bits of floating protein substance in the eye which, .though they are opaque and create a block to vision where they exist, are not true blind spots because they are not a defective area in the eye and they move. They are blind only because they temporarily block vision, not because they are a defect in the eye. Therefore, while muscae volitantes are, technically, positive scotomas where they exist, the question is inartfully drawn, vague and confusing, a conclusion supported by the fact that only 28 percent of the candidates got the correct answer. This low figure, to Mr. Gustafson, Respondent's test statistician, is insignificant. However, a question so confusing that only 29 of 103 examinees get it right and which is capable of such substantial meritorious argument on both sides is truly vague.
Question 73 on the examination read:
A keratoconus patient with "K" readings of 46.00 x 52.00 can best be fitted with which lens:
a spherical firm lens
a soft lens with overglasses
a bitoric gas permeable lens with light touch on the cone
a bitoric gas permeable lens with heavy touch on the cone
Though Petitioner testified his answer was "D," and he defended it at the hearing, his answer on the examination was "A." The Board's correct answer was "C."
The prime consideration in this question is the touch of the lens, not the issue of hard or soft, or gas permeability. The most current edition of Mandell's textbook and the majority of optometrists today feel that the best choice of lens for fitting a keratoconus patient is the bitoric gas permeable lens with light touch. The opinion of the "majority of optometrists" referred to by Dr. Chrycy was garnered in discussions with a personal friend who, as a Fellow of the American College of Optometry, had recently attended a meeting of that body where this exact subject was, discussed and that opinion rendered.
Petitioner cited an earlier edition of Mandell's work to urge the position that a firm lens is required to contain the protrusion of the dark part of the eye that comes along with keratoconus. Later opinion, however, changes that position which is now no longer considered the better treatment. Petitioner also challenged the "K" readings in the question as being unreliable. Unfortunately by doing so, reasonable asthat might be in the practice of optometry, he read into the question a factor that was neither present nor intended by the examiners. The "1(" readings in this question were agiven quantity. Petitioner's treating them as a "trick" was an unfortunate mistake. It is also pertinent to note that 71 of the 103 examinees (69 percent) chose the correct answer to this question.
Question 78 on the examination, the fourth and last one challenged by Petitioner at the hearing, reads:
The extraocular muscle most frequently involved in extropia is the
medial rectus
superior rectus
lateral rectus
superior oblique
Petitioner's answer was "C. lateral rectus." The Board's correct answer was "A. medial rectus."
The term "extropia" means a turning outward of the eye. The term "extraocular" means outside the eye. The medial rectus muscle is the muscle between the eye and the nose which pulls toward the center of the face. The lateral rectus muscle is that on the outward part of the eye which pulls toward the ear. In a normal individual, the muscles, of equal strength, balance each other and the eye looks forward unless the person involved moves it. Extropia is caused when there is an imbalance of the muscles, either by a weakening of the medial rectus, which allows the normallateral rectus to overpower it, or by an unnatural strengthening of the lateral rectus which then overpowers the normal medial rectus. By far the greater weight of optometric opinion, based on observation and testing, reveals that the most frequent" cause of this condition is the weakening ofthe medial rectus, leaving the lateral rectus normal. Consequently, the correct answer is not lateral rectus as claimed by Petitioner, but the medial rectus as stated by the Board,notwithstanding even the Board's expert, witness testified there is no definitive authority to support the Board's choice. In this case, 64 percent of the examinees chose the correct answer.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter of these proceedings.
Chapter 463, Florida Statutes, regulates the practice of optometry in the State of Florida and includes within the requirements for licensure the passing of an examination.
Section 455.217(2), Florida Statutes, sets up a procedure for review of examinations by unsuccessful examinees. The procedures followed by the Board in this case were in conformity with the procedures set out in the statute.
Petitioner has questioned four questions he feels were either incorrectly graded, or are so vague and misleading as to require his being awarded credit for them even though his answer was not the Board's correct answer.
As to Question 8, even were it to be concluded that the Board's preferred answer of 4 percent was incorrect and that of Petitioner's witnesses of less than 1 percent was correct, the fact remains that Petitioner's answer of
9 percent would be incorrect in any case. He is, therefore, not entitled to credit for that question.
Question 31 is inartfully drawn, vague and confusing, a conclusion supported by the fact that only 28 percent of the candidates answered it correctly. While degree of difficulty is not, alone, determinative of validity, the fact that so many of the candidates were wrong and almost 20 percent of the candidates erred identically with Petitioner shows that this question should be declared invalid and Petitioner given credit for it.
In Question 73, at the hearing, Petitioner ind cated his answer was one thing, and he vigorously defended this position. However, it was pointed out that in reality his answer on the examination was "A," an entirely different type of lens. In any case, the Board's preferred answer was neither of those juggled by Petitioner. In addition, Petitioner contested the question on the issue of the inaccuracy of the "K" readings. These statistics in the question were a given factor and should have been accepted as such. That Petitioner may have based his answer on his interpretation that they were unreliable is unfortunate and does not, either alone or taken with anything else, justify the award of credit to him for this question.
In the final contested question, the issue is whether the most frequent muscle involved is that identified by Petitioner or that identified by the Board. While there may be legitimate dispute on this, the dispute is not so significant as to override the decision of the Board based on its best evidence that its choice is the best choice among those provided as potential answers.
As such, there is no legal basis to conclude the Petitioner's.` answer was incorrectly graded.
On the basis of the above, Petitioner is entitled to one additional point credit.
"The parties have submitted posthearing legal memoranda which include proposed findings of fact and conclusions of law. The proposed findings and conclusions have been adopted only to the extent that they are expressly set in the Findings of Fact and Conclusions of Law above. They have been otherwise rejected as contrary to the better weight of the evidence, .not supported by the evidence, irrelevant to the issues, or legally erroneous.
That a final order be entered finding that Petitioner should be awarded one additional point credit for Question 31 and that he, nonetheless, failed to achieve a passing score on the July, 1982, optometry examination.
RECOMMENDED this 19th day of August, 1983, in Tallahassee, Florida.
ARNOLD H. POLLOCK
Filed with the Clerk of the Division of Administrative Hearings this 19th day of August, 1983.
Abraham I. Bateh, Esq. 2124 Park Street
Drucilla E. Bell, Esquire Department of Professional
Mr. Fred Rochep Secretary
Ms. Mildred Gardner Executive Director Board of Optometry
