By: Hancock  S.B. No. 993
         (In the Senate - Filed March 3, 2021; March 18, 2021, read
  first time and referred to Committee on Business & Commerce;
  May 10, 2021, reported adversely, with favorable Committee
  Substitute by the following vote:  Yeas 7, Nays 0; May 10, 2021,
  sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 993 By:  Hancock
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to the practice of therapeutic optometry.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter E, Chapter 351, Occupations Code, is
  amended by adding Section 351.2034 to read as follows:
         Sec. 351.2034.  COMPLAINTS RESULTING FROM GLAUCOMA
  TREATMENT. (a)  The board, in collaboration with the Texas Medical
  Board, shall adopt rules for investigating and reviewing complaints
  filed with the board regarding a therapeutic optometrist's
  treatment of a patient for glaucoma. The rules must ensure that:
               (1)  a person who files a complaint has the opportunity
  to explain the allegations made in the complaint;
               (2)  a complaint is not dismissed without appropriate
  consideration by the board;
               (3)  a complaint is resolved within six months after
  the date the complaint is filed;
               (4)  the board notifies the Texas Medical Board of the
  receipt and disposition of a complaint; and
               (5)  a complaint is reviewed as provided by this
  section.
         (b)  After a complaint regarding a therapeutic optometrist's
  treatment of a patient for glaucoma is filed with the board, the
  board shall select at least one physician licensed in this state who
  specializes in ophthalmology to:
               (1)  review the complaint and determine if the
  therapeutic optometrist's treatment of the patient for glaucoma
  violated the standard of care applicable to a physician
  specializing in ophthalmology; and
               (2)  submit to the board a written report on the
  physician's determination.
         (c)  If the report under Subsection (b) states that the
  standard of care was violated, the board shall forward the
  complaint and report to an expert panel appointed by the board and
  the Texas Medical Board. The panel must be composed of an equal
  number of physicians who specialize in ophthalmology and
  therapeutic optometrists. Each member of the expert panel must be
  licensed to practice medicine or therapeutic optometry, as
  applicable, in this state. A physician who serves on an expert
  panel may also serve as an expert physician for the Texas Medical
  Board.
         (d)  An expert panel selected to review a complaint under
  Subsection (c) shall:
               (1)  review the physician's determination made under
  Subsection (b); and 
               (2)  recommend to the board whether the therapeutic
  optometrist should be subject to disciplinary action and, if so,
  whether the disciplinary action should include suspension or
  revocation of the therapeutic optometrist's certificate issued
  under Section 351.3581(a).
         (e)  A person is not eligible to review a complaint under
  Subsection (b) or serve on an expert panel under Subsection (c) if:
               (1)  the person or the person's spouse is an officer,
  employee, or paid consultant of a Texas trade association, as
  defined by Section 351.053, in the field of health care; or 
               (2)  the person is a member of the faculty or board of
  trustees of an optometry school or an institution of higher
  education with an affiliated school of optometry.
         (f)  The board shall maintain and make publicly available
  online:
               (1)  information regarding the number of complaints
  filed with the board regarding the treatment of patients for
  glaucoma by therapeutic optometrists and the disposition of those
  complaints; and
               (2)  a searchable list of each therapeutic optometrist
  whose certificate under Section 351.3581(a) was suspended or
  revoked by the board.
         (g)  This section expires September 1, 2027.
         SECTION 2.  Section 351.358(c), Occupations Code, is amended
  to read as follows:
         (c)  A therapeutic optometrist may prescribe not more than 
  [oral medications only in the following classifications of oral
  pharmaceuticals:
               [(1)  one 10-day supply of oral antibiotics;
               [(2)  one 72-hour supply of oral antihistamines;
               [(3)  one seven-day supply of oral nonsteroidal
  anti-inflammatories;
               [(4)]  one three-day supply of any medication
  classified as a controlled substance under Schedule [analgesic
  identified in Schedules] III, IV, or [and] V of 21 U.S.C. Section
  812[; and
               [(5)  any other oral pharmaceutical recommended by the
  Optometric Health Care Advisory Committee and approved by the board
  and the Texas State Board of Medical Examiners].
         SECTION 3.  The heading to Section 351.3581, Occupations
  Code, is amended to read as follows:
         Sec. 351.3581.  [DIAGNOSIS AND] TREATMENT OF GLAUCOMA.
         SECTION 4.  Sections 351.3581(a) and (d), Occupations Code,
  are amended to read as follows:
         (a)  A therapeutic optometrist may not administer or
  prescribe an oral or parenteral medication or treat glaucoma unless
  the therapeutic optometrist holds a certificate issued by the
  board. A therapeutic optometrist certified under this section 
  [subsection] shall be known as an optometric glaucoma specialist.
  To obtain a certificate, a therapeutic optometrist must [as
  required under Section 351.165(c)]:
               (1)  complete an instructional clinical review course;
  and
               (2)  pass an examination approved by the board.
         (d)  A therapeutic optometrist shall refer a patient to an
  ophthalmologist if:
               (1)  the patient is younger than 16 years of age and has
  been diagnosed as having glaucoma;
               (2)  the patient has been diagnosed as having acute
  closed angle glaucoma;
               (3)  the patient has been diagnosed as having malignant
  glaucoma or neovascular glaucoma;
               (4)  the patient has definite optic disc, retinal nerve
  fiber layer, or macular imaging abnormalities consistent with
  glaucoma and visual field abnormalities in both hemifields, or loss
  within five degrees of fixation in at least one hemifield as tested
  with standard automated perimetry [therapeutic optometrist
  determines that a patient's glaucoma is caused by a diabetic
  complication and, after joint consultation with the physician
  treating the diabetes and an ophthalmologist by telephone, fax, or
  another method, the physician or ophthalmologist determines that
  the patient should be seen by the physician or ophthalmologist]; or
               (5)  the therapeutic optometrist determines that a
  patient's glaucoma is not responding [appropriately] to
  nonsurgical intervention [a treatment specified in Subsection (f)
  and, after consulting a physician by telephone, fax, or another
  method, the physician determines that the patient should be seen by
  the physician or an appropriate specialist].
         SECTION 5.  Not later than December 1, 2021, the Texas
  Optometry Board shall adopt rules necessary to implement the
  changes in law made by this Act to Chapter 351, Occupations Code.
         SECTION 6.  Sections 351.3581(b) and (c), Occupations Code,
  are repealed.
         SECTION 7.  This Act takes effect September 1, 2021.
 
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