76R12635 JMM-F
By Brimer, Van de Putte, Walker, Maxey H.B. No. 1051
Substitute the following for H.B. No. 1051:
By Gray C.S.H.B. No. 1051
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of the practice of therapeutic
1-3 optometry.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 1.02, Texas Optometry Act (Article
1-6 4552-1.02, Vernon's Texas Civil Statutes), is amended by amending
1-7 Subdivision (7) and adding Subdivision (11) to read as follows:
1-8 (7) The "practice of therapeutic optometry" means the
1-9 employment of objective or subjective means for the purpose of
1-10 ascertaining and measuring the powers of vision of the human eye,
1-11 examining and diagnosing visual defects, abnormal conditions, and
1-12 diseases of the human eye and adnexa, prescribing or fitting lenses
1-13 or prisms to correct or remedy a defect or abnormal condition of
1-14 vision, administering or prescribing a drug or physical treatment
1-15 in the manner authorized by this Act, and treating the visual
1-16 system, including the eye and adnexa as authorized by this Act
1-17 [without the use of surgery or laser surgery]. The practice of
1-18 therapeutic optometry does not include the use of surgery or laser
1-19 surgery.
1-20 (11) "Surgery" means any procedure using instruments,
1-21 including lasers, scalpels, or needles, in which human tissue is
1-22 cut, burned, vaporized, or otherwise altered by any mechanical
1-23 means, laser, or ionizing radiation. The term includes procedures
1-24 using instruments that require closure by suturing, clamping, or
2-1 another device. The term does not include a noninvasive procedure
2-2 to remove a superficial foreign body in the conjunctiva, eyelid, or
2-3 corneal epithelium that has not perforated the Bowman's membrane.
2-4 SECTION 2. Section 1.03, Texas Optometry Act (Article
2-5 4552-1.03, Vernon's Texas Civil Statutes), is amended by amending
2-6 Subsections (b) and (d)-(g) and adding Subsections (h)-(r) to read
2-7 as follows:
2-8 (b) A therapeutic optometrist may administer, perform, or
2-9 [and] prescribe ophthalmic devices, procedures, and appropriate
2-10 medications administered by [over-the-counter oral medications,
2-11 and] topical, oral, or parenteral means, in accordance with this
2-12 section, [ocular pharmaceutical agents, other than antiviral agents
2-13 and antiglaucoma agents,] for the purpose of diagnosing and
2-14 treating visual defects, abnormal conditions, and diseases of the
2-15 human vision system, including the eye and adnexa. A therapeutic
2-16 optometrist is prohibited from performing surgery or laser surgery
2-17 [and may remove superficial foreign matter and eyelashes from the
2-18 external eye or adnexa. If a therapeutic optometrist utilizes
2-19 topical steroids of a strength of one percent concentration to
2-20 treat a condition and the condition has not substantially improved
2-21 within seven days of the initial topical steroid application, the
2-22 therapeutic optometrist shall consult with an ophthalmologist and
2-23 the ophthalmologist shall then establish the treatment regimen. If
2-24 a therapeutic optometrist utilizes topical steroids of a strength
2-25 of less than one percent concentration to treat a condition and the
2-26 condition has not substantially improved within 14 days of the
2-27 initial topical steroid application, the therapeutic optometrist
3-1 shall consult with an ophthalmologist and the ophthalmologist shall
3-2 then establish the treatment regimen. This subsection does not
3-3 authorize an optometrist to treat glaucoma in a manner that was not
3-4 permitted by law on August 31, 1991].
3-5 (d) The board shall adopt rules or the recommendations
3-6 submitted under Section 1.03A of this Act setting forth additional
3-7 classifications of [the specific] pharmaceutical agents therapeutic
3-8 optometrists may use in the practice of therapeutic optometry. Use
3-9 by a therapeutic optometrist of pharmaceutical agents not
3-10 authorized by the board or otherwise authorized by law shall
3-11 constitute a violation of this Act.
3-12 (e) [A five-member technical advisory committee is created
3-13 to assist the board in determining the specific pharmaceutical
3-14 agents which may be used in the practice of therapeutic optometry.
3-15 Appointments to the committee shall be for two-year terms, and no
3-16 member may serve more than two consecutive terms.]
3-17 [(f) The members of the technical advisory committee shall
3-18 be appointed as follows: one must be an optometrist or therapeutic
3-19 optometrist licensed and practicing in this state, appointed by the
3-20 Texas Optometry Board; one must be a physician licensed and
3-21 practicing in this state whose practice is limited to
3-22 ophthalmology, appointed by the Texas State Board of Medical
3-23 Examiners; one must be a pharmacist licensed and practicing
3-24 pharmacy in this state, appointed by the Texas State Board of
3-25 Pharmacy; one must be a faculty member at a state medical
3-26 institution of higher education with expertise in pharmacology,
3-27 appointed by the Texas State Board of Medical Examiners; and one
4-1 must be a faculty member of a college of optometry at a state
4-2 institution of higher education, appointed by the Texas Optometry
4-3 Board.]
4-4 [(g)] A therapeutic optometrist, including an optometric
4-5 glaucoma specialist, is subject to the same standard of
4-6 professional care and judgment as a person practicing as an
4-7 ophthalmologist under the Medical Practice Act (Article 4495b,
4-8 Vernon's Texas Civil Statutes).
4-9 (f) A therapeutic optometrist may prescribe oral medications
4-10 only in the following classifications of oral pharmaceuticals:
4-11 (1) one 10-day supply of oral antibiotics;
4-12 (2) one 72-hour supply of oral antihistamines;
4-13 (3) one seven-day supply of oral nonsteroidal
4-14 anti-inflammatories;
4-15 (4) one three-day supply of any analgesic identified
4-16 in Schedules III, IV, and V of 21 U.S.C. Section 812; and
4-17 (5) any other oral pharmaceutical recommended by the
4-18 optometric health care advisory committee and approved by the board
4-19 and the Texas State Board of Medical Examiners.
4-20 (g) A therapeutic optometrist may independently administer
4-21 oral carbonic anhydrase inhibitors for emergency purposes only and
4-22 shall immediately refer the patient to an ophthalmologist.
4-23 (h) A therapeutic optometrist may inject appropriate
4-24 medication for a patient who has an anaphylactic reaction to
4-25 counteract the anaphylaxis. The therapeutic optometrist shall
4-26 immediately refer the patient to a physician.
4-27 (i) Not later than the 30th day after the date of the
5-1 initial diagnosis of glaucoma, a therapeutic optometrist shall
5-2 engage in consultation with an ophthalmologist to develop an
5-3 individual treatment plan that is approved by the therapeutic
5-4 optometrist and ophthalmologist. The parameters of the
5-5 consultation shall be at the discretion of the ophthalmologist but
5-6 must at least include confirmation of the diagnosis and a plan for
5-7 comanagement of the patient, including periodic review of the
5-8 patient's progress.
5-9 (j) A therapeutic optometrist required to engage in
5-10 comanagement consultation with an ophthalmologist shall inform the
5-11 patient diagnosed with glaucoma that the therapeutic optometrist
5-12 shall have the diagnosis confirmed and comanaged with an
5-13 ophthalmologist of the patient's choosing or, if the patient does
5-14 not choose an ophthalmologist, an ophthalmologist practicing in the
5-15 geographic area in which the therapeutic optometrist practices.
5-16 (k) A therapeutic optometrist shall refer a patient to an
5-17 ophthalmologist if:
5-18 (1) the patient is under 16 years of age and has been
5-19 diagnosed as having glaucoma;
5-20 (2) the patient has been diagnosed as having acute
5-21 closed angle glaucoma;
5-22 (3) the patient has been diagnosed as having malignant
5-23 glaucoma or neovascular glaucoma;
5-24 (4) the therapeutic optometrist determines that a
5-25 patient's glaucoma is caused by a diabetic complication and, after
5-26 joint consultation with the physician treating the diabetes and an
5-27 ophthalmologist by telephone, fax, or another method, the physician
6-1 or ophthalmologist determines that the patient should be seen by
6-2 the physician or ophthalmologist; or
6-3 (5) the therapeutic optometrist determines that a
6-4 patient's glaucoma is not responding appropriately to a treatment
6-5 specified in Subsection (m) of this section and, after consulting a
6-6 physician by telephone, fax, or another method, the physician
6-7 determines that the patient should be seen by the physician or an
6-8 appropriate specialist.
6-9 (l) A therapeutic optometrist who refers a patient to a
6-10 physician or specialist shall inform the patient that the patient
6-11 may go to any physician or specialist the patient chooses. This
6-12 subsection does not prevent a therapeutic optometrist from
6-13 recommending a physician or specialist.
6-14 (m) On making an initial diagnosis of glaucoma, a
6-15 therapeutic optometrist shall set a target pressure that is not
6-16 more than 80 percent of the initial intraocular pressure. The
6-17 patient's glaucoma is considered to not be appropriately responding
6-18 to treatment if the patient fails to achieve the target pressure
6-19 within an appropriate time.
6-20 (n) Before a therapeutic optometrist may prescribe a beta
6-21 blocker, the therapeutic optometrist must take a complete case
6-22 history of the patient and determine whether the patient has had a
6-23 physical examination within the 180 days preceding the date of
6-24 taking the history. If the patient has not had a physical
6-25 examination or if the patient has a history of congestive heart
6-26 failure, bradycardia, heart block, asthma, or chronic obstructive
6-27 pulmonary disease, the therapeutic optometrist shall refer the
7-1 patient to a physician for a physical examination before initiating
7-2 beta blocker therapy.
7-3 (o) A therapeutic optometrist who diagnoses acute closed
7-4 angle glaucoma may initiate appropriate emergency treatment for a
7-5 patient but shall refer the patient to a physician in a timely
7-6 manner.
7-7 (p) A physician may charge a reasonable consultation fee for
7-8 a consultation given as provided by this section.
7-9 (q) A physician to whom a patient is referred by a
7-10 therapeutic optometrist under this section shall forward to the
7-11 therapeutic optometrist, not later than the 30th day after first
7-12 seeing the patient, a written report on the results of the
7-13 referral. The therapeutic optometrist shall maintain the report in
7-14 the patient's records. A physician who, for a medically
7-15 appropriate reason, does not return a patient to the therapeutic
7-16 optometrist who referred the patient, shall state in the
7-17 physician's report to the therapeutic optometrist the specific
7-18 medical reason for failing to return the patient.
7-19 (r) A therapeutic optometrist may not administer or
7-20 prescribe an oral or parenteral medication or treat glaucoma
7-21 without holding a certificate issued by the board. A therapeutic
7-22 optometrist certified under this subsection shall be known as an
7-23 optometric glaucoma specialist. To obtain a certificate, a
7-24 therapeutic optometrist must as required under Section 1.03A(c) of
7-25 this Act:
7-26 (1) complete an instructional clinical review course;
7-27 and
8-1 (2) pass an examination approved by the board.
8-2 SECTION 3. Article 1, Texas Optometry Act (Article 4552-1.01
8-3 et seq.), is amended by adding Section 1.03A to read as follows:
8-4 Sec. 1.03A. OPTOMETRIC HEALTH CARE ADVISORY COMMITTEE. (a)
8-5 The Optometric Health Care Advisory Committee consists of six
8-6 members appointed as follows:
8-7 (1) two members who are therapeutic optometrists,
8-8 appointed by the board;
8-9 (2) two members who are board certified
8-10 ophthalmologists, appointed by the Texas State Board of Medical
8-11 Examiners; and
8-12 (3) two members who are pharmacologists, appointed by
8-13 the Texas State Board of Pharmacy.
8-14 (b) Members of the committee serve staggered two-year terms
8-15 with the terms of half of the members expiring September 1 each
8-16 year.
8-17 (c) The committee shall make recommendations that:
8-18 (1) establish requirements for the education and
8-19 clinical training necessary for certification as an optometric
8-20 glaucoma specialist;
8-21 (2) establish the parameters of care for treatment of
8-22 ocular diseases and conditions by optometric glaucoma specialists
8-23 as health care technology advances; and
8-24 (3) identify additional classes of pharmaceuticals
8-25 under Section 1.03(f) of this Act that are effective treatments for
8-26 ocular diseases and conditions and that may be effectively used by
8-27 certified optometric glaucoma specialists.
9-1 (d) A person is not eligible for appointment as a
9-2 pharmacologist member of the committee if the person is licensed as
9-3 a therapeutic optometrist or ophthalmologist or is related within
9-4 the second degree by affinity or consanguinity, as determined under
9-5 Chapter 573, Government Code, to a person who is licensed as a
9-6 therapeutic optometrist or ophthalmologist.
9-7 (e) In making any recommendation, the committee shall
9-8 consider patient safety, patient costs, the effect on a patient's
9-9 access to health care, patient convenience, and any added
9-10 efficiencies to the health care delivery system the decision may
9-11 involve.
9-12 (f) Before a recommendation made by the committee may become
9-13 law, the board and the Texas State Board of Medical Examiners must
9-14 adopt the recommendation. If either board fails to adopt a
9-15 recommendation of the committee, that board must articulate a sound
9-16 scientific reason for the failure to adopt.
9-17 (g) Unless continued in existence by act of the legislature,
9-18 the Optometric Health Care Advisory Committee is abolished, and
9-19 this section expires September 1, 2005.
9-20 SECTION 4. (a) This Act takes effect September 1, 1999.
9-21 (b) The initial members of the Optometric Health Care
9-22 Advisory Committee shall be appointed not later than October 1,
9-23 1999, as follows:
9-24 (1) one therapeutic optometrist member, one
9-25 ophthalmologist member, and one pharmacologist member for terms
9-26 expiring September 1, 2000; and
9-27 (2) one therapeutic optometrist member, one
10-1 ophthalmologist member, and one pharmacologist member for terms
10-2 expiring September 1, 2001.
10-3 SECTION 5. The importance of this legislation and the
10-4 crowded condition of the calendars in both houses create an
10-5 emergency and an imperative public necessity that the
10-6 constitutional rule requiring bills to be read on three several
10-7 days in each house be suspended, and this rule is hereby suspended.