1-1 By: Brimer, et al. (Senate Sponsor - Madla) H.B. No. 1051
1-2 (In the Senate - Received from the House May 3, 1999;
1-3 May 4, 1999, read first time and referred to Committee on Health
1-4 Services; May 13, 1999, reported favorably, as amended, by the
1-5 following vote: Yeas 3, Nays 1; May 13, 1999, sent to printer.)
1-6 COMMITTEE AMENDMENT NO. 1 By: Madla
1-7 Amend engrossed H.B. 1051 as follows:
1-8 Page 2, line 20, strike subsection (d) and substitute "(d)
1-9 The board shall adopt rules setting forth the classifications of
1-10 [specific] pharmaceutical agents therapeutic optometrists may use
1-11 in the practice of therapeutic optometry as authorized by this Act.
1-12 Additional classifications of medications as authorized by Section
1-13 1.03(c)(3) may only be approved as provided in Section 1.03A. Use
1-14 by a therapeutic optometrist of pharmaceutical agents not
1-15 authorized by the board or otherwise authorized by law shall
1-16 constitute a violation of this Act."
1-17 COMMITTEE AMENDMENT NO. 2 By: Moncrief
1-18 Amend H.B. 1051 as follows:
1-19 (1) On page 1, line 60, strike "topical, oral, or
1-20 parenteral" and substitute "topical or oral".
1-21 (2) On page 2, line 3, insert the following after the period
1-22 and before "A": "In addition, a therapeutic optometrist may
1-23 administer medication by parenteral means for the purposes and in
1-24 the manner set out in subsection (h) of this section."
1-25 A BILL TO BE ENTITLED
1-26 AN ACT
1-27 relating to the regulation of the practice of therapeutic
1-28 optometry.
1-29 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-30 SECTION 1. Section 1.02, Texas Optometry Act (Article
1-31 4552-1.02, Vernon's Texas Civil Statutes), is amended by amending
1-32 Subdivision (7) and adding Subdivision (11) to read as follows:
1-33 (7) The "practice of therapeutic optometry" means the
1-34 employment of objective or subjective means for the purpose of
1-35 ascertaining and measuring the powers of vision of the human eye,
1-36 examining and diagnosing visual defects, abnormal conditions, and
1-37 diseases of the human eye and adnexa, prescribing or fitting lenses
1-38 or prisms to correct or remedy a defect or abnormal condition of
1-39 vision, administering or prescribing a drug or physical treatment
1-40 in the manner authorized by this Act, and treating the visual
1-41 system, including the eye and adnexa as authorized by this Act
1-42 [without the use of surgery or laser surgery]. The practice of
1-43 therapeutic optometry does not include the use of surgery or laser
1-44 surgery.
1-45 (11) "Surgery" means any procedure using instruments,
1-46 including lasers, scalpels, or needles, in which human tissue is
1-47 cut, burned, vaporized, or otherwise altered by any mechanical
1-48 means, laser, or ionizing radiation. The term includes procedures
1-49 using instruments that require closure by suturing, clamping, or
1-50 another device. The term does not include a noninvasive procedure
1-51 to remove a superficial foreign body in the conjunctiva, eyelid, or
1-52 corneal epithelium that has not perforated the Bowman's membrane.
1-53 SECTION 2. Section 1.03, Texas Optometry Act (Article
1-54 4552-1.03, Vernon's Texas Civil Statutes), is amended by amending
1-55 Subsections (b) and (d)-(g) and adding Subsections (h)-(r) to read
1-56 as follows:
1-57 (b) A therapeutic optometrist may administer, perform, or
1-58 [and] prescribe ophthalmic devices, procedures, and appropriate
1-59 medications administered by [over-the-counter oral medications,
1-60 and] topical, oral, or parenteral means, in accordance with this
1-61 section, [ocular pharmaceutical agents, other than antiviral agents
2-1 and antiglaucoma agents,] for the purpose of diagnosing and
2-2 treating visual defects, abnormal conditions, and diseases of the
2-3 human vision system, including the eye and adnexa. A therapeutic
2-4 optometrist is prohibited from performing surgery or laser surgery
2-5 [and may remove superficial foreign matter and eyelashes from the
2-6 external eye or adnexa. If a therapeutic optometrist utilizes
2-7 topical steroids of a strength of one percent concentration to
2-8 treat a condition and the condition has not substantially improved
2-9 within seven days of the initial topical steroid application, the
2-10 therapeutic optometrist shall consult with an ophthalmologist and
2-11 the ophthalmologist shall then establish the treatment regimen. If
2-12 a therapeutic optometrist utilizes topical steroids of a strength
2-13 of less than one percent concentration to treat a condition and the
2-14 condition has not substantially improved within 14 days of the
2-15 initial topical steroid application, the therapeutic optometrist
2-16 shall consult with an ophthalmologist and the ophthalmologist shall
2-17 then establish the treatment regimen. This subsection does not
2-18 authorize an optometrist to treat glaucoma in a manner that was not
2-19 permitted by law on August 31, 1991].
2-20 (d) The board shall adopt rules or the recommendations
2-21 submitted under Section 1.03A of this Act setting forth additional
2-22 classifications of [the specific] pharmaceutical agents therapeutic
2-23 optometrists may use in the practice of therapeutic optometry. Use
2-24 by a therapeutic optometrist of pharmaceutical agents not
2-25 authorized by the board or otherwise authorized by law shall
2-26 constitute a violation of this Act.
2-27 (e) [A five-member technical advisory committee is created
2-28 to assist the board in determining the specific pharmaceutical
2-29 agents which may be used in the practice of therapeutic optometry.
2-30 Appointments to the committee shall be for two-year terms, and no
2-31 member may serve more than two consecutive terms.]
2-32 [(f) The members of the technical advisory committee shall
2-33 be appointed as follows: one must be an optometrist or therapeutic
2-34 optometrist licensed and practicing in this state, appointed by the
2-35 Texas Optometry Board; one must be a physician licensed and
2-36 practicing in this state whose practice is limited to
2-37 ophthalmology, appointed by the Texas State Board of Medical
2-38 Examiners; one must be a pharmacist licensed and practicing
2-39 pharmacy in this state, appointed by the Texas State Board of
2-40 Pharmacy; one must be a faculty member at a state medical
2-41 institution of higher education with expertise in pharmacology,
2-42 appointed by the Texas State Board of Medical Examiners; and one
2-43 must be a faculty member of a college of optometry at a state
2-44 institution of higher education, appointed by the Texas Optometry
2-45 Board.]
2-46 [(g)] A therapeutic optometrist, including an optometric
2-47 glaucoma specialist, is subject to the same standard of
2-48 professional care and judgment as a person practicing as an
2-49 ophthalmologist under the Medical Practice Act (Article 4495b,
2-50 Vernon's Texas Civil Statutes).
2-51 (f) A therapeutic optometrist may prescribe oral medications
2-52 only in the following classifications of oral pharmaceuticals:
2-53 (1) one 10-day supply of oral antibiotics;
2-54 (2) one 72-hour supply of oral antihistamines;
2-55 (3) one seven-day supply of oral nonsteroidal
2-56 anti-inflammatories;
2-57 (4) one three-day supply of any analgesic identified
2-58 in Schedules III, IV, and V of 21 U.S.C. Section 812; and
2-59 (5) any other oral pharmaceutical recommended by the
2-60 optometric health care advisory committee and approved by the board
2-61 and the Texas State Board of Medical Examiners.
2-62 (g) A therapeutic optometrist may independently administer
2-63 oral carbonic anhydrase inhibitors for emergency purposes only and
2-64 shall immediately refer the patient to an ophthalmologist.
2-65 (h) A therapeutic optometrist may inject appropriate
2-66 medication for a patient who has an anaphylactic reaction to
2-67 counteract the anaphylaxis. The therapeutic optometrist shall
2-68 immediately refer the patient to a physician.
2-69 (i) Not later than the 30th day after the date of the
3-1 initial diagnosis of glaucoma, a therapeutic optometrist shall
3-2 engage in consultation with an ophthalmologist to develop an
3-3 individual treatment plan that is approved by the therapeutic
3-4 optometrist and ophthalmologist. The parameters of the
3-5 consultation shall be at the discretion of the ophthalmologist but
3-6 must at least include confirmation of the diagnosis and a plan for
3-7 comanagement of the patient, including periodic review of the
3-8 patient's progress.
3-9 (j) A therapeutic optometrist required to engage in
3-10 comanagement consultation with an ophthalmologist shall inform the
3-11 patient diagnosed with glaucoma that the therapeutic optometrist
3-12 shall have the diagnosis confirmed and comanaged with an
3-13 ophthalmologist of the patient's choosing or, if the patient does
3-14 not choose an ophthalmologist, an ophthalmologist practicing in the
3-15 geographic area in which the therapeutic optometrist practices.
3-16 (k) A therapeutic optometrist shall refer a patient to an
3-17 ophthalmologist if:
3-18 (1) the patient is under 16 years of age and has been
3-19 diagnosed as having glaucoma;
3-20 (2) the patient has been diagnosed as having acute
3-21 closed angle glaucoma;
3-22 (3) the patient has been diagnosed as having malignant
3-23 glaucoma or neovascular glaucoma;
3-24 (4) the therapeutic optometrist determines that a
3-25 patient's glaucoma is caused by a diabetic complication and, after
3-26 joint consultation with the physician treating the diabetes and an
3-27 ophthalmologist by telephone, fax, or another method, the physician
3-28 or ophthalmologist determines that the patient should be seen by
3-29 the physician or ophthalmologist; or
3-30 (5) the therapeutic optometrist determines that a
3-31 patient's glaucoma is not responding appropriately to a treatment
3-32 specified in Subsection (m) of this section and, after consulting a
3-33 physician by telephone, fax, or another method, the physician
3-34 determines that the patient should be seen by the physician or an
3-35 appropriate specialist.
3-36 (l) A therapeutic optometrist who refers a patient to a
3-37 physician or specialist shall inform the patient that the patient
3-38 may go to any physician or specialist the patient chooses. This
3-39 subsection does not prevent a therapeutic optometrist from
3-40 recommending a physician or specialist.
3-41 (m) On making an initial diagnosis of glaucoma, a
3-42 therapeutic optometrist shall set a target pressure that is not
3-43 more than 80 percent of the initial intraocular pressure. The
3-44 patient's glaucoma is considered to not be appropriately responding
3-45 to treatment if the patient fails to achieve the target pressure
3-46 within an appropriate time.
3-47 (n) Before a therapeutic optometrist may prescribe a beta
3-48 blocker, the therapeutic optometrist must take a complete case
3-49 history of the patient and determine whether the patient has had a
3-50 physical examination within the 180 days preceding the date of
3-51 taking the history. If the patient has not had a physical
3-52 examination or if the patient has a history of congestive heart
3-53 failure, bradycardia, heart block, asthma, or chronic obstructive
3-54 pulmonary disease, the therapeutic optometrist shall refer the
3-55 patient to a physician for a physical examination before initiating
3-56 beta blocker therapy.
3-57 (o) A therapeutic optometrist who diagnoses acute closed
3-58 angle glaucoma may initiate appropriate emergency treatment for a
3-59 patient but shall refer the patient to a physician in a timely
3-60 manner.
3-61 (p) A physician may charge a reasonable consultation fee for
3-62 a consultation given as provided by this section.
3-63 (q) A physician to whom a patient is referred by a
3-64 therapeutic optometrist under this section shall forward to the
3-65 therapeutic optometrist, not later than the 30th day after first
3-66 seeing the patient, a written report on the results of the
3-67 referral. The therapeutic optometrist shall maintain the report in
3-68 the patient's records. A physician who, for a medically
3-69 appropriate reason, does not return a patient to the therapeutic
4-1 optometrist who referred the patient, shall state in the
4-2 physician's report to the therapeutic optometrist the specific
4-3 medical reason for failing to return the patient.
4-4 (r) A therapeutic optometrist may not administer or
4-5 prescribe an oral or parenteral medication or treat glaucoma
4-6 without holding a certificate issued by the board. A therapeutic
4-7 optometrist certified under this subsection shall be known as an
4-8 optometric glaucoma specialist. To obtain a certificate, a
4-9 therapeutic optometrist must as required under Section 1.03A(c) of
4-10 this Act:
4-11 (1) complete an instructional clinical review course;
4-12 and
4-13 (2) pass an examination approved by the board.
4-14 SECTION 3. Article 1, Texas Optometry Act (Article 4552-1.01
4-15 et seq.), is amended by adding Section 1.03A to read as follows:
4-16 Sec. 1.03A. OPTOMETRIC HEALTH CARE ADVISORY COMMITTEE.
4-17 (a) The Optometric Health Care Advisory Committee consists of six
4-18 members appointed as follows:
4-19 (1) two members who are therapeutic optometrists,
4-20 appointed by the board;
4-21 (2) two members who are board certified
4-22 ophthalmologists, appointed by the Texas State Board of Medical
4-23 Examiners; and
4-24 (3) two members who are pharmacologists, appointed by
4-25 the Texas State Board of Pharmacy.
4-26 (b) Members of the committee serve staggered two-year terms
4-27 with the terms of half of the members expiring September 1 each
4-28 year.
4-29 (c) The committee shall make recommendations that:
4-30 (1) establish requirements for the education and
4-31 clinical training necessary for certification as an optometric
4-32 glaucoma specialist;
4-33 (2) establish the parameters of care for treatment of
4-34 ocular diseases and conditions by optometric glaucoma specialists
4-35 as health care technology advances; and
4-36 (3) identify additional classes of pharmaceuticals
4-37 under Section 1.03(f) of this Act that are effective treatments for
4-38 ocular diseases and conditions and that may be effectively used by
4-39 certified optometric glaucoma specialists.
4-40 (d) A person is not eligible for appointment as a
4-41 pharmacologist member of the committee if the person is licensed as
4-42 a therapeutic optometrist or ophthalmologist or is related within
4-43 the second degree by affinity or consanguinity, as determined under
4-44 Chapter 573, Government Code, to a person who is licensed as a
4-45 therapeutic optometrist or ophthalmologist.
4-46 (e) In making any recommendation, the committee shall
4-47 consider patient safety, patient costs, the effect on a patient's
4-48 access to health care, patient convenience, and any added
4-49 efficiencies to the health care delivery system the decision may
4-50 involve.
4-51 (f) Before a recommendation made by the committee may become
4-52 law, the board and the Texas State Board of Medical Examiners must
4-53 adopt the recommendation. If either board fails to adopt a
4-54 recommendation of the committee, that board must articulate a sound
4-55 scientific reason for the failure to adopt.
4-56 (g) Unless continued in existence by act of the legislature,
4-57 the Optometric Health Care Advisory Committee is abolished, and
4-58 this section expires September 1, 2005.
4-59 SECTION 4. (a) This Act takes effect September 1, 1999.
4-60 (b) The initial members of the Optometric Health Care
4-61 Advisory Committee shall be appointed not later than October 1,
4-62 1999, as follows:
4-63 (1) one therapeutic optometrist member, one
4-64 ophthalmologist member, and one pharmacologist member for terms
4-65 expiring September 1, 2000; and
4-66 (2) one therapeutic optometrist member, one
4-67 ophthalmologist member, and one pharmacologist member for terms
4-68 expiring September 1, 2001.
4-69 SECTION 5. The importance of this legislation and the
5-1 crowded condition of the calendars in both houses create an
5-2 emergency and an imperative public necessity that the
5-3 constitutional rule requiring bills to be read on three several
5-4 days in each house be suspended, and this rule is hereby suspended.
5-5 * * * * *