S.B. No. 993

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.

______________________________ ______________________________

President of the Senate Speaker of the House

I hereby certify that S.B. No. 993 passed the Senate on May 13, 2021, by the following vote: Yeas 30, Nays 0.

______________________________ Secretary of the Senate

I hereby certify that S.B. No. 993 passed the House on May 24, 2021, by the following vote: Yeas 144, Nays 2, one present not voting.

______________________________ Chief Clerk of the House

Approved:

______________________________

Date

______________________________

Governor