2001-2002 Bill 325: Optometrists May Prescribe Pharmaceutical Agents for Certain Diagnosis

1 BIL: 325 2 TYP: General Bill GB 3 INB: Senate 4 IND: 20010214 5 PSP: Alexander 6 SPO: Alexander, Peeler, Holland, Land, Patterson, Jackson, Pinckney, Grooms, 7 Ford, Branton, Hawkins, Reese, Glover, Martin, Anderson, Matthews, 8 Saleeby, Ravenel, Wilson, Thomas, Mescher, Passailaigue 9 DDN: l:\council\bills\nbd\11155ac01.doc 10 CBN: 3290 11 RBY: Senate 12 COM: Medical Affairs Committee 13 SMA 13 SUB: Optometrists may prescribe pharmaceutical agents for certain diagnosis 14 and eye disease treatment, Optometry, Pharmacies 15 16 17 18 19 20 HST: 21 22 Body Date Action Description Com Leg Involved 23 ______24 Senate 20010306 Co-Sponsor removed by Senator Richardson 25 ------20010220 Companion Bill No. 3290 26 Senate 20010214 Introduced, read first time, 13 SMA 27 referred to Committee 28 29 30 31 Versions of This Bill 32 33 34 35 36 TXT: 1 2 3 4 5 6 7 8 9 A BILL 10 11 TO AMEND SECTION 40-37-10 CODE OF LAWS OF SOUTH 12 CAROLINA, 1976, RELATING TO CONDUCT DEEMED TO 13 BE ENGAGING IN THE PRACTICE OF OPTOMETRY, SO AS 14 TO INCLUDE PERSONS ADMINISTERING AND 15 PRESCRIBING PHARMACEUTICAL AGENTS FOR THE 16 DIAGNOSIS AND TREATMENT OF EYE DISEASE; TO 17 AMEND SECTION 40-37-105, AS AMENDED, RELATING TO 18 THE USE OF PHARMACEUTICAL AGENTS BY 19 OPTOMETRISTS, SO AS TO DELETE PROVISIONS 20 CONCERNING SPECIFIC MEDICATIONS, PROVISIONS 21 REGARDING PATIENT CHART DOCUMENTATION, AND 22 PROVISIONS RELATING TO PROCEDURES FOR MAKING 23 REFERRALS WHEN PRESCRIBING TOPICAL STEROIDS 24 AND WHEN TREATING GLAUCOMA AND TO AUTHORIZE 25 INJECTIONS FOR THE TREATMENT OF ANAPHYLAXIS; 26 AND TO AMEND SECTION 40-37-107, AS AMENDED, 27 RELATING TO PROCEDURES FOR CARE GENERALLY, 28 AND IN TREATING GLAUCOMA, TO REFERRAL OF 29 PATIENTS TO OTHER OPTOMETRISTS AND TO 30 OPHTHALMOLOGISTS WHEN TREATING GLAUCOMA, 31 AND TO THE PROHIBITION AGAINST PERFORMING 32 SURGERY, SO AS TO DELETE THE PROVISIONS 33 CONCERNING PROCEDURES FOR CARE AND REFERRAL 34 OF PATIENTS AND TO MAINTAIN THE PROHIBITION 35 AGAINST PERFORMING SURGERY. 36 37 Be it enacted by the General Assembly of the State of South 38 Carolina: 39 40 SECTION 1. Section 40-37-10 of the 1976 Code is amended to 41 read: 42

1 [325] 1 1 “Section 40-37-10. Any A person shall be is deemed to be 2 practicing optometry within the meaning of this chapter who shall: 3 (1) Display displays a sign or in any way advertise advertises 4 as an optometrist; 5 (2) Employ employs any means, other than the use of drugs 6 except as provided in this chapter, for the measurement of the 7 powers of vision or the adaptation of lenses for the aid of vision; 8 (3) in the sale of spectacles, eyeglasses, or lenses, use uses 9 lenses in the testing of the eye therefor other than lenses actually 10 sold; 11 (4) Examine examines the human eye by the employment of 12 any subjective or objective physical means, without the use of 13 drugs except as provided in this chapter, to ascertain the presence 14 of defects or abnormal conditions for the purpose of relieving them 15 by the use of lenses, prisms, or other physical or mechanical 16 means; or 17 (5) Practice practices orthoptics or prescribe prescribes or fit 18 fits contact lenses.; 19 (6) administers pharmaceutical agents, including 20 pharmaceutical agents for topical application, for the diagnosis of 21 ocular and ocular adnexal eye disease as provided in this chapter; 22 or 23 (7) administers or prescribes, or both, pharmaceutical agents, 24 including oral and topically applied medications, for the diagnosis 25 and treatment of ocular and ocular adnexal eye disease as provided 26 in this chapter.” 27 28 SECTION 2. Section 40-37-105 of the 1976 Code, as last 29 amended by Act 65 of 1993, is further amended to read: 30 31 “Section 40-37-105. (A) Notwithstanding any other provision 32 of law, a diagnostically certified optometrist may purchase, 33 possess, and administer pharmaceutical agents, including 34 pharmaceutical agents for topical application, other than controlled 35 substances as defined in Section 44-53-110, for diagnostic 36 purposes in the practice of optometry. For the purposes of this 37 section subsection, ‘pharmaceutical agent’ means: anesthetics, 38 mydriatics, cycloplegics, miotics, dyes, and over-the-counter 39 drugs. Miotics may be used only pursuant to the following 40 restrictions: 41 (1) miotics may not be used for treatment purposes; 42 (2) miotics may be used only for emergency purposes 43 involving the buildup of pressure within the eyeball and

1 [325] 2 1 immediately upon this emergency use the optometrist shall refer 2 the patient to an ophthalmologist and file with the South Carolina 3 Board of Examiners in Optometry a written report of the incident 4 in the manner prescribed by the board by regulation; and the 5 South Carolina Board of Examiners in Optometry shall ensure that 6 the quality and quantity of miotics possessed by a diagnostically 7 certified optometrist is consistent with the use of miotics only for 8 emergency purposes involving the buildup of pressure within the 9 eyeball. 10 (B) Notwithstanding any other provision of law, a 11 therapeutically certified optometrist may purchase, possess, 12 administer, supply, and prescribe pharmaceutical agents, including 13 oral and topically applied medications other than Schedule I and II 14 controlled substances as defined in Section 44-53-110, for 15 diagnostic and therapeutic purposes in the practice of optometry, 16 except that: 17 (1) when prescribing oral and topically applied medications 18 a therapeutically certified optometrist is limited to these oral 19 pharmaceutical agents: antihistamines, antimicrobial, 20 antiglaucoma, over-the-counter drugs, and analgesics and may 21 only prescribe these medications pharmaceutical agents for the 22 treatment of ocular and ocular adnexal eye disease; 23 (2) when prescribing oral pharmaceutical agents, 24 documentation must be made in the patient’s chart; 25 (3) when prescribing analgesics, the prescription must be 26 limited to a seven-day supply; 27 (4) when prescribing topical steroids, if after ten days of 28 treatment it is necessary to continue this medication, the 29 optometrist shall communicate and collaborate with an 30 ophthalmologist, and if after twenty-one days of treatment it is 31 necessary to continue this medication, the optometrist must refer 32 the patient to an ophthalmologist; 33 (5) when treating glaucoma using beta blocking 34 pharmaceutical agents, a therapeutically certified optometrist must 35 consult personally with or refer to a family practitioner, general 36 practitioner, internist, or other appropriate physician; 37 (6)(2) no medications may be given by injection or 38 intravenously, except injections may be provided for the treatment 39 of anaphylaxis.” 40 41 SECTION 3. Section 40-37-107 of the 1976 Code, as last 42 amended by Act 65 of 1993, is further amended to read: 43

1 [325] 3 1 “Section 40-37-107. (A) In the diagnosis or treatment of eye 2 disease an optometrist, using judgment and that degree of skill, 3 care, knowledge, and attention ordinarily possessed and exercised 4 by optometrists in good standing under like circumstances, shall 5 refer a patient to an appropriate medical or osteopathic doctor 6 including, but not limited to, corneal, glaucoma, or retinal 7 ophthalmological specialists when additional evaluation or 8 treatment is necessary. However, an optometrist who is not 9 therapeutically certified may refer a patient to a therapeutically 10 certified optometrist when additional evaluation or treatment is 11 necessary or to a medical or osteopathic doctor as provided for in 12 this section, and any optometrist may refer a patient to another 13 optometrist for the purpose of fitting or dispensing eye glasses, 14 contact lenses, or low vision aids. The South Carolina Board of 15 Examiners in Optometry shall promulgate regulations for the 16 maintenance of records of referrals by optometrists in accordance 17 with this section. 18 (B) Notwithstanding subsection (A) in treating and managing 19 glaucoma, a therapeutically certified optometrist must strive to 20 achieve a stable range of intraocular pressures considered unlikely 21 to cause further optic nerve damage in that patient. Once this 22 range of pressures is selected based on conditions presented by the 23 patient, the therapeutically certified optometrist must enter this 24 range in the patient’s chart. If no progress is achieved in realizing 25 the selected range of pressures within sixty days of initiating 26 treatment, the optometrist shall refer the patient to an 27 ophthalmologist. However, when treating acute angle closure 28 glaucoma, a therapeutically certified optometrist shall immediately 29 initiate treatment and make an appropriate referral to an 30 ophthalmologist. 31 (C) An optometrist is prohibited from performing surgery. For 32 purposes of this subsection surgery includes, but is not limited to, 33 an invasive procedure using instruments which requires closure by 34 suturing, clamping, or other similar devices or a procedure in 35 which the presence or assistance of a nurse anesthetist or an 36 anesthesiologist is required. Laser surgery is prohibited. 37 However, nothing in subsection (A), this subsection, section or any 38 other provision of law may be construed to prohibit an optometrist 39 from removing superficial ocular and ocular adnexal foreign 40 bodies; removal of other foreign bodies must be referred to an 41 ophthalmologist.” 42

1 [325] 4 1 SECTION 4. This act takes effect upon approval by the 2 Governor. 3 ----XX----

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