84R7368 NC-F
By: Perry S.B. No. 577
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. Sections 351.358(b), (c), (d), and (e),
Occupations Code, are amended to read as follows:
(b) A therapeutic optometrist may:
(1) administer, perform, or prescribe ophthalmic
devices, procedures, and appropriate medications administered by
topical or oral means[, in accordance with this section and Section
351.3581,] to diagnose or treat visual defects, abnormal
conditions, or diseases of the human vision system, including the
eye and adnexa; or
(2) administer medication by parenteral means for a
purpose and in a manner prescribed by Subsection (d) [(e)].
(c) A therapeutic optometrist may administer or prescribe
oral analgesics [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 analgesic classified
as a controlled substance under Schedule [identified in Schedules]
III, IV, or [and] V of 21 U.S.C. Section 812; and
(2) one three-day supply of hydrocodone or of a
hydrocodone combination product classified as a controlled
substance under Schedule II of 21 U.S.C. Section 812
[(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].
(d) [A therapeutic optometrist may independently administer
oral carbonic anhydrase inhibitors for emergency purposes only and
shall immediately refer the patient to an ophthalmologist.
[(e)] A therapeutic optometrist may inject appropriate
medication for a patient who has an anaphylactic reaction to
counteract the anaphylaxis. The therapeutic optometrist shall
immediately refer the patient to a physician.
SECTION 2. Section 351.3581, Occupations Code, is amended
to read as follows:
Sec. 351.3581. [DIAGNOSIS AND] TREATMENT OF GLAUCOMA.
[(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.
[(b) Not later than the 30th day after the date of the
initial diagnosis of glaucoma, a therapeutic optometrist shall
engage in consultation with an ophthalmologist to develop an
individual treatment plan that is approved by the therapeutic
optometrist and ophthalmologist. The parameters of the
consultation shall be at the discretion of the ophthalmologist but
must at least include confirmation of the diagnosis and a plan for
comanagement of the patient, including periodic review of the
patient's progress.
[(c) A therapeutic optometrist required to engage in
comanagement consultation with an ophthalmologist shall inform the
patient diagnosed with glaucoma that the therapeutic optometrist is
required to have the diagnosis confirmed and comanaged with an
ophthalmologist of the patient's choosing or, if the patient does
not choose an ophthalmologist, an ophthalmologist practicing in the
geographic area in which the therapeutic optometrist practices.
[(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 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 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.
[(e) A therapeutic optometrist who refers a patient to a
physician or specialist shall inform the patient that the patient
may go to any physician or specialist the patient chooses. This
subsection does not prevent a therapeutic optometrist from
recommending a physician or specialist.
[(f) On making an initial diagnosis of glaucoma, a
therapeutic optometrist shall set a target pressure that is not
more than 80 percent of the initial intraocular pressure. The
patient's glaucoma is not considered to be appropriately responding
to treatment if the patient fails to achieve the target pressure
within an appropriate time.
[(g) Before a therapeutic optometrist may prescribe a beta
blocker, the therapeutic optometrist must take a complete case
history of the patient and determine whether the patient has had a
physical examination within the 180 days preceding the date of
taking the history. If the patient has not had a physical
examination or if the patient has a history of congestive heart
failure, bradycardia, heart block, asthma, or chronic obstructive
pulmonary disease, the therapeutic optometrist must refer the
patient to a physician for a physical examination before initiating
beta blocker therapy.
[(h) A therapeutic optometrist who diagnoses acute closed
angle glaucoma may initiate appropriate emergency treatment for a
patient but shall refer the patient to a physician in a timely
manner.
[(i) A physician may charge a reasonable consultation fee
for a consultation given as provided by this section.
[(j) A physician to whom a patient is referred by a
therapeutic optometrist under this section shall forward to the
therapeutic optometrist, not later than the 30th day after first
seeing the patient, a written report on the results of the referral.
The therapeutic optometrist shall maintain the report in the
patient's records. A physician who, for a medically appropriate
reason, does not return a patient to the therapeutic optometrist
who referred the patient shall state in the physician's report to
the therapeutic optometrist the specific medical reason for failing
to return the patient.]
SECTION 3. This Act takes effect September 1, 2015.