H*3290(Rat #0114, Act #0084 of 2001)  General Bill, By Walker, Allen, Allison, 
Bales, Barfield, Barrett, Battle, Breeland, G. Brown, J. Brown, R. Brown, Cato, 
Clyburn, Cobb-Hunter, Cooper, Davenport, Delleney, Easterday, Edge, Emory, 
Freeman, Frye, Gilham, Gourdine, Govan, Harrison, Harvin, Haskins, Hayes, 
J. Hines, M. Hines, Hosey, Howard, Jennings, Keegan, Kelley, Kennedy, Kirsh, 
Leach, Lee, Littlejohn, Lloyd, Lucas, Mack, Martin, McCraw, McLeod, 
Meacham-Richardson, Merrill, Miller, Moody-Lawrence, J.H. Neal, J.M. Neal, 
Neilson, Ott, Phillips, Quinn, Rhoad, Riser, Rivers, Rutherford, Sandifer, 
Scott, Sharpe, Sheheen, Simrill, Sinclair, F.N. Smith, G.M. Smith, J.E. Smith, 
J.R. Smith, W.D. Smith, Snow, Stille, Stuart, Talley, Taylor, Townsend, Trotter, 
Vaughn, Webb, Weeks, Whatley, Whipper, White, Wilder, Witherspoon, A. Young, 
J. Young, Loftis and Askins

Similar(S 325)
 A BILL TO AMEND SECTION 40-37-10, CODE OF LAWS OF SOUTH CAROLINA, 1976,
 RELATING TO CONDUCT DEEMED TO BE ENGAGING IN THE PRACTICE OF OPTOMETRY, SO AS
 TO INCLUDE PERSONS ADMINISTERING AND PRESCRIBING PHARMACEUTICAL AGENTS FOR THE
 DIAGNOSIS AND TREATMENT OF EYE DISEASE; TO AMEND SECTION 40-37-105, AS
 AMENDED, RELATING TO THE USE OF PHARMACEUTICAL AGENTS BY OPTOMETRISTS, SO AS
 TO DELETE PROVISIONS CONCERNING SPECIFIC MEDICATIONS, PROVISIONS REGARDING
 PATIENT CHART DOCUMENTATION, AND PROVISIONS RELATING TO PROCEDURES FOR MAKING
 REFERRALS WHEN PRESCRIBING TOPICAL STEROIDS AND WHEN TREATING GLAUCOMA AND TO
 AUTHORIZE INJECTIONS FOR THE TREATMENT OF ANAPHYLAXIS; AND TO AMEND SECTION
 40-37-107, AS AMENDED, RELATING TO THE USE OF PHARMACEUTICAL AGENTS BY
 OPTOMETRISTS, SO AS TO CLARIFY THAT PHARMACEUTICAL AGENTS INCLUDE ORAL AND
 TOPICALLY APPLIED MEDICATIONS, TO REQUIRE THAT PATIENT CHART DOCUMENTATION,
 CONSULTATIONS, AND REFERRALS TO BE IN KEEPING WITH THE STANDARD OF CARE
 REQUIRED OF PHYSICIANS, TO REQUIRE AN OPTOMETRIST PRESCRIBING TOPICAL STEROIDS
 TO COMMUNICATE WITH AN OPHTHALMOLOGIST AFTER TWENTY-ONE DAYS, RATHER THAN TEN
 DAYS, IF IT IS NECESSARY TO CONTINUE THE MEDICATION, AND TO DELETE PROVISIONS
 REQUIRING CONSULTATIONS WITH A PHYSICIAN WHEN TREATING GLAUCOMA WITH BETA
 BLOCKERS; AND TO AMEND SECTION 40-37-107, AS AMENDED, RELATING TO REFERRALS,
 TREATMENT, AND SURGERY, SO AS TO REQUIRE PATIENT CHART DOCUMENTATION,
 CONSULTATIONS, AND REFERRALS TO BE IN KEEPING WITH THE STANDARD OF CARE
 REQUIRED OF PHYSICIANS AND TO CLARIFY WHEN REFERRALS MUST BE MADE TO AN
 OPHTHALMOLOGIST WHEN TREATING GLAUCOMA.-AMENDED TITLE

   01/18/01  House  Introduced, read first time, placed on calendar
                     without reference HJ-7
   01/23/01  House  Member(s) request name removed as sponsor:
                     Huggins, Scarborough
   01/24/01  House  Debate adjourned until Wednesday, February 7,
                     2001 HJ-20
   01/24/01  House  Member(s) request name removed as sponsor: Parks
   01/31/01  House  Member(s) request name removed as sponsor:
                     Robinson, Limehouse
   02/01/01  House  Member(s) request name removed as sponsor: Knotts
   02/06/01  House  Member(s) request name removed as sponsor:
                     Coleman, Chellis, Hinson, Law, Dantzler, Cotty
   02/07/01  House  Member(s) request name removed as sponsor: McGee,
                     Perry, D.C.Smith, D.Owens
   02/07/01  House  Committed to Committee on Medical, Military,
                     Public and Municipal Affairs HJ-12
   03/21/01  House  Member(s) request name removed as sponsor:
                     Thompson, Lourie
   03/21/01  House  Committee report: Majority favorable with amend.,
                     minority unfavorable Medical, Military, Public
                     and Municipal Affairs HJ-6
   03/22/01  House  Member(s) request name removed as sponsor:
                     Bowers, Coates
   03/28/01  House  Member(s) request name removed as sponsor:
                     Rodgers, Rice, Hamilton, Campsen, Altman, Harrell
   03/28/01  House  Amended HJ-23
   03/28/01  House  Read second time HJ-37
   03/28/01  House  Roll call Yeas-81  Nays-30 HJ-37
   03/29/01  House  Read third time and sent to Senate HJ-27
   04/03/01  Senate Introduced and read first time SJ-15
   04/03/01  Senate Referred to Committee on Medical Affairs SJ-15
   05/16/01  Senate Polled out of committee Medical Affairs SJ-5
   05/16/01  Senate Committee report: Favorable with amendment
                     Medical Affairs SJ-5
   05/17/01  Senate Amended SJ-24
   05/17/01  Senate Read second time SJ-24
   05/17/01  Senate Unanimous consent for third reading on next
                     legislative day SJ-24
   05/18/01  Senate Read third time and returned to House with
                     amendments SJ-2
   05/23/01  House  Concurred in Senate amendment and enrolled HJ-39
   06/05/01         Ratified R 114
   08/08/01         Signed By Governor
   08/08/01         Effective date 08/08/01
   08/22/01         Copies available
   08/22/01         Act No. 84

AN ACT TO AMEND SECTION 40-37-10, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO CONDUCT DEEMED TO BE ENGAGING IN THE PRACTICE OF OPTOMETRY, SO AS TO INCLUDE PERSONS ADMINISTERING AND PRESCRIBING PHARMACEUTICAL AGENTS FOR THE DIAGNOSIS AND TREATMENT OF EYE DISEASE; TO AMEND SECTION 40-37-105, AS AMENDED, RELATING TO THE USE OF PHARMACEUTICAL AGENTS BY OPTOMETRISTS, SO AS TO CLARIFY THAT PHARMACEUTICAL AGENTS INCLUDE ORAL AND TOPICALLY APPLIED MEDICATIONS, TO REQUIRE THAT PATIENT CHART DOCUMENTATION, CONSULTATIONS, AND REFERRALS TO BE IN KEEPING WITH THE STANDARD OF CARE REQUIRED OF PHYSICIANS, TO REQUIRE AN OPTOMETRIST PRESCRIBING TOPICAL STEROIDS TO COMMUNICATE WITH AN OPHTHALMOLOGIST AFTER TWENTY-ONE DAYS, RATHER THAN TEN DAYS, IF IT IS NECESSARY TO CONTINUE THE MEDICATION, AND TO DELETE PROVISIONS REQUIRING CONSULTATIONS WITH A PHYSICIAN WHEN TREATING GLAUCOMA WITH BETA BLOCKERS; AND TO AMEND SECTION 40-37-107, AS AMENDED, RELATING TO REFERRALS, TREATMENT, AND SURGERY, SO AS TO REQUIRE PATIENT CHART DOCUMENTATION, CONSULTATIONS, AND REFERRALS TO BE IN KEEPING WITH THE STANDARD OF CARE REQUIRED OF PHYSICIANS AND TO CLARIFY WHEN REFERRALS MUST BE MADE TO AN OPHTHALMOLOGIST WHEN TREATING GLAUCOMA.

Be it enacted by the General Assembly of the State of South Carolina:

Persons deemed to practicing optometry

SECTION 1. Section 40-37-10 of the 1976 Code is amended to read:

"Section 40-37-10. A person is deemed to be practicing optometry within the meaning of this chapter who:

(1) displays a sign or in any way advertises as an optometrist;

(2) employs any means, other than the use of drugs except as provided in this chapter, for the measurement of the powers of vision or the adaptation of lenses for the aid of vision;

(3) in the sale of spectacles, eyeglasses, or lenses, uses lenses in the testing of the eye therefore other than lenses actually sold;

(4) examines the human eye by the employment of any subjective or objective physical means, without the use of drugs except as provided in this chapter, to ascertain the presence of defects or abnormal conditions for the purpose of relieving them by the use of lenses, prisms, or other physical or mechanical means;

(5) practices orthoptics or prescribes or fits contact lenses;

(6) administers pharmaceutical agents, including pharmaceutical agents for topical application, for the diagnosis of ocular and ocular adnexal eye disease as provided in this chapter; or

(7) administers or prescribes, or both, pharmaceutical agents, including oral and topically applied medications, for the diagnosis and treatment of ocular and ocular adnexal eye disease as provided in this chapter."

Use of pharmaceutical agents

SECTION 2. Section 40-37-105 of the 1976 Code, as last amended by Act 65 of 1993, is further amended to read:

"Section 40-37-105. (A) Notwithstanding any other provision of law, a diagnostically certified optometrist may purchase, possess, and administer pharmaceutical agents, including pharmaceutical agents for topical application, other than controlled substances as defined in Section 44-53-110, for diagnostic purposes in the practice of optometry. For the purposes of this subsection, 'pharmaceutical agent' means: anesthetics, mydriatics, cycloplegics, miotics, dyes, and over-the-counter drugs. Miotics may be used only pursuant to the following restrictions:

(1) miotics may not be used for treatment purposes;

(2) miotics may be used only for emergency purposes involving the buildup of pressure within the eyeball and immediately upon this emergency use, the optometrist shall refer the patient to an ophthalmologist and file with the South Carolina Board of Examiners in Optometry a written report of the incident in the manner prescribed by the board by regulation; and the South Carolina Board of Examiners in Optometry shall ensure that the quality and quantity of miotics possessed by a diagnostically certified optometrist is consistent with the use of miotics only for emergency purposes involving the buildup of pressure within the eyeball.

(B) Notwithstanding any other provision of law, a therapeutically certified optometrist may purchase, possess, administer, supply, and prescribe pharmaceutical agents, including oral and topically applied medications other than Schedule I and II controlled substances as defined in Section 44-53-110, for diagnostic and therapeutic purposes in the practice of optometry, except that:

(1) when prescribing oral and topically applied medications, a therapeutically certified optometrist is limited to these oral pharmaceutical agents: antihistamines, antimicrobial, antiglaucoma, over-the-counter drugs, and analgesics for the treatment of ocular and ocular adnexal eye disease. An optometrist may only prescribe these medications for the treatment of ocular and ocular adnexal eye disease;

(2) when prescribing medications for the treatment of ocular and ocular adnexal disease, documentation in the patient's chart and appropriate consultations and referrals must be in keeping with the standard of care in accordance with Section 40-37-108;

(3) when prescribing analgesics, the prescription must be limited to a seven-day supply;

(4) when prescribing topical steroids, if after twenty-one days of treatment it is necessary to continue this medication, the optometrist shall communicate and collaborate with an ophthalmologist;

(5) no medications may be given by injection or intravenously."

Referrals and treatment

SECTION 3. Section 40-37-107 of the 1976 Code, as last amended by Act 65 of 1993, is further amended to read:

"Section 40-37-107. (A) In the diagnosis and treatment of ocular and ocular adnexal eye disease, documentation in the patient's chart and appropriate consultations and referrals must be in keeping with the standard of care in accordance with Section 40-37-108.

(B) In the diagnosis or treatment of eye disease an optometrist, using judgment and that degree of skill, care, knowledge, and attention ordinarily possessed and exercised by optometrists in good standing under like circumstances, shall refer a patient to an appropriate medical or osteopathic doctor including, but not limited to, corneal, glaucoma, or retinal ophthalmological specialists when additional evaluation or treatment is necessary. However, any optometrist may refer a patient to a therapeutically certified optometrist when additional evaluation or treatment is necessary or to a medical or osteopathic doctor as provided for in this section, and any optometrist may refer a patient to another optometrist for the purpose of fitting or dispensing eye glasses, contact lenses, or low vision aids. The South Carolina Board of Examiners in Optometry shall promulgate regulations for the maintenance of records of referrals by optometrists in accordance with this section.

(C) Notwithstanding subsection (B) in treating and managing glaucoma, a therapeutically certified optometrist must strive to achieve a stable range of intraocular pressures considered unlikely to cause further optic nerve damage in that patient. Once this range of pressures is selected based on conditions presented by the patient, the therapeutically certified optometrist must enter this range in the patient's chart. If no measurable progress is achieved in realizing the selected range of pressures within sixty days of initiating treatment, the optometrist shall refer the patient to an ophthalmologist. However, when treating acute angle closure glaucoma, a therapeutically certified optometrist shall immediately initiate treatment after which an appropriate referral must be made to an ophthalmologist.

(D) An optometrist is prohibited from performing surgery. For purposes of this section, surgery includes, but is not limited to, an invasive procedure using instruments which requires closure by suturing, clamping, or other similar devices or a procedure in which the presence or assistance of a nurse anesthetist or an anesthesiologist is required. Laser surgery is prohibited. However, nothing in this section or any other provision of law may be construed to prohibit an optometrist from removing superficial ocular and ocular adnexal foreign bodies; removal of other foreign bodies must be referred to an ophthalmologist."

Time effective

SECTION 4. This act takes effect upon approval by the Governor.

Ratified the 5th day of June, 2001.

Approved the 8th day of August, 2001.