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Bill 3290

Indicates Matter Stricken

Indicates New Matter

COMMITTEE REPORT

March 21, 2001

    H. 3290

Introduced by Reps. Walker, Allen, Allison, Altman, Bales, Barfield, Barrett, Battle, Bowers, Breeland, G. Brown, J. Brown, R. Brown, Campsen, Cato, Clyburn, Coates, Cobb-Hunter, Cooper, Davenport, Delleney, Easterday, Edge, Emory, Freeman, Frye, Gilham, Gourdine, Govan, Hamilton, Harrell, 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, Rice, Riser, Rivers, Rodgers, 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

S. Printed 3/21/01--H.

Read the first time January 18, 2001.

    To whom was referred a Bill (H. 3290) 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, etc., respectfully

    That they have duly and carefully considered the same and recommend that the same do pass with amendment:

    Amend the bill, as and if amended, by striking all after the enacting words and inserting:

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

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

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

    (2)    Employ 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, use uses lenses in the testing of the eye therefore other than lenses actually sold;

    (4)    Examine 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; or

    (5)    Practice practices orthoptics or prescribe prescribes or fit 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."

    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 section 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, and may only prescribe these pharmaceutical agents other oral medications 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. In addition to the documentation in the patient's chart and appropriate referral in keeping with the standard of care in accordance with Section 40-37-108, when prescribing an oral steroid, an optometrist must consult with a physician prior to the prescription and notify the patient of the physician's recommendation. An optometrist may not consult with a physician without the prior consent of the patient. When an optometrist prescribes an oral steroid, a written report of this treatment must be made to the patient's primary care physician or to another physician or medical clinic designated by the patient;

        (2)    when prescribing oral pharmaceutical agents medications for the treatment of ocular and ocular adnexal disease, documentation must be made 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 ten twenty-one days of treatment it is necessary to continue this medication, the optometrist shall communicate and collaborate with an ophthalmologist, and if after twenty-one days of treatment it is necessary to continue this medication, the optometrist must refer the patient to an ophthalmologist;

        (5)    when treating glaucoma using beta blocking pharmaceutical agents, a therapeutically certified optometrist must consult personally with or refer to a family practitioner, general practitioner, internist, or other appropriate physician;

        (6)    no medications may be given by injection or intravenously, except for the utilization, in an emergency only, of an epinephrine auto-injector solely to initiate treatment in the case of anaphylaxis after a determination that the patient's symptoms and medical history do not preclude its use, after which immediate triage of the patient must be made to an appropriate medical facility.

    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, an any optometrist who is not therapeutically certified 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.

    (B)(C)    Notwithstanding subsection (A)(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 and make after which an appropriate referral must be made to an ophthalmologist.

    (C)(D)    An optometrist is prohibited from performing surgery. For purposes of this subsection 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 subsection (A), this subsection, 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.

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

    Renumber sections to conform.

    Amend totals and title to conform.

Majority favorable.    Minority unfavorable.

JOE E. BROWN    KENNY BINGHAM

For Majority.    For Minority.

EXPLANATION OF IMPACT:

    The Department of Labor, Licensing and Regulation has indicated this bill would not have any impact to the department, the General Fund of the State nor on federal and/or other funds.

    Approved By:

    Don Addy

    Office of State Budget

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 PROCEDURES FOR CARE GENERALLY, AND IN TREATING GLAUCOMA, TO REFERRAL OF PATIENTS TO OTHER OPTOMETRISTS AND TO OPHTHALMOLOGISTS WHEN TREATING GLAUCOMA, AND TO THE PROHIBITION AGAINST PERFORMING SURGERY, SO AS TO DELETE THE PROVISIONS CONCERNING PROCEDURES FOR CARE AND REFERRAL OF PATIENTS AND TO MAINTAIN THE PROHIBITION AGAINST PERFORMING SURGERY.

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

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

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

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

    (2)    Employ 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, use uses lenses in the testing of the eye therefor other than lenses actually sold;

    (4)    Examine 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; or

    (5)    Practice practices orthoptics or prescribe prescribes or fit 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."

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 section 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 and may only prescribe these medications pharmaceutical agents for the treatment of ocular and ocular adnexal eye disease;

        (2)    when prescribing oral pharmaceutical agents, documentation must be made in the patient's chart;

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

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

        (5)    when treating glaucoma using beta blocking pharmaceutical agents, a therapeutically certified optometrist must consult personally with or refer to a family practitioner, general practitioner, internist, or other appropriate physician;

        (6)(2)    no medications may be given by injection or intravenously, except injections may be provided for the treatment of anaphylaxis."

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 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, an optometrist who is not therapeutically certified 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.

    (B)    Notwithstanding subsection (A) 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 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 and make an appropriate referral to an ophthalmologist.

    (C)    An optometrist is prohibited from performing surgery. For purposes of this subsection 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 subsection (A), this subsection, 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."

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