PRIOR PRINTER'S NO. 958 PRINTER'S no. 2289
No. 831 Session of 2001
INTRODUCED BY PICCOLA, FUMO, M. WHITE, LAVALLE, KUKOVICH, BOSCOLA, GERLACH, STACK, MADIGAN, LOGAN, LEMMOND, WOZNIAK, SCARNATI, MURPHY, THOMPSON, MUSTO, KITCHEN, TARTAGLIONE, EARLL, KASUNIC, D. WHITE, PUNT, SCHWARTZ, HELFRICK, WAUGH, ROBBINS, RHOADES AND WAGNER, MAY 2, 2001
SENATOR DENT, CONSUMER PROTECTION AND PROFESSIONAL LICENSURE, AS AMENDED, OCTOBER 8, 2002
AN ACT 1 Amending the act of June 6, 1980 (P.L.197, No.57), entitled "An 2 act regulating the licensure and practice of optometry, 3 making repeals and providing penalties," further defining 4 "examination and diagnosis" and "practice of optometry"; and 5 adding to the powers and duties of the State Board of <-- 6 Optometry. PROVIDING FOR REQUIREMENTS CONCERNING <-- 7 PHARMACEUTICAL AGENTS FOR THE TREATMENT OF GLAUCOMA AND FOR 8 APPROVAL OF DRUGS. 9 The General Assembly of the Commonwealth of Pennsylvania 10 hereby enacts as follows: 11 Section 1. The definitions of "examination and diagnosis" 12 and "practice of optometry" in section 2 of the act of June 6, 13 1980 (P.L.197, No.57), known as the Optometric Practice and 14 Licensure Act, amended October 30, 1996 (P.L.721, No.130), are 15 amended to read: 16 Section 2. Definitions. 17 The following words and phrases when used in this act shall 18 have, unless the context clearly indicates otherwise, the 19 meanings given to them in this section:
1 * * * 2 "Examination and diagnosis." Any examination or diagnostic <-- 3 means or method compatible with optometric education and 4 professional competence. The term shall encompass the use of 5 pharmaceutical agents for diagnostic purposes classified as 6 miotics, mydriatics, cycloplegics, topical anesthetics and dyes 7 when applied topically to the eye, which pharmaceutical agents 8 shall be approved by the [Secretary of Health and] State Board 9 of Optometry, subject to the rules and regulations of the board, 10 provided however that with respect to optometrists licensed 11 before March 1, 1974, only such optometrists who have 12 satisfactorily completed a course in pharmacology as it applies 13 to optometry, with particular emphasis on the topical 14 application of diagnostic pharmaceutical agents to the eye, 15 approved by the board shall be permitted to use diagnostic 16 pharmaceutical agents topically in the practice of optometry. 17 * * * 18 "Practice of optometry." 19 (1) The use of any and all means or methods for the 20 examination, diagnosis and treatment of conditions of the 21 human visual system and shall include the examination for, 22 and adapting and fitting of, any and all kinds and types of 23 lenses including contact lenses. 24 (2) The administration and prescription of legend and 25 nonlegend drugs as approved by the [Secretary of Health] 26 State Board of Optometry for treatment of the [anterior 27 segment of the] eye, the eyelids, the lacrimal system and the 28 conjunctiva and the removal of superficial foreign bodies 29 from the ocular surface and adnexa. [so long as treatment of 30 diseases or conditions of the visual system as authorized 20010S0831B2289 - 2 -
1 under this paragraph shall not continue beyond six weeks from 2 the initiation of treatment unless the prescribing 3 optometrist documents consultation with a licensed physician. 4 As used in this paragraph, the initiation of treatment may, 5 but need not, include the prescription or administration of 6 pharmaceutical agents for therapeutic purposes.] 7 (3) The prescribing and administering of 8 diphenhydramine, epinephrine or other medication to 9 counteract anaphylaxis or anaphylactic reaction. 10 (4) The provision of low vision rehabilitation through 11 the examination, diagnosis and management of the low vision 12 patient, including prescription, low vision rehabilitation 13 therapy and interdisciplinary consultation when indicated. 14 [(3)] (5) The term shall not include: 15 (i) surgery, including, but not limited to, laser 16 surgery; the use of lasers for therapeutic purposes; and 17 the use of injections in the treatment of ocular disease, 18 except for anaphylaxis; 19 (ii) the use of Schedule I and Schedule II 20 controlled substances; and 21 [(iii) the use of beta blockers and the use of 22 steroids; 23 (iv)] (iii) treatment of systemic disease, except 24 for anaphylaxis.[; and 25 (v) the treatment of glaucoma.] 26 * * * 27 Section 2. Section 3(b) of the act is amended by adding 28 paragraphs to read: 29 Section 3. Powers and duties of the board. 30 * * * 20010S0831B2289 - 3 -
1 (b) The board shall have the following powers: 2 * * * 3 (14.1) To approve, consistent with the rules and 4 regulations promulgated by the board, those acts, services, 5 procedures and practices which may be performed by a licensed 6 optometrist and, prior to authorization, by appropriate 7 examination, establish the competence of every optometrist to 8 perform the approved acts, services, procedures and 9 practices. 10 (14.2) To issue advisory opinions on those acts, 11 services, procedures or practices which may be legally 12 performed by individuals licensed under its jurisdiction. Any 13 licensee wishing to receive an advisory opinion must submit a 14 written request to the board. The request must describe the 15 act, service, procedure or practice the licensee is 16 questioning, and must do so in sufficient detail to enable 17 the board to make a decision. Upon receipt of such a request, 18 the board shall notify the licensee whether it will issue an 19 advisory opinion, and, if so, the time, date and place of the 20 meeting at which it will be considered. All advisory opinions 21 must be approved by majority vote of the board. No person 22 acting in good faith on an advisory opinion issued to him by 23 the board shall be subject to criminal or civil penalties for 24 so acting, provided that the material facts are as stated in 25 the request for an advisory opinion. 26 * * * 27 Section 3. The act is amended by adding a section to read: 28 Section 6.1. Certain acts to constitute practice of optometry. 29 (a) Any person who prescribes or provides comprehensive low 30 vision examination for the rehabilitation and treatment of the 20010S0831B2289 - 4 -
1 visually impaired or legally blind patient; prescribes 2 corrective eyeglasses, contact lenses, prisms, or sunfilters; 3 employs any means for the adaptation of lenses, low vision 4 devices, prisms or sunfilters; evaluates the need for, 5 recommends or prescribes optical low vision devices is engaged 6 in the practice of optometry; or recommends or provides low 7 vision rehabilitation services independent of documentation of 8 collaboration/communication with an optometrist, physician or 9 osteopath is engaged in the practice of optometry. 10 (b) Any person who assesses, diagnoses, treats or prescribes 11 treatment for conditions of the visual system or manages a 12 patient with vision therapy, visual training, orthopics or eye 13 exercises or who holds themself out as being able to do so for 14 the treatment of physical, physiological, sensorimotor, 15 neuromuscular or perceptual anomalies of the eyes or vision 16 system or who prescribes or utilizes lenses, prisms, sunfilters, 17 occlusion or other optical devices for the enhancement and/or 18 treatment of the visual system or prevention of visual 19 dysfunction, except under the supervision and management of a 20 licensed optometrist, physician or osteopath is engaged in the 21 practice of optometry. 22 Section 4. This act shall take effect immediately. 23 "EXAMINATION AND DIAGNOSIS." ANY EXAMINATION OR DIAGNOSTIC <-- 24 MEANS OR METHOD COMPATIBLE WITH OPTOMETRIC EDUCATION AND 25 PROFESSIONAL COMPETENCE. THE TERM SHALL ENCOMPASS THE USE OF 26 PHARMACEUTICAL AGENTS FOR DIAGNOSTIC PURPOSES CLASSIFIED AS 27 MIOTICS, MYDRIATICS, CYCLOPLEGICS, TOPICAL ANESTHETICS AND DYES 28 WHEN APPLIED TOPICALLY TO THE EYE, WHICH PHARMACEUTICAL AGENTS 29 SHALL BE APPROVED BY THE SECRETARY OF HEALTH AS PROVIDED IN 30 SECTION 4.3 AND, SUBJECT TO THE RULES AND REGULATIONS OF THE 20010S0831B2289 - 5 -
1 BOARD, PROVIDED HOWEVER THAT WITH RESPECT TO OPTOMETRISTS 2 LICENSED BEFORE MARCH 1, 1974, ONLY SUCH OPTOMETRISTS WHO HAVE 3 SATISFACTORILY COMPLETED A COURSE IN PHARMACOLOGY AS IT APPLIES 4 TO OPTOMETRY, WITH PARTICULAR EMPHASIS ON THE TOPICAL 5 APPLICATION OF DIAGNOSTIC PHARMACEUTICAL AGENTS TO THE EYE, 6 APPROVED BY THE BOARD SHALL BE PERMITTED TO USE DIAGNOSTIC 7 PHARMACEUTICAL AGENTS TOPICALLY IN THE PRACTICE OF OPTOMETRY. 8 * * * 9 "PRACTICE OF OPTOMETRY." 10 (1) THE USE OF ANY AND ALL MEANS OR METHODS FOR THE 11 EXAMINATION, DIAGNOSIS AND TREATMENT OF CONDITIONS OF THE 12 HUMAN VISUAL SYSTEM AND SHALL INCLUDE THE EXAMINATION FOR, 13 AND ADAPTING AND FITTING OF, ANY AND ALL KINDS AND TYPES OF 14 LENSES INCLUDING CONTACT LENSES. 15 (2) THE ADMINISTRATION AND PRESCRIPTION OF LEGEND AND 16 NONLEGEND DRUGS AS APPROVED BY THE SECRETARY OF HEALTH AS 17 PROVIDED IN SECTION 4.3 FOR TREATMENT OF THE [ANTERIOR 18 SEGMENT OF THE] EYE, THE EYELIDS, THE LACRIMAL SYSTEM AND THE 19 CONJUNCTIVA AND THE REMOVAL OF SUPERFICIAL FOREIGN BODIES 20 FROM THE OCULAR SURFACE AND ADNEXA SO LONG AS TREATMENT OF 21 DISEASES OR CONDITIONS OF THE VISUAL SYSTEM, OTHER THAN 22 GLAUCOMA, AS AUTHORIZED UNDER THIS PARAGRAPH SHALL NOT 23 CONTINUE BEYOND SIX WEEKS FROM THE INITIATION OF TREATMENT 24 UNLESS THE PRESCRIBING OPTOMETRIST DOCUMENTS CONSULTATION 25 WITH A LICENSED PHYSICIAN. AS USED IN THIS PARAGRAPH, THE 26 INITIATION OF TREATMENT MAY, BUT NEED NOT, INCLUDE THE 27 PRESCRIPTION OR ADMINISTRATION OF PHARMACEUTICAL AGENTS FOR 28 THERAPEUTIC PURPOSES. 29 (3) THE TERM SHALL NOT INCLUDE: 30 (I) SURGERY, INCLUDING, BUT NOT LIMITED TO, LASER 20010S0831B2289 - 6 -
1 SURGERY; THE USE OF LASERS FOR THERAPEUTIC PURPOSES; AND 2 THE USE OF INJECTIONS IN THE TREATMENT OF OCULAR DISEASE; 3 (II) THE USE OF SCHEDULE I AND SCHEDULE II 4 CONTROLLED SUBSTANCES; 5 [(III) THE USE OF BETA BLOCKERS AND THE USE OF 6 STEROIDS; 7 (IV) TREATMENT OF SYSTEMIC DISEASE; AND 8 (V) THE TREATMENT OF GLAUCOMA.] 9 (III) TREATMENT OF SYSTEMIC DISEASE; AND 10 (IV) THE TREATMENT OF GLAUCOMA, EXCEPT THAT 11 OPTOMETRISTS MAY USE ALL TOPICAL PHARMACEUTICAL AGENTS IN 12 THE TREATMENT OF PRIMARY OPEN ANGLE GLAUCOMA, EXFOLIATION 13 GLAUCOMA AND PIGMENTARY GLAUCOMA. 14 * * * 15 SECTION 2. THE ACT IS AMENDED BY ADDING SECTIONS TO READ: 16 SECTION 4.2. ADDITIONAL REQUIREMENTS TO PRESCRIBE AND 17 ADMINISTER PHARMACEUTICAL AGENTS FOR THE 18 TREATMENT OF CERTAIN TYPES OF GLAUCOMA. 19 (A) PRIOR TO TREATING GLAUCOMA FOR THE FIRST TIME, ALL 20 THERAPEUTICALLY CERTIFIED OPTOMETRISTS MUST HAVE PASSED AN 21 EXAMINATION THAT INCLUDED PRESCRIPTION AND ADMINISTRATION OF 22 PHARMACEUTICAL AGENTS FOR THERAPEUTIC PURPOSES AS REQUIRED IN 23 SECTION 4.1(A). THERAPEUTICALLY CERTIFIED OPTOMETRISTS WHO 24 PASSED THE EXAMINATION UNDER SECTION 4.1(A)(2) SHALL ALSO 25 COMPLETE AT LEAST 18 HOURS OF CONTINUING EDUCATION IN GLAUCOMA. 26 IN ORDER TO CONTINUE TREATING GLAUCOMA, THE THERAPEUTICALLY 27 CERTIFIED OPTOMETRIST SHALL, AS PART OF THE CONTINUING EDUCATION 28 REQUIRED FOR RENEWAL OF A LICENSE UNDER THIS ACT, COMPLETE AT 29 LEAST 4 HOURS IN THE STUDY OF THE PRESCRIPTION AND 30 ADMINISTRATION OF PHARMACEUTICAL AGENTS FOR THE TREATMENT OF 20010S0831B2289 - 7 -
1 GLAUCOMA. 2 (B) THERAPEUTICALLY CERTIFIED OPTOMETRISTS WHO PRESCRIBE AND 3 ADMINISTER PHARMACEUTICAL AGENTS FOR THE TREATMENT OF GLAUCOMA 4 PERMITTED UNDER THIS ACT SHALL OBTAIN AND MAINTAIN PROFESSIONAL 5 LIABILITY INSURANCE IN ACCORDANCE WITH SECTION 3(A)(2.5), EXCEPT 6 THAT THE AMOUNT OF PROFESSIONAL LIABILITY INSURANCE MAINTAINED 7 SHALL BE A MINIMUM OF $1,000,000 PER OCCURRENCE AND $3,000,000 8 PER ANNUAL AGGREGATE. 9 SECTION 4.3. APPROVAL OF DRUGS. 10 DRUGS SHALL BE APPROVED AS FOLLOWS: 11 (1) ALL DRUGS CURRENTLY APPROVED BY THE SECRETARY OF 12 HEALTH AND IN USE IN THE PRACTICE OF OPTOMETRY ON THE 13 EFFECTIVE DATE OF THIS SECTION SHALL BE DEEMED APPROVED UNDER 14 THIS SECTION. 15 (2) WITHIN 90 DAYS OF THE EFFECTIVE DATE OF THIS 16 SECTION, THE BOARD SHALL SUBMIT A LIST OF DRUGS AUTHORIZED 17 UNDER THIS ACT TO THE SECRETARY OF HEALTH, WHO, IN 18 CONSULTATION WITH THE PHYSICIAN GENERAL, SHALL APPROVE OR 19 DISAPPROVE FOR GOOD CAUSE EACH DRUG. UPON FAILURE OF THE 20 SECRETARY OF HEALTH TO ACT WITHIN 90 DAYS OF RECEIPT OF THE 21 LIST OF DRUGS, THE DRUGS SHALL BE DEEMED APPROVED FOR USE 22 UNDER THIS ACT. 23 (3) THE STATE BOARD OF OPTOMETRY SHALL PROVIDE THE 24 SECRETARY OF HEALTH WITH LISTS OF ADDITIONAL DRUGS FOR USE 25 UNDER THIS ACT AFTER SUCH DRUGS ARE APPROVED BY THE FOOD AND 26 DRUG ADMINISTRATION, AS PUBLISHED IN THE CODE OF FEDERAL 27 REGULATIONS. THE SECRETARY OF HEALTH, IN CONSULTATION WITH 28 THE PHYSICIAN GENERAL, SHALL APPROVE OR DISAPPROVE FOR GOOD 29 CAUSE ANY SUCH DRUG WITHIN 90 DAYS OF THE RECEIPT OF THE 30 LIST. UPON FAILURE OF THE SECRETARY OF HEALTH TO ACT WITHIN 20010S0831B2289 - 8 -
1 90 DAYS THE DRUGS SHALL BE DEEMED APPROVED FOR USE UNDER THIS 2 ACT. 3 SECTION 3. SECTION 8(A) OF THE ACT IS AMENDED BY ADDING A 4 PARAGRAPH TO READ: 5 SECTION 8. VIOLATIONS AND PENALTIES. 6 (A) * * * 7 (3) IT IS UNLAWFUL FOR OPTOMETRISTS TO HOLD THEMSELVES 8 OUT AS PERFORMING LASER SURGERY OR USING THERAPEUTIC LASERS. 9 * * * 10 SECTION 4. THIS ACT SHALL TAKE EFFECT IMMEDIATELY. D20L63SFL/20010S0831B2289 - 9 -