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        PRIOR PRINTER'S NO. 958                       PRINTER'S no. 2289

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

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.














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