Amendment #100 to H4461
Optometrist Expansion
Representatives Jones of North Reading, Hill of Ipswich, Poirier of North Attleborough, Gifford of Wareham, Frost of Auburn and Smola of Warren move to amend the bill by adding the following new sections:-
SECTION XX. Section 1 of chapter 94C of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by striking out, in line 286, the words "sections 66 and 66B" and inserting in place thereof the following words:- section 66 and section 66B or 66C.
SECTION XX. Section 7 of said chapter 94C, as so appearing, is hereby amended by striking out, in line 212, the words "sections 66 and 66B" and inserting in place thereof the following words:- section 66 and section 66B or 66C.
SECTION XX. Section 9 of said chapter 94C, as so appearing, is hereby amended by striking out, in line 2, the words "sections 66 and 66B" and inserting in place thereof the following words:- section 66 and section 66B or 66C.
SECTION XX. Said section 9 of said chapter 94C, as so appearing, is hereby further amended by inserting after the word "podiatrist", in line 69, the following word:- , optometrist.
SECTION XX. Section 66 of chapter 112 of the General Laws, as so appearing, is hereby amended by inserting after the word "utilization", in line 7, the following words:- and prescription.
SECTION XX. Said section 66 of said chapter 112, as so appearing, is hereby further amended by striking out, in lines 12 and 13, the words “and 66B" and inserting in place thereof the following words:- , 66B and 66C.
SECTION XX. The first paragraph of section 66A of said chapter 112, as so appearing, is hereby amended by adding the following sentence:- A registered optometrist may administer epinephrine, adrenaline or other agents used in the percutaneous treatment of anaphylaxis.
SECTION XX. Section 66B of said chapter 112, as so appearing, is hereby amended by inserting after the word “injection," in line 14, the second time it appears, the following words:-, except for the administration of epinephrine, adrenaline or other agents used in the percutaneous treatment of anaphylaxis.
SECTION XX. Said chapter 112 is hereby further amended by inserting after section 66B the following section:-
Section 66C. (a) A registered optometrist, qualified by an examination for practice under section 68 after January 1, 2013, certified under section 68C and registered to issue written prescriptions pursuant to subsection (h) of section 7 of chapter 94C, may utilize and prescribe topical and oral therapeutic pharmaceutical agents used in the practice of optometry, as defined in section 66 and described in 21 U.S.C. 812 or in said chapter 94C, including those placed in schedules III, IV, V and VI by the commissioner pursuant to section 2 of said chapter 94C for the purpose of diagnosing, preventing, correcting, managing or treating ocular diseases, including glaucoma and ocular abnormalities of the human eye and adjacent tissue and the administration of epinephrine, adrenalin or other agents used in the percutaneous treatment of anaphylaxis; provided, however, a registered optometrist, when utilizing or prescribing a pharmaceutical agent in schedule III shall be limited to the utilization and prescription of narcotic analgesics.
Nothing in this section shall permit optometric utilization or prescription of: (i) therapeutic pharmaceutical agents for the treatment of systemic diseases; (ii) invasive surgical procedures; or (iii) pharmaceutical agents administered by subdermal injection, intramuscular injection, intravenous injection, subcutaneous injection or retrobulbar injection, except as authorized in this section for the percutaneous treatment of anaphylaxis. Oral steroid treatment required beyond 14 days shall be continued only in consultation with the patient’s primary care provider and noted in a patient’s medical record.
(b) If an optometrist, during the course of examining or treating a patient with the aid of a diagnostic or therapeutic pharmaceutical agent, exercising professional judgment and the degree of expertise, care and knowledge ordinarily possessed and exercised by optometrists under like circumstances, determines the existence of the signs of previously unevaluated disease which requires treatment not included in the scope of optometric practice as provided in section 66, the optometrist shall refer the patient to a licensed physician or other qualified health care practitioner. Optometrists may utilize and prescribe nonlegend agents.
(c) Nothing in this section shall prevent an optometrist authorized under this section from serving as an approved investigator in a clinical trial evaluating pharmaceutical agents described in subsection (a).
(d) If a patient exam results in a diagnosis of congenital glaucoma or if, during the course of examining, managing or treating a patient with glaucoma, surgical treatment is indicated, an optometrist shall refer that patient to a qualified health care provider for treatment.
(e) Optometrists licensed under this chapter shall participate in relevant state and federal reports or data collection efforts relative to patient safety and medical error reduction coordinated by the Betsy Lehman center for patient safety and medical error reduction established in section 15 of chapter 12C.
(f) An insurer or risk management organization that provides insurance to an optometrist licensed under this chapter shall make an annual report to the Betsy Lehman center for patient safety and medical error reduction. The report shall provide the 10 most common categories of losses, claims or actions for damages for personal injuries alleged to have been caused by error, omission or negligence in optometrists’ performance of services the company incurred during the previous calendar year. Reports shall include completed cases and settlements only and shall not include information identifying providers or patients. Reports shall be provided to the Betsy Lehman center for patient safety and medical error reduction at the center’s request under annual timelines and reporting requirements established by the center with the input of the patient safety and medical errors reduction board established in subsection (c) of said section 15 of said chapter 12C. The center shall use this information in the development of evidence-based best practices to reduce errors and enhance patient safety as required by subsection (e) of said section 15 of said chapter 12C to increase awareness of error prevention strategies through public and professional education.
SECTION XX. Said chapter 112 is hereby further amended by inserting after section 68B the following section:-
Section 68C. (a) The board of registration in optometry shall administer an examination to permit the utilization and prescription of therapeutic pharmaceutical agents as defined under section 66C. The examination shall: (i) be held in conjunction with examinations provided in sections 68, 68A and 68B; and (ii) include any portion of the examination administered by the National Board of Examiners in Optometry or other appropriate examinations covering the subject matter of therapeutic pharmaceutical agents. The board may administer a single examination to measure the qualifications necessary under said sections 68, 68A and 68B and this section. The board shall qualify optometrists to use and prescribe therapeutic pharmaceutical agents in accordance with said sections 68, 68A and 68B and this section. An applicant that presents satisfactory evidence of graduating from a school or college of optometry approved by the board subsequent to January 1, 2013, shall have satisfied all the requirements of sections 68, 68A and 68B and this section.
(b) Examination for the utilization and prescription of therapeutic pharmaceutical agents placed under schedules III, IV, V and VI by the commissioner pursuant to section 2 of chapter 94C and defined under section 66C shall, upon application, be open to an optometrist registered under section 68, 68A or 68B and to any person who meets the qualifications for examination under said sections 68, 68A and 68B. An applicant, registered as an optometrist under said section 68, 68A or 68B, shall: (i) possess a current Massachusetts controlled substances registration for the use of topical pharmaceutical agents described in section 66B and placed under schedule VI by the commissioner pursuant to said section 2 of said chapter 94C; and (ii) furnish to the board of registration in optometry evidence of the satisfactory completion of 40 hours of didactic education and 20 hours of supervised clinical education relating to the utilization and prescription of therapeutic pharmaceutical agents defined under said section 66C. The education shall: (i) be administered by the Massachusetts Society of Optometrists, Inc.;(ii) be accredited by a college of optometry or medicine; and (iii) meet guidelines and requirements of the board of registration in optometry. The board of registration in optometry shall provide to the department of public health and each successful applicant a certificate of qualification in the utilization and prescription of all therapeutic pharmaceutical agents as defined under said section 66C.
(c) An optometrist licensed in another jurisdiction shall be deemed an applicant under this section by the board of registration in optometry. An optometrist licensed in another jurisdiction may submit evidence to the board of registration in optometry of practice equivalent to that required in section 68, 68A or 68B and the board, at its discretion, may accept the evidence in order to satisfy any of the requirements of this section. An optometrist licensed in another jurisdiction to utilize and prescribe therapeutic pharmaceutical agents substantially equivalent to those placed under schedules III, IV, V and VI by the commissioner pursuant to section 2 of chapter 94C and defined in subsection (a) of section 66C may submit evidence to the board of registration in optometry of equivalent didactic and supervised clinical education in order to satisfy all the requirements of this section.
(d) A licensed optometrist who has completed a post-graduate residency program approved by the Accreditation Council on Optometric Education after July 31, 1997 may submit an affidavit to the board of registration in optometry from licensed optometrist’s residency supervisor or the director of residencies at the affiliated college of optometry attesting that an equivalent level of instruction and supervision was completed in order to satisfy all the requirements of this section.
(e) As a requirement of license renewal, an optometrist licensed under this section shall submit to the board of registration in optometry evidence attesting to the completion of 3 hours of continuing education specific to glaucoma.
SECTION XX. Not more than 90 days after the effective date of this act, the department of public health and the board of registration in optometry shall promulgate the rules and regulations required by sections 7 and 9 of chapter 94C of the General Laws and sections 66A, 66B, 66C and 68C of chapter 112 of the General Laws.