AN ACT FURTHER REGULATING OPTOMETRIC PATIENT CARE.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. The definition of "Practitioner" in section 1 of chapter 94C of the General Laws, as appearing in the 1996 Official Edition, is hereby amended by adding the following clause:-
(c) An optometrist authorized by sections 66 and 66B of chapter 112 and registered pursuant to paragraph (h) of section 7 to utilize and prescribe therapeutic pharmaceutical agents in the course of professional practice in the commonwealth.
SECTION 2. Section 7 of said chapter 94C, as so appearing, is hereby amended by adding the following paragraph:-
(h) The commissioner shall promulgate regulations which provide for the automatic registration of optometrists, upon the receipt of the fee as herein provided, to issue written prescriptions in accordance with the provisions of sections 66 and 66B of chapter 112, unless the registration of such optometrist has been suspended or revoked pursuant to the provisions of section 13 or section 14 or unless such registration is denied for cause by the commissioner pursuant to the provisions of chapter 30A. Prior to promulgating such regulations, the commissioner shall consult with the board of registration in optometry.
SECTION 3. Section 9 of said chapter 94C is hereby amended by striking out paragraphs (a) and (b), as so appearing, and inserting in place thereof the following two paragraphs:-
(a) A physician, dentist, podiatrist, optometrist as limited by sections 66 and 66B of chapter 112 and paragraph (h) of section 7, nurse practitioner and psychiatric nurse mental health clinical specialist as limited by paragraph (g) of said section 7 and section 80E of said chapter 112, physician assistant as limited by said paragraph (g) of said section 7 and section 9E of said chapter 112, a certified nurse-midwife as provided in section 80C of said chapter 112 or a veterinarian when registered pursuant to the provisions of said section 7 and acting in accordance with the provisions of applicable federal law and any provision of this chapter which is consistent with federal law, in good faith and in the course of a professional practice for the alleviation of pain and suffering or for the treatment or alleviation of disease, may possess such controlled substances as may reasonably be required for the purpose of patient treatment and may administer controlled substances or may cause the same to be administered under his direction by a nurse.
(b) Notwithstanding the provisions of section 17, a physician, physician assistant, dentist, podiatrist, optometrist, certified nurse-midwife, nurse practitioner, psychiatric nurse mental health clinical specialist or veterinarian who is registered pursuant to the provisions of section 7, when acting in good faith and in the practice of medicine, dentistry, podiatry, optometry, nurse-midwifery or veterinary medicine or a nurse, when authorized by a physician, dentist, podiatrist, optometrist, nurse practitioner, physician assistant, certified nurse-midwife, psychiatric nurse mental health clinical specialist or veterinarian in the course of such nurse's professional practice, may dispense by delivering to an ultimate user, a controlled substance in a single dose or in such quantity as is, in the opinion of such physician, dentist, podiatrist, optometrist, nurse practitioner, physician assistant, certified midwife, psychiatric nurse mental health clinical specialist or veterinarian, essential for the treatment of the patient; provided, however, that such amount or quantity of such controlled substance shall not exceed the amount needed for the immediate treatment of the patient and that all such controlled substances required by the patient as part of such treatment shall be dispensed by prescription to such ultimate user in accordance with the provisions of this chapter.
For the purposes of this section, the words "amount needed for the immediate treatment of the patient" shall mean the quantity of a controlled substance which is necessary for the proper treatment of the patient until it is possible for such patient to have a prescription filled by a pharmacy.
This section shall not be construed to prohibit or limit the dispensing of any prescription medication that is classified by the department of public health as schedule VI and that is provided free of charge by the manufacturer as part of an indigent patient program or for use as samples if such prescription medications are: (1) dispensed to the patient by a professional authorized to dispense controlled substances pursuant to this section; (2) dispensed in the package provided by the manufacturer; and (3) provided at no charge to the patient.
The department shall promulgate rules and regulations governing the dispensing of medication pursuant to this section. Said rules and regulations shall include, but not be limited to, the types and amounts of medications that may be dispensed and the appropriate safeguards for the labeling and dispensing of such medications.
SECTION 4. Chapter 112 of the General Laws is hereby amended by striking out section 66, as so appearing, and inserting in place thereof the following section:-
Section 66. The practice of optometry, as referred to in sections 67 to 73, inclusive, shall mean the employment of any method or means for the diagnosis, prevention, correction, management or treatment of optical deficiencies, optical deformities, visual anomalies, muscular anomalies, ocular diseases and ocular abnormalities of the human eye and adjacent tissue, including removal of superficial foreign bodies and misaligned eyelashes, by utilization of pharmaceutical agents, by the prescription, adaptation and application of ophthalmic lenses, devices containing lenses, prisms, contact lenses, orthoptics, vision therapy, prosthetic devices and other optical aids and the utilization of corrective procedures to preserve, restore or improve vision, consistent with the provisions of sections 66A and 66B.
SECTION 5. Said chapter 112 is hereby further amended by inserting after section 66A the following section:-
Section 66B. Any registered optometrist, qualified by examination for practice under the provisions of section 68 subsequent to January 1, 1994, duly certified in accordance with the provisions of section 68B and duly registered to issue written prescriptions in accordance with the provisions of paragraph (h) of section 7 of chapter 94C may, for the purpose of preventing, correcting, managing or treating ocular diseases or abnormalities, utilize and prescribe therapeutic pharmaceutical agents; provided, however, that nothing in this section shall be construed to permit optometric use of therapeutic pharmaceutical agents which are: (a) controlled substances as described by Title 21 U.S.C. Section 812 or in chapter 94C, except for those listed in schedule VI; (b) pharmaceutical agents administered by subdermal injection, intramuscular injection, intravenous injection, subcutaneous injection or retrobulbar injection; (c) pharmaceutical agents for the specific treatment of systemic disease; and (d) invasive surgical procedures.
If, during the course of examining or treating a patient with the aid of a diagnostic or therapeutic pharmaceutical agent, an optometrist, exercising professional judgment and that 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 defined in section 66, such optometrist shall refer such patient to a licensed physician or other qualified health care practitioner. Optometrists may utilize and prescribe nonlegend agents.
For the purposes of this section and section 68B, the term "therapeutic pharmaceutical agents" shall mean those topical pharmaceutical agents in schedule VI required for the diagnosis, prevention, management or treatment of abnormal ocular conditions or diseases as defined in section 66, except glaucoma.
SECTION 6. Said chapter 112 is hereby further amended by inserting after section 68A the following section:-
Section 68B. The board of registration in optometry shall administer an examination designed to measure the qualifications necessary to safely utilize the ophthalmic application of therapeutic pharmaceutical agents in section 66B. Such examination shall be held in conjunction with the examination provided in sections 68 and 68A and shall include any portion of the examination administered by the National Board of Examiners in Optometry or other appropriate examination covering the subject matter of therapeutic pharmaceutical agents.
Such examination shall, upon application, be open to any optometrist registered under the provisions of this chapter and to any person who meets the qualifications for examination under the provisions of section 68 or section 68A; provided, however, that each such applicant shall furnish to the board evidence of the satisfactory completion of 90 hours of didactic instruction and 30 hours of supervised clinical education relating to the use of therapeutic pharmaceutical agents by a duly accredited medical school or college of optometry and otherwise meeting the guidelines and requirements of the board of registration. The board shall transmit to all successful applicants a certificate of qualification.
SECTION 7. The department of public health shall promulgate rules and regulations to implement the provisions of this act within 90 days of its effective date.