Bill Text: FL S0278 | 2013 | Regular Session | Comm Sub
Bill Title: Practice of Optometry
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2013-04-04 - Laid on Table, companion bill(s) passed, see CS/CS/HB 239 (Ch. 2013-26) [S0278 Detail]
Download: Florida-2013-S0278-Comm_Sub.html
Florida Senate - 2013 CS for CS for SB 278 By the Committees on Appropriations; and Health Policy; and Senators Richter and Grimsley 576-02866-13 2013278c2 1 A bill to be entitled 2 An act relating to the practice of optometry; amending 3 s. 463.002, F.S.; revising and providing definitions; 4 authorizing a certified optometrist to administer and 5 prescribe ocular pharmaceutical agents; amending s. 6 463.005, F.S.; authorizing the Board of Optometry to 7 adopt rules relating to the administration and 8 prescription of ocular pharmaceutical agents; amending 9 s. 463.0055, F.S.; requiring a certified optometrist 10 to complete a board-approved course and examination on 11 general and ocular pharmaceutical agents before 12 administering or prescribing those agents; requiring 13 the certified optometrist to provide proof to the 14 department of successful completion of the course and 15 examination; authorizing that successful completion of 16 the course and examination be used to satisfy certain 17 continuing education requirements; requiring the board 18 to establish a formulary of topical ocular 19 pharmaceutical agents that may be prescribed and 20 administered by certified optometrists; deleting 21 provisions with respect to a committee; establishing a 22 statutory formulary of oral ocular pharmaceutical 23 agents; prohibiting a certified optometrist from 24 administering or prescribing certain controlled 25 substances; amending s. 463.0057, F.S.; providing 26 conditions under which the holder of an optometric 27 faculty certificate may administer and prescribe oral 28 ocular pharmaceutical agents; amending s. 463.006, 29 F.S.; revising provisions relating to licensure and 30 certification of optometrists, to conform; amending s. 31 463.0135, F.S.; authorizing a certified optometrist to 32 perform certain eye examinations; requiring a transfer 33 of care letter for the co-management of postoperative 34 care; requiring patient consent; requiring the patient 35 to be informed of the fees and provided an itemized 36 statement of services; amending s. 463.014, F.S.; 37 prohibiting a licensed practitioner of optometry from 38 providing any drug for the purpose of treating a 39 systemic disease; specifying procedures that a 40 certified optometrist is authorized to perform; 41 creating s. 463.0141, F.S.; requiring the reporting of 42 adverse incidents in the practice of optometry to the 43 department according to specified procedures; 44 providing a definition; requiring the department to 45 review the conduct of licensed practitioners with 46 respect to adverse incidents, to which disciplinary 47 action may apply; amending s. 483.035, F.S.; requiring 48 a clinical laboratory operated by a licensed 49 practitioner of optometry to be licensed under 50 Optometry Practice Act; amending s. 483.041, F.S.; 51 revising the definition of the term “licensed 52 practitioner” to include certified optometrists; 53 amending s. 483.181, F.S.; providing for an 54 optometrist to accept a human specimen for 55 examination, under certain conditions; amending s. 56 893.02, F.S.; redefining the term “practitioner” to 57 include certified optometrists; amending s. 893.05, 58 F.S.; prohibiting a certified optometrist from 59 administering or prescribing certain controlled 60 substances; amending s. 893.055, F.S.; revising the 61 term “health care practitioner” to include certified 62 optometrists for purposes of the prescription drug 63 monitoring program; amending ss. 463.009 and 641.31, 64 F.S.; conforming cross-references; providing an 65 effective date. 66 67 Be It Enacted by the Legislature of the State of Florida: 68 69 Section 1. Paragraph (b) of subsection (3) and subsection 70 (4) of section 463.002, Florida Statutes, are amended, 71 subsection (5) is renumbered as subsection (7) and amended, 72 present subsections (6) through (10) are renumbered as 73 subsections (8) through (12), respectively, and new subsections 74 (5) and (6) are added to that section, to read: 75 463.002 Definitions.—As used in this chapter, the term: 76 (3) 77 (b) A licensed practitioner who is not a certified 78 optometrist shall be required to display at her or his place of 79 practice a sign which states, “I am a Licensed Practitioner, not 80 a Certified Optometrist, and I am not able to prescribetopical81 ocular pharmaceutical agents.” 82 (4) “Certified optometrist” means a licensed practitioner 83 authorized by the board to administer and prescribetopical84 ocular pharmaceutical agents. 85 (5) “Ocular pharmaceutical agent” means a pharmaceutical 86 agent that is administered topically or orally for the diagnosis 87 or treatment of ocular conditions of the human eye and its 88 appendages without the use of surgery or other invasive 89 techniques. 90 (6) “Surgery” means a procedure using an instrument, 91 including a laser, scalpel, or needle, in which human tissue is 92 cut, burned, scraped except as provided in s. 463.014(4), or 93 vaporized, by incision, injection, ultrasound, laser, infusion, 94 cryotherapy, or radiation. The term includes a procedure using 95 an instrument which requires the closure of human tissue by 96 suture, clamp, or other such device. 97 (7)(5)“Optometry” means the diagnosis of conditions of the 98 human eye and its appendages; the employment of any objective or 99 subjective means or methods, including the administration of 100topicalocular pharmaceutical agents, for the purpose of 101 determining the refractive powers of the human eyes, or any 102 visual, muscular, neurological, or anatomic anomalies of the 103 human eyes and their appendages; and the prescribing and 104 employment of lenses, prisms, frames, mountings, contact lenses, 105 orthoptic exercises, light frequencies, and any other means or 106 methods, includingtopicalocular pharmaceutical agents, for the 107 correction, remedy, or relief of any insufficiencies or abnormal 108 conditions of the human eyes and their appendages. 109 Section 2. Paragraph (g) of subsection (1) of section 110 463.005, Florida Statutes, is amended to read: 111 463.005 Authority of the board.— 112 (1) The Board of Optometry has authority to adopt rules 113 pursuant to ss. 120.536 (1) and 120.54 to implement the 114 provisions of this chapter conferring duties upon it. Such rules 115 shall include, but not be limited to, rules relating to: 116 (g) Administration and prescription oftopicalocular 117 pharmaceutical agents. 118 Section 3. Section 463.0055, Florida Statutes, is amended 119 to read: 120 463.0055 Administration and prescription oftopicalocular 121 pharmaceutical agents; committee.— 122 (1)(a) Certified optometrists may administer and prescribe 123topicalocular pharmaceutical agents as provided in this section 124 for the diagnosis and treatment of ocular conditions of the 125 human eye and its appendages without the use of surgery or other 126 invasive techniques. However, a licensed practitioner who is not 127 certified may use topically applied anesthetics solely for the 128 purpose of glaucoma examinations, but is otherwise prohibited 129 from administering or prescribingtopicalocular pharmaceutical 130 agents. 131 (b) Before a certified optometrist may administer or 132 prescribe oral ocular pharmaceutical agents, the certified 133 optometrist must provide proof to the department of successful 134 completion of a course and subsequent examination, approved by 135 the board, on general and ocular pharmaceutical agents and the 136 side effects of those agents. The course shall consist of 20 137 contact hours, all of which may be web-based. The first course 138 and examination shall be presented by October 1, 2013, and shall 139 be administered at least annually thereafter. The course and 140 examination shall be developed and offered jointly by a 141 statewide professional association of physicians in this state 142 accredited to provide educational activities designated for the 143 American Medical Association Physician’s Recognition Award (AMA 144 PRA) Category 1 credit and a statewide professional association 145 of licensed practitioners which provides board-approved 146 continuing education on an annual basis. The board shall review 147 and approve the content of the initial course and examination if 148 the board determines that the course and examination adequately 149 and reliably satisfy the criteria set forth in this section. The 150 board shall thereafter annually review and approve the course 151 and examination if the board determines that the content 152 continues to adequately and reliably satisfy the criteria set 153 forth in this section. Successful completion of the board 154 approved course and examination may be used by a certified 155 optometrist to satisfy 20 hours of the continuing education 156 requirements in s. 463.007(3), only for the biennial period in 157 which the board-approved course and examination are taken. If a 158 certified optometrist does not complete a board-approved course 159 and examination under this section, the certified optometrist is 160 only authorized to administer and prescribe topical ocular 161 pharmaceutical agents. 162 (2)(a) The board shall establish a formulary of topical 163 ocular pharmaceutical agents that may be prescribed and 164 administered by a certified optometrist.There is hereby created165a committee composed of two optometrists licensed pursuant to166this chapter, appointed by the Board of Optometry, two board167certified ophthalmologists licensed pursuant to chapter 458 or168chapter 459, appointed by the Board of Medicine, and one169additional person with a doctorate degree in pharmacology who is170not licensed pursuant to chapter 458, chapter 459, or this171chapter, appointed by the State Surgeon General. The committee172shall review requests for additions to, deletions from, or173modifications of a formulary of topical ocular pharmaceutical174agents for administration and prescription by certified175optometrists and shall provide to the board advisory opinions176and recommendations on such requests.The formulary shall 177 consist of those topical ocular pharmaceutical agents that are 178 appropriate to treat or diagnose ocular diseases and disorders 179 and thatwhichthe certified optometrist is qualified to use in 180 the practice of optometry. The board shall establish, add to, 181 delete from, or modify the topical formulary by rule. 182 Notwithstanding any provision of chapter 120 to the contrary, 183 the topical formulary rule becomesshall becomeeffective 60 184 days from the date it is filed with the Secretary of State. 185 (b) The formulary may be added to, deleted from, or 186 modified according to the procedure described in paragraph (a). 187 Any person who requests an addition, deletion, or modification 188 of an authorized topical ocular pharmaceutical agent shall have 189 the burden of proof to show cause why such addition, deletion, 190 or modification should be made. 191 (c) The State Surgeon General shall have standing to 192 challenge any rule or proposed rule of the board pursuant to s. 193 120.56. In addition to challenges for any invalid exercise of 194 delegated legislative authority, the administrative law judge, 195 upon such a challenge by the State Surgeon General, may declare 196 all or part of a rule or proposed rule invalid if it: 197 1. Does not protect the public from any significant and 198 discernible harm or damages; 199 2. Unreasonably restricts competition or the availability 200 of professional services in the state or in a significant part 201 of the state; or 202 3. Unnecessarily increases the cost of professional 203 services without a corresponding or equivalent public benefit. 204 205 However, there shall not be created a presumption of the 206 existence of any of the conditions cited in this subsection in 207 the event that the rule or proposed rule is challenged. 208 (d) Upon adoption of the formulary required by this 209 section, and upon each addition, deletion, or modification to 210 the formulary, the board shall mail a copy of the amended 211 formulary to each certified optometrist and to each pharmacy 212 licensed by the state. 213 (3) In addition to the formulary of topical ocular 214 pharmaceutical agents established by rule of the board, there is 215 created a statutory formulary of oral ocular pharmaceutical 216 agents, which includes the following agents: 217 (a) The following analgesics or their generic or 218 therapeutic equivalents, which may not be administered or 219 prescribed for more than 72 hours without consultation with a 220 physician licensed under chapter 458 or chapter 459 who is 221 skilled in diseases of the eye: 222 1. Tramadol hydrochloride. 223 2. Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg. 224 (b) The following antibiotics or their generic or 225 therapeutic equivalents: 226 1. Amoxicillin with or without clavulanic acid. 227 2. Azithromycin. 228 3. Erythromycin. 229 4. Dicloxacillin. 230 5. Doxycycline/Tetracycline. 231 6. Keflex. 232 7. Minocycline. 233 (c) The following antivirals or their generic or 234 therapeutic equivalents: 235 1. Acyclovir. 236 2. Famciclovir. 237 3. Valacyclovir. 238 (d) The following oral anti-glaucoma agents or their 239 generic or therapeutic equivalents, which may not be 240 administered or prescribed for more than 72 hours: 241 1. Acetazolamide. 242 2. Methazolamide. 243 244 Any oral ocular pharmaceutical agent that is listed in the 245 statutory formulary set forth in this subsection and that is 246 subsequently determined by the United States Food and Drug 247 Administration to be unsafe for administration or prescription 248 shall be considered to have been deleted from the formulary of 249 oral ocular pharmaceutical agents. The oral ocular 250 pharmaceutical agents on the statutory formulary set forth in 251 this subsection may not otherwise be deleted by the board, the 252 department, or the State Surgeon General. 253 (4)(3)A certified optometrist shall be issued a prescriber 254 number by the board. Any prescription written by a certified 255 optometrist for ana topicalocular pharmaceutical agent 256 pursuant to this section shall have the prescriber number 257 printed thereon. A certified optometrist may not administer or 258 prescribe: 259 (a) A controlled substance listed in Schedule III, Schedule 260 IV, or Schedule V of s. 893.03, except for an oral analgesic 261 placed on the formulary pursuant to this section for the relief 262 of pain due to ocular conditions of the eye and its appendages. 263 (b) A controlled substance for the treatment of chronic 264 nonmalignant pain as defined in s. 456.44(1)(e). 265 Section 4. Subsection (3) of section 463.0057, Florida 266 Statutes, is amended to read: 267 463.0057 Optometric faculty certificate.— 268 (3) The holder of a faculty certificate may engage in the 269 practice of optometry as permitted by this section,but may not 270 administer or prescribe topical ocular pharmaceutical agents 271 unless the certificateholder has satisfied the requirements of 272 s. 463.006(1)(b)4. and 5. If a certificateholder wishes to 273 administer or prescribe oral ocular pharmaceutical agents, the 274 certificateholder must also satisfy the requirements of s. 275 463.0055(1)(b). 276 Section 5. Subsections (2) and (3) of section 463.006, 277 Florida Statutes, are amended to read: 278 463.006 Licensure and certification by examination.— 279 (2) The examination shall consist of the appropriate 280 subjects, including applicable state laws and rules and general 281 and ocular pharmacology with emphasis on the usetopical282applicationand side effects of ocular pharmaceutical agents. 283 The board may by rule substitute a national examination as part 284 or all of the examination and may by rule offer a practical 285 examination in addition to the written examination. 286 (3) Each applicant who successfully passes the examination 287 and otherwise meets the requirements of this chapter is entitled 288 to be licensed as a practitioner and to be certified to 289 administer and prescribetopicalocular pharmaceutical agents in 290 the diagnosis and treatment of ocular conditions. 291 Section 6. Subsections (10) and (11) are added to section 292 463.0135, Florida Statutes, to read: 293 463.0135 Standards of practice.— 294 (10) A certified optometrist is authorized to perform any 295 eye examination, including a dilated examination, required or 296 authorized by chapter 548 or by rules adopted to implement that 297 chapter. 298 (11) Co-management of postoperative care shall be conducted 299 pursuant to the requirements of this section and a patient 300 specific transfer of care letter that governs the relationship 301 between the physician who performed the surgery and the licensed 302 practitioner. The patient must be fully informed of, and consent 303 in writing to, the co-management relationship for his or her 304 care. The transfer of care letter shall confirm that it is not 305 medically necessary for the physician who performed the surgery 306 to provide such postoperative care to the patient and that it is 307 clinically appropriate for the licensed practitioner to provide 308 such postoperative care. Before co-management of postoperative 309 care commences, the patient shall be informed in writing that he 310 or she has the right to be seen during the entire postoperative 311 period by the physician who performed the surgery. In addition, 312 the patient must be informed of the fees, if any, to be charged 313 by the licensed practitioner and the physician performing the 314 surgery, and must be provided with an accurate and comprehensive 315 itemized statement of the specific postoperative care services 316 that the physician performing the surgery and the licensed 317 practitioner render, along with the charge for each service. 318 Section 7. Subsections (3) and (4) of section 463.014, 319 Florida Statutes, are amended to read: 320 463.014 Certain acts prohibited.— 321 (3) Prescribing, ordering, dispensing, administering, 322 supplying, selling, or giving any drug for the purpose of 323 treating a systemic diseasesystemic drugsby a licensed 324 practitioner is prohibited. However, a certified optometrist is 325 permitted to use commonly accepted means or methods to 326 immediately address incidents of anaphylaxis. 327 (4) Surgery of any kind, including the use of lasers,is 328 expressly prohibited. Certified optometrists may remove 329 superficial foreign bodies. For the purposes of this subsection, 330 the term “superficial foreign bodies” means any foreign matter 331 that is embedded in the conjunctiva or cornea but thatwhichhas 332 not penetrated the globe. Notwithstanding the definition of 333 surgery as provided in s. 463.002(6), a certified optometrist is 334 not prohibited from providing any optometric care within the 335 practice of optometry as defined in s. 463.002(7), such as 336 removing an eyelash by epilation, probing an uninflamed tear 337 duct in a patient 18 years of age or older, blocking the puncta 338 by plug, or superficial scraping for the purpose of removing 339 damaged epithelial tissue or superficial foreign bodies or 340 taking a culture of the surface of the cornea or conjunctiva. 341 Section 8. Section 463.0141, Florida Statutes, is created 342 to read: 343 463.0141 Reports of adverse incidents in the practice of 344 optometry.— 345 (1) Effective January 1, 2014, an adverse incident 346 occurring in the practice of optometry must be reported to the 347 department in accordance with this section. 348 (2) The required notification must be in writing and 349 submitted to the department by certified mail. The required 350 notification must be postmarked within 15 days after the adverse 351 incident if the adverse incident occurs when the patient is at 352 the office of the licensed practitioner. If the adverse incident 353 occurs when the patient is not at the office of the licensed 354 practitioner, the required notification must be postmarked 355 within 15 days after the licensed practitioner discovers, or 356 reasonably should have discovered, the occurrence of the adverse 357 incident. 358 (3) For purposes of notification to the department, the 359 term “adverse incident,” as used in this section, means any of 360 the following events when it is reasonable to believe that the 361 event is attributable to the prescription of an oral ocular 362 pharmaceutical agent by the licensed practitioner: 363 (a) Any condition that requires the transfer of a patient 364 to a hospital licensed under chapter 395. 365 (b) Any condition that requires the patient to obtain care 366 from a physician licensed under chapter 458 or chapter 459, 367 other than a referral or a consultation required under this 368 chapter. 369 (c) Permanent physical injury to the patient. 370 (d) Partial or complete permanent loss of sight by the 371 patient. 372 (e) Death of the patient. 373 (4) The department shall review each incident and determine 374 whether it potentially involved conduct by the licensed 375 practitioner who may be subject to disciplinary action, in which 376 event s. 456.073 applies. Disciplinary action, if any, shall be 377 taken by the board. 378 Section 9. Subsection (1) of section 483.035, Florida 379 Statutes, is amended to read: 380 483.035 Clinical laboratories operated by practitioners for 381 exclusive use; licensure and regulation.— 382 (1) A clinical laboratory operated by one or more 383 practitioners licensed under chapter 458, chapter 459, chapter 384 460, chapter 461, chapter 462, chapter 463, or chapter 466, 385 exclusively in connection with the diagnosis and treatment of 386 their own patients, must be licensed under this part and must 387 comply with the provisions of this part, except that the agency 388 shall adopt rules for staffing, for personnel, including 389 education and training of personnel, for proficiency testing, 390 and for construction standards relating to the licensure and 391 operation of the laboratory based upon and not exceeding the 392 same standards contained in the federal Clinical Laboratory 393 Improvement Amendments of 1988 and the federal regulations 394 adopted thereunder. 395 Section 10. Subsection (7) of section 483.041, Florida 396 Statutes, is amended to read: 397 483.041 Definitions.—As used in this part, the term: 398 (7) “Licensed practitioner” means a physician licensed 399 under chapter 458, chapter 459, chapter 460, or chapter 461; a 400 certified optometrist licensed under chapter 463; a dentist 401 licensed under chapter 466; a person licensed under chapter 462; 402 or an advanced registered nurse practitioner licensed under part 403 I of chapter 464; or a duly licensed practitioner from another 404 state licensed under similar statutes who orders examinations on 405 materials or specimens for nonresidents of the State of Florida, 406 but who reside in the same state as the requesting licensed 407 practitioner. 408 Section 11. Subsection (5) of section 483.181, Florida 409 Statutes, is amended to read: 410 483.181 Acceptance, collection, identification, and 411 examination of specimens.— 412 (5) A clinical laboratory licensed under this part must 413 accept a human specimen submitted for examination by a 414 practitioner licensed under chapter 458, chapter 459, chapter 415 460, chapter 461, chapter 462, chapter 463, s. 464.012, or 416 chapter 466, if the specimen and test are the type performed by 417 the clinical laboratory. A clinical laboratory may only refuse a 418 specimen based upon a history of nonpayment for services by the 419 practitioner. A clinical laboratory shall not charge different 420 prices for tests based upon the chapter under which a 421 practitioner submitting a specimen for testing is licensed. 422 Section 12. Subsection (21) of section 893.02, Florida 423 Statutes, is amended to read: 424 893.02 Definitions.—The following words and phrases as used 425 in this chapter shall have the following meanings, unless the 426 context otherwise requires: 427 (21) “Practitioner” means a physician licensed pursuant to 428 chapter 458, a dentist licensed pursuant to chapter 466, a 429 veterinarian licensed pursuant to chapter 474, an osteopathic 430 physician licensed pursuant to chapter 459, a naturopath 431 licensed pursuant to chapter 462, a certified optometrist 432 licensed pursuant to chapter 463, or a podiatric physician 433 licensed pursuant to chapter 461, provided such practitioner 434 holds a valid federal controlled substance registry number. 435 Section 13. Subsection (1) of section 893.05, Florida 436 Statutes, is amended to read: 437 893.05 Practitioners and persons administering controlled 438 substances in their absence.— 439 (1) A practitioner, in good faith and in the course of his 440 or her professional practice only, may prescribe, administer, 441 dispense, mix, or otherwise prepare a controlled substance, or 442 the practitioner may cause the same to be administered by a 443 licensed nurse or an intern practitioner under his or her 444 direction and supervision only. A veterinarian may so prescribe, 445 administer, dispense, mix, or prepare a controlled substance for 446 use on animals only, and may cause it to be administered by an 447 assistant or orderly under the veterinarian’s direction and 448 supervision only. A certified optometrist licensed under chapter 449 463 may not administer or prescribe a controlled substance 450 listed in Schedule I or Schedule II of s. 893.03. 451 Section 14. Paragraph (d) of subsection (1) of section 452 893.055, Florida Statutes, is amended to read: 453 893.055 Prescription drug monitoring program.— 454 (1) As used in this section, the term: 455 (d) “Health care practitioner” or “practitioner” means any 456 practitioner who is subject to licensure or regulation by the 457 department under chapter 458, chapter 459, chapter 461, chapter 458 462, chapter 463, chapter 464, chapter 465, or chapter 466. 459 Section 15. Section 463.009, Florida Statutes, is amended 460 to read: 461 463.009 Supportive personnel.—No person other than a 462 licensed practitioner may engage in the practice of optometry as 463 defined in s. 463.002(7)463.002(5). Except as provided in this 464 section, under no circumstances shall nonlicensed supportive 465 personnel be delegated diagnosis or treatment duties; however, 466 such personnel may perform data gathering, preliminary testing, 467 prescribed visual therapy, and related duties under the direct 468 supervision of the licensed practitioner. Nonlicensed personnel, 469 who need not be employees of the licensed practitioner, may 470 perform ministerial duties, tasks, and functions assigned to 471 them by and performed under the general supervision of a 472 licensed practitioner, including obtaining information from 473 consumers for the purpose of making appointments for the 474 licensed practitioner. The licensed practitioner shall be 475 responsible for all delegated acts performed by persons under 476 her or his direct and general supervision. 477 Section 16. Subsection (19) of section 641.31, Florida 478 Statutes, is amended to read: 479 641.31 Health maintenance contracts.— 480 (19) Notwithstanding any other provision of law, health 481 maintenance policies or contracts which provide coverage, 482 benefits, or services as described in s. 463.002(7)463.002(5), 483 shall offer to the subscriber the services of an optometrist 484 licensed pursuant to chapter 463. 485 Section 17. This act shall take effect July 1, 2013.