Current Status Introducing Body:
HouseBill Number: 3137Ratification Number: 125Act Number: 65Primary Sponsor: BakerType of Legislation: GBSubject: Optometrists, prescription drugsCompanion Bill Number: 214Date Bill Passed both Bodies: 19930505Computer Document Number: 436/12831AC.93Governor's Action: SDate of Governor's Action: 19930514Introduced Date: 19930114Date of Last Amendment: 19930505Last History Body: ------Last History Date: 19930514Last History Type: Act No. 65Scope of Legislation: StatewideAll Sponsors: Baker M.O. Alexander T.C. Alexander Allison Anderson Askins G. Bailey J. Bailey Baxley Beatty Boan Breeland H. Brown J. Brown Byrd Canty Cato Chamblee Clyborne Cobb-Hunter Cooper Corning Cromer Davenport Delleney Elliott Fair Farr Felder Fulmer Gamble Gonzales Govan Graham Hallman Harrell Harrison Harvin Harwell Haskins Hines Holt Huff Hutson Inabinett Jaskwhich Jennings Keegan Kelley Kennedy Kinon Kirsh Klauber Koon Lanford Littlejohn Marchbanks Martin Mattos McAbee McCraw McElveen McKay McMahand McTeer Meacham Moody-Lawrence Neal Neilson Phillips Quinn Rhoad Richardson Robinson Rogers Rudnick Scott Sharpe Shissias Simrill D. Smith R. Smith Snow Spearman Stoddard Stone Thomas Townsend Trotter Tucker Vaughn Waites Waldrop Walker Wells Whipper White D. Wilder J. Wilder Williams Witherspoon Wofford Worley Wright A. Young R. Young HarrelsonType of Legislation: General Bill
Bill Body Date Action Description CMN Leg Involved ---- ------ ------------ ------------------------------ --- ------------ 3137 ------ 19930514 Act No. 65 3137 ------ 19930514 Signed by Governor 3137 ------ 19930511 Ratified R 125 3137 Senate 19930505 Concurred in House amendment, enrolled for ratification 3137 House 19930505 Senate amendments amended, returned to Senate 3137 Senate 19930429 Read third time, returned to House with amendment 3137 Senate 19930428 Debate interrupted by adjournment, with Senator Bryan retaining the floor 3137 Senate 19930422 Made Special Order 3137 Senate 19930420 Amended, read second time, ordered to third reading with notice of general amendments 3137 Senate 19930407 Committee Report: Favorable 13 with amendment 3137 Senate 19930216 Introduced, read first time, 13 referred to Committee 3137 House 19930211 Read third time, sent to Senate 3137 House 19930210 Amended, read second time 3137 House 19930203 Committee Report: majority 27 favorable, with amendment, minority unfavorable 3137 House 19930114 Introduced, read first time, 27 referred to CommitteeView additional legislative information at the LPITS web site.
(A65, R125, H3137)
AN ACT TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 40-37-103 SO AS TO PROVIDE REQUIREMENTS FOR DIAGNOSTIC AND THERAPEUTIC CERTIFICATION OF AN OPTOMETRIST; BY ADDING SECTION 40-37-106 SO AS TO PROHIBIT AN OPTOMETRIST FROM ESTABLISHING A PHARMACY IN AN OPTOMETRY OFFICE AND TO PROVIDE THAT A CERTIFIED OPTOMETRIST MAY ADMINISTER OR SUPPLY PHARMACEUTICAL AGENTS TO PATIENTS TO INITIATE TREATMENT; BY ADDING SECTION 40-37-108 SO AS TO PROVIDE THAT A THERAPEUTICALLY CERTIFIED OPTOMETRIST MUST BE HELD TO THE STANDARD OF CARE OF PHYSICIANS AND SHALL MAINTAIN ONE MILLION DOLLARS IN MALPRACTICE INSURANCE; TO AMEND SECTION 40-37-20, RELATING TO THE AUTHORITY AND DUTIES OF THE SOUTH CAROLINA BOARD OF EXAMINERS IN OPTOMETRY, SO AS TO INCLUDE EXAMINING APPLICANTS FOR DIAGNOSTIC AND THERAPEUTIC CERTIFICATION; TO AMEND SECTION 40-37-105, RELATING TO THE USE OF TOPICAL APPLICATION OF PHARMACEUTICAL AGENTS BY OPTOMETRISTS, SO AS TO PROVIDE FOR THE DIAGNOSTIC AND THE THERAPEUTIC USE OF THESE AGENTS AND TO PROVIDE RESTRICTIONS; TO AMEND SECTION 40-37-107, RELATING TO REFERRALS OF PATIENTS BY OPTOMETRISTS TO PHYSICIANS, SO AS TO INCLUDE REFERRALS TO OTHER OPTOMETRISTS UNDER CERTAIN CONDITIONS, TO PROVIDE STANDARDS FOR TREATING GLAUCOMA, AND TO PROHIBIT SURGERY; TO ADD SECTION 40-37-109 SO AS TO DEFINE "SUPPLY" CONCERNING PHARMACEUTICAL AGENTS; TO AMEND SECTION 40-37-140, RELATING TO LICENSE RENEWAL AND CONTINUING EDUCATION, SO AS TO REQUIRE TWENTY HOURS OF EDUCATION A YEAR WITH CERTAIN PHARMACOLOGICAL REQUIREMENTS FOR CERTIFIED OPTOMETRISTS; TO AMEND SECTION 40-43-150, AS AMENDED, RELATING TO WHO MAY PRESCRIBE DRUGS AND TO THE SALE OF DRUGS AT WHOLESALE, SO AS TO INCLUDE THERAPEUTICALLY CERTIFIED OPTOMETRISTS AMONG THOSE WHO MAY PRESCRIBE AND TO ALLOW THE SALE OF DRUGS AT WHOLESALE TO DIAGNOSTICALLY AND THERAPEUTICALLY CERTIFIED OPTOMETRISTS; TO AMEND SECTION 40-43-155, AS AMENDED, RELATING TO PHARMACISTS SELLING PHARMACEUTICAL AGENTS TO OPTOMETRISTS, SO AS TO PROVIDE THAT THEY MAY BE SOLD TO OPTOMETRISTS WHO ARE DIAGNOSTICALLY AND THERAPEUTICALLY CERTIFIED OPTOMETRISTS FOR CERTAIN PURPOSES; AND TO AMEND SECTION 40-43-360, AS AMENDED, RELATING TO DEFINITIONS IN THE PHARMACY ACT, SO AS TO INCLUDE A THERAPEUTICALLY CERTIFIED OPTOMETRIST AS A "PRACTITIONER" FOR THE PURPOSE OF DEFINING WHO MAY PRESCRIBE DRUGS.
Be it enacted by the General Assembly of the State of South Carolina:
Requirements for diagnostic and therapeutic certification
SECTION 1. The 1976 Code is amended by adding:
"Section 40-37-103. (A) The board shall certify a licensed optometrist as a diagnostically certified optometrist if the optometrist has:
(1) complied with the educational requirements promulgated by the board; and
(2) passed a pharmaceutical agent examination which must be administered by the board.
(B) The board shall certify a licensed optometrist as a therapeutically certified optometrist if the optometrist has:
(1) satisfied the requirements for diagnostic certification;
(2) passed the Treatment and Management of Ocular Disease Examination administered by the National Board of Examiners in Optometry; and
(3) taken at least one hundred ten hours of board-approved optometric education courses since December 31, 1988, and after graduation from optometry school, of which at least forty hours must have been clinical instruction specifically related to the diagnosis and treatment of glaucoma and must have been taken under the supervision of an ophthalmologist who must submit a written certification to the Board of Examiners in Optometry that the optometrist has completed the forty hours of clinical instruction required by this item.
(4) submitted to the board an affidavit stating that the optometrist has had at least twelve hundred hours of clinical training."
Pharmacy may not be established by optometrist
SECTION 2. The 1976 Code is amended by adding:
"Section 40-37-106. (A) An optometrist may not establish a pharmacy in an optometry office or sell pharmaceutical agents prescribed in treatment unless there is a licensed pharmacist on staff and present when these prescriptions are filled. However, nothing in this section or in any other provision of law prohibits an optometrist who is diagnostically certified from administering pharmaceutical agents to a patient or an optometrist who is therapeutically certified from administering or supplying pharmaceutical agents to a patient, without charge for the pharmaceutical agents, to initiate appropriate treatment.
(B) Notwithstanding subsection (A) or any other provision of law, an optometrist may purchase, possess, administer, sell, prescribe, or dispense contact lenses, contact lens solutions, and topically applied dyes."
Standard of care and malpractice insurance for diagnostically certified optometrists
SECTION 3. The 1976 Code is amended by adding:
"Section 40-37-108. A therapeutically certified optometrist must be held to the same standard of care as persons licensed under Title 40, Chapter 47, Physicians, Surgeons and Osteopaths and shall maintain a minimum of one million dollars in malpractice insurance coverage."
Board powers and duties issuance of certifications
SECTION 4. Section 40-37-20 of the 1976 Code is amended to read:
"Section 40-37-20. (A) There is created the South Carolina Board of Examiners in Optometry which consists of seven members. Five members must be licensed optometrists appointed by the Governor upon nomination by all licensed optometrists in this State through an election conducted by the board. The Governor may reject any or all of those nominated upon satisfactory showing of the unfitness of those rejected. If the Governor declines to appoint any of the nominees submitted, additional nominees must be submitted in the same manner. Vacancies must be filled in like manner by appointment by the Governor for the unexpired portion of the term. Two members of the board must be members of the general public who do not derive their income or support from any optical or related business or who are not related to any members of these professions. These public members may be nominated by any individual, group, or association, and are appointed by the Governor.
(B) The board is responsible for examining applicants for optometric licenses and for diagnostic and therapeutic certifications, for investigating complaints, and for investigating and prosecuting violations of this chapter.
(C) The members of the board are appointed for terms of four years and until their successors are appointed and qualify. No person may serve more than two consecutive four-year terms on the board, except that if a person is appointed to fill an unexpired term on the board, the person may be reappointed for two additional four-year terms. The Governor may remove a member of the board who has been guilty of continued neglect of board duties or who is found to be incompetent or for just cause. No member may be removed without first giving the member an opportunity to refute the charges filed against the member, who must be given a copy of the charges at the time they are filed."
Authority of optometrist to use and prescribe pharmaceutical agents
SECTION 5. Section 40-37-105 of the 1976 Code is amended to read:
"Section 40-37-105. (A) Notwithstanding any other provision of law, a diagnostically certified optometrist may purchase, possess, and administer pharmaceutical agents, including pharmaceutical agents for topical application, other than controlled substances as defined in Section 44-53-110, for diagnostic purposes in the practice of optometry. For the purposes of this section, `pharmaceutical agent' means: anesthetics, mydriatics, cycloplegics, miotics, dyes, and over-the-counter drugs. Miotics may be used only pursuant to the following restrictions:
(1) miotics may not be used for treatment purposes;
(2) miotics may be used only for emergency purposes involving the buildup of pressure within the eyeball and immediately upon this emergency use the optometrist shall refer the patient to an ophthalmologist and file with the South Carolina Board of Examiners in Optometry a written report of the incident in the manner prescribed by the board by regulation; and
(3) the South Carolina Board of Examiners in Optometry shall ensure that the quality and quantity of miotics possessed by a diagnostically certified optometrist is consistent with the use of miotics only for emergency purposes involving the buildup of pressure within the eyeball.
(B) Notwithstanding any other provision of law, a therapeutically certified optometrist may purchase, possess, administer, supply, and prescribe pharmaceutical agents, other than Schedule I and II controlled substances as defined in Section 44-53-110, for diagnostic and therapeutic purposes in the practice of optometry, except that:
(1) when prescribing oral medications a therapeutically certified optometrist is limited to these oral pharmaceutical agents: antihistamines, antimicrobial, antiglaucoma, over-the-counter drugs, and analgesics and may only prescribe these pharmaceutical agents for the treatment of ocular and ocular adnexal eye disease;
(2) when prescribing oral pharmaceutical agents, documentation must be made in the patient's chart;
(3) when prescribing analgesics, the prescription must be limited to a seven-day supply;
(4) when prescribing topical steroids, if after ten days of treatment it is necessary to continue this medication, the optometrist shall communicate and collaborate with an ophthalmologist, and if after twenty-one days of treatment it is necessary to continue this medication, the optometrist must refer the patient to an ophthalmologist;
(5) when treating glaucoma using beta blocking pharmaceutical agents, a therapeutically certified optometrist must consult personally with or refer to a family practitioner, general practitioner, internist, or other appropriate physician;
(6) no medications may be given by injection or intravenously."
Authority to diagnose and treatment; requirement to refer; surgery prohibited
SECTION 6. Section 40-37-107 of the 1976 Code is amended to read:
"Section 40-37-107. (A) In the diagnosis or treatment of eye disease an optometrist, using judgment and that degree of skill, care, knowledge, and attention ordinarily possessed and exercised by optometrists in good standing under like circumstances, shall refer a patient to an appropriate medical or osteopathic doctor including, but not limited to, corneal, glaucoma, or retinal opthamological specialists when additional evaluation or treatment is necessary. However, an optometrist who is not therapeutically certified may refer a patient to a therapeutically certified optometrist when additional evaluation or treatment is necessary or to a medical or osteopathic doctor as provided for in this section, and any optometrist may refer a patient to another optometrist for the purpose of fitting or dispensing eye glasses, contact lenses, or low vision aids. The South Carolina Board of Examiners in Optometry shall promulgate regulations for the maintenance of records of referrals by optometrists in accordance with this section.
(B) Notwithstanding subsection (A) in treating and managing glaucoma, a therapeutically certified optometrist must strive to achieve a stable range of intraocular pressures considered unlikely to cause further optic nerve damage in that patient. Once this range of pressures is selected based on conditions presented by the patient, the therapeutically certified optometrist must enter this range in the patient's chart. If no progress is achieved in realizing the selected range of pressures within sixty days of initiating treatment, the optometrist shall refer the patient to an ophthalmologist. However, when treating acute angle closure glaucoma, a therapeutically certified optometrist shall immediately initiate treatment and make an appropriate referral to an ophthalmologist.
(C) An optometrist is prohibited from performing surgery. For purposes of this subsection surgery includes, but is not limited to, an invasive procedure using instruments which requires closure by suturing, clamping, or other similar devices or a procedure in which the presence or assistance of a nurse anesthetist or an anesthesiologist is required. Laser surgery is prohibited. However, nothing in subsection (A), this subsection, or any other provision of law may be construed to prohibit an optometrist from removing superficial ocular and ocular adnexal foreign bodies; removal of other foreign bodies must be referred to an ophthalmologist."
SECTION 7. The 1976 Code is amended by adding:
"Section 40-37-109. For purposes of this chapter `supply' is limited to pharmaceutical agents given to a patient by a therapeutically-certified optometrist for the purpose of initiating treatment until the patient's prescription can be filled by a registered pharmacist."
License renewal and continuing education
SECTION 8. Section 40-37-140 of the 1976 Code is amended to read:
"Section 40-37-140. (a) An optometrist practicing in this State who desires to continue to be licensed annually shall pay before the second day of October of each year a renewal fee to be fixed by regulation. In case of default in making this payment the license of an optometrist is automatically terminated provided the board gives the licensee thirty days' notice in writing before the imposition of the mandatory termination. The deposit of this notice in the United States Post Office addressed to the licensee at the licensee's last current address as registered with the board, with postage prepaid, is due and legal service of the notice. If within the thirty-day period the licensee pays a penalty that the board may impose, not to exceed fifty dollars, and the renewal fee, the license must be renewed. A person whose license is terminated because of a failure to pay a renewal fee may apply to have it reinstated upon payment to the board of all renewal fees that should have been paid had the license remained active and a penalty of one hundred dollars. If the license has lapsed for more than two years, the licensee shall appear before the board who shall then determine whether or upon what conditions the license may be reinstated.
(B) An optometrist annually shall attend a minimum of twenty hours of continuing educational courses or meetings. The instruction must be on subjects relative to optometry, exclusive of office management or administration, at board-approved and recognized educational seminars and courses or accredited institutions of learning. For optometrists diagnostically or therapeutically certified, eight of the twenty hours must be pharmacology related. Satisfactory proof of compliance with this requirement is a prerequisite for annual license renewal."
Professionals authorized to prescribe
SECTION 9. Section 40-43-150 of the 1976 Code, as last amended by Act 303 of 1992, is further amended to read:
"Section 40-43-150. (A) It is unlawful for a person to sell, give away, barter, exchange, distribute, or possess in the State, except on a prescription of a licensed medical or osteopathic physician, podiatrist, dentist, therapeutically certified optometrist, nurse practitioner, or veterinarian a drug bearing on its manufacturer's or distributor's original commercial container the legend, `CAUTION: Federal law prohibits dispensing without a prescription' and those which, in the discretion of the Board of Pharmacy, are classified as `dangerous drugs' within the meaning of this section.
(B) The prescription must be compounded only by a licensed pharmacist, licensed assistant pharmacist, or under the direct personal supervision of a licensed pharmacist. No prescription may be refilled except upon the authorization of the licensed medical or osteopathic physician, podiatrist, dentist, therapeutically certified optometrist, nurse practitioner, or veterinarian who prescribed it.
(C) This section does not apply to the sale at wholesale by recognized drug jobbers or wholesalers or drug manufacturers to pharmacists or drug outlets or licensed medical or osteopathic physicians, podiatrists, dentists, diagnostically or therapeutically certified optometrists, or veterinarians qualified to practice their professions according to the laws of this State, nor to the sale by pharmacists in drug outlets to one another. This section applies to the sale by a manufacturer, wholesaler, or retailer to a person other than those legally qualified and authorized to purchase and hold them for resale in this State."
Sale of pharmaceutical agents
SECTION 10. Section 40-43-155 of the 1976 Code, as last amended by Act 548 of 1988, is further amended to read:
"Section 40-43-155. (A) Licensed pharmacists may sell pharmaceutical agents, other than controlled substances as defined in Section 44-53-110, to optometrists who are diagnostically certified by the South Carolina Board of Examiners in Optometry for diagnostic purposes in the practice of optometry in accordance with Section 40-37-105(A). In this subsection, `pharmaceutical agent' means anesthetics, mydriatics, cycloplegics, miotics, dyes, and over-the-counter drugs.
(B) Licensed pharmacists may sell pharmaceutical agents, other than Schedule I and Schedule II controlled substances as defined in Section 44-53-110, to optometrists who are therapeutically certified by the South Carolina Board of Examiners in Optometry for diagnostic and therapeutic purposes in the practice of optometry in accordance with Section 40-37-105(B)."
SECTION 11. The third paragraph of Section 40-43-360 of the 1976 Code, as last amended by Act 303 of 1992, is further amended to read:
"`Pharmacy' means an outlet dispensing drugs on the order of a practitioner licensed to prescribe drugs. `Practitioner' means a physician, dentist, osteopath, podiatrist, therapeutically certified optometrist, nurse practitioner, or veterinarian licensed by any state or territory, other than pharmacists engaged in the practice of pharmacy, to prescribe with regard to drugs or devices in the course of professional practice or research. Nothing in this section supersedes the Nursing Dispensing Act." Time effective
SECTION 12. This act takes effect upon approval by the Governor.
Approved the 14th day of May, 1993.