Florida Senate - 2017                                    SB 1168
       
       
        
       By Senator Latvala
       
       
       
       
       
       16-00693-17                                           20171168__
    1                        A bill to be entitled                      
    2         An act relating to optometry; amending s. 463.002,
    3         F.S.; redefining and defining terms; amending s.
    4         463.005, F.S.; specifying that the Board of Optometry
    5         has the sole authority to determine what constitutes
    6         the practice of optometry; authorizing the board to
    7         issue specified advisory opinions and declaratory
    8         rulings; providing construction for ch. 463, F.S.;
    9         amending s. 463.0055, F.S.; restricting what a
   10         licensed practitioner may administer or prescribe if
   11         he or she does not complete a certain board-approved
   12         course and examination; revising the date after which
   13         a formulary rule becomes effective; deleting
   14         provisions related to the creation of a statutory
   15         formulary of oral ocular pharmaceutical agents;
   16         revising the conditions under which an ocular
   17         pharmaceutical agent is deleted from the formulary;
   18         revising the controlled substances that a certified
   19         optometrist in pharmaceutical agents is prohibited
   20         from prescribing and administering; conforming
   21         provisions to changes made by the act; creating s.
   22         463.0056, F.S.; requiring a licensed practitioner to
   23         complete a board-approved course and examination to
   24         become a certified optometrist in ophthalmic surgery;
   25         authorizing a certified optometrist in ophthalmic
   26         surgery to perform laser and non-laser ophthalmic
   27         surgery; requiring a certified optometrist in
   28         ophthalmic surgery to provide proof of completion of a
   29         certain course and examination before he or she may
   30         perform such surgeries; providing requirements for the
   31         development and offering of such course and
   32         examination; requiring the board to review and approve
   33         the content of the initial course and examination if
   34         it determines the course and examination satisfy
   35         certain requirements; requiring an annual review
   36         thereafter; authorizing the successful completion of
   37         the course and examination to be used by a licensed
   38         practitioner to satisfy continuing education
   39         requirements; prohibiting a certified optometrist in
   40         ophthalmic surgery from performing specified surgery
   41         procedures; amending s. 463.014, F.S.; providing that
   42         specified prohibited acts may be authorized by the
   43         State Health Officer during a public emergency;
   44         deleting a provision prohibiting surgery of any kind
   45         by a certified optometrist; amending ss. 463.007,
   46         463.009, 463.013, 463.0135, and 641.31, F.S.;
   47         conforming provisions to changes made by the act;
   48         providing an effective date.
   49          
   50  Be It Enacted by the Legislature of the State of Florida:
   51  
   52         Section 1. Section 463.002, Florida Statutes, is reordered
   53  and amended, to read:
   54         463.002 Definitions.—As used in this chapter, the term:
   55         (2)(1) “Board” means the Board of Optometry.
   56         (3) “Certified optometrist in ophthalmic surgery” means a
   57  licensed practitioner authorized by the board to perform
   58  ophthalmic surgery.
   59         (6)(2) “Department” means the Department of Health.
   60         (9)(a)(3)(a) “Licensed practitioner” means a person who is
   61  a primary health care provider licensed to engage in the
   62  practice of optometry under the authority of this chapter.
   63         (b) A licensed practitioner who is not a certified
   64  optometrist in pharmaceutical agents is shall be required to
   65  display at her or his place of practice a sign that which
   66  states, “I am a Licensed Practitioner, not a Certified
   67  Optometrist in Pharmaceutical Agents, and I am not able to
   68  prescribe ocular pharmaceutical agents.”
   69         (c) All practitioners initially licensed after July 1,
   70  1993, must be certified optometrists in pharmaceutical agents.
   71         (d)A licensed practitioner who is not a certified
   72  optometrist in ophthalmic surgery is required to display at her
   73  or his place of practice a sign that states, “I am a Licensed
   74  Practitioner, not a Certified Optometrist in Ophthalmic Surgery,
   75  and I am not able to perform laser or non-laser ophthalmic
   76  surgery.”
   77         (4) “Certified optometrist in pharmaceutical agents” means
   78  a licensed practitioner authorized by the board to administer
   79  and prescribe ocular pharmaceutical agents.
   80         (10)(5) “Ocular pharmaceutical agent” means any
   81  prescription or nonprescription drug delivered by any route of
   82  administration, used or prescribed for the diagnosis, treatment,
   83  prevention, or mitigation of abnormal conditions and diseases of
   84  the human eye and its adnexa and visual system, or products that
   85  may be used for such purposes, and approved narcotics when used
   86  in the treatment of disorders or diseases of the eye and its
   87  adnexa and visual system. The term does not include any drug or
   88  other substance that is prohibited from use by a licensed
   89  practitioner and is listed in Schedule I of the federal
   90  Controlled Substances Act, 21 U.S.C. s. 812(c) a pharmaceutical
   91  agent that is administered topically or orally for the diagnosis
   92  or treatment of ocular conditions of the human eye and its
   93  appendages without the use of surgery or other invasive
   94  techniques.
   95         (11)(6) “Ophthalmic surgery” means a procedure performed on
   96  the human eye and its adnexa and visual system in which human
   97  tissue is injected, cut, burned, frozen, sutured, vaporized,
   98  coagulated, or photodisrupted by the use of surgical
   99  instrumentation such as, but not limited to, a scalpel, a
  100  cryoprobe, a laser, an electric cautery, or ionizing radiation
  101  using an instrument, including a laser, scalpel, or needle, in
  102  which human tissue is cut, burned, scraped except as provided in
  103  s. 463.014(4), or vaporized, by incision, injection, ultrasound,
  104  laser, infusion, cryotherapy, or radiation. The term includes a
  105  procedure using an instrument which requires the closure of
  106  human tissue by suture, clamp, or other such device.
  107         (12)(7) “Optometry” means the practice in which a person:
  108         (a) Employs primary eye care procedures, including the
  109  prescription of ocular pharmaceutical agents, medical devices,
  110  and ophthalmic surgery;
  111         (b) Measures the power and range of vision of the human eye
  112  using subjective and objective means, including the use of
  113  lenses and prisms before the eye, autorefractors, and other
  114  automated testing devices to determine the eye’s accommodative
  115  and refractive state and general scope of function;
  116         (c) Engages in the adaption, sale, and dispensing of frames
  117  and lenses in all their forms, including plano or zero power
  118  contact lenses, to overcome errors of refraction and restore, as
  119  nearly as possible, normal human vision, or for orthotic,
  120  prosthetic, therapeutic, or cosmetic purposes with respect to
  121  contact lenses; or
  122         (d) Examines for, diagnoses, and treats abnormal conditions
  123  and diseases of the human eye and its adnexa and visual system,
  124  including the use or prescription of vision therapy, ocular
  125  exercises, rehabilitation therapy, subnormal vision therapy,
  126  appropriate diagnostic lab or imaging tests, and samples to
  127  initiate treatment diagnosis of conditions of the human eye and
  128  its appendages; the employment of any objective or subjective
  129  means or methods, including the administration of ocular
  130  pharmaceutical agents, for the purpose of determining the
  131  refractive powers of the human eyes, or any visual, muscular,
  132  neurological, or anatomic anomalies of the human eyes and their
  133  appendages; and the prescribing and employment of lenses,
  134  prisms, frames, mountings, contact lenses, orthoptic exercises,
  135  light frequencies, and any other means or methods, including
  136  ocular pharmaceutical agents, for the correction, remedy, or
  137  relief of any insufficiencies or abnormal conditions of the
  138  human eyes and their appendages.
  139         (7)(8) “Direct supervision” means supervision to an extent
  140  that the licensee remains on the premises while all procedures
  141  are being done and gives final approval to any procedures
  142  performed by an employee.
  143         (8)(9) “General supervision” means the responsible
  144  supervision of supportive personnel by a licensee who need not
  145  be present when such procedures are performed, but who assumes
  146  legal liability therefor. Except in cases of emergency, “general
  147  supervision” shall require the easy availability or physical
  148  presence of the licensee for consultation with and direction of
  149  the supportive personnel.
  150         (1)(10) “Adnexa Appendages” means the eyelids, the
  151  eyebrows, the conjunctiva, and the lacrimal apparatus.
  152         (13)(11) “Transcript-quality” means a course which is in
  153  conjunction with or sponsored by a school or college of
  154  optometry or equivalent educational entity, which course is
  155  approved by the board and requires a test and passing grade.
  156         (5)(12) “Clock hours” means the actual time engaged in
  157  approved coursework and clinical training.
  158         Section 2. Subsections (3) and (4) are added to section
  159  463.005, Florida Statutes, to read:
  160         463.005 Authority of the board.—
  161         (3) The board has the sole authority to determine what
  162  constitutes the practice of optometry and to exercise any powers
  163  and duties conferred on it under this chapter. The board may
  164  issue advisory opinions and declaratory rulings related to this
  165  chapter and the administrative rules adopted under this chapter.
  166         (4) This chapter may not be construed to authorize an
  167  agency or a medical board or entity of this state other than the
  168  board to determine what constitutes the practice of optometry.
  169         Section 3. Section 463.0055, Florida Statutes, is amended
  170  to read:
  171         463.0055 Administration and prescription of ocular
  172  pharmaceutical agents.—
  173         (1)(a) Certified optometrists in pharmaceutical agents may
  174  administer and prescribe ocular pharmaceutical agents as
  175  provided in this section for the diagnosis and treatment of
  176  ocular conditions of the human eye and its adnexa and visual
  177  system appendages without the use of surgery or other invasive
  178  techniques. However, a licensed practitioner who is not a
  179  certified optometrist in pharmaceutical agents may use topically
  180  applied anesthetics solely for the purpose of glaucoma
  181  examinations, but is otherwise prohibited from administering or
  182  prescribing ocular pharmaceutical agents.
  183         (b) Before a certified optometrist in pharmaceutical agents
  184  may administer or prescribe oral ocular pharmaceutical agents,
  185  the certified optometrist in pharmaceutical agents must provide
  186  proof to the department of successful completion of a course and
  187  subsequent examination, approved by the board, on general and
  188  ocular pharmaceutical agents and the side effects of those
  189  agents. The course must shall consist of 20 contact hours, all
  190  of which may be web-based. The first course and examination
  191  shall be presented by October 1, 2013, and shall be administered
  192  at least annually thereafter. The course and examination shall
  193  be developed and offered jointly by a statewide professional
  194  association of physicians in this state accredited to provide
  195  educational activities designated for the American Medical
  196  Association Physician’s Recognition Award (AMA PRA) Category 1
  197  credit and a statewide professional association of licensed
  198  practitioners which provides board-approved continuing education
  199  on an annual basis. The board shall review and approve the
  200  content of the initial course and examination if the board
  201  determines that the course and examination adequately and
  202  reliably satisfy the criteria set forth in this section. The
  203  board shall thereafter annually review and approve the course
  204  and examination if the board determines that the content
  205  continues to adequately and reliably satisfy the criteria set
  206  forth in this section. Successful completion of the board
  207  approved course and examination may be used by a licensed
  208  practitioner certified optometrist to satisfy 20 hours of the
  209  continuing education requirements in s. 463.007(3), only for the
  210  biennial period in which the board-approved course and
  211  examination are taken. If a licensed practitioner certified
  212  optometrist does not complete a board-approved course and
  213  examination under this section, the licensed practitioner may
  214  certified optometrist is only authorized to administer and
  215  prescribe only topically applied anesthetics solely for the
  216  purpose of glaucoma examinations, but is otherwise prohibited
  217  from administering or prescribing topical ocular pharmaceutical
  218  agents.
  219         (2)(a) The board shall establish a formulary of topical
  220  ocular pharmaceutical agents that may be prescribed and
  221  administered by a certified optometrist in pharmaceutical
  222  agents. The formulary must shall consist of those topical ocular
  223  pharmaceutical agents that are appropriate to treat or diagnose
  224  ocular diseases and disorders and that the certified optometrist
  225  in pharmaceutical agents is qualified to use in the practice of
  226  optometry. The board shall establish, add to, delete from, or
  227  modify the topical formulary by rule. Notwithstanding any
  228  provision of chapter 120 to the contrary, the topical formulary
  229  rule becomes effective 20 60 days from the date it is filed with
  230  the Secretary of State.
  231         (b) The formulary may be added to, deleted from, or
  232  modified according to the procedure described in paragraph (a).
  233  Any person who requests an addition, deletion, or modification
  234  of an authorized topical ocular pharmaceutical agent shall have
  235  the burden of proof to show cause why such addition, deletion,
  236  or modification should be made.
  237         (c) The State Surgeon General shall have standing to
  238  challenge any rule or proposed rule of the board pursuant to s.
  239  120.56. In addition to challenges for any invalid exercise of
  240  delegated legislative authority, the administrative law judge,
  241  upon such a challenge by the State Surgeon General, may declare
  242  all or part of a rule or proposed rule invalid if it:
  243         1. Does not protect the public from any significant and
  244  discernible harm or damages;
  245         2. Unreasonably restricts competition or the availability
  246  of professional services in the state or in a significant part
  247  of the state; or
  248         3. Unnecessarily increases the cost of professional
  249  services without a corresponding or equivalent public benefit.
  250  
  251  However, there shall not be created a presumption of the
  252  existence of any of the conditions cited in this subsection in
  253  the event that the rule or proposed rule is challenged.
  254         (d) Upon adoption of the formulary required by this
  255  section, and upon each addition, deletion, or modification to
  256  the formulary, the board shall mail a copy of the amended
  257  formulary to each certified optometrist in pharmaceutical agents
  258  and to each pharmacy licensed by the state.
  259         (3) In addition to the formulary of topical ocular
  260  pharmaceutical agents established by rule of the board, there is
  261  created a statutory formulary of oral ocular pharmaceutical
  262  agents, which includes the following agents:
  263         (a) The following analgesics or their generic or
  264  therapeutic equivalents, which may not be administered or
  265  prescribed for more than 72 hours without consultation with a
  266  physician licensed under chapter 458 or chapter 459 who is
  267  skilled in diseases of the eye:
  268         1. Tramadol hydrochloride.
  269         2. Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg.
  270         (b) The following antibiotics or their generic or
  271  therapeutic equivalents:
  272         1. Amoxicillin with or without clavulanic acid.
  273         2. Azithromycin.
  274         3. Erythromycin.
  275         4. Dicloxacillin.
  276         5. Doxycycline/Tetracycline.
  277         6. Keflex.
  278         7. Minocycline.
  279         (c) The following antivirals or their generic or
  280  therapeutic equivalents:
  281         1. Acyclovir.
  282         2. Famciclovir.
  283         3. Valacyclovir.
  284         (d) The following oral anti-glaucoma agents or their
  285  generic or therapeutic equivalents, which may not be
  286  administered or prescribed for more than 72 hours:
  287         1. Acetazolamide.
  288         2. Methazolamide.
  289         (e) Any oral ocular pharmaceutical agent that is in the
  290  formulary established by the board under paragraph (a) listed in
  291  the statutory formulary set forth in this subsection and that is
  292  subsequently determined by the United States Food and Drug
  293  Administration to be unsafe for administration or prescription
  294  shall be considered to have been deleted from the formulary of
  295  oral ocular pharmaceutical agents. The oral ocular
  296  pharmaceutical agents on the statutory formulary set forth in
  297  this subsection may not otherwise be deleted by the board, the
  298  department, or the State Surgeon General.
  299         (3)(4) A certified optometrist in pharmaceutical agents
  300  shall be issued a prescriber number by the board. Any
  301  prescription written by a certified optometrist in
  302  pharmaceutical agents for an ocular pharmaceutical agent
  303  pursuant to this section must shall have the prescriber number
  304  printed thereon. A certified optometrist in pharmaceutical
  305  agents may not administer or prescribe:
  306         (a) a controlled substance listed in Schedule I of the
  307  Controlled Substances Act, 21 U.S.C. s. 812(c) III, Schedule IV,
  308  or Schedule V of s. 893.03, except for an oral analgesic placed
  309  on the formulary pursuant to this section for the relief of pain
  310  due to ocular conditions of the eye and its appendages.
  311         (b) A controlled substance for the treatment of chronic
  312  nonmalignant pain as defined in s. 456.44(1)(e).
  313         Section 4. Section 463.0056, Florida Statutes, is created
  314  to read:
  315         463.0056 Administration and performance of laser and non
  316  laser surgical procedures.—
  317         (1)(a) A licensed practitioner must complete a board
  318  approved course and examination under this section to become a
  319  certified optometrist in ophthalmic surgery.
  320         (b) A certified optometrist in ophthalmic surgery may
  321  perform laser and non-laser ophthalmic surgery. To perform laser
  322  and non-laser ophthalmic surgery, the certified optometrist in
  323  ophthalmic surgery must provide to the department proof of the
  324  successful completion of a course and subsequent examination,
  325  approved by the board, on laser and non-laser ophthalmic
  326  surgery.
  327         (2) The course and examination shall be developed and
  328  offered jointly by a statewide professional association of
  329  physicians in this state accredited to provide educational
  330  activities designated for the American Medical Association
  331  Physician’s Recognition Award (AMA PRA) Category 1 Credit and a
  332  statewide professional association of licensed practitioners
  333  which provides board-approved continuing education on an annual
  334  basis. The board shall review and approve the content of the
  335  initial course and examination if the board determines that the
  336  course and examination adequately and reliably satisfy the
  337  requirements for AMA PRA Category 1 Credit eligibility. The
  338  board shall thereafter annually review and approve the course
  339  and examination if the board determines that the content
  340  continues to adequately and reliably satisfy the requirements
  341  for AMA PRA Category 1 Credit eligibility. Successful completion
  342  of the board-approved course and examination may be used by a
  343  licensed practitioner to satisfy the continuing education
  344  requirements in s. 463.007(3), only for the biennial period in
  345  which the board-approved course and examination are taken.
  346         (3)The following surgical procedures, except for the
  347  preoperative and postoperative care of these procedures, are
  348  excluded from the scope of practice of optometry by a certified
  349  optometrist in ophthalmic surgery:
  350         (a)Penetrating keratoplasty, corneal transplant, or
  351  lamellar keratoplasty.
  352         (b)The administration of general anesthesia.
  353         (c)Surgery done with general anesthesia.
  354         (d)Laser or non-laser injection into the vitreous chamber
  355  of the eye to treat a macular or retinal disease.
  356         (e)Surgery related to the removal of the eye from a living
  357  human being.
  358         (f)Surgery requiring full-thickness incision or excision
  359  of the cornea or sclera, other than paracentesis in an emergency
  360  situation requiring immediate reduction of the pressure inside
  361  the eye.
  362         (g)Surgery requiring incision of the iris and ciliary
  363  body, including iris diathermy or incision with cryotherapy.
  364         (h)Surgery requiring incision of the vitreous.
  365         (i)Surgery requiring incision of the retina.
  366         (j)Surgical extraction of the crystalline lens.
  367         (k)Surgical intraocular prosthetic implants.
  368         (l)Incisional or excisional surgery of extraocular
  369  muscles.
  370         (m)Surgery of the eyelid for suspect eyelid malignancies
  371  or for repair of, including plastic surgery for,
  372  blepharochalasis or mechanical ptosis.
  373         (n) Tarsorrhaphy.
  374         (o)Surgery of the boney orbit, including orbital implants.
  375         (p)Incisional or excisional surgery of the lacrimal system
  376  other than lacrimal probing or related procedures.
  377         (q)Surgery requiring full-thickness conjunctivoplasty with
  378  graft or flap.
  379         (r)Pterygium surgery.
  380         Section 5. Subsections (3) and (4) of section 463.014,
  381  Florida Statutes, are amended to read:
  382         463.014 Certain acts prohibited.—
  383         (3) Prescribing, ordering, dispensing, administering,
  384  supplying, selling, or giving any drug for the purpose of
  385  treating a systemic disease by a licensed practitioner is
  386  prohibited, unless authorized by the State Health Officer during
  387  a public health emergency. However, a certified optometrist in
  388  pharmaceutical agents is permitted to use commonly accepted
  389  means or methods to immediately address incidents of
  390  anaphylaxis.
  391         (4) Surgery of any kind is expressly prohibited. Certified
  392  optometrists may remove superficial foreign bodies. For the
  393  purposes of this subsection, the term “superficial foreign
  394  bodies” means any foreign matter that is embedded in the
  395  conjunctiva or cornea but that has not penetrated the globe.
  396  Notwithstanding the definition of surgery as provided in s.
  397  463.002(6), a certified optometrist is not prohibited from
  398  providing any optometric care within the practice of optometry
  399  as defined in s. 463.002(7), such as removing an eyelash by
  400  epilation, probing an uninflamed tear duct in a patient 18 years
  401  of age or older, blocking the puncta by plug, or superficial
  402  scraping for the purpose of removing damaged epithelial tissue
  403  or superficial foreign bodies or taking a culture of the surface
  404  of the cornea or conjunctiva.
  405         Section 6. Subsection (3) of section 463.007, Florida
  406  Statutes, is amended to read:
  407         463.007 Renewal of license; continuing education.—
  408         (3) As a condition of license renewal, a licensee must
  409  demonstrate his or her professional competence by completing up
  410  to 30 hours of continuing education during the 2-year period
  411  preceding license renewal. For certified optometrists in
  412  pharmaceutical agents, the 30-hour continuing education
  413  requirement includes 6 or more hours of approved transcript
  414  quality coursework in ocular and systemic pharmacology and the
  415  diagnosis, treatment, and management of ocular and systemic
  416  conditions and diseases during the 2-year period preceding
  417  application for license renewal.
  418         Section 7. Section 463.009, Florida Statutes, is amended to
  419  read:
  420         463.009 Supportive personnel.—No person other than a
  421  licensed practitioner may engage in the practice of optometry as
  422  defined in s. 463.002(12) s. 463.002(7). Except as provided in
  423  this section, under no circumstances shall nonlicensed
  424  supportive personnel be delegated diagnosis or treatment duties;
  425  however, such personnel may perform data gathering, preliminary
  426  testing, prescribed visual therapy, and related duties under the
  427  direct supervision of the licensed practitioner. Nonlicensed
  428  personnel, who need not be employees of the licensed
  429  practitioner, may perform ministerial duties, tasks, and
  430  functions assigned to them by and performed under the general
  431  supervision of a licensed practitioner, including obtaining
  432  information from consumers for the purpose of making
  433  appointments for the licensed practitioner. The licensed
  434  practitioner shall be responsible for all delegated acts
  435  performed by persons under her or his direct and general
  436  supervision.
  437         Section 8. Section 463.013, Florida Statutes, is amended to
  438  read:
  439         463.013 Optometric services for certain public agencies.
  440  Any agency of the state or county or any commission, clinic, or
  441  board administering relief, social security, health insurance,
  442  or health service under the laws of the state shall accept the
  443  services of licensed practitioners for the purposes of
  444  diagnosing and correcting any and all visual, muscular,
  445  neurological, and anatomic anomalies of the human eyes and their
  446  adnexa and visual systems appendages of any persons under the
  447  jurisdiction of said agency, clinic, commission, or board
  448  administering such relief, social security, health insurance, or
  449  health service on the same basis and on a parity with any other
  450  person authorized by law to render similar professional service,
  451  when such services are needed, and shall pay for such services
  452  in the same way as other professionals may be paid for similar
  453  services.
  454         Section 9. Subsections (3) and (10) of section 463.0135,
  455  Florida Statutes, are amended to read:
  456         463.0135 Standards of practice.—
  457         (3) When an infectious corneal disease condition has not
  458  responded to standard methods of treatment within the scope of
  459  optometric practice, the licensed practitioner or certified
  460  optometrist in pharmaceutical agents shall consult with a
  461  physician skilled in diseases of the eye and licensed under
  462  chapter 458 or chapter 459.
  463         (10) A certified optometrist in pharmaceutical agents is
  464  authorized to perform any eye examination, including a dilated
  465  examination, required or authorized by chapter 548 or by rules
  466  adopted to implement that chapter.
  467         Section 10. Subsection (19) of section 641.31, Florida
  468  Statutes, is amended to read:
  469         641.31 Health maintenance contracts.—
  470         (19) Notwithstanding any other provision of law, health
  471  maintenance policies or contracts that which provide coverage,
  472  benefits, or services as described in s. 463.002(12) s.
  473  463.002(7), shall offer to the subscriber the services of an
  474  optometrist licensed pursuant to chapter 463.
  475         Section 11. This act shall take effect July 1, 2017.