85R9085 KKR-F     By: Zedler H.B. No. 4082       A BILL TO BE ENTITLED   AN ACT   relating to the practice of therapeutic optometry.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Sections 351.358(b), (c), (d), and (e),   Occupations Code, are amended to read as follows:          (b)  A therapeutic optometrist may:                (1)  administer, perform, or prescribe ophthalmic   devices, procedures, and appropriate medications administered by   topical or oral means[, in accordance with this section and Section   351.3581,] to diagnose or treat visual defects, abnormal   conditions, or diseases of the human vision system, including the   eye and adnexa; or                (2)  administer medication by parenteral means for a   purpose and in a manner prescribed by Subsection (d) [(e)].          (c)  A therapeutic optometrist may administer or prescribe   oral analgesics [medications] only in the following   classifications of oral pharmaceuticals:                (1)  [one 10-day supply of oral antibiotics;                [(2)  one 72-hour supply of oral antihistamines;                [(3)     one seven-day supply of oral nonsteroidal   anti-inflammatories;                [(4)]  one three-day supply of any analgesic classified   as a controlled substance under Schedule [identified in Schedules]   III, IV, or [and] V of 21 U.S.C. Section 812; and                (2)  one three-day supply of hydrocodone or of a   hydrocodone combination product classified as a controlled   substance under Schedule II of 21 U.S.C. Section 812          [(5)     any other oral pharmaceutical recommended by the   Optometric Health Care Advisory Committee and approved by the board   and the Texas State Board of Medical Examiners].          (d)  [A therapeutic optometrist may independently administer   oral carbonic anhydrase inhibitors for emergency purposes only and   shall immediately refer the patient to an ophthalmologist.          [(e)]  A therapeutic optometrist may inject appropriate   medication for a patient who has an anaphylactic reaction to   counteract the anaphylaxis. The therapeutic optometrist shall   immediately refer the patient to a physician.          SECTION 2.  Section 351.3581, Occupations Code, is amended   to read as follows:          Sec. 351.3581.  [DIAGNOSIS AND] TREATMENT OF GLAUCOMA.   [(a)] A therapeutic optometrist may not administer or prescribe an   oral or parenteral medication or treat glaucoma unless the   therapeutic optometrist holds a certificate issued by the board. A   therapeutic optometrist certified under this section [subsection]   shall be known as an optometric glaucoma specialist. To obtain a   certificate, a therapeutic optometrist must [as required under   Section 351.165(c)]:                (1)  complete an instructional clinical review course;   and                (2)  pass an examination approved by the board.          [(b)     Not later than the 30th day after the date of the   initial diagnosis of glaucoma, a therapeutic optometrist shall   engage in consultation with an ophthalmologist to develop an   individual treatment plan that is approved by the therapeutic   optometrist and ophthalmologist. The parameters of the   consultation shall be at the discretion of the ophthalmologist but   must at least include confirmation of the diagnosis and a plan for   comanagement of the patient, including periodic review of the   patient's progress.          [(c)     A therapeutic optometrist required to engage in   comanagement consultation with an ophthalmologist shall inform the   patient diagnosed with glaucoma that the therapeutic optometrist is   required to have the diagnosis confirmed and comanaged with an   ophthalmologist of the patient's choosing or, if the patient does   not choose an ophthalmologist, an ophthalmologist practicing in the   geographic area in which the therapeutic optometrist practices.          [(d)     A therapeutic optometrist shall refer a patient to an   ophthalmologist if:                [(1)     the patient is younger than 16 years of age and   has been diagnosed as having glaucoma;                [(2)     the patient has been diagnosed as having acute   closed angle glaucoma;                [(3)     the patient has been diagnosed as having   malignant glaucoma or neovascular glaucoma;                [(4)     the therapeutic optometrist determines that a   patient's glaucoma is caused by a diabetic complication and, after   joint consultation with the physician treating the diabetes and an   ophthalmologist by telephone, fax, or another method, the physician   or ophthalmologist determines that the patient should be seen by   the physician or ophthalmologist; or                [(5)     the therapeutic optometrist determines that a   patient's glaucoma is not responding appropriately to a treatment   specified in Subsection (f) and, after consulting a physician by   telephone, fax, or another method, the physician determines that   the patient should be seen by the physician or an appropriate   specialist.          [(e)     A therapeutic optometrist who refers a patient to a   physician or specialist shall inform the patient that the patient   may go to any physician or specialist the patient chooses. This   subsection does not prevent a therapeutic optometrist from   recommending a physician or specialist.          [(f)     On making an initial diagnosis of glaucoma, a   therapeutic optometrist shall set a target pressure that is not   more than 80 percent of the initial intraocular pressure. The   patient's glaucoma is not considered to be appropriately responding   to treatment if the patient fails to achieve the target pressure   within an appropriate time.          [(g)     Before a therapeutic optometrist may prescribe a beta   blocker, the therapeutic optometrist must take a complete case   history of the patient and determine whether the patient has had a   physical examination within the 180 days preceding the date of   taking the history. If the patient has not had a physical   examination or if the patient has a history of congestive heart   failure, bradycardia, heart block, asthma, or chronic obstructive   pulmonary disease, the therapeutic optometrist must refer the   patient to a physician for a physical examination before initiating   beta blocker therapy.          [(h)     A therapeutic optometrist who diagnoses acute closed   angle glaucoma may initiate appropriate emergency treatment for a   patient but shall refer the patient to a physician in a timely   manner.          [(i)     A physician may charge a reasonable consultation fee   for a consultation given as provided by this section.          [(j)     A physician to whom a patient is referred by a   therapeutic optometrist under this section shall forward to the   therapeutic optometrist, not later than the 30th day after first   seeing the patient, a written report on the results of the referral.   The therapeutic optometrist shall maintain the report in the   patient's records. A physician who, for a medically appropriate   reason, does not return a patient to the therapeutic optometrist   who referred the patient shall state in the physician's report to   the therapeutic optometrist the specific medical reason for failing   to return the patient.]          SECTION 3.  This Act takes effect September 1, 2017.