S.B. No. 993         AN ACT   relating to the practice of therapeutic optometry.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter E, Chapter 351, Occupations Code, is   amended by adding Section 351.2034 to read as follows:          Sec. 351.2034.  COMPLAINTS RESULTING FROM GLAUCOMA   TREATMENT. (a)  The board, in collaboration with the Texas Medical   Board, shall adopt rules for investigating and reviewing complaints   filed with the board regarding a therapeutic optometrist's   treatment of a patient for glaucoma. The rules must ensure that:                (1)  a person who files a complaint has the opportunity   to explain the allegations made in the complaint;                (2)  a complaint is not dismissed without appropriate   consideration by the board;                (3)  a complaint is resolved within six months after   the date the complaint is filed;                (4)  the board notifies the Texas Medical Board of the   receipt and disposition of a complaint; and                (5)  a complaint is reviewed as provided by this   section.          (b)  After a complaint regarding a therapeutic optometrist's   treatment of a patient for glaucoma is filed with the board, the   board shall select at least one physician licensed in this state who   specializes in ophthalmology to:                (1)  review the complaint and determine if the   therapeutic optometrist's treatment of the patient for glaucoma   violated the standard of care applicable to a physician   specializing in ophthalmology; and                (2)  submit to the board a written report on the   physician's determination.          (c)  If the report under Subsection (b) states that the   standard of care was violated, the board shall forward the   complaint and report to an expert panel appointed by the board and   the Texas Medical Board. The panel must be composed of an equal   number of physicians who specialize in ophthalmology and   therapeutic optometrists. Each member of the expert panel must be   licensed to practice medicine or therapeutic optometry, as   applicable, in this state. A physician who serves on an expert   panel may also serve as an expert physician for the Texas Medical   Board.          (d)  An expert panel selected to review a complaint under   Subsection (c) shall:                (1)  review the physician's determination made under   Subsection (b); and                 (2)  recommend to the board whether the therapeutic   optometrist should be subject to disciplinary action and, if so,   whether the disciplinary action should include suspension or   revocation of the therapeutic optometrist's certificate issued   under Section 351.3581(a).          (e)  A person is not eligible to review a complaint under   Subsection (b) or serve on an expert panel under Subsection (c) if:                (1)  the person or the person's spouse is an officer,   employee, or paid consultant of a Texas trade association, as   defined by Section 351.053, in the field of health care; or                 (2)  the person is a member of the faculty or board of   trustees of an optometry school or an institution of higher   education with an affiliated school of optometry.          (f)  The board shall maintain and make publicly available   online:                (1)  information regarding the number of complaints   filed with the board regarding the treatment of patients for   glaucoma by therapeutic optometrists and the disposition of those   complaints; and                (2)  a searchable list of each therapeutic optometrist   whose certificate under Section 351.3581(a) was suspended or   revoked by the board.          (g)  This section expires September 1, 2027.          SECTION 2.  Section 351.358(c), Occupations Code, is amended   to read as follows:          (c)  A therapeutic optometrist may prescribe not more than    [oral 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 medication   classified as a controlled substance under Schedule [analgesic   identified in Schedules] III, IV, or [and] V of 21 U.S.C. Section   812[; and                [(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].          SECTION 3.  The heading to Section 351.3581, Occupations   Code, is amended to read as follows:          Sec. 351.3581.  [DIAGNOSIS AND] TREATMENT OF GLAUCOMA.          SECTION 4.  Sections 351.3581(a) and (d), Occupations Code,   are amended to read as follows:          (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.          (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 patient has definite optic disc, retinal nerve   fiber layer, or macular imaging abnormalities consistent with   glaucoma and visual field abnormalities in both hemifields, or loss   within five degrees of fixation in at least one hemifield as tested   with standard automated perimetry [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   nonsurgical intervention [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].          SECTION 5.  Not later than December 1, 2021, the Texas   Optometry Board shall adopt rules necessary to implement the   changes in law made by this Act to Chapter 351, Occupations Code.          SECTION 6.  Sections 351.3581(b) and (c), Occupations Code,   are repealed.          SECTION 7.  This Act takes effect September 1, 2021.             ______________________________ ______________________________      President of the Senate Speaker of the House                 I hereby certify that S.B. No. 993 passed the Senate on           May 13, 2021, by the following vote:  Yeas 30, Nays 0.       ______________________________   Secretary of the Senate                I hereby certify that S.B. No. 993 passed the House on           May 24, 2021, by the following vote:  Yeas 144, Nays 2, one present   not voting.       ______________________________   Chief Clerk of the House            Approved:     ______________________________                Date       ______________________________              Governor