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Substitute Senate Bill No. 353

PUBLIC ACT NO. 96-70

AN ACT CONCERNING OPTOMETRY.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 20-127 of the general statutes, as amended by sections 12 and 21 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(a) For the purposes of this chapter: (1) THE "PRACTICE OF ADVANCED OPTOMETRIC CARE" MEANS ANY ONE OR MORE OF THE FOLLOWING PRACTICES AND PROCEDURES: (A) MEASURING, EXAMINING, DIAGNOSING, PREVENTING, ENHANCING, MANAGING OR TREATING VISUAL FUNCTIONS, DEFECTS OF VISION, MUSCULAR FUNCTIONS OR ANOMALIES, OR OTHER CONDITIONS OR DISEASES OF THE VISUAL SYSTEM, THE EYE AND OCULAR ADNEXAE; (B) THE PRESCRIBING, SUPPLYING, ADJUSTING, FITTING, OR ADAPTING OF OPHTHALMIC DEVICES AND LENSES, SPECTACLES, PRISMS, ORTHOPTIC THERAPY, VISUAL THERAPY, VISUAL REHABILITATION, OCULOMOTOR THERAPY, TINTED LENSES, FILTERS, CONTACT LENSES, DIAGNOSING, PREVENTING, ENHANCING, MANAGING, TREATING OR RELIEVING VISUAL FUNCTIONS, DEFECTS OF VISION, MUSCULAR FUNCTIONS OR ANOMALIES, OR DISEASES OF THE VISUAL SYSTEM, THE EYE AND OCULAR ADNEXAE; (C) THE ADMINISTRATION OR PRESCRIPTION OF ANY PHARMACEUTICAL AGENTS RELATED TO THE DIAGNOSIS AND TREATMENT OF CONDITIONS AND DISEASES OF THE EYE AND OCULAR ADNEXAE, EXCLUDING NONEMERGENCY ORAL GLAUCOMA AGENTS BUT INCLUDING CONTROLLED SUBSTANCES UNDER SCHEDULES II, III, IV AND V IN ACCORDANCE WITH SECTION 21a-252, AS AMENDED, SUBJECT TO THE LIMITATIONS OF SUBSECTION (f) OF THIS SECTION RELATING TO QUANTITIES DISPENSED, PERFORMANCE OR ORDERING OF PROCEDURES OR LABORATORY TESTS RELATED TO THE DIAGNOSIS AND TREATMENT OF CONDITIONS AND DISEASES OF THE EYE AND OCULAR ADNEXAE; THESE PROCEDURES INCLUDE, BUT ARE NOT LIMITED TO, REMOVAL OF SUPERFICIAL FOREIGN BODIES OF THE CORNEAL EPITHELIUM THAT HAVE NOT PERFORATED BOWMAN'S MEMBRANE, ULTRASOUND, AND TOPICAL, ORAL OR INJECTABLE MEDICATION TO COUNTERACT ANAPHYLAXIS OR ANAPHYLACTIC REACTION; (D) THE NONSURGICAL TREATMENT OF GLAUCOMA CONSISTENT WITH SUBSECTION (k) OF THIS SECTION; OR (E) THE USE OF PUNCTAL PLUGS. THE "PRACTICE OF ADVANCED OPTOMETRIC CARE" DOES NOT INCLUDE SURGICAL TREATMENT OF GLAUCOMA; TREATMENT OF OCULAR CANCER; TREATMENT OF INFECTIOUS DISEASES OF THE RETINA; DIAGNOSIS AND TREATMENT OF SYSTEMIC DISEASES; USE OF THERAPEUTIC LASERS; USE OF INJECTABLE MEDICATIONS OTHER THAN TO COUNTERACT ANAPHYLAXIS OR ANAPHYLACTIC REACTION; SURGICAL PROCEDURES, OTHER THAN NONINVASIVE PROCEDURES; USE OF GENERAL ANESTHESIA; USE OF INTRAVENOUS INJECTIONS; PROCEDURES THAT REQUIRE THE CUTTING OR OPENING OF THE GLOBE; ENUCLEATION OF THE EYE; EXTRAOCULAR MUSCLE SURGERY; OR ANY INVASIVE PROCEDURE PERFORMED ON THE HUMAN BODY OTHER THAN NONINVASIVE PROCEDURES PERFORMED ON THE EYE OR OCULAR ADNEXAE. [(1)] (2) "Optometrist" means an individual licensed pursuant to this chapter to engage in the practice of optometry. [(2)] (3) The "practice of optometry" means any one or more of the following practices and procedures: (A) The examination of the human eye and the eyelid for the purpose of diagnosis, treatment excluding the lacrimal drainage system and lacrimal gland, or referral for consultation, as authorized by this section or, where appropriate, [to refer] REFERRAL to an ophthalmologist; (B) the use of tests, instruments, devices, ocular agents-D, ocular agents-T and noninvasive procedures for the purpose of investigation, examination, diagnosis, treatment excluding the lacrimal drainage system and lacrimal gland, or correction, as authorized by this section, of visual defects, abnormal conditions or diseases of the human eye and eyelid; (C) the prescription and application of ophthalmic lenses, prisms, filters, devices containing lenses or prisms or filters or any combination thereof, orthoptics, vision training, ocular agents-D for the purpose of diagnosing visual defects, abnormal conditions or diseases of the human eye and eyelid, ocular agents-T and noninvasive procedures for the purpose of correction, alleviation or treatment, as authorized by this section, of visual defects, abnormal conditions or diseases of the human eye and eyelid excluding the lacrimal drainage system, lacrimal gland and structures posterior to the iris but including the treatment of iritis; (D) the examination of the human eye for purposes of prescribing, fitting or insertion of contact lenses to the human eye. The practice of optometry shall not include the use of surgery, x-ray, photocoagulation, or ionizing radiation, or the treatment of glaucoma. Nothing in this subdivision shall be construed to limit the scope of practice of opticians licensed pursuant to chapter 381 or the practice of physicians licensed pursuant to chapter 370. [(3)] (4) "Ocular agents-D" means: (A) Topically administered agents used for the purpose of diagnosing visual defects, abnormal conditions or the diseases of the human eye and eyelid known generally as cycloplegics not to exceed one [(1)] per cent, mydriatics other than phenylephrine hydrochloride ten [(10)] per cent, and topical anesthetics, which are administered topically for the examination of the human eye and the analysis of ocular functions; [,] (B) those vision training or optical devices which have been designated drugs for preclearance testing by the federal Food and Drug Administration or similar agency; and (C) fluorescein and similar dyes used in fitting contact lenses. The drugs described in subparagraph (A) of this subdivision may be acquired and used only for diagnostic purposes. Nothing in this subdivision shall be construed to allow an optometrist to acquire or use a controlled substance listed under section 21a-243. [(4)] (5) "Ocular agents-T" means: (A) Topically administered ophthalmic agents used for the purpose of treating or alleviating the effects of diseases or abnormal conditions of the human eye or eyelid excluding the lacrimal drainage system, lacrimal gland and structures posterior to the iris, but including the treatment of iritis, excluding allergens, alpha adrenergic agonists, antiparasitics, antifungal agents, antimetabolites, antineoplastics, beta adrenergic blocking agent, carbonic anhydrase inhibitors, collagen corneal shields, epinephrine preparations, miotics used for the treatment of glaucoma, temporary collagen implants, and succus cineraria maritima; (B) orally administered antibiotics, antihistamines and antiviral agents used for the purpose of treating or alleviating the effects of diseases or abnormal conditions of the human eye or eyelid excluding the lacrimal drainage system, lacrimal gland and structures posterior to the iris, but including the treatment of iritis; and (C) orally administered analgesic agents used for the purpose of alleviating pain caused by diseases or abnormal conditions of the human eye or eyelid excluding the lacrimal drainage system, lacrimal gland and structures posterior to the iris, but including the treatment of iritis. "Ocular agent-T" does not include any controlled substance or drug administered by injection. [(5)] (6) "Noninvasive procedures" means procedures used to diagnose or treat a disease or abnormal condition of the human eye or eyelid excluding the lacrimal drainage system, lacrimal gland and structures posterior to the iris and which exclude the removal of superficial foreign bodies of the corneal epithelium which have perforated bowman's membrane but including the treatment of iritis, provided the procedures do not require an incision or use of a laser.

(b) Optometrists who were first licensed prior to April 1, 1985, shall be permitted to acquire and use ocular agents-D topically in the practice of optometry only after they have completed a course which (1) consists of a minimum of forty-five classroom hours and fifteen clinic hours, (2) is conducted by an institution accredited by a regional professional accreditation organization recognized or approved by the National Commission on Accrediting or the United States Commissioner of Education and (3) is approved by the Department of Public Health, and have passed an examination, prescribed by said department with the advice and consent of the board of examiners in optometry, in pharmacology as it applies to optometry, with a particular emphasis on the topical application of ocular agents-D to the eye for the purpose of examination of the human eye and the analysis of ocular functions. Optometrists licensed on and after April 1, 1985, shall not be required to take a course or pass an examination in order to acquire and use said agents topically in the practice of optometry.

(c) Optometrists who were first licensed in this state prior to January 1, 1991, shall be permitted to acquire, administer, dispense and prescribe ocular agents-T in the practice of optometry only after they have (1) successfully completed a minimum of ninety-six classroom hours and fourteen clinical hours in the didactic and clinical use of ocular agents-T for the purposes of treating deficiencies, deformities, diseases or abnormalities of the human eye, including the removal of foreign bodies from the eye and adnexae, conducted by a duly accredited school or college of optometry or medical school, and have passed an examination as administered by the accredited school or college of optometry or medical school which conducted the course of study and (2) successfully completed a course in cardiopulmonary resuscitation offered by an accredited hospital, the American Heart Association or a comparable institution or organization. Proof of successful completion of the courses required under subdivisions (1) and (2) of this subsection shall be reported to the Department of Consumer Protection. Optometrists licensed on and after January 1, 1991, and who have graduated from an accredited school or college of optometry on or after January 1, 1991, shall not be required to take either a course in the didactic and clinical use of ocular agents-T or a course in cardiopulmonary resuscitation or pass an examination in order to acquire, administer, dispense and prescribe such ocular agents-T.

(d) OPTOMETRISTS SHALL BE PERMITTED TO ENGAGE IN THE PRACTICE OF ADVANCED OPTOMETRIC CARE ONLY AFTER THEY HAVE (1) SUCCESSFULLY COMPLETED A MINIMUM OF SEVENTY-FIVE CLASSROOM HOURS AND FIFTY-ONE CLINICAL HOURS IN THE STUDY OF ADVANCED OPTOMETRIC CARE THAT INCLUDES THE TREATMENT OF DEFICIENCIES, DEFORMITIES, DISEASES OR ABNORMALITIES OF THE HUMAN EYE, INCLUDING ANTERIOR SEGMENT DISEASE, LACRIMOLOGY AND GLAUCOMA CONDUCTED BY A DULY ACCREDITED SCHOOL OR COLLEGE OF OPTOMETRY OR MEDICAL SCHOOL, (2) PASSED AN EXAMINATION AS ADMINISTERED BY THE ACCREDITED SCHOOL OR COLLEGE OF OPTOMETRY OR MEDICAL SCHOOL THAT CONDUCTED THE COURSE OF STUDY AND (3) MET THE REQUIREMENTS THAT PERMIT THEM TO ACQUIRE AND USE OCULAR AGENTS-D AND TO ACQUIRE, ADMINISTER, DISPENSE AND PRESCRIBE OCULAR AGENTS-T PURSUANT TO SUBSECTIONS (b) AND (c) OF THIS SECTION.

[(d)] (e) No licensed optometrist authorized pursuant to this section to acquire, administer, dispense and prescribe an ocular agent-T shall dispense such agent to any person unless no charge is imposed for such agent and the quantity dispensed does not exceed a seventy-two-hour supply, except if the minimum available quantity for said agent is greater than a seventy-two-hour supply, the optometrist may dispense the minimum available quantity.

(f) NO LICENSED OPTOMETRIST AUTHORIZED PURSUANT TO THIS SECTION TO PRACTICE ADVANCED OPTOMETRIC CARE SHALL DISPENSE CONTROLLED SUBSTANCES UNDER SCHEDULES II, III, IV AND V OR UNDER SECTION 21a-252, AS AMENDED, TO ANY PERSON UNLESS NO CHARGE IS IMPOSED FOR SUCH SUBSTANCES AND THE QUANTITY DISPENSED DOES NOT EXCEED A SEVENTY-TWO-HOUR SUPPLY, EXCEPT IF THE MINIMUM AVAILABLE QUANTITY FOR SAID AGENT IS GREATER THAN A SEVENTY-TWO-HOUR SUPPLY, THE OPTOMETRIST MAY DISPENSE THE MINIMUM AVAILABLE QUANTITY.

[(e)] (g) No optometrist shall delegate to any person the use, application or prescription of any ocular agent-D or ocular agent-T except that an optometrist may cause the same to be self-administered by a patient under the care and direction of the optometrist.

[(f)] (h) An optometrist shall refer any patient with iritis or a corneal ulcer to an ophthalmologist not later than seventy-two hours after commencement of initial treatment of such condition unless there is documented substantial improvement of such condition within such time period.

[(g)] (i) Notwithstanding the provisions of section 52-184c, each optometrist authorized by this section TO PRACTICE ADVANCED OPTOMETRIC CARE, OR to use ocular agents-D or ocular agents-T or both,shall be held to the same standard of care as ophthalmologists with regard to SUCH ADVANCED OPTOMETRIC CARE the use of such ocular agents-D or ocular agents-T or both and [the] ANY OTHER procedures authorized by this section.

[(h)] (j) Each optometrist authorized pursuant to this section TO PRACTICE ADVANCED OPTOMETRIC CARE, OR to use ocular agents-D or ocular agents-T or both, shall post in a conspicuous location in each office waiting room, a standardized notice stating that said optometrist is authorized TO PRACTICE ADVANCED OPTOMETRIC CARE, OR to use ocular agents for diagnosis or treatment or both,m within the scope of his practice.

(k) AN OPTOMETRIST ENGAGED IN THE PRACTICE OF ADVANCED OPTOMETRIC CARE AND THE NONSURGICAL TREATMENT OF GLAUCOMA SHALL REFER TO AN OPHTHALMOLOGIST OR OTHER PHYSICIAN, FOR EVALUATION, ANY GLAUCOMA PATIENT WHO (1) PRESENTS WITH AN INTRAOCULAR PRESSURE OVER THIRTY-FIVE, (2) PRESENTS WITH THE PRESENCE OF PEDIATRIC GLAUCOMA, CLOSED ANGLE GLAUCOMA OR SECONDARY GLAUCOMA OR (3) DOES NOT HAVE DOCUMENTED SUBSTANTIAL IMPROVEMENT IN RESPONSE TO TREATMENT. NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO PROHIBIT THE EMERGENCY ADMINISTRATION, PRIOR TO REFERRAL, OF MEDICATION OTHERWISE AUTHORIZED UNDER THIS SECTION.

(l) EACH OPTOMETRIST AUTHORIZED PURSUANT TO THIS SECTION TO PRACTICE ADVANCED OPTOMETRIC CARE SHALL NOTIFY THE DEPARTMENT OF PUBLIC HEALTH OF HIS INTENT TO ENGAGE IN SUCH PRACTICE. THE COMMISSIONER OF PUBLIC HEALTH SHALL DEVELOP LICENSE RENEWAL FORMS THAT INDICATE WHETHER A PERSON HOLDS HIMSELF OUT AS AUTHORIZED TO PRACTICE ADVANCED OPTOMETRIC CARE.

Sec. 2. Section 21a-252 of the general statutes, as amended by section 5 of public act 95-332, is repealed and the following is substituted in lieu thereof:

(a) A physician, in good faith and in the course of his professional practice only, may prescribe, administer and dispense controlled substances or he may cause the same to be administered by a physician assistant, nurse or intern under his direction and supervision, for demonstrable physical or mental disorders but not for drug dependence except in accordance with state and federal laws and regulations adopted thereunder. Notwithstanding the provisions of this subsection the Department of Consumer Protection may approve protocols allowing the dispensing of take-home doses of methadone, by a registered nurse or licensed practical nurse, to outpatients in duly licensed substance abuse treatment facilities. Such dispensing shall be done pursuant to the order of a licensed prescribing practitioner and using computerized dispensing equipment into which bulk supplies of methadone are dispensed by a pharmacist. The quantity of methadone dispensed by such nurse shall not exceed at any one time that amount allowed under federal or state statutes or regulations governing the treatment of drug dependent patients. The Department of Consumer Protection shall conduct inspections of such treatment facilities to ensure that the computerized dispensing equipment and related dispensing procedures documented in the approved protocols are adhered to.

(b) An osteopath, in good faith and in the course of his professional practice only, may prescribe, administer or dispense controlled substances or he may cause the same to be administered by a nurse under his direction and supervision, for relief of pain to the extent permitted by the federal Controlled Substances Act and state laws and regulations relating to osteopathy.

(c) A dentist, in good faith and in the course of his professional practice only, may prescribe, administer or dispense controlled substances or he may cause the same to be administered by a nurse under his direction and supervision, to the extent permitted by the federal Controlled Substances Act, federal food and drug laws and state laws and regulations relating to dentistry.

(d) A podiatrist, in good faith and in the course of his professional practice only, may prescribe, administer and dispense controlled substances in schedules II, III, IV or V or he may cause the same to be administered by a nurse under his direction and supervision, to the extent permitted by the federal Controlled Substances Act, the federal food and drug laws and state laws and regulations relating to podiatry.

(e) A veterinarian, in good faith in the course of his professional practice only, and not for use by a human being, may prescribe, administer and dispense controlled substances, and he may cause them to be administered by an assistant or orderly under his direction and supervision, to the extent permitted by the federal Controlled Substances Act, the federal food and drug laws and state laws and regulations relating to veterinary medicine.

(f) An advanced practice registered nurse licensed pursuant to section 20-94a, AS AMENDED, in good faith and in the course of his professional practice only, may prescribe, dispense, and administer controlled substances in schedule II, III, IV or V or may cause the same to be administered by a registered nurse or licensed practical nurse under his direction and supervision, to the extent permitted by the federal Controlled Substances Act, the federal food and drug laws and state laws and regulations relating to advanced nursing practice.

(g) A nurse-midwife licensed under chapter 377, in good faith and in the course of his professional practice only, may prescribe, dispense, and administer controlled substances in schedules II, III, IV and V or he may cause the same to be administered by a registered nurse or licensed practical nurse under his direction and supervision, to the extent permitted by the federal Controlled Substances Act, the federal food and drug laws and state laws.

(h) A physician assistant licensed pursuant to section 20-12b, AS AMENDED, in good faith and in the course of his professional practice only, may prescribe, dispense, and administer controlled substances in schedule II, III, IV or V, or may cause the same to be administered by an advanced practice registered nurse, registered nurse, or licensed practical nurse who is acting under a physician's direction, to the extent permitted by the federal Controlled Substances Act, the federal food and drug laws and state laws and regulations relating to physician assistant practice.

(i) AN OPTOMETRIST AUTHORIZED TO PRACTICE ADVANCED OPTOMETRICAL CARE, IN GOOD FAITH AND IN THE COURSE OF HIS PROFESSIONAL PRACTICE ONLY AND WHO IS DULY AUTHORIZED BY SECTION 20-127, AS AMENDED BY SECTION 1 OF THIS ACT, MAY PRESCRIBE, ADMINISTER OR DISPENSE CONTROLLED SUBSTANCES IN SCHEDULE II, III, IV OR V TO THE EXTENT PERMITTED BY THE FEDERAL CONTROLLED SUBSTANCES ACT, THE FEDERAL FOOD AND DRUG LAWS AND STATE LAWS AND REGULATIONS RELATING TO OPTOMETRY.

[(i)] (j) Any person who has obtained directly from a physician, osteopath, dentist, podiatrist, OPTOMETRIST, veterinarian, physician assistant, advanced practice registered nurse or nurse-midwife any controlled substance for administration to himself or to a patient during the absence of such physician, osteopath, dentist, podiatrist, OPTOMETRIST, veterinarian, physician assistant, advanced practice registered nurse or nurse-midwife shall return to such physician, osteopath, dentist, podiatrist, OPTOMETRIST, veterinarian, physician assistant, advanced practice registered nurse or nurse-midwife any unused portion of such controlled substance, when it is no longer required by him or the patient, or he may surrender such controlled substance to the Commissioner of Consumer Protection for proper disposition.

Sec. 3. Section 21a-316 of the general statutes is repealed and the following is substituted in lieu thereof:

As used in this chapter, "practitioner" means: (1) A physician, dentist, veterinarian, podiatrist, osteopath, OPTOMETRIST, physician assistant licensed pursuant to section 20-12b, AS AMENDED, advanced practice registered nurse as defined in subsection (b) of section 20-87a, nurse-midwife, scientific investigator or other person licensed, registered or otherwise permitted to distribute, dispense, conduct research with respect to or to administer a controlled substance in the course of professional practice or research in this state; (2) a hospital or other institution licensed, registered or otherwise permitted to distribute, dispense, conduct research with respect to or to administer a controlled substance in the course of professional practice or research in this state.

Approved May 8, 1996. Effective October 1, 1996.

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