Bill Text: NY A01193 | 2019-2020 | General Assembly | Amended


Bill Title: Requires optometrists to meet certain standards, including the completion of a course, to prescribe oral medications.

Spectrum: Slight Partisan Bill (Democrat 76-26)

Status: (Introduced) 2019-06-14 - print number 1193b [A01193 Detail]

Download: New_York-2019-A01193-Amended.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                         1193--B

                               2019-2020 Regular Sessions

                   IN ASSEMBLY

                                    January 14, 2019
                                       ___________

        Introduced  by  M.  of  A.  PAULIN, COOK, CYMBROWITZ, ABINANTI, GUNTHER,
          WEPRIN, HEVESI, RYAN, TITUS,  STIRPE,  BUCHWALD,  DiPIETRO,  BRABENEC,
          BLAKE,  FAHY, ORTIZ, COLTON, NORRIS, BARRETT, PHEFFER AMATO, DINOWITZ,
          LALOR, ZEBROWSKI, STECK,  HUNTER,  BRONSON,  SOLAGES,  PEOPLES-STOKES,
          DE LA ROSA,  B. MILLER, RAIA, GARBARINO, MORINELLO, FITZPATRICK, DICK-
          ENS, MAGNARELLI, PICHARDO, SANTABARBARA,  GIGLIO,  D. ROSENTHAL,  KIM,
          RODRIGUEZ,  ABBATE,  JONES, ARROYO, VANEL, McDONOUGH, AUBRY, L. ROSEN-
          THAL,  ENGLEBRIGHT,  LAVINE,  D'URSO,   JAFFEE,   JOYNER,   SEAWRIGHT,
          M. L. MILLER,  FERNANDEZ,  FALL, BURKE, REILLY, REYES, SALKA, WALLACE,
          JACOBSON, JEAN-PIERRE, MOSLEY, MANKTELOW,  TAYLOR,  BENEDETTO,  STERN,
          GRIFFIN,  CRESPO, BUTTENSCHON, MALLIOTAKIS, EICHENSTEIN -- Multi-Spon-
          sored by -- M. of A. BARCLAY, BLANKENBUSH,  CAHILL,  CARROLL,  CROUCH,
          CUSICK,  DAVILA,  EPSTEIN,  FRIEND, GALEF, GOODELL, GOTTFRIED, HAWLEY,
          LENTOL, LIFTON, LUPARDO, PALMESANO,  PERRY,  QUART,  RIVERA,  SIMOTAS,
          STEC,  TAGUE, THIELE, WALSH, WOERNER, WRIGHT -- read once and referred
          to the Committee on Higher Education  --  committee  discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee -- again reported from said  committee  with  amendments,  ordered
          reprinted as amended and recommitted to said committee

        AN  ACT to amend the education law, in relation to the use of oral medi-
          cations by optometrists

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Paragraph  (e)  of subdivision 1 of section 7101-a of the
     2  education law, as added by chapter 517 of the laws of 1995,  is  amended
     3  to read as follows:
     4    (e) [Phase one] Topical therapeutic pharmaceutical agents. [Phase one]
     5  Topical  therapeutic  pharmaceutical agents shall mean those drugs which
     6  shall be limited to topical application to the surface of  the  eye  for
     7  therapeutic purposes and shall be limited to:
     8    (i) antibiotic/antimicrobials;

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01275-08-9

        A. 1193--B                          2

     1    (ii) decongestants/anti-allergenics;
     2    (iii) non-steroidal anti-inflammatory agents;
     3    (iv) steroidal anti-inflammatory agents;
     4    (v) antiviral agents;
     5    (vi) hyperosmotic/hypertonic agents;
     6    (vii) cycloplegics;
     7    (viii) artificial tears and lubricants; and
     8    (ix) immunosuppressive agents.
     9    § 2. Paragraph (f) of subdivision 1 of section 7101-a of the education
    10  law,  as added by chapter 517 of the laws of 1995, is amended to read as
    11  follows:
    12    (f) [Phase two  therapeutic]  Therapeutic  pharmaceutical  agents  for
    13  treatment  of glaucoma and ocular hypertension.  [Phase two] Therapeutic
    14  pharmaceutical agents for treatment of glaucoma and ocular  hypertension
    15  shall  mean those drugs which shall be limited to topical application to
    16  the surface of the eye and shall be limited to:
    17    (i) beta blockers;
    18    (ii) alpha agonists;
    19    (iii) direct acting cholinergic agents;
    20    (iv) prostaglandin analogs; and
    21    (v) carbonic anhydrase inhibitors.
    22    § 3. Subdivision 1 of section 7101-a of the education law  is  amended
    23  by adding a new paragraph (g) to read as follows:
    24    (g)  Oral  therapeutic pharmaceutical agents. Oral therapeutic pharma-
    25  ceutical agents shall mean those  orally  administered  drugs  used  for
    26  therapeutic purposes solely for the treatment of diseases of the eye and
    27  adnexa and shall be limited to:
    28    (i) the following antibiotics:
    29    (1) amoxicillin/clavulanate potassium;
    30    (2) cephalexin;
    31    (3) azithromycin;
    32    (4) sulfamethoxazole/trimethoprim;
    33    (5) doxycycline; and
    34    (6) tetracycline;
    35    (ii)  the  following  antiglaucoma  agents  used for the management of
    36  acute increases in intraocular pressure; provided, however,  an  optome-
    37  trist   may   use  or  prescribe  a  maximum  of  one  twenty-four  hour
    38  prescription and shall immediately  refer  the  patient  to  a  licensed
    39  physician specializing in diseases of the eye:
    40    (1) acetazolamide; and
    41    (2) methazolamide; and
    42    (iii) the following antiviral agents used for herpes zoster ophthalmi-
    43  cus;  provided  an  optometrist  shall  use or prescribe in maximum, one
    44  seven-day prescription; provided, however, if  a  patient  is  diagnosed
    45  with  herpes  zoster ophthalmicus and has not already been examined by a
    46  primary care physician or other appropriate  physician  for  such  viral
    47  condition,  an optometrist shall refer the patient to a licensed primary
    48  care physician, licensed physician specializing in diseases of the  eye,
    49  or other appropriate physician within three days of such diagnosis:
    50    (1) valacyclovir; and
    51    (2) acyclovir.
    52    §  4.  The  subdivision  heading and paragraph (a) of subdivision 4 of
    53  section 7101-a of the education law, as added by chapter 517 of the laws
    54  of 1995, are amended to read as follows:
    55    [Phase one] Topical  therapeutic  pharmaceutical  agents.  (a)  Before
    56  using  or  prescribing  [phase  one]  topical therapeutic pharmaceutical

        A. 1193--B                          3

     1  agents, each optometrist shall have completed  at  least  three  hundred
     2  hours of clinical training in the diagnosis, treatment and management of
     3  patients  with  ocular  disease other than glaucoma and ocular hyperten-
     4  sion,  not fewer than twenty-five hours of such training shall have been
     5  completed subsequent to June thirtieth,  nineteen  hundred  ninety-three
     6  and  additionally  shall  either  have taken and successfully passed the
     7  treatment and management of ocular  diseases  portion  of  the  National
     8  Board  of  Examiners  in  Optometry  test or have taken and successfully
     9  passed an examination acceptable to the board.
    10    § 5. Paragraph (b) of subdivision 4 of section 7101-a of the education
    11  law, as added by chapter 517 of the laws of 1995, is amended to read  as
    12  follows:
    13    (b) Before using or prescribing [phase two] therapeutic pharmaceutical
    14  agents for treatment of glaucoma and ocular hypertension, an optometrist
    15  must  be  certified  for  diagnostic and [phase one] topical therapeutic
    16  agents and have completed an additional one hundred  hours  of  clinical
    17  training  in  the  diagnosis,  treatment and management of patients with
    18  glaucoma and ocular hypertension, not fewer than  twenty-five  hours  of
    19  such  training shall have been completed subsequent to July first, nine-
    20  teen hundred ninety-four, and shall have taken and  successfully  passed
    21  an oral or written examination acceptable by the board.
    22    §  6. Paragraphs (c) and (d) of subdivision 4 of section 7101-a of the
    23  education law are relettered paragraphs (d) and (e) and a new  paragraph
    24  (c) is added to read as follows:
    25    (c)  Before  using  or  prescribing  oral  therapeutic  pharmaceutical
    26  agents, an optometrist must be certified to prescribe diagnostic pharma-
    27  ceutical agents and topical therapeutic and  therapeutic  pharmaceutical
    28  agents for treatment of glaucoma and ocular hypertension, have completed
    29  an  oral  therapeutic pharmaceutical agent certification course and have
    30  passed an examination within five years of the department's approval  of
    31  the  initial  certification course or the initial examination, whichever
    32  is later provided, however, an optometrist who has  commenced  the  oral
    33  therapeutic  pharmaceutical  agent  certification course within the five
    34  year time period but has not yet passed an examination shall be  allowed
    35  to  take  such examination and become certified after the five year time
    36  period provided for in this paragraph has ended.
    37    (i) The curriculum  for  the  oral  therapeutic  pharmaceutical  agent
    38  certification  course  shall include, but not be limited to, instruction
    39  in pharmacology and drug interaction in treating ocular disease  and  be
    40  taught  through  clinical case scenarios and emphasize clinical decision
    41  making and shall be no less than forty hours,  of  which  no  less  than
    42  twenty-four hours shall be live instruction.
    43    (ii)  Such  course shall qualify towards meeting the continuing educa-
    44  tion per triennial  registration  requirement  pursuant  to  subdivision
    45  seven of this section.
    46    (iii)  The  examination shall assess the knowledge of materials in the
    47  curriculum  and  reflect  the  oral  therapeutic  pharmaceutical  agents
    48  described in paragraph (g) of subdivision one of this section, and shall
    49  be acceptable to the department.
    50    (iv) The initial, and any subsequent, curriculum and examination shall
    51  be subject to review and approval by the department.
    52    (v)  The  requirement  for  the  oral therapeutic pharmaceutical agent
    53  certification course and examination shall not apply  to  those  optome-
    54  trists  who graduated from an accredited college of optometry subsequent
    55  to January first, two thousand seven and  have  taken  and  successfully

        A. 1193--B                          4

     1  passed  the  National  Board of Examiners in Optometry examination or an
     2  examination acceptable to the department.
     3    § 7. Subdivision 5 of section 7101-a of the education law, as added by
     4  chapter 517 of the laws of 1995, is amended to read as follows:
     5    5.  Suspension  of  certification.  The  department  shall suspend the
     6  certification for the use and prescribing of [phase one] topical  thera-
     7  peutic  agents of any optometrist who fails to receive certification for
     8  [phase two] therapeutic pharmaceutical agents for treatment of  glaucoma
     9  and  ocular hypertension within three years of having been certified for
    10  [phase one] topical therapeutic pharmaceutical agents.
    11    § 8. The subdivision heading of subdivision 6 of section 7101-a of the
    12  education law, as added by chapter 517 of the laws of 1995,  is  amended
    13  to read as follows:
    14    Consultation  with  use  of certain topical therapeutic pharmaceutical
    15  agents for treatment of glaucoma and ocular hypertension.
    16    § 9. Subdivision 7 of section 7101-a of the education law, as added by
    17  chapter 517 of the laws of 1995, is amended to read as follows:
    18    7. Continuing education. (a) Each optometrist certified to use  [phase
    19  one  or  phase two] topical therapeutic pharmaceutical agents and thera-
    20  peutic pharmaceutical agents for treatment of glaucoma and ocular hyper-
    21  tension, shall complete a minimum  of  thirty-six  hours  of  continuing
    22  education  in  the area of ocular disease and pharmacology per triennial
    23  registration period. [The education shall  be  in  the  area  of  ocular
    24  disease  and  pharmacology  and  may  include both didactic and clinical
    25  components.] Each optometrist certified to use oral therapeutic  pharma-
    26  ceutical  agents  shall,  in addition to the minimum thirty-six hours of
    27  continuing education provided for in this subdivision, complete an addi-
    28  tional minimum of eighteen hours  of  continuing  education  related  to
    29  systemic  disease  and  therapeutic treatment per triennial registration
    30  period. Such educational programs may include both didactic and clinical
    31  components and shall be approved  in  advance  by  the  department  [and
    32  evidence  of  the completion of this requirement shall be submitted with
    33  each application for license renewal as required by  section  sixty-five
    34  hundred  two  of this chapter]. Beginning on January first, two thousand
    35  twenty-two,  all  sponsors  of  continuing  education  courses   seeking
    36  advanced  approval from the department shall file an application and pay
    37  a fee determined by the department in accordance with the regulations of
    38  the commissioner. An optometrist  subject  to  the  provisions  of  this
    39  subdivision  whose  first registration date following the effective date
    40  of this section occurs less than three years from such  effective  date,
    41  but  on  or after January first, two thousand twenty-two, shall complete
    42  continuing education hours on a prorated basis at the rate of  one  hour
    43  per  month  for the period beginning January first, two thousand twenty-
    44  two up to the first registration date thereafter. An optometrist who has
    45  not satisfied the mandatory continuing education requirement pursuant to
    46  this subdivision shall not be issued a  triennial  registration  certif-
    47  icate by the department and shall not practice unless and until a condi-
    48  tional  registration  is issued as provided for in paragraph (b) of this
    49  subdivision. Continuing education hours taken during one  triennium  may
    50  not be transferred to the subsequent triennium.
    51    (b)  The department, in its discretion, may issue a conditional regis-
    52  tration to an optometrist who fails to  meet  the  continuing  education
    53  requirements  established  in paragraph (a) of this subdivision, but who
    54  agrees to make up any deficiencies and complete any additional education
    55  which the department may require. The fee for such a conditional  regis-
    56  tration shall be the same as, and in addition to, the fee for the trien-

        A. 1193--B                          5

     1  nial  registration.  The duration of such conditional registration shall
     2  be determined by the department, but shall  not  exceed  one  year.  Any
     3  optometrist who is notified of the denial of registration for failure to
     4  submit  evidence, satisfactory to the department, of required continuing
     5  education and who practices without such registration may be subject  to
     6  disciplinary  proceedings  pursuant to section sixty-five hundred ten of
     7  this title.
     8    (c) In accordance with the intent of this section, adjustment  to  the
     9  mandatory continuing education requirement may be granted by the depart-
    10  ment  for  reasons of health that are certified by an appropriate health
    11  care professional, for extended active duty with the armed forces of the
    12  United States, or for other good  cause  acceptable  to  the  department
    13  which may prevent compliance.
    14    (d)  An  optometrist  not  engaged  in  practice, as determined by the
    15  department, shall be exempt  from  the  mandatory  continuing  education
    16  requirement upon the filing of a statement with the department declaring
    17  such  status.  Any  licensee  who  returns  to the practice of optometry
    18  during the triennial registration period  shall  notify  the  department
    19  prior to reentering the profession and shall meet such continuing educa-
    20  tion  requirements  as shall be prescribed by regulations of the commis-
    21  sioner.
    22    (e) Optometrists subject to the provisions of this  subdivision  shall
    23  maintain  adequate  documentation of completion of acceptable continuing
    24  education credits and shall provide such documentation at the request of
    25  the department. Failure to provide such documentation upon  the  request
    26  of  the department shall be an act of misconduct subject to disciplinary
    27  proceedings pursuant to section sixty-five hundred ten of this title.
    28    (f) The mandatory continuing education fee shall be determined by  the
    29  department.    Such  fee  shall be payable on or before the first day of
    30  each triennial registration period, and shall be paid in addition to the
    31  triennial registration fee required  by  subdivision  eight  of  section
    32  seventy-one hundred four of this article.
    33    § 10. The subdivision heading and subparagraph (i) of paragraph (a) of
    34  subdivision  8 of section 7101-a of the education law, as added by chap-
    35  ter 517 of the laws of 1995, are amended to read as follows:
    36    Notice to patient with the use or prescription of topical  therapeutic
    37  pharmaceutical  agents  and therapeutic pharmaceutical agents for treat-
    38  ment of glaucoma and ocular hypertension.
    39    (i) An optometrist prescribing topical steroids or  antiviral  medica-
    40  tion  shall inform each patient that in the event the condition does not
    41  improve within five days, a physician of the patient's  choice  will  be
    42  notified.
    43    §  11. Subdivision 10 of section 7101-a of the education law, as added
    44  by chapter 517 of the laws of 1995, is amended to read as follows:
    45    10. Pharmaceutical agents. Optometrists who  have  been  approved  and
    46  certified  by  the  department  shall  be permitted to use the following
    47  drugs:
    48    (a) Diagnostic pharmaceuticals.
    49    (b) Those optometrists having been certified for [phase  one]  topical
    50  therapeutic  pharmaceutical  agents  shall be authorized [(i) to use and
    51  recommend all nonprescription medications appropriate for ocular disease
    52  whether intended for topical or oral use; and (ii)] to use and prescribe
    53  all [phase one] topical therapeutic pharmaceutical agents  specified  in
    54  paragraph (e) of subdivision one of this section, which are FDA approved
    55  and commercially available for topical use.

        A. 1193--B                          6

     1    In the event an optometrist treats a patient with topical antiviral or
     2  steroidal  drugs  and the patient's condition either fails to improve or
     3  worsens within five days,  the  optometrist  shall  notify  a  physician
     4  designated by the patient or, if none, by the treating optometrist.
     5    (c) Those optometrists having been certified for [phase two] therapeu-
     6  tic pharmaceutical agents for treatment of glaucoma and ocular hyperten-
     7  sion  shall  be  authorized to use and prescribe [phase two] therapeutic
     8  pharmaceutical agents for treatment of glaucoma and ocular  hypertension
     9  specified in paragraph (f) of subdivision one of this section, which are
    10  FDA approved and commercially available.
    11    (d)  Those  optometrists  having  been  certified for oral therapeutic
    12  pharmaceutical agents shall be authorized  to  use  and  prescribe  oral
    13  therapeutic pharmaceutical agents specified in paragraph (g) of subdivi-
    14  sion one of this section, which are FDA approved and commercially avail-
    15  able  and  shall  comply with all safety information and side-effect and
    16  warning advisories contained in the most current physicians' desk refer-
    17  ence.
    18    (e) Those optometrists having been certified for  topical  therapeutic
    19  pharmaceutical  agents,  therapeutic pharmaceutical agents for treatment
    20  of glaucoma and ocular hypertension or oral  therapeutic  pharmaceutical
    21  agents  shall  be  authorized  to  use and recommend all nonprescription
    22  medications, whether intended for topical or oral use,  appropriate  for
    23  the treatment of the eye and adnexa.
    24    §  12.  Subdivision 8 of section 7104 of the education law, as amended
    25  by chapter 517 of the laws of 1995, is amended to read as follows:
    26    (8) Fees: pay a fee of two hundred twenty dollars  to  the  department
    27  for  admission  to a department conducted examination and for an initial
    28  license, a fee of one hundred fifteen dollars for each reexamination,  a
    29  fee  of  one  hundred  thirty-five  dollars  for  an initial license for
    30  persons not requiring admission to a department  conducted  examination,
    31  [and]  a  fee of two hundred ten dollars for each triennial registration
    32  period, [and] for additional authorization for the purpose of  utilizing
    33  diagnostic  pharmaceutical  agents,  a  fee  of  sixty  dollars, and for
    34  certification  to  use  or  prescribe  oral  therapeutic  pharmaceutical
    35  agents, a fee of two hundred fifty dollars.
    36    §  13. This act shall take effect two years after it shall have become
    37  a law; provided that section nine of this act shall take effect  January
    38  1,  2022.   Effective immediately, the addition, amendment and/or repeal
    39  of any rule or regulation necessary for the implementation of  this  act
    40  on  its  effective  date  are  authorized  and  directed  to be made and
    41  completed on or before such effective date.
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