Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. SB 278
                                Barcode 606544                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/21/2013           .                                

       The Committee on Health Policy (Garcia) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (b) of subsection (3) and subsections
    6  (4) and (5) of section 463.002, Florida Statutes, are amended,
    7  and subsection (11) is added to that section, to read:
    8         463.002 Definitions.—As used in this chapter, the term:
    9         (3) 
   10         (b) A licensed practitioner who is not a certified
   11  optometrist is shall be required to display at her or his place
   12  of practice a sign that which states, “I am a licensed
   13  practitioner, not a certified optometrist, and I am not able to
   14  prescribe topical ocular pharmaceutical agents.”
   15         (4) “Certified optometrist” means a licensed practitioner
   16  authorized by the board to administer and prescribe topical
   17  ocular pharmaceutical agents.
   18         (5) “Optometry” means the diagnosis of conditions of the
   19  human eye and its appendages; the employment of any objective or
   20  subjective means or methods, including the administration of
   21  topical ocular pharmaceutical agents, for the purpose of
   22  determining the refractive powers of the human eyes, or any
   23  visual, muscular, neurological, or anatomic anomalies of the
   24  human eyes and their appendages; and the prescribing and
   25  employment of lenses, prisms, frames, mountings, contact lenses,
   26  orthoptic exercises, light frequencies, and any other means or
   27  methods, including topical ocular pharmaceutical agents, for the
   28  correction, remedy, or relief of any insufficiencies or abnormal
   29  conditions of the human eyes and their appendages.
   30         (11) “Ocular pharmaceutical agent” means a pharmaceutical
   31  agent that is administered topically or orally for the diagnosis
   32  or treatment of ocular conditions of the human eye and its
   33  appendages without the use of surgery or other invasive
   34  techniques.
   35         Section 2. Paragraph (g) of subsection (1) of section
   36  463.005, Florida Statutes, is amended to read:
   37         463.005 Authority of the board.—
   38         (1) The Board of Optometry may has authority to adopt rules
   39  pursuant to ss. 120.536(1) and 120.54 to implement the
   40  provisions of this chapter conferring duties upon it. Such rules
   41  shall include, but are not be limited to, rules relating to:
   42         (g) Administration and prescription of topical ocular
   43  pharmaceutical agents.
   44         Section 3. Section 463.0055, Florida Statutes, is amended
   45  to read:
   46         463.0055 Administration and prescription of topical ocular
   47  pharmaceutical agents; committee.—
   48         (1)(a) Certified optometrists may administer and prescribe
   49  topical ocular pharmaceutical agents as provided in this section
   50  for the diagnosis and treatment of ocular conditions of the
   51  human eye and its appendages without the use of surgery or other
   52  invasive techniques. However, a licensed practitioner who is not
   53  certified may use topically applied anesthetics solely for the
   54  purpose of glaucoma examinations, but is otherwise prohibited
   55  from administering or prescribing topical ocular pharmaceutical
   56  agents.
   57         (b) Before a certified optometrist may administer or
   58  prescribe oral ocular pharmaceutical agents, the certified
   59  optometrist must complete a course and subsequent examination on
   60  general and ocular pharmaceutical agents and the side effects of
   61  those agents. For certified optometrists licensed before January
   62  1, 1990, the course consists of 50 contact hours, with 25 of
   63  those hours web-based. For certified optometrists licensed on or
   64  after January 1, 1990, the course consists of 20 contact hours,
   65  with 10 of those hours web-based. The first course and
   66  examination shall be presented by July 1, 2013, and shall be
   67  administered at least annually thereafter. The Florida Medical
   68  Association and the Florida Optometric Association shall jointly
   69  develop and administer a course and examination for such purpose
   70  and jointly determine the site or sites for the course and
   71  examination.
   72         (2)(a) There is hereby created a committee composed of two
   73  certified optometrists licensed pursuant to this chapter,
   74  appointed by the Board of Optometry, two board-certified
   75  ophthalmologists licensed pursuant to chapter 458 or chapter
   76  459, appointed by the Board of Medicine, and one additional
   77  person with a doctorate degree in pharmacology who is not
   78  licensed pursuant to chapter 458, chapter 459, or this chapter,
   79  appointed by the State Surgeon General. The committee shall
   80  review requests for additions to, deletions from, or
   81  modifications of a formulary of topical ocular pharmaceutical
   82  agents for administration and prescription by certified
   83  optometrists and shall provide to the board advisory opinions
   84  and recommendations on such requests. The committee’s opinions
   85  and recommendations must state specific findings of fact and
   86  grounds for its recommendation. The committee’s findings,
   87  opinions, and recommendations are not subject to review pursuant
   88  to ss. 120.569 and 120.57. The formulary shall consist of those
   89  topical ocular pharmaceutical agents that which are appropriate
   90  to treat and diagnose ocular diseases and disorders and which
   91  the certified optometrist is qualified to use in the practice of
   92  optometry. The board shall establish, add to, delete from, or
   93  modify the formulary by rule. The board is bound by the
   94  committee’s recommendations on oral ocular pharmaceutical agents
   95  unless competent substantial evidence is presented to the board
   96  sufficient to rebut the committee’s recommendation.
   97  Notwithstanding any provision of chapter 120 to the contrary,
   98  the formulary rule becomes shall become effective 60 days from
   99  the date it is filed with the Secretary of State.
  100         (b) The formulary may be added to, deleted from, or
  101  modified according to the procedure described in paragraph (a).
  102  A Any person who requests an addition, deletion, or modification
  103  of an authorized topical ocular pharmaceutical agent has shall
  104  have the burden of proof to show cause why such addition,
  105  deletion, or modification should be made.
  106         (c) The State Surgeon General has shall have standing to
  107  challenge a any rule or proposed rule of the board pursuant to
  108  s. 120.56. In addition to challenges to an for any invalid
  109  exercise of delegated legislative authority, the administrative
  110  law judge, upon such a challenge by the State Surgeon General,
  111  may declare all or part of a rule or proposed rule invalid if
  112  it:
  113         1. Does not protect the public from any significant and
  114  discernible harm or damages;
  115         2. Unreasonably restricts competition or the availability
  116  of professional services in the state or in a significant part
  117  of the state; or
  118         3. Unnecessarily increases the cost of professional
  119  services without a corresponding or equivalent public benefit.
  121  However, there shall not be created a presumption of the
  122  existence of any of the conditions cited in this subsection is
  123  not created in the event that the rule or proposed rule is
  124  challenged.
  125         (d) Upon adoption of the formulary required by this
  126  section, and upon each addition, deletion, or modification to
  127  the formulary, the board shall mail a copy of the amended
  128  formulary to each certified optometrist and to each pharmacy
  129  licensed by the state.
  130         (3) A certified optometrist shall be issued a prescriber
  131  number by the board. Any prescription written by a certified
  132  optometrist for an a topical ocular pharmaceutical agent
  133  pursuant to this section must include shall have the prescriber
  134  number printed thereon.
  135         Section 4. Subsection (3) of section 463.0057, Florida
  136  Statutes, is amended to read:
  137         463.0057 Optometric faculty certificate.—
  138         (3) The holder of a faculty certificate may engage in the
  139  practice of optometry as permitted by this section, but may not
  140  administer or prescribe topical ocular pharmaceutical agents
  141  unless the certificateholder has satisfied the requirements of
  142  ss. 463.0055(1)(b) and s. 463.006(1)(b)4. and 5.
  143         Section 5. Subsections (2) and (3) of section 463.006,
  144  Florida Statutes, are amended to read:
  145         463.006 Licensure and certification by examination.—
  146         (2) The examination consists shall consist of the
  147  appropriate subjects, including applicable state laws and rules
  148  and general and ocular pharmacology with emphasis on the use
  149  topical application and side effects of ocular pharmaceutical
  150  agents. The board may by rule substitute a national examination
  151  as part or all of the examination and may by rule offer a
  152  practical examination in addition to the written examination.
  153         (3) Each applicant who successfully passes the examination
  154  and otherwise meets the requirements of this chapter is entitled
  155  to be licensed as a practitioner and to be certified to
  156  administer and prescribe topical ocular pharmaceutical agents in
  157  the diagnosis and treatment of ocular conditions.
  158         Section 6. Subsection (10) is added to section 463.0135,
  159  Florida Statutes, to read:
  160         463.0135 Standards of practice.—
  161         (10) A certified optometrist may perform any eye
  162  examination, including a dilated examination, required or
  163  authorized by chapter 548 or by rules adopted to implement that
  164  chapter.
  165         Section 7. Subsection (3) of section 463.014, Florida
  166  Statutes, is amended to read:
  167         463.014 Certain acts prohibited.—
  168         (3) Prescribing, ordering, dispensing, administering,
  169  supplying, selling, or giving any drug for the purpose of
  170  treating a systemic disease systemic drugs by a licensed
  171  practitioner is prohibited.
  172         Section 8. Subsection (1) of section 483.035, Florida
  173  Statutes, is amended to read:
  174         483.035 Clinical laboratories operated by practitioners for
  175  exclusive use; licensure and regulation.—
  176         (1) A clinical laboratory operated by one or more
  177  practitioners licensed under chapter 458, chapter 459, chapter
  178  460, chapter 461, chapter 462, chapter 463, or chapter 466,
  179  exclusively in connection with the diagnosis and treatment of
  180  their own patients, must be licensed under this part and must
  181  comply with the provisions of this part, except that the agency
  182  shall adopt rules for staffing, for personnel, including
  183  education and training of personnel, for proficiency testing,
  184  and for construction standards relating to the licensure and
  185  operation of the laboratory based upon and not exceeding the
  186  same standards contained in the federal Clinical Laboratory
  187  Improvement Amendments of 1988 and the federal regulations
  188  adopted thereunder.
  189         Section 9. Subsection (7) of section 483.041, Florida
  190  Statutes, is amended to read:
  191         483.041 Definitions.—As used in this part, the term:
  192         (7) “Licensed practitioner” means a physician licensed
  193  under chapter 458, chapter 459, chapter 460, or chapter 461, or
  194  chapter 463; a dentist licensed under chapter 466; a person
  195  licensed under chapter 462; or an advanced registered nurse
  196  practitioner licensed under part I of chapter 464; or a duly
  197  licensed practitioner from another state licensed under similar
  198  statutes who orders examinations on materials or specimens for
  199  nonresidents of the State of Florida, but who reside in the same
  200  state as the requesting licensed practitioner.
  201         Section 10. Subsection (5) of section 483.181, Florida
  202  Statutes, is amended to read:
  203         483.181 Acceptance, collection, identification, and
  204  examination of specimens.—
  205         (5) A clinical laboratory licensed under this part must
  206  accept a human specimen submitted for examination by a
  207  practitioner licensed under chapter 458, chapter 459, chapter
  208  460, chapter 461, chapter 462, chapter 463, s. 464.012, or
  209  chapter 466, if the specimen and test are the type performed by
  210  the clinical laboratory. A clinical laboratory may only refuse a
  211  specimen based upon a history of nonpayment for services by the
  212  practitioner. A clinical laboratory may shall not charge
  213  different prices for tests based upon the chapter under which a
  214  practitioner submitting a specimen for testing is licensed.
  215         Section 11. Subsection (21) of section 893.02, Florida
  216  Statutes, is amended to read:
  217         893.02 Definitions.—The following words and phrases as used
  218  in this chapter shall have the following meanings, unless the
  219  context otherwise requires:
  220         (21) “Practitioner” means a physician licensed pursuant to
  221  chapter 458, a dentist licensed pursuant to chapter 466, a
  222  veterinarian licensed pursuant to chapter 474, an osteopathic
  223  physician licensed pursuant to chapter 459, a naturopath
  224  licensed pursuant to chapter 462, a certified optometrist
  225  licensed pursuant to chapter 463, or a podiatric physician
  226  licensed pursuant to chapter 461, provided such practitioner
  227  holds a valid federal controlled substance registry number.
  228         Section 12. Subsection (1) of section 893.05, Florida
  229  Statutes, is amended to read:
  230         893.05 Practitioners and persons administering controlled
  231  substances in their absence.—
  232         (1) A practitioner, in good faith and in the course of his
  233  or her professional practice only, may prescribe, administer,
  234  dispense, mix, or otherwise prepare a controlled substance, or
  235  the practitioner may cause the same to be administered by a
  236  licensed nurse or an intern practitioner under his or her
  237  direction and supervision only. A veterinarian may so prescribe,
  238  administer, dispense, mix, or prepare a controlled substance for
  239  use on animals only, and may cause it to be administered by an
  240  assistant or orderly under the veterinarian’s direction and
  241  supervision only. A certified optometrist licensed under chapter
  242  463 may not administer or prescribe pharmaceutical agents listed
  243  in Schedule I or Schedule II of s. 893.03. A certified
  244  optometrist who has complied with the provisions of section
  245  463.0055(1)(b) may administer oral analgesics listed in Schedule
  246  III, IV, or V for the relief of pain due to ocular conditions of
  247  the eye and its appendages.
  248         Section 13. This act shall take effect July 1, 2013.
  250  ================= T I T L E  A M E N D M E N T ================
  251         And the title is amended as follows:
  252         Delete everything before the enacting clause
  253  and insert:
  254                        A bill to be entitled                      
  255         An act relating to the practice of optometry; amending
  256         s. 463.002, F.S.; requiring a licensed practitioner
  257         who is not a certified optometrist to display a
  258         specifically worded sign; revising definitions;
  259         defining the term “ocular pharmaceutical agent”;
  260         amending s. 463.005, F.S.; authorizing the Board of
  261         Optometry to adopt rules relating to the
  262         administration and prescription of ocular
  263         pharmaceutical agents; amending s. 463.0055, F.S.;
  264         requiring a certified optometrist to complete a course
  265         and examination on general and ocular pharmaceutical
  266         agents before administering or prescribing oral ocular
  267         pharmaceutical agents; specifying the number of
  268         required course hours based on the date of licensure;
  269         requiring the Florida Medical Association and the
  270         Florida Optometric Association to jointly develop and
  271         administer the course and examination; revising
  272         provisions relating to the development of a formulary
  273         of pharmaceutical agents; amending s. 463.0057, F.S.;
  274         prohibiting the holder of an optometric faculty
  275         certificate from administering or prescribing
  276         pharmaceutical agents; amending s. 463.006, F.S.;
  277         revising provisions relating to licensure and
  278         certification of optometrists; amending s. 463.0135,
  279         F.S.; authorizing a certified optometrist to perform
  280         certain eye examinations; amending s. 463.014, F.S.;
  281         prohibiting a licensed practitioner of optometry from
  282         providing any drug for the purpose of treating a
  283         systemic disease; amending s. 483.035, F.S.; requiring
  284         a clinical laboratory operated by a licensed
  285         practitioner of optometry to be licensed under ch.
  286         463, F.S.; amending s. 483.041, F.S.; revising the
  287         definition of the term “licensed practitioner” to
  288         include certified optometrists; amending s. 483.181,
  289         F.S.; providing for an optometrist to accept a human
  290         specimen for examination, under certain conditions;
  291         amending s. 893.02, F.S.; redefining the term
  292         “practitioner” to include certified optometrists;
  293         amending s. 893.05, F.S.; prohibiting a certified
  294         optometrist from administering or prescribing
  295         pharmaceutical agents listed in Schedule I or Schedule
  296         II of the Florida Comprehensive Drug Abuse Prevention
  297         and Control Act; authorizing certain certified
  298         optometrists to administer certain oral analgesics;
  299         providing an effective date.