Assembly Bill No. 432–Committee on Commerce and Labor

March 10, 1999

____________

Referred to Committee on Commerce and Labor

 

SUMMARY—Revises provisions governing practice of optometry. (BDR 54-339)

FISCAL NOTE: Effect on Local Government: No.

Effect on the State or on Industrial Insurance: No.

~

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

 

AN ACT relating to optometry; revising the authority of an optometrist to prescribe certain therapeutic pharmaceutical agents; authorizing an optometrist to treat persons diagnosed with glaucoma, under certain circumstances, if he holds a certificate issued by the Nevada state board of optometry; requiring the board to adopt regulations that prescribe the requirements for the issuance of such a certificate; authorizing an optometrist to practice under an assumed or fictitious name if the name has been registered with the board; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

1-1 Section 1. Chapter 636 of NRS is hereby amended by adding thereto

1-2 the provisions set forth as sections 2 to 5, inclusive, of this act.

1-3 Sec. 2. An optometrist who is certified to administer and prescribe a

1-4 therapeutic pharmaceutical agent pursuant to NRS 636.288 shall not

1-5 prescribe an analgesic of hydrocodone with compounds, codeine with

1-6 compounds or propoxyphene with compounds unless he:

1-7 1. Has completed an optometric examination of the patient for whom

1-8 the therapeutic pharmaceutical agent is prescribed;

1-9 2. Prescribes the therapeutic pharmaceutical agent in an amount

1-10 that will not last more than 72 hours; and

1-11 3. Sets forth in the prescription for the therapeutic pharmaceutical

1-12 agent that the prescription may not be refilled.

1-13 Sec. 3. 1. An optometrist shall not treat a person diagnosed with

1-14 glaucoma unless he has been issued a certificate by the board pursuant

1-15 to section 5 of this act.

2-1 2. An optometrist who has been issued a certificate to treat persons

2-2 diagnosed with glaucoma pursuant to section 5 of this act shall refer a

2-3 patient diagnosed with glaucoma to an ophthalmologist for treatment if

2-4 any one of the following is applicable:

2-5 (a) The patient is under 16 years of age.

2-6 (b) The patient has been diagnosed with malignant glaucoma or

2-7 neovascular glaucoma.

2-8 (c) The patient has been diagnosed with acute closed angle glaucoma.

2-9 The provisions of this paragraph do not prohibit the optometrist from

2-10 administering appropriate emergency treatment to the patient.

2-11 (d) The patient’s glaucoma is caused by diabetes, and, after joint

2-12 consultation with a physician who is treating the diabetes and an

2-13 ophthalmologist, the physician or ophthalmologist determines that the

2-14 patient should be treated by an ophthalmologist. If an optometrist

2-15 determines that a patient’s glaucoma is caused by diabetes, he shall

2-16 consult with a physician and ophthalmologist in the manner provided in

2-17 this paragraph.

2-18 Sec. 4. The board shall adopt regulations that prescribe the

2-19 requirements for the issuance of a certificate to treat persons diagnosed

2-20 with glaucoma pursuant to section 5 of this act. The requirements must

2-21 include, without limitation:

2-22 1. A license to practice optometry in this state;

2-23 2. The successful completion of the "Treatment and Management of

2-24 Ocular Disease Examination" administered by the National Board of

2-25 Examiners in Optometry on or after January 1, 1993, or an equivalent

2-26 examination approved by the board; and

2-27 3. Proof that each optometrist who applies for a certificate has

2-28 treated at least 15 persons who were:

2-29 (a) Diagnosed with glaucoma by an ophthalmologist licensed in this

2-30 state; and

2-31 (b) Treated by the optometrist, in consultation with that

2-32 ophthalmologist, for at least 1 year.

2-33 Sec. 5. The board shall issue a certificate to treat persons diagnosed

2-34 with glaucoma to each optometrist who has complied with the

2-35 requirements prescribed by the board pursuant to section 4 of this act.

2-36 Sec. 6. NRS 636.022 is hereby amended to read as follows:

2-37 636.022 "Prescription" means [a] :

2-38 1. An order given individually for the person for whom prescribed,

2-39 directly from a licensed optometrist who is certified to prescribe and

2-40 administer therapeutic pharmaceutical agents pursuant to NRS 636.288,

2-41 or his agent, to a pharmacist or indirectly by means of an order signed by

2-42 the licensed optometrist or an electronic transmission from the licensed

2-43 optometrist to a pharmacist; or

3-1 2. A written direction from a licensed optometrist to:

3-2 [1.] (a) Prepare an ophthalmic lens for a patient; or

3-3 [2.] (b) Dispense a prepackaged contact lens that does not require any

3-4 adjustment, modification or fitting.

3-5 Sec. 7. NRS 636.024 is hereby amended to read as follows:

3-6 636.024 "Therapeutic pharmaceutical agent" means [a] :

3-7 1. A topical medication [or an] ;

3-8 2. An oral antibiotic ;

3-9 3. An oral medication for allergies that does not contain steroids; or

3-10 4. An analgesic of hydrocodone with compounds, codeine with

3-11 compounds or propoxyphene with compounds,

3-12 approved by the Food and Drug Administration for the treatment of

3-13 abnormalities of the eye or its appendages.

3-14 Sec. 8. NRS 636.025 is hereby amended to read as follows:

3-15 636.025 1. The acts [enumerated] set forth in this section, or any of

3-16 them, whether done severally, collectively or in combination with other acts

3-17 that are not [enumerated] set forth in this section constitute practice in

3-18 optometry within the purview of this chapter:

3-19 (a) Advertisement or representation as an optometrist.

3-20 (b) Adapting, or prescribing or dispensing, without prescription by a

3-21 [licensed Nevada] practitioner of optometry or medicine [,] licensed in this

3-22 state, any ophthalmic lens, frame or mounting, or any part thereof, for

3-23 correction, relief or remedy of any abnormal condition or insufficiency of

3-24 the eye or any appendage or visual process . [thereof.] The provisions of

3-25 this subsection do not prevent an optical mechanic from doing the mere

3-26 mechanical work of replacement or duplication of the ophthalmic lens or

3-27 prevent a licensed dispensing optician from engaging in the practice of

3-28 ophthalmic dispensing.

3-29 (c) The examination of the human eye and its appendages, the

3-30 measurement of the powers or range of human vision, the determination of

3-31 the accommodative and refractive states of the eye or the scope of its

3-32 function in general , or the diagnosis or determination of any visual,

3-33 muscular, neurological, interpretative or anatomic anomalies or deficiencies

3-34 of the eye or its appendages or visual processes.

3-35 (d) Prescribing, directing the use of or using any optical device in

3-36 connection with ocular exercises, orthoptics or visual training.

3-37 (e) The prescribing of contact lenses.

3-38 (f) The measurement, fitting or adaptation of contact lenses to the

3-39 human eye except under the direction and supervision of a physician,

3-40 surgeon or optometrist licensed in the State of Nevada.

3-41 (g) The topical use of diagnostic pharmaceutical agents to determine any

3-42 visual, muscular, neurological, interpretative or anatomic anomalies or

3-43 deficiencies of the eye or its appendages or visual processes.

4-1 (h) Prescribing, directing the use of or using a therapeutic

4-2 pharmaceutical agent to treat an abnormality of the eye or its appendages.

4-3 (i) Removing a foreign object from the surface or epithelium of the eye.

4-4 (j) The ordering of laboratory tests to assist in the diagnosis of an

4-5 abnormality of the eye or its appendages.

4-6 2. The provisions of this section do not authorize an optometrist to

4-7 engage in any practice which includes:

4-8 (a) The incision or suturing of the eye or its appendages; or

4-9 (b) The use of lasers for surgical purposes . [; or

4-10 (c) The treatment of glaucoma.]

4-11 Sec. 9. NRS 636.350 is hereby amended to read as follows:

4-12 636.350 [A licensee]

4-13 1. An optometrist shall not [be entitled to] practice optometry under an

4-14 assumed or fictitious name [.] unless he has been issued a certificate of

4-15 registration by the board to practice optometry under an assumed or

4-16 fictitious name.

4-17 2. An optometrist who applies for a certificate of registration to

4-18 practice optometry under an assumed or fictitious name must submit to

4-19 the board an application on a form provided by the board.

4-20 3. Each optometrist who is issued a certificate of registration

4-21 pursuant to this section shall:

4-22 (a) Comply with the provisions of chapter 602 of NRS; and

4-23 (b) Display or cause to be displayed near the entrance of his business

4-24 his full name and the words or letters that designate him as an

4-25 optometrist.

4-26 4. The board shall adopt regulations that prescribe the requirements

4-27 for the issuance of a certificate of registration to practice optometry

4-28 under an assumed or fictitious name.

4-29 5. As used in this section, "assumed or fictitious name" means a

4-30 name that is not the real name of each person who owns an interest in a

4-31 business.

4-32 Sec. 10. NRS 652.210 is hereby amended to read as follows:

4-33 652.210 No person other than a licensed physician, a licensed

4-34 optometrist, a licensed practical nurse, a registered nurse, a licensed or

4-35 certified physician’s assistant, a certified intermediate emergency medical

4-36 technician, a certified advanced emergency medical technician or a licensed

4-37 dentist may manipulate a person for the collection of specimens, except that

4-38 technical personnel of a laboratory may collect blood, remove stomach

4-39 contents, perform certain diagnostic skin tests or field blood tests or collect

4-40 material for smears and cultures.

5-1 Sec. 11. NRS 453.126 is hereby amended to read as follows:

5-2 453.126 "Practitioner" means:

5-3 1. A physician, dentist, veterinarian or podiatric physician who holds a

5-4 [valid] license to practice his profession in this state and is registered

5-5 pursuant to this chapter.

5-6 2. An advanced practitioner of nursing who holds a certificate from the

5-7 state board of nursing and a certificate from the state board of pharmacy

5-8 [permitting] authorizing him to dispense controlled substances.

5-9 3. A scientific investigator or a pharmacy, hospital or other institution

5-10 licensed, registered or otherwise [permitted by] authorized in this state to

5-11 distribute, dispense, conduct research with respect to, to administer, or use

5-12 in teaching or chemical analysis, a controlled substance in the course of

5-13 professional practice or research.

5-14 4. A euthanasia technician who is licensed by the Nevada state board

5-15 of veterinary medical examiners and registered pursuant to this chapter,

5-16 [when] while he possesses or administers sodium pentobarbital pursuant to

5-17 his license and registration.

5-18 5. A physician’s assistant who:

5-19 (a) Holds a license from the board of medical examiners or a certificate

5-20 from the state board of osteopathic medicine; and

5-21 (b) Is authorized by the board to possess, administer, prescribe or

5-22 dispense controlled substances under the supervision of a physician or

5-23 osteopathic physician as required by chapter 630 or 633 of NRS.

5-24 6. An optometrist who is certified by the Nevada state board of

5-25 optometry to prescribe and administer therapeutic pharmaceutical agents

5-26 pursuant to NRS 636.288, when he prescribes or administers therapeutic

5-27 pharmaceutical agents within the scope of his certification.

5-28 Sec. 12. NRS 453.128 is hereby amended to read as follows:

5-29 453.128 1. "Prescription" means:

5-30 (a) An order given individually for the person for whom prescribed,

5-31 directly from a physician, physician’s assistant, dentist, podiatric physician

5-32 , optometrist or veterinarian, or his agent, to a pharmacist or indirectly by

5-33 means of an order signed by the practitioner or an electronic transmission

5-34 from the practitioner to a pharmacist [.] ; or

5-35 (b) A chart order written for an inpatient specifying drugs which he is to

5-36 take home upon his discharge.

5-37 2. ["Prescription"] The term does not include a chart order written for

5-38 an inpatient for use while he is an inpatient.

5-39 Sec. 13. NRS 453.336 is hereby amended to read as follows:

5-40 453.336 1. [It is unlawful for a] A person shall not knowingly or

5-41 intentionally [to] possess a controlled substance , unless the substance was

5-42 obtained directly from, or pursuant to, a [valid] prescription or order of a

5-43 physician, physician’s assistant, dentist, podiatric physician , optometrist

6-1 or veterinarian while acting in the course of his professional practice, or

6-2 except as otherwise authorized by the provisions of NRS 453.011 to

6-3 453.552, inclusive.

6-4 2. Except as otherwise provided in subsections 3, 4 and 5 and in NRS

6-5 453.3363, and unless a greater penalty is provided in NRS 212.160,

6-6 453.3385, 453.339 or 453.3395, a person who violates this section shall be

6-7 punished:

6-8 (a) For the first or second offense, if the controlled substance is listed in

6-9 schedule I, II, III or IV, for a category E felony as provided in NRS

6-10 193.130.

6-11 (b) For a third or subsequent offense, if the controlled substance is listed

6-12 in schedule I, II, III or IV, or if the offender has previously been convicted

6-13 two or more times in the aggregate of any violation of the law of the United

6-14 States or of any state, territory or district relating to a controlled substance,

6-15 for a category D felony as provided in NRS 193.130, and may be further

6-16 punished by a fine of not more than $20,000.

6-17 (c) For the first offense, if the controlled substance is listed in schedule

6-18 V, for a category E felony as provided in NRS 193.130.

6-19 (d) For a second or subsequent offense, if the controlled substance is

6-20 listed in schedule V, for a category D felony as provided in NRS 193.130.

6-21 3. Unless a greater penalty is provided in NRS 212.160, 453.337 or

6-22 453.3385, a person who is convicted of the possession of flunitrazepam or

6-23 gamma-hydroxybutyrate, or any substance for which flunitrazepam or

6-24 gamma-hydroxybutyrate is an immediate precursor, is guilty of a category

6-25 B felony and shall be punished by imprisonment in the state prison for a

6-26 minimum term of not less than 1 year and a maximum term of not more

6-27 than 6 years.

6-28 4. Unless a greater penalty is provided in NRS 212.160, a person who

6-29 is [under] less than 21 years of age and is convicted of the possession of

6-30 less than 1 ounce of marihuana:

6-31 (a) For the first and second offense, is guilty of a category E felony and

6-32 shall be punished as provided in NRS 193.130.

6-33 (b) For a third or subsequent offense, is guilty of a category D felony

6-34 and shall be punished as provided in NRS 193.130, and may be further

6-35 punished by a fine of not more than $20,000.

6-36 5. Before sentencing under the provisions of subsection 4 for a first

6-37 offense, the court shall require the parole and probation officer to submit a

6-38 presentencing report on the person convicted in accordance with the

6-39 provisions of NRS 176A.200. After the report is received but before

6-40 sentence is pronounced the court shall:

6-41 (a) Interview the person convicted and make a determination as to the

6-42 possibility of his rehabilitation; and

7-1 (b) Conduct a hearing at which evidence may be presented as to the

7-2 possibility of rehabilitation and any other relevant information.

7-3 6. As used in this section, "controlled substance" includes

7-4 flunitrazepam, gamma-hydroxybutyrate and each substance for which

7-5 flunitrazepam or gamma-hydroxybutyrate is an immediate precursor.

~