Published March 27, 2014
Compliments of Unicameral Update
LB526, introduced by Omaha Sen. Sara Howard, would expand the scope of practice for licensed optometrists in Nebraska by authorizing those who have completed the required training and demonstrated the necessary skills to:
• inject pharmaceutical agents into the eyelid for certain therapeutic purposes;
• perform minor surgical procedures on the eyelid and ocular adnexa; and
• prescribe oral steroids, oral antiglaucoma medication and immunosuppressives.
Howard said the bill would allow optometrists to inject patients for treatment of anaphylaxis, remove several narrow restrictions on prescription authority and allow them to lance benign cysts. Patients often attempt to lance such cysts at home, she said, which carries a greater risk of infection.
Many rural counties in Nebraska are not served by an ophthalmologist, Howard said, and allowing optometrists to perform a limited number of additional procedures would benefit under-served areas of the state.
“LB526 is primarily a bill about enhanced access to eye care services,” she said.
A Health and Human Services Committee amendment, adopted 25-7, clarified that qualified optometrists would be limited to the treatment of chalazions, hordeolums, sweat gland cysts or oil gland cysts of the eyelids.
The amendment also would add four hours of tested education from an accredited school of optometry to the requirements for certification in the use of pharmaceutical agents authorized under the bill.
An optometrist licensed in Nebraska would be allowed to administer injections authorized by the bill if he or she provides:
• evidence of certification in another state that is deemed satisfactory by the state board;
• evidence of passing the injection skills examination of the national licensing board for optometrists for a licensee graduating from a school of optometry after Dec. 31, 2012; or
• evidence of completion of a minimum of eight hours of transcript-quality education from an accredited school of optometry for a licensee who graduated on or before Dec. 31, 2012.
An optometrist licensed in Nebraska would be allowed to perform minor surgical procedures authorized by the bill if he or she provides:
• evidence of certification in another state that is deemed satisfactory by the board;
• evidence of competency from an accredited school of optometry that is deemed satisfactory by the board, or proof of compliance by the end of the first licensure renewal period, for a licensee graduating after Dec. 31, 2012; or
• evidence of completion of a minimum of 16 hours of transcript-quality education from an accredited school of optometry for a licensee who graduated on or before Dec. 31, 2012.
Finally, the amendment states that a licensed optometrist who performs minor surgical procedures or administers injections would be required to provide a standard of care to patients comparable to that provided by a physician licensed in Nebraska to practice medicine and surgery.
O’Neill Sen. Tyson Larson supported the bill, saying residents of his district face a wait of up to a month to see an ophthalmologist. Expanding the scope of practice for optometrists would improve access to eye care, he said, adding that optometrists would continue to refer patients to an ophthalmologist when necessary.
“LB526 gives optometrists the ability to perform simple procedures that are not controversial, not complex, and if they feel uncomfortable, they won’t do it,” Larson said.
Grand Island Sen. Mike Gloor opposed the bill, saying the state’s process for evaluating proposed scope of practice changes yielded a mixed report. While the state board of health recommended the change, he said, a technical review board and the state’s chief medical officer did not.
Senators are not clinicians, Gloor said, and should either trust the review process or change it. Otherwise, he said, health care providers of all types would be encouraged to bypass the scope of practice review process and come directly to the Legislature with their requests.
“Let’s not fall into that trap,” he said.
The bill advanced to select file on a 27-10 vote.