Review of Optometric Laws and Regulations for the State of Oregon

The Oregon Board of Optometry has promulgated an administrative rule that requires all optometric physicians to have 1 hour of continuing optometric education in ethics or Oregon law and administrative rules for license renewal beginning in 2005.

The Board made this decision for the following reasons: (1.) Our society has seen what occurs when those in positions of leadership whether in business, political life or healthcare fail to act ethically. There is now a demand that there be assurances and institutional safeguards to ensure that leaders act responsibly. (2.) Licensing boards, professions and professional associations have all begun to renew the allegiance to ethical standards for their members. Particularly in healthcare - where doctors make decisions that can intimately impact patients' lives - it is vital that they have a framework on which to base those decisions. Society holds optometric physicians and other medical professionals to high standards of conduct; ethical decision making plays a large role in helping physicians to meet those standards. (3.) The increased scope of practice for optometric physicians puts them in situations that would not have been contemplated even a few years ago. This is part of the ongoing knowledge and increased sophistication with which optometric physicians need to practice. The use of oral medications now make it imperative that optometric physicians are even more aware of the laws and requirements that come with increased responsibility.

The increasing choices and implications in healthcare decision making are becoming more complicated and nuanced. Knowledge of Oregon law and administrative rules and ethical guidelines help optometric physicians make the critical decisions that keep their patients - the citizens of Oregon - safe and well served.

The Oregon Board of Optometry requires a course that reviews the Oregon laws as it relates to Optometry or an ethics course every other year when a licensee applies for renewal. Successful completion of this course will satisfy the review of Oregon law requirement. The course is an adaptation of the wording from Oregon law. It is not meant to replace the actual wording in the law. If one needs to reference the actual language, the source of the information is given in parentheses. One might say this is the Good News interpretation of Greek and Hebrew scriptures.

The material in the course has been reviewed and approved by the Oregon Board during April 2006, but laws and regulations are subject to change. If an optometrist practicing in Oregon has a question of significant consequence regarding laws and regulations, it is recommended that the Oregon Board of Optometry Web site (http://www.obo.state.or.us/) be consulted for the most recent versions of the laws and regulations.

A recent change to the Administrative Rules was made by the Oregon Board of Optometry. “On April 1, 2006, all optometrists who have been certified to use, administers and prescribe from the nontopical formulary and have received the “AT” designation following their license number will be issued new licenses with the designation “ATI” following the license number. Effective with year 2009, license renewal, beginning January 1, 2009, all active status licensees practicing optometry in Oregon shall have obtained certification to use “topical and nontopical therapeutic pharmaceutical agents” as a condition of license renewal (AT license).” (OBO Update, April 2006, Vol 7, No 1)

The goal of this course is to offer a pragmatic approach to the law and the responsibilities we all share and the requirements to comply with Oregon laws, statutes and administrative rules. This course will limit itself to these specific laws. There are other statutes that govern treatment of optometrists in other venues, but not treatment by optometrists. An example is the insurance statutes that define non-discrimination against professions that have overlap in treatment privileges.

The Laws governing optometry are contained in Chapter 683 of the Oregon Revised Statutes (ORS) and Chapter 852 of the Oregon Administrative Rules (OAR). The Oregon Board of Optometry’s web site has URL connections to these sections. See http://www.oregonobo.org

The “Practice of Optometry” (ORS 683.010, OAR 852-020-0050) As with any beginning, there must be a definition. Quoting from ORS 683.010, the "“Practice of Optometry” means the employment of any means other than invasive or laser surgery, or the prescription of Schedule I and II drugs or pharmaceutical agents that are not on the optometric nontopical formulary, for diagnosis and treatment in the human eye, for the measurement or assistance of the powers or range of human vision or the determination of the accommodative and refractive states of the human eye or the scope of its functions in general or the adaptation of lenses or frames for the aid thereof, subject to the limitations of ORS 683.040”. 683.040 gives the qualifications of applicants who wish to practice optometry in Oregon.

The Scope of Practice includes procedures that are performed to diagnose or treat the eye. Notable exclusions include:

• Invasive surgery
• Laser surgery
• Sub-Tenon injections
• Retrobulbar injections
• Intraocular injections
• Botulinum toxin injections
• Administer IV or general anesthesia

The Oregon Board of Optometry has prepared questions an optometric physician may ask prior to performing a procedure. If the answers to ALL the questions are “Yes”, the procedure is within the scope of optometric practice.

1. Does the procedure involve the eye or the scope of functions of the eye?
2. Will this procedure be done without invasive surgery?
3. Will it be done without laser surgery?
4. Will it be done without closure by suture?
5. Will it be done without requiring pharmaceuticals other than those categorized in Division 80?
6. Will it be done without requiring sub-Tenon, retrobulbar, intraocular or botulinum toxin injection?
7. Will it be done without requiring conscious sedation, deep sedation, or general anesthesia?

The optometric physician carries the sole responsibility for the patient’s care. If direct supervision is necessary, it requires the optometrist to monitor the activities of the supervised individuals and has an appropriate intervention protocol in place.

Procedures that cannot be delegated include:

1. Ophthalmoscopy
2. Gonioscopy
3. Final central nervous system assessment
4. Final biomicroscopy
5. Final refraction
6. Final determination of any prescription or treatment plans
7. Therapeutic procedures that involve the use of pharmaceutical agents, other than to instill medication as directed by optometrist

Tonometry can be delegated to well-trained and directly supervised personnel. An Oregon licensed optometric physician must personally perform tonometry on glaucoma patients.

There is a portion of the ORS that prohibits discrimination against a practicing optometrist by state agencies. There is also a protection against fee adjustments by said agencies when paying different professions for the same service.

The OBO has the responsibility to maintain a list of the location(s) optometrists are practicing. It is the responsibility of each optometric physician to notify the OBO, in writing, where he or she is practicing prior to seeing patients at each location.

It is required to notify the OBO of one’s Official Address of Record. This address may be one’s home or a place of practice and must be a street address. It is important to have a single address to which the OBO can send notifications, mailings, updates and renewals. The OBO will not send notifications to each address an optometrist is practicing when there are multiple sites of practice. Each location must have a current license conspicuously posted.

Fines can be levied for not notifying the OBO one’s change in practice locations or change of official address of record.

Optometric physicians who have an inactive license are exempt from reporting each place of business.

Optometric physicians are responsible for keeping complete and accurate records for each patient. The records are to be sufficiently detailed and legible so that an appropriate provider could continue care without detriment to the patient.

Records are to be kept for a minimum of 7 years from the last pertinent clinical notation. If the patient is a minor, the records shall be kept until the patient is 21 years of age or 7 years, whichever is longer.

Records are to be retained by a doctor of optometry for the required amount of time or until care of the records can be transferred to a doctor of optometry licensed and practicing in the state of Oregon.

The OBO must be notified if records are transferred to the care of another doctor of optometry, or the location of the records is changed. The location may change in the event of a practice closure or moving to a new site. The notification must take place prior to the effective date of change.

Copies of records or summaries must be sent to a patient who makes a written request, within 30 days of the request. The records do not include personal office notes or personal notes between referring or consulting physicians.

A reasonable fee can be charged to the patient for copying records. ORS 192.521 gives legal rules for charging patients.

A health care provider or state health plan that receives an authorization to disclose protected health information may charge:

1. No more than $25 for copying 10 or fewer pages of written material and no more than 25 cents per page for each additional page.
2. Postage costs to mail copies of protected health information or an explanation or summary of protected health information, if requested by an individual or a personal representative of the individual.
3. Actual costs of preparing an explanation or summary of protected health information, if requested by an individual or a personal representative of the individual. [2003 c.86 §4].

No fees will be assessed any licensed doctor of optometry for providing services to a charitable nonprofit corporation on a voluntary basis.

Provisos:

1. Services must be given without payment for services.
2. The organization must qualify as non-profit via 501(c) (3) of the IRS code.
3. An optometric director must be named by the organization, who will then be responsible for the patient records.
4. The license for working with a non-profit organization cannot be used at any other location.

The doctor is responsible for any advertisement regarding services at each facility. If there is an employment relationship between doctors, the employer is responsible for the advertising.

If price is advertised, the licensee must include:

1. The type of lenses being offered.
2. Does the price include frames and /or lenses?
3. Whether the price includes an eye examination
4. Whether the price includes all dispensing fees
5. Contact lens pricing will specify the type of lenses, limits of care and any additional materials provided.

Licensees are not allowed to enter into contracts, agreements or understandings, expressly or implied, that provides a channel of referral with understandings there are avenues of paid remuneration. This remuneration can be specific or through promises of sending the patient back for services or hardware that could otherwise be provided by the consulting doctor.

The rule does not apply to the rules of a pre-paid insurance plan. The insurance plan must be actuarially based, be lawfully organized according to state law and allows all licensed Doctors of Optometry to be a member of the panel. As a member, the licensee becomes subject to the conditions of the provider agreement.

The schedule of fees for licensure, renewals and examinations are listed in this section of the administrative rules.

Those of us who practice in Oregon are very aware of the renewal process and fees that are required on an annual basis. The license is to be displayed conspicuously in each place the optometric physician practices. There are consequences for not renewing in the timelines established by the OBO.

There are specific infractions by an optometric physician that can result in the revocation of a license, imposing probation, limiting the practice of any optometrist or impose a civil penalty not to exceed $10,000 for each offense. The first two offenses may not be set aside by appeal. The other offenses have allowances for some leniency after six months have passed from the date of sanction.

1. Conviction of a felony or misdemeanor where such offense bears a demonstrable relationship to the duties of an optometric physician.
2. Securing a license by means of deceit or fraud.
3. Unprofessional conduct, or for gross ignorance or inefficiency in the profession.
4. Obtaining any fee by fraud.
5. Employing directly or indirectly any suspended or unlicensed optometrist to perform work as defined by these statutes.
6. Advertising services that are misleading.
7. Habitual or excessive use of intoxicants, drugs or controlled substances.
8. Permitting another person to use the license.
9. Using advertisements that do not indicate that a licensed optometrist is practicing at the advertised location or locations or advertising optometric services without having a licensed optometrist at the location or locations.
10. Advertising professional methods or professional superiority.
11. Failing to comply with the requirements for continuing education.
12. Violating the federal Controlled Substances Act.
13. Prescribing controlled substances without a legitimate optometric purpose, or without following accepted procedures for examination of patients or for record keeping.
14. Failing to report to the board any adverse action taken against the optometrist or person by another licensing jurisdiction, health regulatory board, peer review body, health care institution, professional optometric society or association, governmental agency, law enforcement agency or court for acts similar to conduct that would constitute grounds for disciplinary action as described in this section.
15. Having been disciplined by any health regulatory board of another state based on acts similar to acts described in this section. A certified copy of the record of disciplinary action of the health regulatory board taking the disciplinary action is considered conclusive evidence of the action.
16. Any violation of the provisions of ORS 683.010 to 683.335.

The administrative rules noted above contain more definitions of unprofessional conduct and gross ignorance and inefficiency.

If a consumer presents an old pair of lenses and wishes to have them duplicated, the only person who can duplicate the lens is a licensed optometric physician and optician (Opticians may not duplicate contact lenses). This does not prohibit the fabrication of a lens from the prescription of an optometrist by an optician.

Following an examination, an optometric physician is to give a prescription to a patient. This includes an eyeglass prescription if one is recommended or a contact lens prescription following a fitting process. Specifically, ““Prescription” means the signed written prescription which a doctor of optometry shall immediately release to the patient at the time he/she would provide spectacles or contact lenses without additional examination.”

A licensee may not charge additional fees for releasing a prescription, other than reasonable charges for long distance calls or fax, or unusual shipping or mailing costs. As a condition of release, the optometric physician may not:

1. Require purchase of contact lenses, glasses or other materials.
2. Require the patient to sign a waiver or release as a condition of releasing or verifying a prescription.

The requirements of a glasses or contact lens prescription are specific. Both types of prescriptions are to include:

1. Patient’s name
2. Exam date
3. Issuance date (when prescription was released)
4. Doctor’s name, postal address, telephone number and fax number
5. Sphere, cylinder, axis and/or add
6. A reasonable and clinically – prudent expiration date
7. Any special features that may include type of bifocal, prism, tints, etc.

Special to contact lens prescriptions, additional information and restrictions include:

1. Lens base curve or series
2. Lens diameter
3. Lens material and/or brand name
4. The maximum number of refills
5. Any limitations, including wearing schedule and follow-up care
6. Written in such a way that allows the patient to fill the prescription by an office or outlet of their choice
7. A seller may not alter a contact lens prescription. However, if a type of lens is sold with a private label, and it is available under several labels, the seller may fill the prescription with lenses that are made by the same manufacturer under a different label.

An optometric physician may prescribe controlled substances in Schedules III, IV, and V. The use, prescription or administration of any of these controlled substances is limited to a person the optometric physician has a physician / patient relationship.

The optometric physician is not allowed to use, administer or prescribe controlled substances to oneself. Nor can they be prescribed to the doctor’s immediate family members, except in the case of an emergency. Immediate family members include the doctor’s spouse, children, siblings, parents or others who may not receive a non-emotional judgment from the optometric physician.

In no case may an optometric physician prescribe controlled substances for conditions outside the scope of practice of optometry.

Optometric Physicians are required to continue their education after receiving a license in Oregon. The purpose is to assure the public that optometric physicians are advancing their skills and knowledge of new techniques, clinical and scientific advances and research. The OBO can waive these requirements in the event of illness, undue hardship or other appropriate reasons.

Eighteen (18) hours of approved continuing education are required annually. One may roll excess hours to the next year.

1. Nine (9) hours must be in the area of diagnosis, treatment and management of eye disease.
2. One (1) hour in the area of ethics or Oregon law is required every other licensed year.
3. Five (5) hours of live observation in a surgical facility can count towards the requirement. Five hours is an annual limit.
4. Up to nine (9) hours can be achieved by coursework in Internet, journal or video courses.
5. If identical courses are taken, the OBO may disallow duplication. Courses should be essentially different from each other.