Untitled Texas Attorney General Opinion

Office of ttp JZUmep Qknerat &ate of QCexae DAN MORALES .ATT”RSEI GENERAL September 23, 1996 Bruce A. Levy, M.D., J.D. Opinion No. DM-4 16 Executive Director Texas State Board of Medical Examiners Re: Whether the Texas Optometry Board P.O. Box 149134 may adopt a rule authorixing a therapeutic Austin, Texas 78714-9134 optometrist to administer cocaine eye drops for diagnostic purposes (RQ-877) Dear Dr. Levy: A therapeutic optometrist may, under V.T.C.S. article 4552-1.03(b), administer a topical ocular pharmaceutical agent, other than an antiviral or antiglaucoma agent, “for the purpose of diagnosing and treating visual defects, abnormal conditions, and diseases of the human eye and adnexa.” The Texas Optometry Board (the “board”) must, by rule, specify the topical ocular pharmaceutical agents a therapeutic optometrist may use. You ask whether the board may adopt a rule authorixing a therapeutic optometrist to administer cocaine eye drops for diagnostic purposest Because V.T.C.S. article 4552-1.03(b) explicitly authorizes a therapeutic optome- trist to administer a topical ocular pharmaceutical agent for certain diagnostic purposes, we believe the board may promulgate a rule permitting a therapeutic optometrist to admin- ister cocaine eye drops for those diagnostic purposes. Cocaine eye drops may not, however, be an antiviral or antiglaucoma agent; furthermore, they may be used only for the purpose of diagnosing problems of the human eye and adnexa. To the extent the pro- posed rule authorizes a therapeutic optometrist to use cocaine eye drops to diagnose problems other than those of the human eye and adnexa, it is htvalid. We begin by briefly discussing pertinent portions of the Texas Optometry Act,2 which provides for the practice of optometry and therapeutic optometry. Lie an optome- trist, a therapeutic optometrist may use “objective or subjective means” to aScertain and measure “the powers of vision of the human eye,“3 examine and diagnose “visual defects, LBcolusethcpm~ruledocsnot~crtothcuscofcocainc eycdmpsforuwmcntpqoscs, we do not considerwhaler the boardmay adopt a mlc authorizinga thaapcutic optonutri.9to use co- caine drop3for treaunentpurposes. ‘V.T.C.S. al.%4552-1.02 - 7.02. 3&e id an. 4552-1.02(2) (ddining “dning and measuringthe powersof vision of the hu- man eye”). Bruce A. Levy, M.D., J.D. - Page 2 (DM-416) abnormal wnditions, and diseases of the human eye and adnexa,” and prescribe or fit cor- rective lenses to remedy vision defects.4 By contrast, only a therapeutic optometrist may adminkr or prescribe a drug, ifthe therapeutic optometrist does so in compliance with the acts Specifically, a therapeutic optometrist may administer a topical ocular pharma- ceutical agent.6 among other things, aside from an antiviral or antiglaucoma agent, to diagnose and treat “vimal defects, abnormal conditions, and diseases of the human eye and hexa.- The “adnexa” are the lids and drainage system of the eye.* Under article 4552, the board must specify by rule the pharmaceutical agents a thempa& optometrist may use in his or her praotice9 In accordance with this directive, the board claims, it has amended title 22 of the Texas Administrative Code, section 280.5 to include among the list of permksible phammceutical agents “cocaine eye drops for di- agnostic purposes.“tc You contend that the proposed amendment impermissibly expands the scope of practice of therapeutic optometry. As we understand your argument, cocaine eye drops may be used only in the diagnosis of Homer’s syndrome.tl A letter you en- closed with your request describes Homer’s syndrome as “an extremely serious systemic disease[] aibting neurologic pathways. “12 Homer’s syndrome is not, according to the letter, a disease of the eye or adnexa.t3’ 'Id. ut.4552~1.03@);sae DM-152(1992)u 1;rc also V.T.C.S.art Anomcy Gamal Opinion 4552-1.02(3)(ddiaiq “ftniag latxs or prtsms”). ‘V.T.C.S.art 4552-1.020; arc koraay Genasl DpintoaDM-152(1992)at I-2. eAtcpkateadarphannam&catageattsadtuga@tedtetkeyetoatdiaexanGagL Atter- n9y Gemal opiion Jh4-454(1986)at 1. ‘V.T.C.S.art. 4552-1.03(b). at.4552-1.02(S). 'Id. 91d. 4552-1.03(d). art. “‘See21 Ta Reg. 1093.94(1996)(ccdttiedat 22 T.A.C.g 280.5)(Tex Opomeay Ed.). ~~SarLcElcrfromSamV.~Jr.,~TorTerprOp~ApDdltio4~ LoioEwald,Bxecatk Direaer, Texasopomtry Bcatd (NW.17.1995). Bruce A Levy, M.D., J.D. - Page 3 (DM-416) Whether Homer’s syndrome is a disease of the eye or adnexa is a question of fact that we cannot resolve in the opinion process.t* Jf it is not such a disease, and if cocaine eye drops’ sole use as a diagnostic tool is to detect Homer’s syndrome, then a thempeutic optometrist may not administer the eye drops. Moreover, because an administrative agency inay not adopt a rule that is inconsistent with statute.ts the board may not adopt a rule permitting a therapeutic optometrist to use cocaine eye drops. On the other hand, if Homer’s syndrome is a disease of the eye or adnexa, or if cocaine eye drops may be used to diagnose conditions, other than Homer’s syndrome, of the eye or adnexa, the board’s proposed amendment to title 22 of the Texas Administrative Code, section 280.5 is proper.16 The board is authorized to determine these fkct-based questions, subject to ju- dicial review. We are unaware of any statute mandating a contrary result. The pomession and administration of cocaine by health-care professionals is controlled by the Texas Con- trolled Substances Act.” Under that act, only a practitioner, as the act detines that term, may administer a controlled substance, and only in spechkd circumstances.t* While the Controlled Substances Act does not define “practitioner” expressly to include a therapeu- tic optometrist, the definition encompasses any person who is permitted to administer a controkd substance in the course of professional practice. In our opinion, V.T.C.S. arti- cle 4552-I .03(b) permits a therapeutic optometrist to administer a controlled substance in the course of professional practice ifthe drug is not an antkiml or antiglaucoma agent and ifthe purpose of the drug is to diagnose problems of the human eye and adnexa. We now wig answer your questions explicitly. You 6rst ask whether the Optome- try Act authorizes an optometrist to use cocaine, and if so. to what extent. The statute does not authorize an optometrist, as distinguished from a therapeutic optometrist, to use any drugs. A therapeutic optometrist may. however, use certain topical ocular pharma- ceutical agents, and the topical ocular pharmaceutical agents may include cocaine eye drops. Cocaine eye drops may not be an antiviral or antiglaucoma agent, and they must be administered for the purpose of diagnosing visual defects, abnormal conditions, and dis- “See, e.g.. Atmmey Ckrerol Opiniom DM-98 (1992) a~ 3, H-56 (1973) at 3, M-187 (1968) a 3, O-2911 (194O)at2. “SeeState 376S.W.2d 341.344-45(Tcx. 1964). Y.Jackson, ‘%caIth&SafetyCn&ch481. TkTcxas czonmlM-MllIIIcomincaIa~- ok ll anrk Id. $481.033(l)@). BNIX A Levy, M.D., J.D. - Page 4 (DM-416) eases of the human eye or adnexa. Furthermore, a therapeutic optometrist may not admin- is&r cocaine eye drops unless the board has adopted a rule authorizing a tkrapeutic optometrist to use them. Second, you ask whe%he-rthe board may promulgate a valid rule allowing optome- trists to possess and administer cccaine for diagnostic purposes. Again, an optometrist may not administer any drugs, and the board may not promulgate a rule au&king an optometrist to do so. On the other hand, the board may promulgate a rule authorizing a tbempeutic optometrioi to possess and adminkter a topical ocular pharmaceutics agent if the pbaxm~~tical agent is not an antiviral or antiglaucoma agent and ifthe phsrmaceuti- ad agent is used for the purpose of diagnosing visual defkcts, abnormal conditions, and dkases of the human eye and adnexa. The board must, of course, comply with V.T.C.S. article 4552-2.14 and other applicable statutes in adopting its nde.19 SUMMARY The Texas Optometry Board may adopt a rule Permitting a the-rape&c optometrist to administer cocaine eye drops for diagmm- tic purposes, but only if the eye drops are not an antiviral or antiglauwma agent and ifthe purpose of the eye drops is to diagnose visual defects, abnormal conditions, and dkeases of the human eye and adnexa. DAN MORALES Attorney General of Texas JORGE VEGA Fii As&ant Attorney General SARAH J. SHIRLEY Chair, Opiion Committee Prepred by Kymberly K. Oltrogge Ass&ant Attorney General ‘9.%e Go-f1Codech 551 (OpenMecliogs id.ch.2001, ntbch B (MminismtivcF’mcc- Act); durIAd).