North Carolina has recently augmented its legislation – the second-oldest TPA law in the nation

Issue: August 1997

North Carolina granted optometrists therapeutic pharmaceutical agent (TPA) legislation in 1977, making it the second state in the United States to pass such a law. West Virginia passed its optometric TPA law in 1976.

Ever since the original law, North Carolina optometrists have had some of the broadest prescribing privileges in the country. "Ours has been a broad law all along," said John D. Robinson, OD, executive director of the North Carolina Board of Optometry. "Our prescribing laws now include any drug, either topical or systemic, for conditions of the eye or its adnexa. We have full Drug Enforcement Administration registration for Schedules II through V."

The state's optometrists have not had any trouble getting DEA numbers, said Sue Gardner, director of the North Carolina State Optometric Society. "When new members or new ODs come into the state, I refer them to the state board, and the board gives them the route to go to get a DEA number. I don't know of any trouble with obtaining DEA numbers."

Dr. Robinson said there are 962 optometrists licensed in the state, and more than 95% are TPA certified. Since 1977, no optometrist has been licensed other than as "certified."

Existing law strengthened

The state's optometrists strengthened their already thorough law with an amplification passed May 22. The amplification requires North Carolina hospitals to consider applications for hospital privileges by optometrists on a "nondiscriminatory basis." It allows optometrists in the state to prescribe all pharmaceuticals used to treat the eye or its adnexa without consulting a physician, changing a clause in the original legislation.

Despite strong opposition from the state Medical Society, the bill passed by a final vote of 91-22 in the House and 44-4 in the Senate.

ODs on equal footing

With the new law, hospitals are required to consider ODs on the same footing as other providers when they apply for hospital privileges, although the law does not force hospitals to grant ODs privileges. This amplification makes North Carolina only the second state to have specific language authorizing hospital privileges for optometrists.

Relationships in the state between MDs and ODs "overall are excellent," said Dr. Robinson.

"Most ophthalmologists have very good relations with some optometrists. There's a lot of competition here in the managed care market, so that's created a lot of alliances," he said.

North Carolina, like many states, is gearing up to become a major managed care area, said Dr. Robinson. This has changed the profession a bit.

"It is my opinion that two optometrists are evolving," he said. "One is driven by the optical side and the sale of optical goods," and the other is driven by patient care, "which includes diagnosing, treatment and long-term management of diseases of the eye."

Why encourage prescribing?

The state board or association does not actively encourage the state's ODs to prescribe for the sake of prescribing, Dr. Robinson said. "Why would you?" he said. "We expect them to use therapeutics appropriately and in the interest of good patient care. We're not out there saying: prescribe, prescribe, prescribe. You might well drive people toward unnecessary prescribing that way."

Dr. Robinson said prescribing patterns vary among optometrists in the state. "We have many who provide the full scope as far as glaucoma treatment," he said, "and we have some who prescribe little or none at all."

To become licensed and certified in North Carolina, optometrists must take the National Board Examinations. They must also take a state clinical exam. They maintain their certification with 20 hours of continuing education a year.

For Your Information:

John D. Robinson, OD, can be reached at 109 Graham St., Wallace, NC 28466; (910) 285-3160; fax: (910) 285-4546.

The North Carolina State Optometric Society an be reached at P.O. Box 1206, Wilson NC 27894-1206; (919) 237-9191; fax: (919) 237-9233.