The Weekend SLT Course and the Missing Endorsement
Dr. Lena Ortiz, OD, has held a Montana optometry license since 2016 and practices in Billings. She has no laser surgical endorsement. Last month she completed a six-hour online continuing education course on selective laser trabeculoplasty (SLT) sponsored by a device manufacturer, and her practice purchased a used SLT laser. A 67-year-old established patient with primary open-angle glaucoma has intraocular pressure of 24 mmHg on two topical medications despite documented adherence. The patient has read about SLT and asks Dr. Ortiz to perform it next Tuesday. Dr. Ortiz plans to proceed and to have a local ophthalmologist "available by phone" if anything goes wrong. She also asks whether she can perform YAG capsulotomy on a different patient who had cataract surgery two years ago and now has posterior capsule opacification. The Board's laser endorsement rule is ARM 24.168.801.
1. May Dr. Ortiz legally perform the SLT next Tuesday under Montana law? Identify the controlling authority and explain your conclusion.
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No. The starting point is the statutory definition of optometry in Title 37, chapter 10, MCA, which the Board enforces through ARM 24.168. HB 218 expanded the scope of optometric practice to include specified laser surgical procedures, but only for an optometrist who holds a Board-issued laser surgical endorsement. The endorsement is not automatic with licensure, and a manufacturer-sponsored online course does not itself confer scope. Dr. Ortiz would need to satisfy ARM 24.168.801's education and training requirements, apply, and receive the endorsement before treating this patient. Having an ophthalmologist "available by phone" does not cure the problem because the statute does not authorize an unendorsed optometrist to perform the procedure with telephone backup. Proceeding would be practice beyond the authorized scope and unprofessional conduct exposing her to discipline.
2. What must she complete before she may advertise and perform SLT, and how should she analyze the YAG capsulotomy question?
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She must complete the Board-approved didactic and supervised clinical training specified in ARM 24.168.801, document that training, submit the endorsement application and fee, and receive Board approval. She should also confirm malpractice coverage, establish written protocols for informed consent, pre- and post-laser care, and adverse-event reporting, and maintain procedure-specific records. Advertising before endorsement would be misleading. The YAG capsulotomy is analyzed the same way only if it is one of the laser procedures included in the expanded scope; the endorsement, not the particular laser, is the key. If YAG is within the authorized list, the same endorsement and training requirements apply. A course certificate is not a substitute for the Board credential.
3. Suppose she performs the SLT without endorsement and the patient develops a severe pressure spike and vision loss. What Board exposure and reporting issues arise?
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The Board could treat the conduct as unprofessional conduct and practice beyond scope, independent of the clinical outcome. The adverse event worsens exposure because it shows foreseeable risk, and the Board will examine informed consent, records, follow-up, and whether she held herself out as qualified. Montana adverse-event and malpractice obligations may require disclosure to the patient and insurer, and the Board may require a written report during its investigation. She should not alter records. Possible outcomes include reprimand, suspension, conditions, civil penalty, or revocation, depending on aggravating factors. The absence of an endorsement is the central violation; telephone availability of an ophthalmologist does not create legal authority.