Amended in Senate April 1, 2013

Senate Bill No. 492

Introduced by Senator Hernandez

February 21, 2013

An act to begin delete amend Section 3167 end delete begin insert repeal and add Sections 3041 and 3041.2 end insert of the Business and Professions Code, relating to optometry.

LEGISLATIVE COUNSEL’S DIGEST

SB 492, as amended, Hernandez. begin delete Optometric corporations. end delete begin insert Optometrist: practice: licensure. end insert

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The Optometry Practice Act creates the State Board of Optometry, which licenses optometrists and regulates their practice. Existing law defines the practice of optometry to include, among other things, the prevention and diagnosis of disorders and dysfunctions of the visual system, and the treatment and management of certain disorders and dysfunctions of the visual system, as well as the provision of rehabilitative optometric services, and doing certain things, including, but not limited to, the examination of the human eyes, the determination of the powers or range of human vision, and the prescribing of contact and spectacle lenses. Existing law provides that the State Board of Optometry is required, by regulation, to establish educational and examination requirements for licensure to ensure the competence of optometrists to practice. Any violation of the act is a crime.

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This bill would delete the definition of the practice of optometry and would instead provide that a licensed optometrist would be authorized to perform certain health-related services, including, but not limited to, examining, preventing, diagnosing, and treating any disease, condition, or disorder of the visual system, the human eye, and adjacent and related structures, prescribing appropriate drugs, including narcotics, and administering immunizations. The bill would require the board to require applicants for licensure to successfully complete specified examinations, and would authorize the board to require the passage of additional examinations with regard to competency to utilize diagnostic and therapeutic pharmaceutical agents, if not covered by the required examinations.

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Because this bill would change the definition of a crime, it would create a state-mandated local program.

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The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

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This bill would provide that no reimbursement is required by this act for a specified reason.

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The Optometry Practice Act creates the State Board of Optometry, which licenses optometrists and regulates their practice. The act requires an optometric corporation, as defined, in conducting its practice, to observe and be bound by statutes, rules, and regulations to the same extent as a person holding a license to practice optometry. The act authorizes the board to formulate and enforce rules and regulations to carry out the purposes and objectives of the statutes governing optometric corporations, as specified.

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This bill would make technical, nonsubstantive changes to these provisions.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

end insert

begin insert Section 3041 of the end insert begin insert Business and Professions
Code end insert begin insert is repealed. end insert

begin delete

3041.  

(a) The practice of optometry includes the prevention
and diagnosis of disorders and dysfunctions of the visual system,
and the treatment and management of certain disorders and
dysfunctions of the visual system, as well as the provision of
rehabilitative optometric services, and is the doing of any or all of
the following:

(1) The examination of the human eye or eyes, or its or their
appendages, and the analysis of the human vision system, either
subjectively or objectively.

(2) The determination of the powers or range of human vision
and the accommodative and refractive states of the human eye or
eyes, including the scope of its or their functions and general
condition.

(3) The prescribing or directing the use of, or using, any optical
device in connection with ocular exercises, visual training, vision
training, or orthoptics.

(4) The prescribing of contact and spectacle lenses for, or the
fitting or adaptation of contact and spectacle lenses to, the human
eye, including lenses that may be classified as drugs or devices by
any law of the United States or of this state.

(5) The use of topical pharmaceutical agents for the purpose of
the examination of the human eye or eyes for any disease or
pathological condition.

(b) (1) An optometrist who is certified to use therapeutic
pharmaceutical agents, pursuant to Section 3041.3, may also
diagnose and treat the human eye or eyes, or any of its or their
appendages, for all of the following conditions:

(A) Through medical treatment, infections of the anterior
segment and adnexa, excluding the lacrimal gland, the lacrimal
drainage system, and the sclera in patients under 12 years of age.

(B) Ocular allergies of the anterior segment and adnexa.

(C) Ocular inflammation, nonsurgical in cause except when
comanaged with the treating physician and surgeon, limited to
inflammation resulting from traumatic iritis, peripheral corneal
inflammatory keratitis, episcleritis, and unilateral nonrecurrent
nongranulomatous idiopathic iritis in patients over 18 years of age.
Unilateral nongranulomatous idiopathic iritis recurring within one
year of the initial occurrence shall be referred to an
ophthalmologist. An optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if a patient
has a recurrent case of episcleritis within one year of the initial
occurrence. An optometrist shall consult with an ophthalmologist
or appropriate physician and surgeon if a patient has a recurrent
case of peripheral corneal inflammatory keratitis within one year
of the initial occurrence.

(D) Traumatic or recurrent conjunctival or corneal abrasions
and erosions.

(E) Corneal surface disease and dry eyes.

(F) Ocular pain, nonsurgical in cause except when comanaged
with the treating physician and surgeon, associated with conditions
optometrists are authorized to treat.

(G) Pursuant to subdivision (f), glaucoma in patients over 18
years of age, as described in subdivision (j).

(2) For purposes of this section, “treat” means the use of
therapeutic pharmaceutical agents, as described in subdivision (c),
and the procedures described in subdivision (e).

(c) In diagnosing and treating the conditions listed in subdivision
(b), an optometrist certified to use therapeutic pharmaceutical
agents pursuant to Section 3041.3 may use all of the following
therapeutic pharmaceutical agents:

(1) Pharmaceutical agents as described in paragraph (5) of
subdivision (a), as well as topical miotics.

(2) Topical lubricants.

(3) Antiallergy agents. In using topical steroid medication for
the treatment of ocular allergies, an optometrist shall consult with
an ophthalmologist if the patient’s condition worsens 21 days after
diagnosis.

(4) Topical and oral anti-inflammatories. In using steroid
medication for:

(A) Unilateral nonrecurrent nongranulomatous idiopathic iritis
or episcleritis, an optometrist shall consult with an ophthalmologist
or appropriate physician and surgeon if the patient’s condition
worsens 72 hours after the diagnosis, or if the patient’s condition
has not resolved three weeks after diagnosis. If the patient is still
receiving medication for these conditions six weeks after diagnosis,
the optometrist shall refer the patient to an ophthalmologist or
appropriate physician and surgeon.

(B) Peripheral corneal inflammatory keratitis, excluding
Moorens and Terriens diseases, an optometrist shall consult with
an ophthalmologist or appropriate physician and surgeon if the
patient’s condition worsens 72 hours after diagnosis.

(C) Traumatic iritis, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the
patient’s condition worsens 72 hours after diagnosis and shall refer
the patient to an ophthalmologist or appropriate physician and
surgeon if the patient’s condition has not resolved one week after
diagnosis.

(5) Topical antibiotic agents.

(6) Topical hyperosmotics.

(7) Topical and oral antiglaucoma agents pursuant to the
certification process defined in subdivision (f).

(A) The optometrist shall refer the patient to an ophthalmologist
if requested by the patient or if angle closure glaucoma develops.

(B) If the glaucoma patient also has diabetes, the optometrist
shall consult with the physician treating the patient’s diabetes in
developing the glaucoma treatment plan and shall inform the
physician in writing of any changes in the patient’s glaucoma
medication.

(8) Nonprescription medications used for the rational treatment
of an ocular disorder.

(9) Oral antihistamines.

(10) Prescription oral nonsteroidal anti-inflammatory agents.

(11) Oral antibiotics for medical treatment of ocular disease.

(A) If the patient has been diagnosed with a central corneal ulcer
and the central corneal ulcer has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.

(B) If the patient has been diagnosed with preseptal cellulitis
or dacryocystitis and the condition has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.

(12) Topical and oral antiviral medication for the medical
treatment of the following: herpes simplex viral keratitis, herpes
simplex viral conjunctivitis, and periocular herpes simplex viral
dermatitis; and varicella zoster viral keratitis, varicella zoster viral
conjunctivitis, and periocular varicella zoster viral dermatitis.

(A) If the patient has been diagnosed with herpes simplex
keratitis or varicella zoster viral keratitis and the patient’s condition
has not improved seven days after diagnosis, the optometrist shall
refer the patient to an ophthalmologist. If a patient’s condition has
not resolved three weeks after diagnosis, the optometrist shall refer
the patient to an ophthalmologist.

(B) If the patient has been diagnosed with herpes simplex viral
conjunctivitis, herpes simplex viral dermatitis, varicella zoster
viral conjunctivitis, or varicella zoster viral dermatitis, and if the
patient’s condition worsens seven days after diagnosis, the
optometrist shall consult with an ophthalmologist. If the patient’s
condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.

(13) Oral analgesics that are not controlled substances.

(14) Codeine with compounds and hydrocodone with
compounds as listed in the California Uniform Controlled
Substances Act (Division 10 (commencing with Section 11000)
of the Health and Safety Code) and the United States Uniform
Controlled Substances Act (21 U.S.C. Sec. 801 et seq.). The use
of these agents shall be limited to three days, with a referral to an
ophthalmologist if the pain persists.

(d) In any case where this chapter requires that an optometrist
consult with an ophthalmologist, the optometrist shall maintain a
written record in the patient’s file of the information provided to
the ophthalmologist, the ophthalmologist’s response, and any other
relevant information. Upon the consulting ophthalmologist’s
request and with the patient’s consent, the optometrist shall furnish
a copy of the record to the ophthalmologist.

(e) An optometrist who is certified to use therapeutic
pharmaceutical agents pursuant to Section 3041.3 may also perform
all of the following:

(1) Corneal scraping with cultures.

(2) Debridement of corneal epithelia.

(3) Mechanical epilation.

(4) Venipuncture for testing patients suspected of having
diabetes.

(5) Suture removal, with prior consultation with the treating
physician and surgeon.

(6) Treatment or removal of sebaceous cysts by expression.

(7) Administration of oral fluorescein to patients suspected as
having diabetic retinopathy.

(8) Use of an auto-injector to counter anaphylaxis.

(9) Ordering of smears, cultures, sensitivities, complete blood
count, mycobacterial culture, acid fast stain, urinalysis, tear fluid
analysis, and X-rays necessary for the diagnosis of conditions or
diseases of the eye or adnexa. An optometrist may order other
types of images subject to prior consultation with an
ophthalmologist or appropriate physician and surgeon.

(10) A clinical laboratory test or examination classified as
waived under CLIA and designated as waived in paragraph (9)
necessary for the diagnosis of conditions and diseases of the eye
or adnexa, or if otherwise specifically authorized by this chapter.

(11) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.

(12) The prescription of therapeutic contact lenses, including
lenses or devices that incorporate a medication or therapy the
optometrist is certified to prescribe or provide.

(13) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva with any appropriate instrument other than a scalpel
or needle. Corneal foreign bodies shall be nonperforating, be no
deeper than the midstroma, and require no surgical repair upon
removal.

(14) For patients over 12 years of age, lacrimal irrigation and
dilation, excluding probing of the nasal lacrimal tract. The board
shall certify any optometrist who graduated from an accredited
school of optometry before May 1, 2000, to perform this procedure
after submitting proof of satisfactory completion of 10 procedures
under the supervision of an ophthalmologist as confirmed by the
ophthalmologist. Any optometrist who graduated from an
accredited school of optometry on or after May 1, 2000, shall be
exempt from the certification requirement contained in this
paragraph.

(f) The board shall grant a certificate to an optometrist certified
pursuant to Section 3041.3 for the treatment of glaucoma, as
described in subdivision (j), in patients over 18 years of age after
the optometrist meets the following applicable requirements:

(1) For licensees who graduated from an accredited school of
optometry on or after May 1, 2008, submission of proof of
graduation from that institution.

(2) For licensees who were certified to treat glaucoma under
this section prior to January 1, 2009, submission of proof of
completion of that certification program.

(3) For licensees who have substantially completed the
certification requirements pursuant to this section in effect between
January 1, 2001, and December 31, 2008, submission of proof of
completion of those requirements on or before December 31, 2009.
“Substantially completed” means both of the following:

(A) Satisfactory completion of a didactic course of not less than
24 hours in the diagnosis, pharmacological, and other treatment
and management of glaucoma.

(B) Treatment of 50 glaucoma patients with a collaborating
ophthalmologist for a period of two years for each patient that will
conclude on or before December 31, 2009.

(4) For licensees who completed a didactic course of not less
than 24 hours in the diagnosis, pharmacological, and other
treatment and management of glaucoma, submission of proof of
satisfactory completion of the case management requirements for
certification established by the board pursuant to Section 3041.10.

(5) For licensees who graduated from an accredited school of
optometry on or before May 1, 2008, and not described in
paragraph (2), (3), or (4), submission of proof of satisfactory
completion of the requirements for certification established by the
board pursuant to Section 3041.10.

(g) Other than for prescription ophthalmic devices described in
subdivision (b) of Section 2541, any dispensing of a therapeutic
pharmaceutical agent by an optometrist shall be without charge.

(h) The practice of optometry does not include performing
surgery. “Surgery” means any procedure in which human tissue
is cut, altered, or otherwise infiltrated by mechanical or laser
means. “Surgery” does not include those procedures specified in
subdivision (e). Nothing in this section shall limit an optometrist’s
authority to utilize diagnostic laser and ultrasound technology
within his or her scope of practice.

(i) An optometrist licensed under this chapter is subject to the
provisions of Section 2290.5 for purposes of practicing telehealth.

(j) For purposes of this chapter, “glaucoma” means either of the
following:

(1) All primary open-angle glaucoma.

(2) Exfoliation and pigmentary glaucoma.

(k) For purposes of this chapter, “adnexa” means ocular adnexa.

(l) In an emergency, an optometrist shall stabilize, if possible,
and immediately refer any patient who has an acute attack of angle
closure to an ophthalmologist.

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begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 3041 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3041. end insert   

(a) An optometrist license authorizes the holder to do
all of the following:

(1) Examine, prevent, diagnose, and treat any disease, condition,
or disorder of the visual system, the human eye, and adjacent and
related structures.

(2) The use or prescription of appropriate drugs, including
narcotic substances other than those listed in Schedule 1.

(3) The performance of surgical and nonsurgical primary care
procedures requiring no more than topical or local anesthetic, or
both.

(4) The use or prescription of visual therapy, ocular exercises
or vision habilitation, and rehabilitation services.

(5) The performance or ordering of appropriate laboratory and
diagnostic imaging tests.

(b) An optometrist may administer immunizations.

(c) In addition to diagnosing and treating conditions of the
visual system pursuant to subdivision (a), an optometrist may
diagnose other conditions that have ocular manifestations, initiate
treatment, and, in consultation with a physician, manage
medications for these conditions.

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begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 3041.2 of the end insert begin insert Business and Professions Code end insert
begin insert is repealed. end insert

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3041.2.  

(a) The State Board of Optometry shall by regulation,
establish educational and examination requirements for licensure
to insure the competence of optometrists to practice pursuant to
subdivision (a) of Section 3041. Satisfactory completion of the
educational and examination requirements shall be a condition for
the issuance of an original certificate of registration under this
chapter, on and after January 1, 1980. Only those optometrists who
have successfully completed educational and examination
requirements as determined by the State Board of Optometry shall
be permitted the use of pharmaceutical agents specified by
subdivision (a) of Section 3041.

(b) Nothing in this section shall authorize an optometrist issued
an original certificate under this chapter before January 1, 1996,
to use or prescribe therapeutic pharmaceutical agents specified in
subdivision (d) of Section 3041 without otherwise meeting the
requirements of Section 3041.3.

end delete

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begin insert SEC. 4. end insert   

end insert

begin insert Section 3041.2 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.2. end insert   

(a) The State Board of Optometry shall establish, by
regulation, educational and examination requirements for licensure
to ensure the competence of optometrists to practice.

(b) On and after January 1, 2014, the board shall require each
applicant for licensure to successfully complete the Part I, Part
II, and Part III examinations of the National Board of Examiners
in Optometry.

(c) On and after January 1, 2014, the board shall require each
applicant for licensure to successfully complete an examination
in California law and ethics developed and administered by the
board.

(d) On and after January 1, 2014, the board may require
passage of additional examinations to ensure the competency of
licentiates to utilize diagnostic and therapeutic pharmaceutical
agents, if not otherwise covered by the examinations required
pursuant to subdivisions (a) and (b).

end insert

begin insert

begin insert SEC. 5. end insert   

end insert begin insert

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

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SECTION 1.  

Section 3167 of the Business and Professions
Code is amended to read:

3167.  

The board may formulate and enforce rules and
regulations to carry out the purposes and objectives of this article,
including rules and regulations requiring both of the following:

(a) The articles of incorporation or bylaws of an optometric
corporation shall provide for the sale of any capital stock of the
corporation owned by a disqualified person, as defined in the
Moscone-Knox Professional Corporation Act, or a deceased person
to the corporation or to the remaining shareholders of the
corporation within the time as the rules and regulations may
provide.

(b) An optometric corporation, as a condition of obtaining a
certificate pursuant to the Moscone-Knox Professional Corporation
Act and this article, shall provide adequate security by insurance
or otherwise for any claim against it by a patient arising out of the
rendering of professional services.

end delete