BILL NUMBER: SB 492	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 1, 2013

INTRODUCED BY   Senator Hernandez

                        FEBRUARY 21, 2013

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



	LEGISLATIVE COUNSEL'S DIGEST


   SB 492, as amended, Hernandez.  Optometric corporations.
  Optometrist: practice: licensure.  
   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.  
   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.  
   Because this bill would change the definition of a crime, it would
create a state-mandated local program.  
   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.  
   This bill would provide that no reimbursement is required by this
act for a specified reason.  
   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. 

   This bill would make technical, nonsubstantive changes to these
provisions. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program:  no
  yes  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 3041 of the   Business
and Professions Code  is repealed.  
   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. 
   SEC. 2.    Section 3041 is added to the  
Business and Professions Code   , to read:  
   3041.  (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.
   SEC. 3.    Section 3041.2 of the   Business
and Professions Code   is repealed.  
   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. 
   SEC.   4.    Section 3041.2 is added to the
  Business and Professions Code   , to read: 

   3041.2.  (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). 
   SEC. 5.    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.  
  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.