BILL NUMBER: SB 492 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 24, 2013
AMENDED IN SENATE APRIL 16, 2013
AMENDED IN SENATE APRIL 1, 2013
INTRODUCED BY Senator Hernandez
FEBRUARY 21, 2013
An act to repeal and add Sections 3041 and 3041.2
amend Sections 3041 and 3041.1 of the Business
and Professions Code, relating to optometry.
LEGISLATIVE COUNSEL'S DIGEST
SB 492, as amended, Hernandez. 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.
Existing law authorizes an optometrist certified to
use therapeutic pharmaceutical agents to diagnose and treat specified
conditions, use specified pharmaceutical agents, and order specified
diagnostic tests. 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 of the visual system, prescribing
appropriate drugs, including narcotics, and administering
immunizations and to diagnose other common primary care conditions
that have ocular manifestations. The bill would also authorize an
optometrist, who is operating under a protocol with a physician and
surgeon or a health care facility, or participating in a specified
system of care in which the patient is being otherwise treated, to
initiate treatment and manage medications for those diagnosed
conditions. 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.
This bill would add the provision of habilitative optometric
services to the definition of the practice of optometry. The bill
would expand the practice parameters of optometrists who are
certified to use therapeutic pharmaceutical agents by removing
certain limitations on their practice and adding certain
responsibilities, including, but not limited to, the ability to
immunize and treat certain diseases, and deleting the specified drugs
the optometrist would be authorized to use, and authorizing the
optometrist to use all therapeutic pharmaceutical agents approved by
the United States Food and Drug Administration, as provided. The bill
would also delete limitations on what kinds of diagnostic tests an
optometrist could order and instead would authorize an optometrist to
order appropriate laboratory and diagnostic imaging tests.
Existing law requires optometrists in diagnosing or treating eye
disease to be held to the same standard of care as physicians and
surgeons and osteopathic physicians and surgeons.
This bill would expand this requirement to include other diseases,
and would require an optometrist to consult with and, if necessary,
refer to a physician and surgeon or other appropriate health care
provider if a situation or condition was beyond the optometrist's
education and training.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Sec tion 3041 of the
Business and Professions Code is amended to read:
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 habilitative or
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.
adnexa.
(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. inflammation.
(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. pain.
(G) Pursuant to subdivision (f), (e),
glaucoma in patients over 18 years of age, as described in
subdivision (j). (i).
(H) Eyelid disorders.
(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)
(d) .
(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:
therapeutic pharmaceutical agents approved by the United States Food
and Drug Administration for use in treating eye conditions set forth
in this chapter, including narcotic substances other than those
listed in Schedule I.
(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)
(d) 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
appropriate laboratory and diagnostic imaging tests .
(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)
(10) Punctal occlusion by plugs, excluding laser,
diathermy, cryotherapy, or other means constituting surgery as
defined in this chapter.
(12)
(11) 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)
(12) 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)
(13) 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.
(14) Immunizations for influenza and shingles and additional
immunizations that may be necessary to protect public health during a
declared disaster or public health emergency.
(15) In addition to diagnosing and treating conditions of the
visual system pursuant to subdivision (a), diagnoses of diabetes
mellitus, hypertension, and hyperlipidemia.
(f)
(e) 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)
(i) , 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)
(f) 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)
(g) 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) (d) . 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)
(h) An optometrist licensed under this chapter is
subject to the provisions of Section 2290.5 for purposes of
practicing telehealth.
(j)
(i) For purposes of this chapter, "glaucoma" means
either of the following:
(1) All primary open-angle glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(k)
(j) For purposes of this chapter, "adnexa" means ocular
adnexa.
(l)
(k) 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 3041.1 of the Business
and Professions Code is amended to read:
3041.1. With respect to the practices set forth in
subdivisions (b), (d), and (e) of Section 3041,
optometrists diagnosing or treating eye disease
or other diseases shall be held to the same standard of
care to which physicians and surgeons and osteopathic physicians and
surgeons are held. An optometrist shall consult with and, if
necessary, refer to a physician and surgeon or other appropriate
health care provider if a situation or condition occurs that is
beyond the optometrist's education and training.
SECTION 1. Section 3041 of the Business and
Professions Code is repealed.
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 of the visual system.
(2) The use or prescription of appropriate drugs, including
narcotic substances other than those listed in Schedule 1.
(3) The performance of minor surgical and nonsurgical primary eye
care procedures requiring no more than topical or local anesthetic,
or both, consistent with an optometrist's education and training.
(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 common primary care conditions that have ocular
manifestations.
(d) In addition to the authority provided in subdivisions (a) to
(c), inclusive, an optometrist who is operating under a protocol with
a physician and surgeon or a health care facility, or participating
in a medical home, accountable care organization, or other system of
care in which the patient is being otherwise treated, may initiate
treatment and manage medications for conditions diagnosed pursuant to
subdivision (c).
SEC. 3. Section 3041.2 of the Business and
Professions Code is repealed.
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. SEC. 3. 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.