Amended in Senate May 8, 2013

Amended in Senate April 24, 2013

Amended in Senate April 16, 2013

Amended in Senate April 1, 2013

Senate Bill No. 492

Introduced by Senator Hernandez

February 21, 2013

An act to 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 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 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 begin delete what end delete begin insert certain end insert kinds of diagnostic tests an optometrist begin delete could end delete begin insert can end insert order and begin delete instead end delete would authorize an optometrist to order appropriate laboratory and diagnostic imaging tests begin insert , as provided end insert .

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 begin insert diagnosing end insert 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 begin delete education and training end delete begin insert scope of practice end insert .

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.  

Section 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.

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

(C) Ocular inflammation begin insert , nonsurgical in cause except when
comanaged with the treating physician and surgeon end insert .

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

(E) Corneal surface disease and dry eyes.

(F) Ocular pain begin insert , nonsurgical in cause except when comanaged
with the treating physician and surgeon end insert .

(G) Pursuant to subdivision begin delete (e) end delete begin insert (f) end insert , glaucoma in patients over
18 years of age, as described in subdivision begin delete (i) end delete begin insert (j) end insert .

(H) Eyelid disorders begin insert , including hypotrichosis and blepharitis end insert .

(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 begin delete (d) end delete begin insert (e) end insert .

(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 therapeutic
pharmaceutical agents approved by the United States Food and
Drug Administration for use in treating eye conditions set forth in
this chapter, including begin delete narcotic substances other than those listed
in Schedule I end delete begin insert 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 end insert begin insert Controlled
Substances Act (21 U.S.C. Sec. 801 et seq.). The use of these agents
shall be limited to three days end insert .

begin insert

(d) In any case that an optometrist consults with a physician
and surgeon, the optometrist and the physician and surgeon shall
both maintain a written record in the patient’s file of the
information provided to the physician and surgeon, the physician
and surgeon’s response, and any other relevant information. Upon
the request of the optometrist or physician and surgeon and with
the patient’s consent, a copy of the record shall be furnished to
the requesting party.

end insert begin delete

(d)

end delete

begin insert (e) end insert  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 begin insert , upon notification of the treating physician
and surgeon end insert .

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

(7) Administration of oral fluorescein .

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

(9) Ordering of appropriate laboratory and diagnostic imaging
tests begin insert for conditions authorized to be treated pursuant to this
section end insert .

begin insert

(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.

end insert begin delete

(10)

end delete

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

begin delete

(11)

end delete

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

begin delete

(12)

end delete

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

begin delete

(13)

end delete

begin insert (14) end insert  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.

begin delete

(14)

end delete

begin insert (15) end insert   begin delete Immunizations end delete begin insert Administration of immunizations end insert for
influenza begin delete and shingles end delete begin insert , Herpes Zoster Virus, end insert and additional
immunizations that may be necessary to protect public health
during a declared disaster or public health emergency.

begin delete

(15)

end delete

begin insert (16) end insert  In addition to diagnosing and treating conditions of the
visual system pursuant to begin delete subdivision (a) end delete begin insert this section, testing for
and end insert , diagnoses of diabetes mellitus, hypertension, and
begin delete hyperlipidemia end delete begin insert hypercholesterolemia end insert .

begin delete

(e)

end delete

begin insert (f) end insert  The board shall grant a certificate to an optometrist certified
pursuant to Section 3041.3 for the treatment of glaucoma, as
described in subdivision begin delete (i) end delete begin insert (j) end insert , 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.

begin delete

(f)

end delete

begin insert (g) end insert  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.

begin delete

(g)

end delete

begin insert (h) end insert  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 begin delete (d) end delete begin insert (e) end insert . Nothing in this section shall limit an
optometrist’s authority to utilize diagnostic laser and ultrasound
technology within his or her scope of practice.

begin delete

(h)

end delete

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

begin delete

(i)

end delete

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

(1) All primary open-angle glaucoma.

(2) Exfoliation and pigmentary glaucoma.

begin delete

(j)

end delete

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

begin delete

(k)

end delete

begin insert (l) end insert  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 Section 3041,
optometrists diagnosing or treating eye begin insert disease end insert or begin insert diagnosing end insert 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
begin delete education and training end delete begin insert scope of practice end insert .

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.