BILL NUMBER: SB 492 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 8, 2013
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 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 what
certain kinds of diagnostic tests an optometrist could
can order and instead would
authorize an optometrist to order appropriate laboratory and
diagnostic imaging tests , as provided .
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 diagnosing
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
scope of practice .
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 , nonsurgical in cause except when
comanaged with the treating physician and surgeon .
(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 .
(G) Pursuant to subdivision (e) (f) ,
glaucoma in patients over 18 years of age, as described in
subdivision (i) (j) .
(H) Eyelid disorders , including hypotrichosis and
blepharitis .
(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 (d)
(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
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 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
Controlled Substances Act (21 U.S.C. Sec. 801 et seq.). The use
of these agents shall be limited to three days .
(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.
(d)
(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 , upon notification of the treating
physician and surgeon .
(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 for conditions authorized to be treated pursuant
to this section .
(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.
(10)
(11) Punctal occlusion by plugs, excluding laser,
diathermy, cryotherapy, or other means constituting surgery as
defined in this chapter.
(11)
(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.
(12)
(13) 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.
(13)
(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.
(14)
(15) Immunizations
Administration of immunizations for influenza and
shingles , Herpes Zoster Virus, and additional
immunizations that may be necessary to protect public health during a
declared disaster or public health emergency.
(15)
(16) In addition to diagnosing and treating conditions
of the visual system pursuant to subdivision (a)
this section, testing for and , diagnoses of diabetes
mellitus, hypertension, and hyperlipidemia
hypercholesterolemia .
(e)
(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 (i)
(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.
(f)
(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.
(g)
(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 (d) (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.
(h)
(i) An optometrist licensed under this chapter is
subject to the provisions of Section 2290.5 for purposes of
practicing telehealth.
(i)
(j) For purposes of this chapter, "glaucoma" means
either of the following:
(1) All primary open-angle glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(j)
(k) For purposes of this chapter, "adnexa" means ocular
adnexa.
(k)
(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 3041.1 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 disease or
diagnosing 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
scope of practice .
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.