BILL NUMBER: SB 492 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 5, 2013
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
3041, 3041.1, and 3110 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 certain kinds of diagnostic tests
an optometrist can order and would authorize an optometrist to order
appropriate laboratory and diagnostic imaging tests, as provided.
This bill would include the provision of habilitative optometric
services within the scope of practice of optometry. The bill would
expand the scope of practice of optometrists who are certified to use
therapeutic pharmaceutical agents by, among other things,
authorizing those optometrists to use all therapeutic pharmaceutical
agents approved by the United States Food and Drug Administration for
use in treating the eye conditions covered by these provisions. The
bill would also expand the ability of an optometrist certified to use
therapeutic pharmaceutical agents to diagnose and treat certain
diseases, as provided. The bill would require the board to grant a
certificate to an optometrist for the use of advanced procedures,
which include the administration of certain immunizations, if the
optometrist meets certain educational requirements.
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 scope of practice.
This bill would delete obsolete provisions and make conforming
changes.
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, inflammation
nonsurgical in cause 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. Treatment for
purposes of this subparagraph includes, but is not limited to, the
use of mechanical lipid extraction of meibomian glands using
nonsurgical techniques.
(F) Ocular pain, pain nonsurgical in
cause cause, except when comanaged
with the treating physician and surgeon.
(G) Pursuant to subdivision (f), glaucoma in patients over 18
years of age, as described in subdivision (j).
(l).
(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 (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 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
federal Controlled Substances Act (21 U.S.C. Sec. 801 et
seq.). The use of these agents controlled
substances 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.
(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 . surgeon or optome
trist.
(6) Treatment or removal of sebaceous cysts by expression.
(7) Administration of oral fluorescein .
(8)
( 7) Use of an auto-injector to counter
anaphylaxis.
(9)
( 8) Ordering of appropriate laboratory and
diagnostic imaging tests for conditions authorized to be treated
pursuant to this section.
(10)
( 9) 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. the federal Clinical
Laboratory Improvement Amendments of 1988 (42 U.S.C. Sec. 263a)
(CLIA). These laboratory tests are required to be performed in
compliance with both CLIA and all clinical laboratory licensing
requirements in Chapter 3 (commencing with Section 1200), and any
ancillary personnel utilized shall be in compliance with those same
requirements.
(11)
(10) Punctal occlusion by plugs, excluding laser,
diathermy, cryotherapy, or other means constituting surgery as
defined in this chapter.
(12)
(1 1) 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)
(1 2) Removal of foreign bodies from the
cornea, eyelid, and conjunctiva with any appropriate instrument other
than a scalpel . scalpel. Corneal
foreign bodies shall be nonperforating, be no deeper than the
midstroma, and require no surgical repair upon removal.
(14)
(1 3) 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 or lacrimal irrigation and dilation
certified optometrist as confirmed by the ophthalmologist
or lacrimal irrigation and dilation certified optometrist
. Any optometrist who graduated from an accredited school of
optometry on or after May 1, 2000, shall be
is exempt from the certification requirement contained in this
paragraph.
(15) Administration of immunizations for influenza, Herpes Zoster
Virus, and additional immunizations that may be necessary to protect
public health during a declared disaster or public health emergency.
(16)
(1 4) In addition to diagnosing and treating
conditions of the visual system pursuant to this section, testing
for and, diagnoses and diagnosis of
diabetes mellitus, hypertension, and hypercholesterolemia.
(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), (l),
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)
( 3) 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)
( 4) 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), (2)
or (3), submission of proof of satisfactory completion of the
requirements for certification established by the board pursuant to
Section 3041.10.
(g) The board shall grant a certificate
to an optometrist certified pursuant to subdivision (f) for the use
of advanced procedures, as described in subdivision (h), after the
optometrist meets the following applicable requirement:
(1) For licensees who graduated from an accredited school of
optometry that includes satisfactory curriculum on advanced
procedures, as determined by the board, on or after May 1, 2016,
submission of proof of graduation from that institution.
(2) For licensees who graduated from an accredited school before
May 1, 2016, submission of proof of completion of a 32-hour course
that includes clinical training in advanced procedures and is
approved the board.
(h) For the purposes of this chapter, "advanced procedures' means
any of the following:
(1) Therapeutic lasers used for posterior capsulotomy secondary to
cataract surgery.
(2) Therapeutic lasers appropriate for treatment of glaucoma and
peripheral iridotomy for the prophylactic treatment of angle closure
glaucoma.
(3) Excision, scraping, and biopsy, or any combination of those,
of superficial lesions of the eyelid and adnexa.
(4) Cauterization or suture repairs of the eyelid and conjunctiva.
(5) Injections for the treatment of conditions of the eye and
adnexa described in paragraph (1) of subdivision (b), excluding
intraorbital injections and injections administered for cosmetic
effect.
(6) Administration of immunizations for influenza, Herpes Zoster
Virus, and additional immunizations that may be necessary to protect
public health during a declared disaster or public health emergency
in compliance with individual Advisory Committee on Immunization
Practices (ACIP) vaccine recommendations published by the federal
Centers for Disease Control and Prevention (CDC) for persons three
years of age or older.
(7) Any noninvasive technology authorized by the board for the
treatment of conditions described in paragraph (1) of subdivision
(b).
(g)
( i) 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
(j) Except as authorized by this
section, 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)
( k) An optometrist licensed under this
chapter is subject to the provisions of Section 2290.5 for purposes
of practicing telehealth.
(j)
( l) For purposes of this chapter, "glaucoma"
means either of the following:
(1) All primary open-angle glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(k)
( m) For purposes of this chapter, "adnexa"
means ocular adnexa.
(l)
( n) 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 scope
of practice.
SEC. 3. Section 3110 of the Business
and Professions Code is amended to read:
3110. The board may take action against any licensee who is
charged with unprofessional conduct, and may deny an application for
a license if the applicant has committed unprofessional conduct. In
addition to other provisions of this article, unprofessional conduct
includes, but is not limited to, the following:
(a) Violating or attempting to violate, directly or indirectly
assisting in or abetting the violation of, or conspiring to violate
any provision of this chapter or any of the rules and regulations
adopted by the board pursuant to this chapter.
(b) Gross negligence.
(c) Repeated negligent acts. To be repeated, there must be two or
more negligent acts or omissions.
(d) Incompetence.
(e) The commission of fraud, misrepresentation, or any act
involving dishonesty or corruption, that is substantially related to
the qualifications, functions, or duties of an optometrist.
(f) Any action or conduct that would have warranted the denial of
a license.
(g) The use of advertising relating to optometry that violates
Section 651 or 17500.
(h) Denial of licensure, revocation, suspension, restriction, or
any other disciplinary action against a health care professional
license by another state or territory of the United States, by any
other governmental agency, or by another California health care
professional licensing board. A certified copy of the decision or
judgment shall be conclusive evidence of that action.
(i) Procuring his or her license by fraud, misrepresentation, or
mistake.
(j) Making or giving any false statement or information in
connection with the application for issuance of a license.
(k) Conviction of a felony or of any offense substantially related
to the qualifications, functions, and duties of an optometrist, in
which event the record of the conviction shall be conclusive evidence
thereof.
(l) Administering to himself or herself any controlled substance
or using any of the dangerous drugs specified in Section 4022, or
using alcoholic beverages to the extent, or in a manner, as to be
dangerous or injurious to the person applying for a license or
holding a license under this chapter, or to any other person, or to
the public, or, to the extent that the use impairs the ability of the
person applying for or holding a license to conduct with safety to
the public the practice authorized by the license, or the conviction
of a misdemeanor or felony involving the use, consumption, or self
administration of any of the substances referred to in this
subdivision, or any combination thereof.
(m) Committing or soliciting an act punishable as a sexually
related crime, if that act or solicitation is substantially related
to the qualifications, functions, or duties of an optometrist.
(n) Repeated acts of excessive prescribing, furnishing or
administering of controlled substances or dangerous drugs specified
in Section 4022, or repeated acts of excessive treatment.
(o) Repeated acts of excessive use of diagnostic or therapeutic
procedures, or repeated acts of excessive use of diagnostic or
treatment facilities.
(p) The prescribing, furnishing, or administering of controlled
substances or drugs specified in Section 4022, or treatment without a
good faith prior examination of the patient and optometric reason.
(q) The failure to maintain adequate and accurate records relating
to the provision of services to his or her patients.
(r) Performing, or holding oneself out as being able to perform,
or offering to perform, any professional services beyond the scope of
the license authorized by this chapter.
(s) The practice of optometry without a valid, unrevoked,
unexpired license.
(t) The employing, directly or indirectly, of any suspended or
unlicensed optometrist to perform any work for which an optometry
license is required.
(u) Permitting another person to use the licensee's optometry
license for any purpose.
(v) Altering with fraudulent intent a license issued by the board,
or using a fraudulently altered license, permit certification or any
registration issued by the board.
(w) Except for good cause, the knowing failure to protect patients
by failing to follow infection control guidelines of the board,
thereby risking transmission of blood borne infectious diseases from
optometrist to patient, from patient to patient, or from patient to
optometrist. In administering this subdivision, the board shall
consider the standards, regulations, and guidelines of the State
Department of Health Services developed pursuant to Section 1250.11
of the Health and Safety Code and the standards, guidelines, and
regulations pursuant to the California Occupational Safety and Health
Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of
the Labor Code) for preventing the transmission of HIV, hepatitis B,
and other blood borne pathogens in health care settings. As
necessary, the board may consult with the Medical Board of
California, the Board of Podiatric Medicine, the Board of Registered
Nursing, and the Board of Vocational Nursing and Psychiatric
Technicians, to encourage appropriate consistency in the
implementation of this subdivision.
(x) Failure or refusal to comply with a request for the clinical
records of a patient, that is accompanied by that patient's written
authorization for release of records to the board, within 15 days of
receiving the request and authorization, unless the licensee is
unable to provide the documents within this time period for good
cause.
(y) Failure to refer a patient to an appropriate physician
in either of the following circumstances: if
an examination of the eyes indicates a substantial
likelihood of any pathology that requires the attention of that
physician.
(1) Where an examination of the eyes indicates a substantial
likelihood of any pathology that requires the attention of that
physician.
(2) As required by subdivision (c) of Section 3041.
SEC. 4. It is the intent of the Legislature that
the Office of Statewide Health Planning and Development, under the
Health Workforce P ilot Projects Program, designate a
pilot project intended to test, demonstrate, and evaluate expanded
roles for optometrists in the performance of management and treatment
of diabetes mellitus, hypertension, and hypercholesterolemia.
SEC. 3. 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.