BILL NUMBER: SB 492 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 4, 2014
AMENDED IN ASSEMBLY JULY 1, 2014
AMENDED IN ASSEMBLY JUNE 16, 2014
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, 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 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 and
indicated for use in diagnosing and treating the eye conditions
covered by these provisions. The bill would also modify the ability
of an optometrist certified to use therapeutic pharmaceutical agents
to diagnose and treat certain diseases. The bill would require the
board to grant a certificate to an optometrist for the use of
advanced procedures, as defined, if the optometrist meets certain
educational and certification requirements. The board would also be
required to grant a certificate to an optometrist for immunizations
if the optometrist meets certain educational and certification
requirements. The bill would authorize the board to allow
optometrists to use any noninvasive technology to treat specified
conditions.
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 of the anterior segment and adnexa
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. 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 nonsurgical in 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 (m).
(n).
(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 and indicated for use in diagnosing and
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 federal
Controlled Substances Act (21 U.S.C. Sec. 801 et seq.). The use of
controlled substances shall be limited to five 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 or optometrist.
(6) Treatment or removal of sebaceous cysts by expression.
(7) Use of an auto-injector to counter anaphylaxis.
(8) Ordering of appropriate laboratory and diagnostic
imaging tests necessary to diagnose conditions of the eye or adnexa.
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.
(9) A clinical laboratory test or examination necessary
to diagnose conditions of the eye or adnexa and classified
as waived under 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.
(CLIA) and designated as waived in paragraph (8) necessary for the
diagnosis of conditions and diseases of the eye or adnexa, or if
otherwise specifically authorized by this chapter.
(10) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.
(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.
(12) 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) 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, is 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 (m), (n),
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 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.
(4) For licensees who graduated from an accredited school of
optometry on or before May 1, 2008, and not described in paragraph
(2) or (3), submission of proof of satisfactory completion of the
requirements for certification established by the board
pursuant to Section 3041.10. board.
(g) The board shall grant to an optometrist, certified pursuant to
subdivision (f), a certificate for the use of advanced procedures,
as described in subdivision (h), after the optometrist meets the
following applicable requirement:
(1) Licensees who graduated from an accredited school of
optometry, on or after May 1, 2016, shall submit proof of completion
at that school of a satisfactory curriculum on advanced procedures,
as determined by the board, including passage of a test for
competency and performance of the procedures contained in
subparagraph (F) of paragraph (2).
(2) Licensees who graduated from an accredited school before May
1, 2016, are required to submit proof of completion of a
board-approved course that meets all of the requirements in
subparagraphs (A) to (G), inclusive. An optometrist certified
pursuant to Section 3041.3 may perform the training procedures in
their own practices under the supervision of a physician and surgeon
or an optometrist with an advanced procedure certification.
(A) Provided by an accredited school of optometry and developed in
consultation with an ophthalmologist who has experience teaching
optometric students.
(B) Taught by full-time or adjunct faculty members of an
accredited school of optometry.
(C) Sponsored by an organization that meets the standards of
Section 1536 of Title 16 of the California Code of Regulations.
(D) Included passage of a test for competency.
(E) Included all of the following didactic instruction:
(i) Laser physics, hazards, and safety.
(ii) Biophysics of laser.
(iii) Laser application in clinical optometry.
(iv) Laser tissue interactions.
(v) Laser indications, contraindications, and potential
complications.
(vi) Gonioscopy.
(vii) Laser therapy for open angle glaucoma.
(viii) Laser therapy for angle closure glaucoma.
(ix) Posterior capsulotomy.
(x) Common complications: lids, lashes, and lacrimal.
(xi) Medicolegal aspects of anterior segment procedures.
(xii) Peripheral iridotomy.
(xiii) Laser Trabeculoplasty.
(xiv) Minor surgical procedures.
(xv) Overview of surgical instruments, asepsis, and the federal
Occupational Safety and Health Administration.
(xvi) Surgical anatomy of the eyelids.
(xvii) Emergency surgical procedures.
(xviii) Chalazion management.
(xix) Epilumeninesence microscopy.
(xx) Suture techniques.
(xxi) Local anesthesia: techniques and complications.
(xxii) Anaphylaxsis and other office emergencies.
(xxiii) Radiofrequency surgery.
(xxiv) Postoperative wound care.
(F) Included all of the following clinical or laboratory
experience: experience on live human patients:
(i) Video demonstration.
(ii)
(i ) Between 20 and 35 clinical eyelid or
adnexa surgical training procedures, between 18 and 25 laser training
procedures, and between 6 and 12 injection training procedures. The
board shall convene an advisory committee to establish the exact
number of training procedures required, including a minimum number of
training procedures for each procedure listed in subdivision (h).
The advisory committee shall be composed of the Director of Consumer
Affairs or his or her appointee, who shall also serve as the
chair, chairperson, two practicing
optometrists, two practicing ophthalmologists, one faculty member of
a school of optometry, and one ophthalmologist that teaches at a
school of optometry. The members of the advisory committee shall be
appointed by the respective licensing boards. Recommendations from
the advisory committee shall be reported to the board within six
months of being convened.
(ii) Video demonstration.
(iii) A formal clinical or laboratory practical
examination.
(G) Required passage of a written test utilizing the National
Board of Examiners in Optometry format.
(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) Removal, destruction, or drainage of lesions of the eyelid and
adnexa clinically evaluated by the optometrist to be noncancerous.
(4) Closure of a wound resulting from a procedure described in
paragraph (3).
(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.
(i) "Advanced procedures" does not include performing
blepharoplasty or other cosmetic surgery procedures that reshape
normal structures of the body in order to improve appearance and
self-esteem.
(i)
( j) The board shall grant to an
optometrist, certified pursuant to subdivision (f), a certificate for
immunizations, as described in subdivision (o),
(p), after the optometrist meets all of the following
applicable requirements:
(1) For licensees who graduated, on or after May 1, 2016, from an
accredited school of optometry that includes satisfactory curriculum
on immunizations, as determined by the board, submission of proof of
graduation from that institution.
(2) Licensees who graduated from an accredited school before May
1, 2016, shall do all of the following:
(A) Submit proof of completion of a board-approved immunization
training program that, at a minimum, includes hands-on injection
technique, clinical evaluation of indications and contraindications
of vaccines, and the recognition and treatment of emergency reactions
to vaccines, and shall maintain that training.
(B) Be certified in basic life support for health care
professionals.
(C) Comply with all state and federal recordkeeping and reporting
requirements, including providing documentation to the patient's
primary care provider and entering information in the appropriate
immunization registry designated by the immunization branch of the
State Department of Public Health.
(j)
( k) 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.
(k)
( l) 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. Nothing in
this section shall limit an optometrist's authority to utilize
diagnostic laser and ultrasound technology within his or her scope of
practice.
(l)
( m) An optometrist licensed under this
chapter is subject to the provisions of Section 2290.5 for purposes
of practicing telehealth.
(m)
( n) For purposes of this chapter, "glaucoma"
means either of the following:
(1) All primary open-angle glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(n)
( o) For purposes of this chapter, "adnexa"
means ocular adnexa.
(o)
( p) For the purposes of this chapter,
"immunization" means administration of immunizations for influenza,
Pertussis, 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 18 years of age or older.
(p)
( q) 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.
(q)
( r) The board may authorize optometrists to
use any noninvasive technology to treat a condition listed in
paragraph (1) of subdivision (b).
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) (1) 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.
(2) Committing any act of sexual abuse, misconduct, or relations
with a patient. The commission of and conviction for any act of
sexual abuse, sexual misconduct, or attempted sexual misconduct,
whether or not with a patient, shall be considered a crime
substantially related to the qualifications, functions, or duties of
a licensee. This paragraph shall not apply to sexual contact between
any person licensed under this chapter and his or her spouse or
person in an equivalent domestic relationship when that licensee
provides optometry treatment to his or her spouse or person in an
equivalent domestic relationship.
(3) Conviction of a crime that requires the person to register as
a sex offender pursuant to Section 290
Chapter 5.5 (commencing with Section 290) of Title 9 of Part 1
of the Penal Code. A conviction within the meaning of this paragraph
means a plea or verdict of guilty or a conviction following a plea of
nolo contendere. A conviction described in this paragraph shall be
considered a crime substantially related to the qualifications,
functions, or duties of a licensee.
(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 Public Health Care 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 if an
examination of the eyes indicates a substantial likelihood of any
pathology that requires the attention of that physician.
SEC. 4. It is the intent of the Legislature that the Office of
Statewide Health Planning and Development, under the Health Workforce
Pilot 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. 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.