BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 492|
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THIRD READING
Bill No: SB 492
Author: Hernandez (D)
Amended: 5/8/13
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM. : 8-0, 4/29/13
AYES: Price, Block, Corbett, Galgiani, Hernandez, Hill,
Padilla, Yee
NO VOTE RECORDED: Emmerson, Wyland
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/13
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SUBJECT : Optometrists: practice: licensure
SOURCE : Author
DIGEST : This bill permits an optometrist to diagnose, treat
and manage additional conditions with ocular manifestations;
directs the California Board of Optometry to establish
educational and examination requirements; and permits
optometrists to perform vaccinations and surgical and
non-surgical primary care procedures.
ANALYSIS : Existing law defines the practice of optometry; and
specifies that an optometrist who is certified to use
therapeutic pharmaceutical agents (TPAs) may also diagnose and
treat specified conditions, use TPAs, and order specified
diagnostic tests.
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This bill:
1. Adds the provision of habilitative optometric services to the
definition of the practice of optometry.
2. Allows an optometrist who is TPA certified to treat the
lacrimal gland, lacrimal drainage system and the sclera in
patients under 12 years of age.
3. Allows an optometrist to treat ocular inflammation and pain,
nonsurgical in cause except when comanaged with the patient's
treating physician and surgeon.
4. Permits optometrists to treat eye lid disorders, including
hypotrichosis and blepharitis.
5. Allows an optometrist to use all TPAs approved by the Food
and Drug Administration (FDA) for use in treating eye
conditions including codeine with compounds and hydrocodone
with compounds as listed in the California Uniform Controlled
Substances Act and the U.S. Controlled Substances Act.
Limits the use of these agents to three days.
6. Requires, in any case that an optometrist consults with a
physician and surgeon, the optometrist and the physician and
surgeon to 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.
7. Removes the requirement for optometrists to only utilize
specific TPAs.
8. Allows TPA-certified optometrists to remove sutures, upon
notification of the treating physician and surgeon.
9. Removes the restriction that optometrists can only administer
oral fluorescein to patients suspected as having diabetic
retinopathy.
10.Deletes the list of specific tests optometrists are permitted
to order and permits optometrists to order any laboratory and
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diagnostic imaging tests for conditions authorized to be
treated pursuant to this bill.
11.Authorizes an optometrist to perform a clinical laboratory
test or exam classified as waived under CLIA (Clinical
Laboratory Improvement Amendments) and designated as waived
in #10 above necessary for the diagnosis of conditions and
diseases of the eye or adnexa, or if otherwise specifically
authorized.
12.Adds the provision that optometrists can administer
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.
13.Permits optometrists to test for and diagnose diabetes
mellitus, hypertension and hypercholesterolemia.
14.Specifies that an optometrist 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.
15.Requires an optometrist to consult with and refer to a
physician and surgeon or other appropriate health care
provider if a situation/condition occurs that is beyond the
optometrist's scope of practice.
16.Allows an optometrist to consult with and refer to a
physician and surgeon or appropriate health care provider if
a situation or condition occurs that is beyond the
optometrist's education and training.
Background
Shortage of optometrists . According to a report prepared by the
Center for the Health Professions at the University of
California San Francisco, the number of optometrist licenses in
California has declined, but the number of licensees with a
secondary practice location has increased. According to the
California Board of Optometry, there are approximately 9,000
optometrists in California, the largest population of
optometrists in the United States. These optometrists are
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generally concentrated in coastal counties, the Bay Area and
counties in the Sacramento region. Several counties have no
licensed optometrists with an address of record in those
counties, and a number of other counties have ratios that
indicate there is approximately one optometrist for every 10,000
people.
Optometrists' education, training and scope . After completion
of an undergraduate degree, optometrists complete four years of
an accredited optometry college after which they are awarded the
Doctor of Optometry degree. Some optometrists also undertake an
optional one year non-surgical residency program to enhance
their experience in a particular area. Students graduate with
2,500-3,000 patient encounters; these include a mix of
post-surgical, medical and routine visits.
Optometrists are trained to diagnose mild to severe eye problems
such as serious eye infections, inflammations of the eye,
trauma, foreign bodies and glaucoma. They also examine the eye
for vision prescription and corrective lenses. Optometrists may
apply for certification to administer TPA; to perform lacrimal
irrigation and dilation; and to diagnose and treat primary open
angle glaucoma.
Ophthalmologists' education, training and scope . After
obtaining an undergraduate degree, ophthalmologists complete
four years at an accredited medical school and earn a Medical
Degree. This is followed by a one year internship and a three
or four year surgical residency. Many ophthalmologists pursue
additional fellowship training in specialized areas such as
retina, glaucoma or cornea. Ophthalmologists may become
certified by the American Board of Ophthalmology, which
requires, serving as primary surgeon or first assistant to the
primary surgeon on a minimum of 364 eye surgeries.
The central focus of ophthalmology is surgery and management of
complex eye diseases. An ophthalmologist specializes in the
refractive, medical and surgical care of the eyes and visual
system and in the prevention of disease and injury.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
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One-time costs of about $950,000 over two years to revise
regulations and certify additional optometrists to use
therapeutic pharmaceutical agents by the California Board of
Optometry (State Optometry Fund).
Ongoing costs of about $350,000 for certifications and
enforcement activities (State Optometry Fund).
Increased fee revenues of about $80,000 over the first two
years and about $10,000 per year thereafter for additional
certifications (State Optometry Fund).
Indeterminate impact on state health care programs, such as
the California Public Employees' Retirement System and
Medi-Cal.
SUPPORT : (Verified 5/24/13)
Bay Area Council
Blue Shield of California
California Hospital Association
California Optometric Association
California Pharmacists Association/California Society of
Health-System Pharmacists
Californians for Patient Care
United Nurses Associations of California/Union of Health Care
Professionals
Vision Service Plan
Western University of Health Sciences
OPPOSITION : (Verified 5/24/13)
American College of Emergency Physicians- California Chapter
Blind Children's Center
California Academy of Eye Physicians & Surgeons
California Academy of Family Physicians
California Association for Medical Laboratory Technology
California Medical Association
California Society of Anesthesiologists
California Society of Plastic Surgeons
Canvasback Missions Inc.
Here4Them
Lighthouse for Christ Mission Eye Center
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Osteopathic Physicians & Surgeons of California
Union of American Physicians and Dentists
ARGUMENTS IN SUPPORT : According to the author's office, this
bill is intended to allow optometrists to practice to the full
extent of their education and training in order to expand access
to the health care delivery system for the millions of
Californians who will have new access to coverage through the
implementation of the federal Patient Protection and Affordable
Care Act (ACA). This bill allows optometrists to diagnose,
treat and manage specific eye disorders and common diseases such
as diabetes, hypertension and hyperlipidemia; expands the drugs
optometrists can prescribe; and permits optometrists to
administer immunizations and to perform surgical and
non-surgical procedures.
Blue Shield of California states, "Expanding the range of
services that these practitioners are able to provide will
improve access and quality of care as they are well trained and
highly educated professionals that are already providing
integral health services."
Californians for Patient Care note, "It is widely noted that
there are not enough trained medical professionals to
appropriately care for the influx of new patients. We believe
it is important that qualified, educated and trained
optometrists be allowed to practice to the extent of their
licenses to best serve California's patient population
throughout the state."
The California Optometric Association believes that this bill,
"addresses the health care provider gap by expanding the scope
of practice of optometry. Optometrists are positioned and
prepared to be part of the solution to meeting the additional
health care needs upon enactment of the ACA in 2014."
The United Nurses Associations of California/ Union of Health
Care Professionals indicate, "SB 492 would allow optometrists to
practice to the full extent of their education and training in
order to expand access to the health care delivery system for
the millions of Californians who will have new access to
coverage through implementation of the federal ACA."
ARGUMENTS IN OPPOSITION : The California Medical Association
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(CMA) outline several concerns. Included is the provision of
primary care services that optometrists would be permitted to do
if the bill passed. CMA believes that this is "?beyond the
existing scope of practice related to visual disorders and could
result in serious harm to patients." They also note that
optometrists "?do not have the training and experience necessary
to provide comprehensive primary care. In addition, SB 492
would allow optometrists to practice medicine without being
subject to the Medical Practice Act. Currently, optometrists
are licensed by the Board of Optometry. Under SB 492, the scope
of practice for optometrists would be expanded to the point
where they would be practicing as ophthalmologists, who are
required to have a medical license, without being subject to the
controls and oversight of the Medical Practice Act."
The California Association for Medical Laboratory Technology
notes, "While we recognize the ability of optometrists to
perform certain waived tests limited to their scope of practice,
we have concerns about the broad range of testing contained in
this bill. Of greater concern is whether or not optometrists
receive the proper education and training to perform as a
laboratory director."
The California Academy of Eye Physicians & Surgeons is concerned
about the expanded scope of practice for optometrists permitted
by this bill. Specifically, they are concerned about the
provisions that would allow optometrists to conduct eye
surgeries and prescribe medications by all routes with no
additional training.
The Union of American Physicians and Dentists states that "SB
492 rolls out an uncertain health care delivery system with
patients subject to unintended consequences of the bill.
Medical supervision over optometrists is critical to safe
patient outcomes. SB 492 raises serious patient safety concerns
in allowing optometrists to prescribe medication and perform
surgical procedures without and medical supervision."
The Lighthouse for Christ Mission Eye Center and the Canvasback
Missions, Inc. states, "The bill would give optometrists greatly
increased privileges, including the ability to treat any disease
that might have a "manifestation" in the eye without additional
specific training requirements. The Board of Optometry, whose
members have no experience doing surgery or treating the added
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diseases would be allowed to decide those training
requirements."
The California Society of Anesthesiologists argues, "SB 492
would allow the diagnosis and initiation of treatment of any
condition with ocular manifestation. This is a broad and
unclear authorization that has not attained scientific
consensus. It is not a sufficient basis to authorize
comprehensive primary care. Also, by granting full drug
prescribing authority to optometrists, the bill would add a new
category of authorized controlled substance prescribers at a
time when more controls are being sought over excessive
prescribing."
MW:d 5/24/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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