BILL ANALYSIS                                                                                                                                                                                                    



                                                                  SB 492
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          SENATE THIRD READING
          SB 492 (Ed Hernandez)
          As Amended  August 19, 2014
          Majority vote 

           SENATE VOTE  :25-5  
           
           BUSINESS & PROFESSIONS      8-1 APPROPRIATIONS      10-1        
           
           ----------------------------------------------------------------- 
          |Ayes:|Bonilla, Jones,           |Ayes:|Gatto, Bocanegra,         |
          |     |Dickinson, Eggman,        |     |Bradford,                 |
          |     |Gordon, Mullin, Skinner,  |     |Ian Calderon, Campos,     |
          |     |Wilk                      |     |Eggman, Gomez, Holden,    |
          |     |                          |     |Quirk, Weber              |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Maienschein               |Nays:|Ridley-Thomas             |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Authorizes an optometrist to administer influenza and  
          herpes zoster virus (shingles) immunizations for persons 18  
          years of age and older after completing a training program.   
          Specifically,  this bill  :

          1)Requires the Board of Optometry (Board) to grant an  
            optometrist, certified as specified, a certificate for the use  
            of certain immunizations once the optometrist meets the  
            following requirements:

             a)   Completes an immunization training program endorsed by  
               the federal Centers for Disease Control and Prevention  
               (CDC) 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 maintains  
               that training;

             b)   Is certified in basic life support; and,

             c)   Complies 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  








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               designated by the immunization branch of the State  
               Department of Public Health (DPH).

          2)Defines "immunization" for purposes of this bill to mean the  
            "administration of immunizations for influenza and herpes  
            zoster virus in compliance with individual Advisory Committee  
            on Immunization Practices (ACIP) vaccine recommendations  
            published by the CDC for persons 18 years of age or older.

          3)Requires the Board to set the fee by regulation, which shall  
            not exceed $100, for the issuance and renewal of an  
            immunization administration certificate at the reasonable cost  
            of regulating immunization certified optometrists.  

          4)Makes other technical or non-substantive amendments. 

          5)Declares that no reimbursement is required by this bill  
            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,  
            changes the penalty for a crime or infraction, or changes the  
            definition of a crime.
                                                      
           EXISTING LAW  : 

          1)Establishes the Board within the Department of Consumer  
            Affairs, which licenses optometrists and regulates the  
            practice of optometry.  (Business and Professions Code (BPC)  
            Section 3010.5)

          2)Authorizes the Board to establish educational and examination  
            requirements for licensure.  (BPC Section 3041.2)

          3)Authorizes a licensed pharmacist administer immunizations  
            pursuant to a protocol with a prescriber. (BPC Section 4052)

          4)Authorizes a licensed pharmacist to independently initiate and  
            administer vaccines listed on the routine immunization  
            schedules recommended by the ACIP, in compliance with  
            individual ACIP vaccine recommendations, and published by the  
            CDC for persons three years of age and older. (BPC Section  
            4052.8(a))

          5)Requires a licensed pharmacist, in order to initiate and  








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            administer an immunization, to do the following: 

             a)   Complete an immunization training program endorsed by  
               the CDC or the Accreditation Council for Pharmacy Education  
               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; and,

             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 DPH.

          6)Authorizes a pharmacist to initiate and administer epinephrine  
            or diphenhydramine by injection for the treatment of a severe  
            allergic reaction. (BPC Section 4052.8)

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee:

          1)One-time costs of approximately $150,000 per year for the  
            first two years for exam development, Information Technology  
            changes, regulations, licensing, enforcement, and program  
            oversight.

          2)Ongoing costs for enforcement and program oversight are  
            expected to be approximately $100,000. 

          3)Increased revenues of $50,000 associated with an increase in  
            certification fees currently authorized for treatment of  
            glaucoma, as this certification is necessary to pursue the  
            advanced certification created by this bill.  

           COMMENTS  :  

          1)Purpose of this bill.  This bill would authorize an  
            optometrist to administer influenza and herpes zoster virus  
            (shingles) immunizations to persons 18 years of age and older  
            after completing a training program endorsed by the CDC.  This  
            bill is sponsored by the California Optometric Association. 








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          2)The practice of optometry.  An optometrist (Doctor of  
            Optometry or O.D.) is an independent primary health care  
            professional for the eye.  Optometrists examine, diagnose,  
            treat, and manage diseases, injuries, and disorders of the  
            visual system, the eye, and associated structures, as well as  
            identify related systemic conditions affecting the eye.   
            O.D.'s are authorized to prescribe certain medications, low  
            vision rehabilitation, vision therapy, spectacle lenses,  
            contact lenses, and perform certain surgical procedures.   
            Optometrists have a narrower scope of practice than do  
            ophthalmologists (physicians that specialize in treating the  
            eye), but are held to the identical standard of care for the  
            same treatments they provide. 

            In order to be licensed to practice by the Board, an  
            individual must obtain an O.D. degree, pass the three-part  
            National Board of Examiners in Optometry examination, and the  
            California Optometric State Law Examination.  There are  
            currently more than 9,100 optometrists in practice in  
            California.

            Optometrists are trained to diagnose mild to severe eye  
            problems such as serious eye infections, inflammations of the  
            eye, trauma, foreign bodies and glaucoma (pressure inside the  
            eye).  They also examine the eye for vision prescription and  
            corrective lenses.  Optometrists may also pursue any of five  
            additional state certifications to perform certain advanced  
            procedures: use of diagnostic pharmaceutical agents; use of  
            therapeutic pharmaceutical agents (TPA); lacrimal irrigation  
            and dilation for individuals over the age of 12 in addition to  
            the TPA certification; diagnosis and treatment of open angle  
            glaucoma for adults in addition to the TPA certification; and  
            a combination of TPA, TPL and TPG certifications. 
           
          3)Immunizations.  This bill would authorize a TPA-certified  
            optometrist to administer immunization shots to persons 18  
            years of age and older for influenza and herpes zoster virus  
            (shingles).  As a prerequisite, the optometrist must complete  
            a CDC-approved training program that includes hands-on  
            injection technique, clinical evaluation of indications and  
            contraindications of vaccines, and the recognition and  
            treatment of emergency reactions to vaccines.  The optometrist  
            must also be certified in basic life support and comply with  








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            state and federal recordkeeping and reporting requirements. 


           Analysis Prepared by  :    Hank Dempsey / B., P. & C.P. / (916)  
          319-3301 


                                                                FN: 0004994