BILL ANALYSIS                                                                                                                                                                                                    �






                             SENATE JUDICIARY COMMITTEE
                             Senator Noreen Evans, Chair
                              2013-2014 Regular Session


          SB 724 (Emmerson)
          As Amended April 29, 2013
          Hearing Date: May 7, 2013
          Fiscal: No
          Urgency: No
          TW


                                        SUBJECT
                                           
                      Liability:  Charitable Vision Screenings

                                      DESCRIPTION  

          This bill would provide qualified immunity from damages or  
          injury liability to a nonprofit charitable organization,  
          licensed optometrist, ophthalmologist, or trained volunteer  
          providing vision screenings or donated or recycled glasses, as  
          specified.

                                      BACKGROUND  

          Due to the economic decline over the last several years, it has  
          become increasingly important for individuals of low income or  
          without health insurance to have access to medical care  
          services.  Although many individuals may have access to  
          emergency care services provided through hospitals, there are  
          few options for these individuals to receive proper eye care  
          services.

          Noncharitable organizations have begun providing volunteer  
          vision screenings and eyeglass donations to provide individuals,  
          with no other means to obtain such services, with the gift of  
          sight.  These noncharitable organizations rely on volunteer  
          optometrists, ophthalmologists, and others, to provide vision  
          screenings and eyeglass fittings.  

          Of concern to these nonprofit organizations and volunteers is  
          liability for negligent treatment of the individuals to whom  
          vision screening and eyeglass fitting services are provided.   
          Because of the potential for being held liable for damages to an  
                                                                (more)



          SB 724 (Emmerson)
          Page 2 of ?



          individual treated by the volunteer, these volunteers are wary  
          of providing these volunteer services to their communities.   
          Although four other states, Alaska, Arizona, Oregon, and  
          Washington currently provide vision screening and eyeglass  
          fitting volunteers with limited liability from damages,  
          California has no such protection.

          This bill would provide immunity from damage liability to  
          nonprofit organizations, licensed optometrists,  
          ophthalmologists, and trained volunteers in order to encourage  
          these volunteers to provide greater access to vision screenings  
          and eyeglass fittings for individuals who would otherwise be  
          unable to afford such services. 

                                CHANGES TO EXISTING LAW
           
           Existing law  , the California Constitution, provides that a  
          person may not be deprived of life, liberty, or property without  
          due process of law or denied equal protection of the laws.   
          (Cal. Const., art. I, sec. 7.)  The California Constitution also  
          provides that no citizen, or class of citizen, shall be granted  
          privileges or immunities which, upon the same terms, shall not  
          be granted to all citizens.  (Cal. Const., art I, sec. 21.)

           Existing law  provides protection for all Californians from  
          another person's negligence.  (Civ. Code Sec. 1714.)

           Existing law  states legislative intent to create an environment  
          in which philanthropy and voluntarism in the health care field  
          and the vast benefits arising from it for the citizens of  
          California can be encouraged.  (Health & Saf. Code Sec. 101983.)

           Existing federal law  , the Volunteer Protection Act of 1997,  
          provides a limitation on liability for volunteers of nonprofit  
          organizations and governmental entities.  (42 U.S.C.S. Sec.  
          14500 et seq.)

           Existing law  provides immunity from liability to a director or  
          executive officer of a nonprofit public benefit corporation for  
          damages (other than those resulting from reckless or wanton  
          misconduct or gross or intentional negligence) if the act or  
          omission was done in good faith and within the scope of duty.    
          If the damages are not covered by a liability insurance policy,  
          the volunteer director or executive officer is not liable if it  
          can be established that all reasonable efforts were made in good  
          faith to obtain available liability insurance.  (Corp. Code Sec.  
                                                                      



          SB 724 (Emmerson)
          Page 3 of ?



          5239.)  Similar immunities are provided to unpaid directors and  
          officers of mutual benefit and nonprofit religious corporations.  
           (Corp. Code Sec. 5047.5.)

           This bill  would provide a qualified immunity from liability for  
          any damage or injury, except for injury resulting from gross  
          negligence or a willful act, on the part of a nonprofit  
          charitable organization that provides vision screenings and, if  
          applicable, provides donated or recycled glasses, or a  
          participating licensed optometrist, ophthalmologist, or trained  
          volunteer who works with such a nonprofit charitable  
          organization in the performance of vision screenings, if all of  
          the following conditions are met:
           the vision screening is provided to address ocular health  
            concerns and, if applicable, to provide a temporary solution  
            in the form of donated or recycled eyeglasses until the  
            patient can get a full examination and eyeglasses;
           the vision screening is not intended to replace a full ocular  
            health examination provided by a licensed optometrist or  
            ophthalmologist;
           the patient signs a waiver acknowledging that the services  
            provided are a temporary solution until the patient can get a  
            full examination by a licensed optometrist or ophthalmologist;
           each vision screening is supervised by an attending licensed  
            optometrist or ophthalmologist;
           the eyeglass prescription determinations and ocular health  
            recommendations are provided by an attending licensed  
            optometrist or ophthalmologist;
           a written prescription is not provided to the patient;
           the eyeglasses provided to the patients are a close or  
            approximate match, within tolerances allowed by the attending  
            licensed optometrist or ophthalmologist, to the prescription  
            determined during the vision screening;
           the vision screening and eyeglasses are provided without a  
            charge;
           the optometrist, ophthalmologist, or volunteer is authorized  
            by the nonprofit organization to provide the vision screening  
            and eyeglasses on behalf of the nonprofit organization and is  
            acting within the scope of his or her authorized  
            responsibilities and the guidelines of the nonprofit  
            charitable organization when providing the vision screening or  
            eyeglasses; and
           the nonprofit charitable organization provides procedural,  
            risk management, and quality control training, as applicable,  
            to the participating optometrist, ophthalmologist, or  
            volunteer who provides the vision screening or eyeglasses.
                                                                      



          SB 724 (Emmerson)
          Page 4 of ?




           This bill  would not provide immunity if an action is brought by  
          an officer of a state or local government pursuant to state or  
          local law or if the conduct of the nonprofit charitable  
          organization, optometrist, ophthalmologist, or volunteer  
          includes any of the following types of misconduct: (1) a crime  
          of violence; (2) a hate crime; (3) an act involving a sexual  
          offense; (4) an act involving misconduct in violation of federal  
          or state civil rights laws; or (5) an act performed while the  
          defendant was under the influence of drugs or alcohol.

           This bill  would define "nonprofit charitable organization" to  
          mean an organization exempt from federal income tax as an  
          organization described in Internal Revenue Code Section  
          501(c)(3).

           This bill  would define "vision screening" to mean a test or  
          examination of an individual using a portion of the usual  
          examination procedures in a comprehensive eye examination and  
          refraction, that are selected or directed by an attending  
          licensed optometrist or ophthalmologist, and are within the  
          guidelines of the nonprofit charitable organization.

                                        COMMENT
           
          1.  Stated need for the bill  
          
          The author writes:
          
            Current law does not address the criteria for vision  
            screenings or the distribution of used or recycled eyeglasses.  
             The Federal Volunteer Protection Act provides immunity from  
            liability for individuals providing volunteer services for  
            government or nonprofit entities as long as the volunteer does  
            not commit an act or omission that constitutes gross  
            negligence.  In general, the Volunteer Protection Act provides  
            that, if a volunteer meets certain criteria, he or she has a  
            complete defense to an action and has no liability. 

            This bill would specify the criteria for immunity to nonprofit  
            entities for vision screenings and associated distribution of  
            used or recycled eyeglasses.
               
          2.  Qualified immunity for vision screening volunteerism  

          This bill would provide a qualified immunity from liability for  
                                                                      



          SB 724 (Emmerson)
          Page 5 of ?



          a nonprofit charitable organization, licensed optometrist,  
          ophthalmologist, or trained volunteer, who works with the  
          nonprofit charitable organization, in the performance of vision  
          screenings.  

          Sponsor, the California Lions Friends in Sight, writes:  "The  
          California Lions Friends In Sight (FIS) organization currently  
          conducts approximately thirty (30) vision screenings per year  
          which includes helping approximately 8,000 patients.  This bill  
          would provide general guidelines of conducting a vision  
          screening and would enable [a] licensed optometrist,  
          ophthalmologist, and assisting trained volunteers to provide  
          no-cost services to those who cannot afford eye care or  
          eyeglasses."

          This bill is similar to the federal Volunteer Protection Act of  
          1997 (VPA) (42 U.S.C.S. Sec. 14500 et seq.), which provides a  
          variety of protections from liability to individuals who  
          volunteer for nonprofit organizations or government agencies,  
          principally insulating volunteers from actions for harm caused  
          by ordinary negligence (i.e., not caused by willful or criminal  
          conduct, gross negligence, reckless misconduct, or a conscious,  
          or flagrant indifference to the rights or safety of others).   
          VPA protection from civil liability does not apply to volunteers  
          acting outside the scope of their responsibility, volunteers  
          acting without a required license, certification, or  
          authorization, or harm caused by a motor vehicle.

          This bill would only provide immunity from liability for a  
          nonprofit organization, licensed optometrist, ophthalmologist,  
          or trained volunteer if all of the following qualifications are  
          met: 
           the vision screening is provided to address ocular health  
            concerns and, if applicable, to provide a temporary solution  
            in the form of donated or recycled eyeglasses until the  
            patient can get a full examination and eyeglasses;
           the vision screening is not intended to replace a full ocular  
            health examination;
           the patient signs a waiver acknowledging that the services  
            provided are a temporary solution until the patient can get a  
            full examination;
           each vision screening is supervised by an attending licensed  
            optometrist or ophthalmologist;
           the eyeglass prescription determinations and ocular health  
            recommendations are provided by an attending licensed  
            optometrist or ophthalmologist;
                                                                      



          SB 724 (Emmerson)
          Page 6 of ?



           a written prescription is not provided to the patient;
           the eyeglasses provided to the patients are a close or  
            approximate match, within tolerances allowed by the attending  
            licensed optometrist or ophthalmologist, to the prescription  
            determined during the vision screening;
           the vision screening and eyeglasses are provided without a  
            charge;
           the optometrist, ophthalmologist, or volunteer is authorized  
            by the nonprofit organization to provide the vision screening  
            and eyeglasses on behalf of the nonprofit organization and is  
            acting within the scope of his or her authorized  
            responsibilities and the guidelines of the nonprofit  
            charitable organization; and
           the nonprofit charitable organization provides procedural,  
            risk management, and quality control training, as applicable,  
            to the participating optometrist, ophthalmologist, or  
            volunteer who provides the vision screening or eyeglasses  
            (this provision would define who would be considered a  
            "trained volunteer" under this bill).

          Notably, this bill would not provide immunity from liability if  
          an action is brought by an officer of a state or local  
          government pursuant to state or local law or if the conduct of  
          the nonprofit charitable organization, optometrist,  
          ophthalmologist, or volunteer includes any of the following  
          types of misconduct: (1) a crime of violence; (2) a hate crime;  
          (3) an act involving a sexual offense; (4) an act involving  
          misconduct in violation of federal or state civil rights laws;  
          or (5) an act performed while the defendant was under the  
          influence of drugs or alcohol.

          In support, the Civil Justice Association of California (CJAC)  
          argues that this bill is consistent with federal law, which  
          recognizes that communities suffer from the withdrawal of  
          nonprofits and their volunteers due to liability concerns and  
          that it is in the interest of the country to have liability  
          reform for volunteers.  Further, CJAC notes that the "bill is  
          narrowly drafted and limits this protection to only those cases  
          where the screening and provision of eyeglasses (if needed) are  
          a temporary solution, the screening is supervised by a licensed  
          optometrist or ophthalmologist, the patient is aware he or she  
          needs a full examination and the services are provided free of  
          charge.    . . . [This bill] furthers the important policy of  
          encouraging the provision of charitable, much-needed social  
          services without fearing costly lawsuits." 

                                                                      



          SB 724 (Emmerson)
          Page 7 of ?



          3.  Equal protection under the Constitution
           
          The California Constitution provides that a person may not be  
          deprived of life, liberty, or property without due process of  
          law or denied equal protection of the laws.  (Cal. Const., art.  
          I, sec. 7.)   Further, the California Constitution provides that  
          no citizen, or class of citizen, shall be granted privileges or  
          immunities which, upon the same terms, are not granted to all  
          citizens.  (Cal. Const., art I, sec. 21.)  Additionally, Civil  
          Code Sec. 1714 provides protection for all Californians from  
          another person's negligence.  

          This bill would limit the ability of an injured person to seek  
          damages from a nonprofit organization, licensed optometrist,  
          ophthalmologist, or trained volunteer who provided free vision  
          screening services or donated eyeglasses, unless there was gross  
          negligence or a willful act.  In this way, a person receiving  
          these free services would have less protection under the law  
          than a person who had paid for these services.  

          Equal protection for individuals who are providing charitable  
          services has been analyzed by the California Supreme Court.  In  
          Malloy v. Fong (1939) 37 Cal.2d 356 and Silva v. Providence  
          Hospital (1939) 14 Cal.2d 762, the California Supreme Court  
          abolished charitable immunity in California on the basis that an  
          individual who "utilized a charitable institution (primarily  
          hospitals) could not be realistically said to have consented to  
          the charity's exemption from liability from negligence, nor  
          could the state interest in promoting charities be said  
          rationally to justify the withdrawal of protection from the  
          charity's beneficiaries.  Citing Civil Code section 1714, the  
          Malloy court observed that it is the general policy in  
          California to afford protection from negligence to everyone;  
          moreover, the court emphasized, 'that policy admits of no  
          exception based upon the objectives, however laudable of the  
          tort feasor.  (37 Cal.2d at p. 366.)  As the Silva court  
          declared:  'it is a principal of law as well as of morals that  
          men must be just before they are generous."  (14 Cal.2d at p.  
          776.)"  (Brown v. Merlo (1973) 8 Cal.3d 855, 870.)

              a.   Rational basis test  

            In Brown v. Merlo (1973) 8 Cal.3d 855, the California Supreme  
            Court, citing recent United States Supreme Court holdings that  
            "[a] classification 'must be reasonable, not arbitrary, and  
            must rest upon some ground of difference having a fair and  
                                                                      



          SB 724 (Emmerson)
          Page 8 of ?



            substantial relation to the object of the legislation, so that  
            all persons similarly circumstanced shall be treated alike.   
            [Citations omitted.]  Thus, when a statute provides that one  
            class shall receive different treatment from another, our  
            constitutional provisions demand more 'than nondiscriminatory  
            application with the class . . . [established] . . . . [They]  
            also [impose] a requirement of some rationality in the nature  
            of the class singled out.'"  (Id. at pp. 862-863.)

            Under this bill, people who received vision screening services  
            and donated eyeglasses would be a classification of  
            individuals who did not have the same protections against  
            damage and injury resulting from the negligent conduct of the  
            nonprofit organization, optometrist, ophthalmologist, or  
            volunteer.  Arguably, the state has multiple rational bases  
            for providing a qualified immunity for vision screening  
            volunteerism.  First, vision screening services and eyeglasses  
            typically are not provided by emergency service hospitals  
            where people of limited means may otherwise go for medical  
            services.  As such, there is a need to provide vision  
            screening and eyeglasses to individuals who would not  
            otherwise have access to these services.  Second,  
            philanthropic support for these services should be encouraged  
            so that these services are available to these individuals.   
            Third, philanthropy imbues members of the community with a  
            sense of pride in their volunteerism.  Fourth, philanthropy of  
            this nature pays for necessary expenditures that otherwise  
            would have to be paid by patients or by the government.

              b.   Legislative directives  

            The Brown court further held that "[i]n determining the scope  
            of the class singled out for special burdens or benefits, a  
            court cannot confine its view to the terms of the specific  
            statute under attack, but must judge the enactment's operation  
            against the background of other legislative, administrative  
            and judicial directives which govern the legal rights of  
            similarly situated persons."  (Brown v. Merlo, supra, 8 Cal.3d  
            at p. 862.)

            Existing state law provides a legislative directive to create  
            an environment in which philanthropy and voluntarism in the  
            health care field and the vast benefits arising from it for  
            the citizens of California can be encouraged.  (Health & Saf.  
            Code Sec. 101983.)  Further, this bill is modeled after a  
            federal legislative directive - the VPA, which provides  
                                                                      



          SB 724 (Emmerson)
          Page 9 of ?



            limitation on liability for nonprofit organization volunteers.  
             As under the VPA, this bill would provide a qualified  
            immunity from liability for volunteers who were acting within  
            the scope of the volunteer's responsibilities in the nonprofit  
            organization, were properly licensed or authorized by the  
            appropriate authorities, and the harm was not caused by  
            willful misconduct or gross negligence.   (See 42 U.S.C.S.  
            Sec. 14503(a).)

            In addition to (and authorized by) the provisions under the  
            VPA, this bill would require the nonprofit organization to  
            adhere to risk management procedures, including mandatory  
            training of volunteers.  (See 42 U.S.C.S. Sec. 14503(d).)   
            Further, the immunity would not apply if a civil action was  
            brought by an officer of a state or local government, nor  
            would the immunity apply if the volunteer's conduct  
            constituted a crime of violence, a hate crime, involved a  
            sexual offense, involved misconduct in violation of federal or  
            state civil rights laws, or where the volunteer was under the  
            influence of intoxicating alcohol or any drug at the time of  
            the misconduct.  (See 42 U.S.C.S. Sec. 14503(d)(3), (f).)

          In support of this bill, the California Association of  
          Nonprofits writes:

            Charitable organizations play crucial roles in providing  
            health care assistance, such as vision care, to communities in  
            need.  In particular, volunteer professionals such as  
            optometrists are essential to the delivery of these services.

            [SB 724] strikes the right balance between encouraging  
            volunteerism and the involvement of charitable organizations  
            by limiting liability for services performed within  
            appropriate procedural protocol, and ensuring that people  
            receiving free vision care are protected from instances of  
            negligence or misconduct.  We feel this is the right balance  
            to allow nonprofits to serve our communities and to encourage  
            community members to seek and receive these services.
            It is important to note that the Federal Volunteer Protection  
            Act does grant immunity from liability for individuals  
            providing volunteer services for government or nonprofit  
            entities as long as the volunteer does not commit an act or  
            omission that constitutes gross negligence.  However, current  
            law does not address the criteria used for vision screenings  
            or the distribution of used or recycled eyeglasses.  By  
            specifying this criteria for immunity, it will help encourage  
                                                                      



          SB 724 (Emmerson)
          Page 10 of ?



            licensed optometrists, ophthalmologists, and volunteers to  
            offer their services at vision screenings thereby increasing  
            access to care for Californians in need.

          4.  Other state laws providing liability immunity for vision  
            screening volunteers

           Four other states, Alaska, Arizona, Oregon, and Washington,  
          currently provide vision screening and eyeglass fitting  
          volunteers with limited liability from damages.
           In Alaska, a nonprofit organization is not liable for  
            distributing recycled used eyeglasses if:  (1) the eyeglasses  
            are distributed and fitted free of charge and the fitting  
            conforms, to the extent possible, with a written prescription  
                                                                            from a licensed physician or optometrist; and (2) the  
            organization obtains informed consent from the person  
            receiving the eyeglasses and provides the person receiving the  
            eyeglasses advance written notice of the immunity provided  
            under this section.  (Alaska Stat. Sec. 09.65.305.)
           Arizona provides a qualified immunity from damages to a health  
            professional who, within the professional's scope of practice,  
            provides previously owned prescription eyeglasses free of  
            charge through a charitable, nonprofit, or fraternal  
            organization is not liable for an injury to the recipient if  
            the recipient or the recipient's parent or legal guardian has  
            signed a medical malpractice release form and the injury is  
            not a direct result of the health professional's intentional  
            misconduct or gross negligence. (Ariz. Rev. Stat. Sec.  
            12-571.)  Legislation has been introduced this year to extend  
            the immunity to include care or screening services.  (See  
            Ariz. H.B. No. 2407, 51st Leg., 1st Reg. Sess. (2013).)
           Oregon provides a qualified immunity to a fraternal  
            organization that is also a charitable corporation, and any  
            other charitable corporation that is affiliated with the  
            fraternal organization, from damages arising out of providing  
            previously owned eyeglasses to a person if:  (1) the person is  
            at least 14 years of age; and (2) the eyeglasses are provided  
            to the person without charge.  This immunity applies to  
            eyeglasses only if the eyeglasses are provided by a licensed  
            optometrist or ophthalmologist who has personally examined the  
            person who will receive the eyeglasses and issued a  
            prescription for the eyeglasses or personally consulted with  
            the licensed optometrist or ophthalmologist who issued the  
            prescription for the eyeglasses.  (Or. Rev. Stats. 30.809.)
           Washington provides that a charitable organization is not  
            liable for any civil damages arising out of any act or  
                                                                      



          SB 724 (Emmerson)
          Page 11 of ?



            omission, other than acts or omissions constituting gross  
            negligence or willful or wanton misconduct, associated with  
            providing previously owned eyeglasses or hearing instruments  
            to a person if:  (1) the person is at least 14 years of age;  
            and (2) the eyeglasses or hearing instruments are provided to  
            the person without compensation or the expectation of  
            compensation.  This immunity from liability applies to  
            eyeglasses only if the eyeglasses are provided by a licensed  
            physician, optometrist, optician, or optician's optical  
            assistant who has personally examined the person who will  
            receive the eyeglasses or personally consulted with the  
            licensed physician or optometrist who examined the person who  
            will receive the eyeglasses.  (Rev. Code Wash. Sec. 4.24.800.)
           
           
           Support  :  California Association of Nonprofits; Civil Justice  
          Association of California

           Opposition  :  None Known

                                        HISTORY
           
           Source  :  California Lions Friends In Sight

           Related Pending Legislation  :  None Known

           Prior Legislation  :  None Known

                                   **************