Amended in Senate April 9, 2015

Senate Bill No. 622

Introduced by Senator Hernandez

February 27, 2015

begin delete An act to amend Section 2842 of the Business and Professions Code, relating to vocational nursing. end delete begin insert An act to amend Section 3041 of, to add Sections 3041.4, 3041.5, 3041.6, 3041.7, and 3041.8 to, and to repeal and add Sections 3041.1, 3041.2, and 3041.3 of, the Business and Professions Code, relating to optometry, and making an appropriation therefor. end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 622, as amended, Hernandez. begin delete Vocational nursing. end delete begin insert Optometry. end insert

begin insert

The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry, and 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. The act requires optometrists treating or diagnosing eye disease, as specified, to be held to the same standard of care to which physicians and surgeons and osteopathic physician and surgeons are held. The act makes a violation of any of its provisions a crime. All moneys collected pursuant to the act, except where otherwise provided, are deposited in the Optometry Fund and continuously appropriated to the board to carry out the act.

end insert begin insert

This bill would revise and recast those provisions. The bill would additionally define the practice of optometry as the provision of habilitative optometric services, and would authorize the board to allow optometrists to use nonsurgical technology to treat any authorized condition under the act. The bill would authorize an optometrist to use diagnostic pharmaceutical agents, as specified, including, but not limited to, oral and topical diagnostic pharmaceutical agents that are not controlled substances. The bill would authorize an optometrist to independently initiate and administer vaccines, as specified, for a person 3 years of age and older, if the optometrist meets certain requirements, including, but not limited to, that he or she is certified in basic life support for health care professionals. The bill would additionally authorize an optometrist certified to use therapeutic pharmaceutical agents to, among other things, be certified to use anterior segment lasers, as specified, and to be certified to perform specified minor procedures, as specified, if certain requirements are met.

end insert begin insert

The bill would require the board to charge a fee of not more than $150 to cover the reasonable regulatory cost of certifying an optometrist to use anterior segment lasers. Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.

end insert begin insert

Because a violation of the act is a crime, this bill would expand the scope of an existing crime and would, therefore, result in a state-mandated local program.

end insert begin insert

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.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert begin delete

The Vocational Nursing Practice Act provides for the licensure and regulation of the practice of vocational nursing by the Board of Vocational Nursing and Psychiatric Technicians within the Department of Consumer Affairs. The act requires the board to consist of 11 members, including one member that is a licensed vocational nurse or registered nurse who has had no less than 5 years’ experience as a teacher or administrator in an accredited school of vocational nursing.

end delete begin delete

This bill would require that the vocational nurse or registered nurse’s experience be in an accredited school of vocational nursing approved by the board.

end delete

Vote: majority. Appropriation:  begin delete no end delete begin insert yes end insert . Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 3041 of the end insert begin insert Business and Professions
Code end insert begin insert is amended to read: end insert

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
begin insert habilitative or end insert 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.

begin delete

(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, excluding the lacrimal gland, the lacrimal
drainage system, and the sclera in patients under 12 years of age.

(B) Ocular allergies of the anterior segment and adnexa.

(C) Ocular inflammation, nonsurgical in cause except when
comanaged with the treating physician and surgeon, limited to
inflammation resulting from traumatic iritis, peripheral corneal
inflammatory keratitis, episcleritis, and unilateral nonrecurrent
nongranulomatous idiopathic iritis in patients over 18 years of age.
Unilateral nongranulomatous idiopathic iritis recurring within one
year of the initial occurrence shall be referred to an
ophthalmologist. An optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if a patient
has a recurrent case of episcleritis within one year of the initial
occurrence. An optometrist shall consult with an ophthalmologist
or appropriate physician and surgeon if a patient has a recurrent
case of peripheral corneal inflammatory keratitis within one year
of the initial occurrence.

(D) Traumatic or recurrent conjunctival or corneal abrasions
and erosions.

(E) Corneal surface disease and dry eyes.

(F) Ocular pain, nonsurgical in cause except when comanaged
with the treating physician and surgeon, associated with conditions
optometrists are authorized to treat.

(G) Pursuant to subdivision (f), glaucoma in patients over 18
years of age, as described in subdivision (j).

(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 of the following
therapeutic pharmaceutical agents:

(1) Pharmaceutical agents as described in paragraph (5) of
subdivision (a), as well as topical miotics.

(2) Topical lubricants.

(3) Antiallergy agents. In using topical steroid medication for
the treatment of ocular allergies, an optometrist shall consult with
an ophthalmologist if the patient’s condition worsens 21 days after
diagnosis.

(4) Topical and oral anti-inflammatories. In using steroid
medication for:

(A) Unilateral nonrecurrent nongranulomatous idiopathic iritis
or episcleritis, an optometrist shall consult with an ophthalmologist
or appropriate physician and surgeon if the patient’s condition
worsens 72 hours after the diagnosis, or if the patient’s condition
has not resolved three weeks after diagnosis. If the patient is still
receiving medication for these conditions six weeks after diagnosis,
the optometrist shall refer the patient to an ophthalmologist or
appropriate physician and surgeon.

(B) Peripheral corneal inflammatory keratitis, excluding
Moorens and Terriens diseases, an optometrist shall consult with
an ophthalmologist or appropriate physician and surgeon if the
patient’s condition worsens 72 hours after diagnosis.

(C) Traumatic iritis, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the
patient’s condition worsens 72 hours after diagnosis and shall refer
the patient to an ophthalmologist or appropriate physician and
surgeon if the patient’s condition has not resolved one week after
diagnosis.

(5) Topical antibiotic agents.

(6) Topical hyperosmotics.

(7) Topical and oral antiglaucoma agents pursuant to the
certification process defined in subdivision (f).

(A) The optometrist shall refer the patient to an ophthalmologist
if requested by the patient or if angle closure glaucoma develops.

(B) If the glaucoma patient also has diabetes, the optometrist
shall consult with the physician treating the patient’s diabetes in
developing the glaucoma treatment plan and shall inform the
physician in writing of any changes in the patient’s glaucoma
medication.

(8) Nonprescription medications used for the rational treatment
of an ocular disorder.

(9) Oral antihistamines.

(10) Prescription oral nonsteroidal anti-inflammatory agents.

(11) Oral antibiotics for medical treatment of ocular disease.

(A) If the patient has been diagnosed with a central corneal ulcer
and the central corneal ulcer has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.

(B) If the patient has been diagnosed with preseptal cellulitis
or dacryocystitis and the condition has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.

(12) Topical and oral antiviral medication for the medical
treatment of the following: herpes simplex viral keratitis, herpes
simplex viral conjunctivitis, and periocular herpes simplex viral
dermatitis; and varicella zoster viral keratitis, varicella zoster viral
conjunctivitis, and periocular varicella zoster viral dermatitis.

(A) If the patient has been diagnosed with herpes simplex
keratitis or varicella zoster viral keratitis and the patient’s condition
has not improved seven days after diagnosis, the optometrist shall
refer the patient to an ophthalmologist. If a patient’s condition has
not resolved three weeks after diagnosis, the optometrist shall refer
the patient to an ophthalmologist.

(B) If the patient has been diagnosed with herpes simplex viral
conjunctivitis, herpes simplex viral dermatitis, varicella zoster
viral conjunctivitis, or varicella zoster viral dermatitis, and if the
patient’s condition worsens seven days after diagnosis, the
optometrist shall consult with an ophthalmologist. If the patient’s
condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.

(13) Oral analgesics that are not controlled substances.

(14) 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 Uniform
Controlled Substances Act (21 U.S.C. Sec. 801 et seq.). The use
of these agents shall be limited to three days, with a referral to an
ophthalmologist if the pain persists.

(d) In any case where this chapter requires that an optometrist
consult with an ophthalmologist, the optometrist shall maintain a
written record in the patient’s file of the information provided to
the ophthalmologist, the ophthalmologist’s response, and any other
relevant information. Upon the consulting ophthalmologist’s
request and with the patient’s consent, the optometrist shall furnish
a copy of the record to the ophthalmologist.

(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, with prior consultation with the treating
physician and surgeon.

(6) Treatment or removal of sebaceous cysts by expression.

(7) Administration of oral fluorescein to patients suspected as
having diabetic retinopathy.

(8) Use of an auto-injector to counter anaphylaxis.

(9) Ordering of 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.

(10) 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.

(11) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.

(12) 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) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva with any appropriate instrument other than a scalpel
or needle. Corneal foreign bodies shall be nonperforating, be no
deeper than the midstroma, and require no surgical repair upon
removal.

(14) 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 as confirmed by the
ophthalmologist. Any optometrist who graduated from an
accredited school of optometry on or after May 1, 2000, shall be
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 (j), 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) 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) 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), submission of proof of satisfactory
completion of the requirements for certification established by the
board pursuant to Section 3041.10.

(g) 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 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) An optometrist licensed under this chapter is subject to the
provisions of Section 2290.5 for purposes of practicing telehealth.

(j) For purposes of this chapter, “glaucoma” means either of the
following:

(1) All primary open-angle glaucoma.

(2) Exfoliation and pigmentary glaucoma.

(k) For purposes of this chapter, “adnexa” means ocular adnexa.

(l) 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.

end delete begin insert

(b) The State Board of Optometry shall, by regulation, establish
educational and examination requirements for licensure to ensure
the competence of optometrists to practice pursuant to this chapter.
Satisfactory completion of the required educational and
examination requirements shall be a condition for the issuance of
an original optometrist license or required certifications pursuant
to this chapter.

end insert begin insert

(c) The board may authorize optometrists to use nonsurgical
technology to treat a condition authorized by this chapter.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 3041.1 of the end insert begin insert Business and Professions Code end insert
begin insert is repealed. end insert

begin delete

3041.1.  

With respect to the practices set forth in subdivisions
(b), (d), and (e) of Section 3041, optometrists diagnosing or treating
eye disease shall be held to the same standard of care to which
physicians and surgeons and osteopathic physicians and surgeons
are held.

end delete

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 3041.1 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.1. end insert   

(a) (1) An optometrist who is certified to use
therapeutic pharmaceutical agents pursuant to this section 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 that is nonsurgical in cause, except
when comanaged with the treating physician and surgeon.

(D) Traumatic or recurrent conjunctival or corneal abrasions
and erosions.

(E) Corneal and conjunctival surface disease and dry eyes
disease.

(F) Ocular pain that is nonsurgical in cause, except when
comanaged with the treating physician and surgeon.

(G) Eyelid disorders, including, but not limited to, hypotrichosis
and blepharitis.

(2) For purposes of this section, “treat” means the use of
therapeutic pharmaceutical agents, as described in subdivision
(b), and the procedures described in subdivision (c).

(3) For purposes of this chapter, “adnexa” means ocular
adnexa.

(b) In diagnosing and treating the conditions listed in
subdivision (a), an optometrist certified to use therapeutic
pharmaceutical agents pursuant to this section may use all of the
following diagnostic and therapeutic pharmaceutical agents:

(1) Oral and topical diagnostic and therapeutic pharmaceutical
agents that are not controlled substances. The use of
pharmaceutical agents shall be limited to the use for which the
drug has been approved for marketing by the federal Food and
Drug Administration (FDA).

(2) Notwithstanding paragraph (1), an optometrist certified to
use therapeutic pharmaceutical agents may use a drug in a way
for which the drug has not been approved for marketing by the
FDA if all of the following requirements are met:

(A) The drug is approved by the FDA.

(B) The drug has been recognized for treatment of the condition
by either of the following:

(i) The American Hospital Formulary Service’s Drug
Information.

(ii) Two articles from major peer reviewed medical journals
that present data supporting the proposed off-label use or uses as
generally safe and effective, unless there is clear and convincing
contradictory evidence presented in a major peer reviewed medical
journal.

(3) Notwithstanding paragraph (1), 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.) may be
used. The use of these controlled substances shall be limited to
five days.

(c) An optometrist who is certified to use therapeutic
pharmaceutical agents pursuant to this section may also perform
all of the following:

(1) Corneal scraping with cultures.

(2) Debridement of corneal epithelia.

(3) Mechanical epilation.

(4) Collection of a blood specimen by finger prick method or
venipuncture for testing patients suspected of having diabetes.

(5) Suture removal, with prior consultation with the treating
health care provider.

(6) Treatment or removal of sebaceous cysts by expression.

(7) Administration of oral fluorescein to patients suspected as
having diabetic retinopathy.

(8) Use of an auto-injector to counter anaphylaxis.

(9) Ordering of clinical laboratory and imaging tests related
to the practice of optometry.

(10) A clinical laboratory test or examination classified as
waived under CLIA and related to the practice of optometry.

(11) Skin test to diagnose ocular allergies. Skin tests shall be
limited to the superficial lawyer of the skin.

(12) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.

(13) The prescription of therapeutic contact lenses, diagnostic
contact lenses, or biological or technological corneal devices.

(14) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva with any appropriate instrument other than a scalpel
or needle. Corneal foreign bodies shall be nonperforating, be no
deeper than the midstroma, and require no surgical repair upon
removal.

(15) 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 and confirmation
of 10 procedures under the supervision of an ophthalmologist or
optometrist who is certified in lacrimal irrigation and dilation.
Any optometrist who graduated from an accredited school of
optometry on or after May 1, 2000, shall be exempt from the
certification requirement contained in this paragraph.

(16) Use of mechanical lipid extraction of meibomian glands
and nonsurgical techniques.

(17) Notwithstanding subdivision (b), administration of
injections for the diagnoses or treatment of conditions of the eye
and adnexa, excluding intraorbital injections and injections
administered for cosmetic effect, provided that the optometrist has
satisfactorily received four hours of continuing education on
performing all injections authorized by this paragraph.

(d) In order to be certified to use therapeutic pharmaceutical
agents and authorized to diagnose and treat the conditions listed
in this section, an optometrist shall apply for a certificate from
the board and meet all requirements imposed by the board.

(e) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry prior to January 1,
1996, is licensed as an optometrist in California, and meets all of
the following requirements:

(1) Satisfactorily completes a didactic course of no less than
80 classroom hours in the diagnosis, pharmacological, and other
treatment and management of ocular disease provided by either
an accredited school of optometry in California or a recognized
residency review committee in ophthalmology in California.

(2) Completes a preceptorship of no less than 65 hours, during
a period of not less than two months nor more than one year, in
either an ophthalmologist’s office or an optometric clinic. The
training received during the preceptorship shall be on the
diagnosis, treatment, and management of ocular, systemic disease.
The preceptor shall certify completion of the preceptorship.
Authorization for the ophthalmologist to serve as a preceptor shall
be provided by an accredited school of optometry in California,
or by a recognized residency review committee in ophthalmology,
and the preceptor shall be licensed as an ophthalmologist in
California, board-certified in ophthalmology, and in good standing
with the Medical Board of California. The individual serving as
the preceptor shall schedule no more than three optometrist
applicants for each of the required 65 hours of the preceptorship
program. This paragraph shall not be construed to limit the total
number of optometrist applicants for whom an individual may
serve as a preceptor, and is intended only to ensure the quality of
the preceptorship by requiring that the ophthalmologist preceptor
schedule the training so that each applicant optometrist completes
each of the 65 hours of the preceptorship while scheduled with no
more than two other optometrist applicants.

(3) Successfully completes a minimum of 20 hours of
self-directed education.

(4) Passes the National Board of Examiners in Optometry’s
“Treatment and Management of Ocular Disease” examination or,
in the event this examination is no longer offered, its equivalent,
as determined by the State Board of Optometry.

(5) Passes the examination issued upon completion of the
80-hour didactic course required under paragraph (1) and
provided by the accredited school of optometry or residency
program in ophthalmology.

(6) When any or all of the requirements contained in paragraph
(1), (4), or (5) have been satisfied on or after July 1, 1992, and
before January 1, 1996, an optometrist shall not be required to
fulfill the satisfied requirements in order to obtain certification to
use therapeutic pharmaceutical agents. In order for this paragraph
to apply to the requirement contained in paragraph (5), the didactic
examination that the applicant successfully completed shall meet
equivalency standards, as determined by the board.

(7) Any optometrist who graduated from an accredited school
of optometry on or after January 1, 1992, and before January 1,
1996, shall not be required to fulfill the requirements contained
in paragraphs (1), (4), and (5).

(f) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry on or after January 1,
1996, who is licensed as an optometrist in California, and who
meets all of the following requirements:

(1) Passes the National Board of Examiners in Optometry’s
national board examination, or its equivalent, as determined by
the State Board of Optometry.

(2) Of the total clinical training required by a school of
optometry’s curriculum, successfully completed at least 65 of those
hours on the diagnosis, treatment, and management of ocular,
systemic disease.

(3) Is certified by an accredited school of optometry as
competent in the diagnosis, treatment, and management of ocular,
systemic disease to the extent authorized by this section.

(4) Is certified by an accredited school of optometry as having
completed at least 10 hours of experience with a board-certified
ophthalmologist.

(g) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who is an optometrist who
obtained his or her license outside of California if he or she meets
all of the requirements for an optometrist licensed in California
to be certified to use therapeutic pharmaceutical agents.

(1) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and graduated from an accredited
school of optometry prior to January 1, 1996, shall be required
to fulfill the requirements set forth in subdivision (e). In order for
the applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received at the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry in
California for persons who graduated before January 1, 1996.
For those out-of-state applicants who request that any of the
requirements contained in subdivision (e) be waived based on
fulfillment of the requirement in another state, if the board
determines that the completed requirement was equivalent to that
required in California, the requirement shall be waived.

(2) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and who graduated from an accredited
school of optometry on or after January 1, 1996, shall be required
to fulfill the requirements set forth in subdivision (f). In order for
the applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received by the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry for
persons who graduated on or after January 1, 1996. For those
out-of-state applicants who request that any of the requirements
contained in subdivision (f) be waived based on fulfillment of the
requirement in another state, if the board determines that the
completed requirement was equivalent to that required in
California, the requirement shall be waived.

(3) The State Board of Optometry shall decide all issues relating
to the equivalency of an optometrist’s education or training under
this subdivision.

(h) 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.

(i) Except as authorized by this chapter, 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 (c). This section
does not limit an optometrist’s authority to utilize diagnostic laser
and ultrasound technology within his or her scope of practice.

(j) 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.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 3041.2 of the end insert begin insert Business and Professions Code end insert
begin insert is repealed. end insert

begin delete

3041.2.  

(a) The State Board of Optometry shall, by regulation,
establish educational and examination requirements for licensure
to ensure the competence of optometrists to practice pursuant to
subdivision (a) of Section 3041. Satisfactory completion of the
educational and examination requirements shall be a condition for
the issuance of an original optometrist license under this chapter,
on and after January 1, 1980. Only those optometrists who have
successfully completed educational and examination requirements
as determined by the State Board of Optometry shall be permitted
the use of pharmaceutical agents specified by subdivision (a) of
Section 3041.

(b) Nothing in this section shall authorize an optometrist issued
an original optometrist license under this chapter before January
1, 1996, to use or prescribe therapeutic pharmaceutical agents
specified in subdivision (d) of Section 3041 without otherwise
meeting the requirements of Section 3041.3.

end delete

begin insert

begin insert SEC. 5. end insert   

end insert

begin insert Section 3041.2 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.2. end insert   

(a) For purposes of this chapter, “glaucoma” means
any of the following:

(1) All primary open-angle glaucoma.

(2) Exfoliation and pigmentary glaucoma.

(3) Increase in intraocular pressure caused by steroid
medication.

(b) An optometrist certified pursuant to Section 3041.1 shall be
certified for the treatment of glaucoma, as described in subdivision
(a), 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.

(4) For licensees who graduated from an accredited school of
optometry on or before May 1, 2008, and are not described in
paragraph (2) or (3), submission of proof of satisfactory completion
of the requirements for certification established by the board.

end insert

begin insert

begin insert SEC. 6. end insert   

end insert

begin insert Section 3041.3 of the end insert begin insert Business and Professions Code end insert
begin insert is repealed. end insert

begin delete

3041.3.  

(a) In order to be certified to use therapeutic
pharmaceutical agents and authorized to diagnose and treat the
conditions listed in subdivisions (b), (d), and (e) of Section 3041,
an optometrist shall apply for a certificate from the board and meet
all requirements imposed by the board.

(b) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry prior to January 1, 1996,
is licensed as an optometrist in California, and meets all of the
following requirements:

(1) Satisfactorily completes a didactic course of no less than 80
classroom hours in the diagnosis, pharmacological, and other
treatment and management of ocular disease provided by either
an accredited school of optometry in California or a recognized
residency review committee in ophthalmology in California.

(2) Completes a preceptorship of no less than 65 hours, during
a period of not less than two months nor more than one year, in
either an ophthalmologist’s office or an optometric clinic. The
training received during the preceptorship shall be on the diagnosis,
treatment, and management of ocular, systemic disease. The
preceptor shall certify completion of the preceptorship.
Authorization for the ophthalmologist to serve as a preceptor shall
be provided by an accredited school of optometry in California,
or by a recognized residency review committee in ophthalmology,
and the preceptor shall be licensed as an ophthalmologist in
California, board-certified in ophthalmology, and in good standing
with the Medical Board of California. The individual serving as
the preceptor shall schedule no more than three optometrist
applicants for each of the required 65 hours of the preceptorship
program. This paragraph shall not be construed to limit the total
number of optometrist applicants for whom an individual may
serve as a preceptor, and is intended only to ensure the quality of
the preceptorship by requiring that the ophthalmologist preceptor
schedule the training so that each applicant optometrist completes
each of the 65 hours of the preceptorship while scheduled with no
more than two other optometrist applicants.

(3) Successfully completes a minimum of 20 hours of
self-directed education.

(4) Passes the National Board of Examiners in Optometry’s
“Treatment and Management of Ocular Disease” examination or,
in the event this examination is no longer offered, its equivalent,
as determined by the State Board of Optometry.

(5) Passes the examination issued upon completion of the
80-hour didactic course required under paragraph (1) and provided
by the accredited school of optometry or residency program in
ophthalmology.

(6) When any or all of the requirements contained in paragraph
(1), (4), or (5) have been satisfied on or after July 1, 1992, and
before January 1, 1996, an optometrist shall not be required to
fulfill the satisfied requirements in order to obtain certification to
use therapeutic pharmaceutical agents. In order for this paragraph
to apply to the requirement contained in paragraph (5), the didactic
examination that the applicant successfully completed shall meet
equivalency standards, as determined by the board.

(7) Any optometrist who graduated from an accredited school
of optometry on or after January 1, 1992, and before January 1,
1996, shall not be required to fulfill the requirements contained in
paragraphs (1), (4), and (5).

(c) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry on or after January 1,
1996, who is licensed as an optometrist in California, and who
meets all of the following requirements:

(1) Passes the National Board of Examiners in Optometry’s
national board examination, or its equivalent, as determined by
the State Board of Optometry.

(2) Of the total clinical training required by a school of
optometry’s curriculum, successfully completed at least 65 of those
hours on the diagnosis, treatment, and management of ocular,
systemic disease.

(3) Is certified by an accredited school of optometry as
competent in the diagnosis, treatment, and management of ocular,
systemic disease to the extent authorized by this section.

(4) Is certified by an accredited school of optometry as having
completed at least 10 hours of experience with a board-certified
ophthalmologist.

(d) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who is an optometrist who
obtained his or her license outside of California if he or she meets
all of the requirements for an optometrist licensed in California to
be certified to use therapeutic pharmaceutical agents.

(1) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and graduated from an accredited
school of optometry prior to January 1, 1996, shall be required to
fulfill the requirements set forth in subdivision (b). In order for
the applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received at the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry in
California for persons who graduate before January 1, 1996. For
those out-of-state applicants who request that any of the
requirements contained in subdivision (b) be waived based on
fulfillment of the requirement in another state, if the board
determines that the completed requirement was equivalent to that
required in California, the requirement shall be waived.

(2) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and who graduated from an accredited
school of optometry on or after January 1, 1996, shall be required
to fulfill the requirements set forth in subdivision (c). In order for
the applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received by the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry for
persons who graduate on or after January 1, 1996. For those
out-of-state applicants who request that any of the requirements
contained in subdivision (c) be waived based on fulfillment of the
requirement in another state, if the board determines that the
completed requirement was equivalent to that required in
California, the requirement shall be waived.

(3) The State Board of Optometry shall decide all issues relating
to the equivalency of an optometrist’s education or training under
this subdivision.

end delete

begin insert

begin insert SEC. 7. end insert   

end insert

begin insert Section 3041.3 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.3. end insert   

(a) For the purposes of this chapter, “anterior segment
laser” means any of the following:

(1) Therapeutic lasers appropriate for treatment of glaucoma.

(2) Notwithstanding subdivision (a) of Section 3041.2,
peripheral iridotomy for the prophylactic treatment of angle
closure glaucoma.

(3) Therapeutic lasers used for posterior capsulotomy secondary
to cataract surgery.

(b) An optometrist certified to treat glaucoma pursuant to
Section 3041.2 shall be additionally certified for the use of anterior
segment lasers after submitting proof of satisfactory completion
of a course that is approved by the board, provided by an
accredited school of optometry, and developed in consultation
with an ophthalmologist who has experience educating optometric
students.

(1) The board-approved course shall be a minimum of 16 hours
in length, and include a test for competency of the following:

(A) Laser physics, hazards, and safety.

(B) Biophysics of laser.

(C) Laser application in clinical optometry.

(D) Laser tissue interactions.

(E) Laser indications, contraindications, and potential
complications.

(F) Gonioscopy.

(G) Laser therapy for open-angle glaucoma.

(H) Laser therapy for angle closure glaucoma.

(I) Posterior capsulotomy.

(J) Common complications of the lids, lashes, and lacrimal
system.

(K) Medicolegal aspects of anterior segment procedures.

(L) Peripheral iridotomy.

(M) Laser trabeculoplasty.

(2) The school of optometry shall require each applicant for
certification to perform a sufficient number of anterior segment
laser procedures to verify that the applicant has demonstrated
competency to practice independently. At a minimum, each
applicant shall complete 14 anterior segment laser procedures on
live humans.

(c) The board, by regulation, shall set the fee for issuance and
renewal of a certificate authorizing the use of anterior segment
lasers at an amount no higher than the reasonable cost of
regulating anterior segment laser certified optometrists pursuant
to this section. The fee shall not exceed one hundred fifty dollars
($150).

end insert

begin insert

begin insert SEC. 8. end insert   

end insert

begin insert Section 3041.4 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.4. end insert   

(a) For the purposes of this chapter, “minor
procedure” means either of the following:

(1) Removal, destruction, or drainage of lesions of the eyelid
and adnexa clinically evaluated by the optometrist to be
noncancerous, not involving the eyelid margin, lacrimal supply
or drainage systems, no deeper than the orbicularis muscle, and
smaller than five millimeters in diameter.

(2) Closure of a wound resulting from a procedure described
in paragraph (1).

(b) An optometrist certified to treat glaucoma pursuant to
Section 3041.2 shall be additionally certified to perform minor
procedures after submitting proof of satisfactory completion of a
course that is approved by the board, provided by an accredited
school of optometry, and developed in consultation with an
ophthalmologist who has experience teaching optometric students.

(1) The board-approved course shall be a minimum of 32 hours
in length and include a test for competency of the following:

(A) Minor surgical procedures.

(B) Overview of surgical instruments, asepsis, and the state and
federal Occupational Safety and Health Administrations.

(C) Surgical anatomy of the eyelids.

(D) Emergency surgical procedures.

(E) Chalazion management.

(F) Epilumeninesence microscopy.

(G) Suture techniques.

(H) Local anesthesia techniques and complications.

(I) Anaphylaxsis and other office emergencies.

(J) Radiofrequency surgery.

(K) Postoperative wound care.

(2) The school of optometry shall require each applicant for
certification to perform a sufficient number of minor procedures
to verify that the applicant has demonstrated competency to
practice independently. At a minimum, each applicant shall
complete five minor procedures on live humans.

end insert

begin insert

begin insert SEC. 9. end insert   

end insert

begin insert Section 3041.5 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.5. end insert   

(a) An optometrist may independently initiate and
administer vaccines listed on the routine immunization schedules
recommended by the federal Advisory Committee on Immunization
Practices (ACIP), in compliance with individual ACIP vaccine
recommendations, and published by the federal Centers for Disease
Control and Prevention (CDC) for persons three years of age and
older.

(b) In order to initiate and administer an immunization
described in subdivision (a), an optometrist shall do all of the
following:

(1) 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.

(2) Be certified in basic life support for health care
professionals.

(3) 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.

end insert

begin insert

begin insert SEC. 10. end insert   

end insert

begin insert Section 3041.6 is added to the end insert begin insert Business and
Professions Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.6. end insert   

An optometrist licensed under this chapter is subject
to the provisions of Section 2290.5 for purposes of practicing
telehealth.

end insert

begin insert

begin insert SEC. 11. end insert   

end insert

begin insert Section 3041.7 is added to the end insert begin insert Business and
Professions Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.7. end insert   

Optometrists diagnosing or treating eye disease 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 when a
situation or condition occurs that is beyond the optometrist’s scope
of practice.

end insert

begin insert

begin insert SEC. 12. end insert   

end insert

begin insert Section 3041.8 is added to the end insert begin insert Business and
Professions Code end insert begin insert , to read: end insert

begin insert

begin insert 3041.8. end insert   

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 to
test, demonstrate, and evaluate expanded roles for optometrists
in the performance of management and treatment of diabetes
mellitus, hypertension, and hypercholesterolemia.

end insert

begin insert

begin insert SEC. 13. end insert   

end insert begin insert

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.

end insert

begin delete

SECTION 1.  

Section 2842 of the Business and Professions
Code is amended to read:

2842.  

(a) Each member of the board shall be a citizen of the
United States and a resident of the State of California. The board
shall have the following composition:

(1) Two members shall be duly licensed vocational nurses who
have been licensed for a period of not less than three years prior
to appointment.

(2) Two members shall be licensed psychiatric technicians, each
of whom shall have had not less than five years’ experience in a
psychiatric hospital, or in a psychiatric unit of a hospital licensed
by the State Department of Health Services, or a private institution
licensed by the State Department of Health Services.

(3) One member shall be a licensed vocational nurse or
registered nurse who shall have had not less than five years’
experience as a teacher or administrator in an accredited school
of vocational nursing approved by the board.

(4) Six members shall be public members who are not licentiates
of the board or any other board under this division or of any board
referred to in Sections 1000 and 3600.

(b) No person may serve as a member of the board for more
than two consecutive terms.

(c) Per diem and expenses of members of the board who are
licensed psychiatric technicians shall be paid solely from revenues
received pursuant to Chapter 10 (commencing with Section 4500)
of Division 2.

end delete