Amended in Senate May 4, 2015

Amended in Senate April 9, 2015

Senate Bill No. 622

Introduced by Senator Hernandez

February 27, 2015

An act to amend begin delete Section end delete begin insert Sections end insert 3041 begin insert and 3110 end insert 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.

LEGISLATIVE COUNSEL’S DIGEST

SB 622, as amended, Hernandez. Optometry.

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. begin insert The act requires an optometrist, in certain circumstances, to refer a patient to an opthamologist or a physician and surgeon, including when a patient has been diagnosed with a central corneal ulcer and the central corneal ulcer has not improved within 48 hours of the diagnosis. end insert 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.

This bill would revise and recast those provisions. begin insert The bill would delete certain requirements that an optometrist refer a patient to an opthamologist or a physician and surgeon, including when a patient has been diagnosed with a central corneal ulcer and the central corneal ulcer has not improved within 48 hours of the diagnosis. end insert 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 begin insert additionally end insert authorize an optometrist begin insert certified end insert to use begin delete diagnostic end delete begin insert therapeutic end insert pharmaceutical begin delete agents, as specified, including, but not limited to, oral and topical diagnostic pharmaceutical agents that are not controlled substances. end delete begin insert agents to collect a blood specimen by finger prick method, to perform skin tests, as specified, to diagnose ocular allergies, and to use mechanical lipid extraction of meibomian glands and nonsurgical techniques. end insert The bill would begin delete 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, end delete begin insert require the board to grant an optometrist certified to treat glaucoma a certificate for the use of specified immunizations if certain conditions are met, including, among others, end insert that begin delete he or she end delete begin insert the optometrist end insert is certified in basic life begin delete support for health care professionals. end delete begin insert support. end insert 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.

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 begin delete lasers. end delete begin insert lasers, a fee of not more than $150 to cover the reasonable regulatory cost of certifying an optometrist to use minor procedures, and end insert begin insert a fee of not more than $100 to cover the reasonable regulatory cost of certifying an optometrist to use immunizations. end insert Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.

begin insert

Existing law establishes the Office of Statewide Health Planning and Development, which is vested with all the duties, powers, responsibilities, and jurisdiction of the State Department of Public Health relating to health planning and research development.

end insert begin insert

This bill would declare the intent of the Legislature that the Office of Statewide Health Planning 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

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.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

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

Vote: majority. Appropriation: yes. Fiscal committee: yes. State-mandated local program: yes.

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

SECTION 1.  

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

3041.  

(a) The practice of optometry includes the prevention
and diagnosis of disorders and dysfunctions of the visual system,
and the treatment and management of certain disorders and
dysfunctions of the visual system, as well as the provision of
habilitative or rehabilitative optometric services, and is the doing
of any or all of the following:

(1) The examination of the human eye or eyes, or its or their
appendages, and the analysis of the human vision system, either
subjectively or objectively.

(2) The determination of the powers or range of human vision
and the accommodative and refractive states of the human eye or
eyes, including the scope of its or their functions and general
condition.

(3) The prescribing or directing the use of, or using, any optical
device in connection with ocular exercises, visual training, vision
training, or orthoptics.

(4) The prescribing of contact and spectacle lenses for, or the
fitting or adaptation of contact and spectacle lenses to, the human
eye, including lenses that may be classified as drugs or devices by
any law of the United States or of this state.

(5) The use of topical pharmaceutical agents for the purpose of
the examination of the human eye or eyes for any disease or
pathological condition.

(b) 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 begin delete chapter. end delete
begin insert chapter, except as specified in Section 3041.3 related to the use
of anterior segment lasers and in Section 3041.4 related to minor
procedures. end insert 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.

(c) The board may begin delete authorize end delete begin insert promulgate regulations authorizing end insert
optometrists to use begin insert noninvasive, end insert nonsurgical technology to treat a
condition authorized by this chapter. begin insert The board shall require a
licensee to take a minimum of four hours of education courses on
the new technology and perform an appropriate number of
complete clinical procedures on live human patients to qualify to
use each new technology authorized by the board pursuant to this
subdivision. end insert

SEC. 2.  

Section 3041.1 of the Business and Professions Code
is repealed.

SEC. 3.  

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

3041.1.  

(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.

begin delete

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

end delete begin insert

(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.

end insert

(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)  begin delete Eyelid disorders, including, but not limited to, hypotrichosis
and blepharitis. end delete begin insert Hypotrichosis and blepharitis. end insert

(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
begin delete diagnostic and end delete therapeutic pharmaceutical agents:

begin delete

(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.

end delete begin insert

(1) Topical pharmaceutical agents for the purpose of the
examination of the human eye or eyes for any disease or
pathological condition, including, but not limited to, topical
miotics.

end insert begin insert

(2) Topical lubricants.

end insert begin insert

(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.

end insert begin insert

(4) Topical and oral anti-inflammatories.

end insert begin insert

(5) Topical antibiotic agents.

end insert begin insert

(6) Topical hyperosmotics.

end insert begin insert

(7) Topical and oral antiglaucoma agents pursuant to the
certification process defined in Section 3041.2.

end insert begin insert

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

end insert begin insert

(9) Oral antihistamines.

end insert begin insert

(10) Prescription oral nonsteroidal anti-inflammatory agents.

end insert begin insert

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

end insert begin insert

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

end insert begin insert

(13) Oral analgesics that are not controlled substances.

end insert begin insert

(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 five days, with a referral to an ophthalmologist if the
pain persists.

end insert

(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.

begin delete

(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.

end delete begin insert

(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 the appropriate
physician and surgeon.

end insert begin insert

(10) A clinical laboratory test or examination classified as
waived under the Clinical Laboratory Improvement Amendments
of 1988 (CLIA)(42 U.S.C. Sec. 263a; Public Law 100-578) or any
regulations adopted pursuant to CLIA, and that are necessary for
the diagnosis of conditions and diseases of the eye or adnexa, or
if otherwise specifically authorized by this chapter.

end insert

(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 begin delete devices. end delete
begin insert devices that diagnose or treat a condition authorized under this
chapter. end insert

(14) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva with any appropriate instrument other than a begin delete scalpel
or needle. end delete begin insert scalpel. end insert 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.

begin delete

(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.

end delete

(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.

SEC. 4.  

Section 3041.2 of the Business and Professions Code
is repealed.

SEC. 5.  

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

3041.2.  

(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 begin delete medication. end delete
begin insert medication prescribed by the optometrist. end insert

begin insert

(4) Increase in intraocular pressure caused by steroid
medication not prescribed by the optometrist, after consultation
and treatment approval by the prescribing physician.

end insert

(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.

SEC. 6.  

Section 3041.3 of the Business and Professions Code
is repealed.

SEC. 7.  

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

3041.3.  

(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.
begin insert The board shall issue a certificate pursuant to this section only to
an optometrist that has graduated from an approved school of
optometry. end insert

(1) The board-approved course shall be begin delete a minimum of 16 end delete begin insert at
least 25 end insert 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 begin insert complete end insert anterior
segment laser procedures to verify that the applicant has
demonstrated competency to practice independently. At a
minimum, each applicant shall complete begin delete 14 end delete begin insert 24 end insert anterior segment
laser procedures on live begin delete humans. end delete begin insert humans as follows: end insert

begin insert

(A) Eight YAG capsulotomy procedures.

end insert begin insert

(B) Eight laser trabeculoplasty procedures.

end insert begin insert

(C) Eight peripheral iridotomy procedures.

end insert

(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).

begin insert

(d) An optometrist certified to use anterior segment lasers
pursuant to this section shall complete four hours of continuing
education on anterior segment lasers as part of the required 50
hours of continuing education required to be completed every two
years on the diagnosis, treatment, and management of glaucoma.

end insert

SEC. 8.  

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

3041.4.  

(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).

begin insert

(3) Administration of injections for the diagnoses or treatment
of conditions of the eye and adnexa authorized by this chapter,
excluding intraorbital injections and injections administered for
cosmetic effect.

end insert begin insert

(4) “Minor procedures” does not include blepharoplasty or
other cosmetic surgery procedures that reshape normal structures
of the body in order to improve appearance and self-esteem.

end insert

(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.
begin insert The board shall issue a certificate pursuant to this section only to
an optometrist that has graduated from an approved school of
optometry. end insert

(1) The board-approved course shall be begin delete a minimum of 32 hours end delete
begin insert at least 25 hours end insert 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) Epiluminescence microscopy.

(G) Suture techniques.

(H) Local anesthesia techniques and complications.

(I) Anaphylaxsis and other office emergencies.

(J) Radiofrequency surgery.

(K) Postoperative wound care.

begin insert

(L) Injection techniques.

end insert

(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 begin insert perform
32 end insert complete begin delete five end delete minor procedures on live humans.

begin insert

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

end insert begin insert

(d) An optometrist certified to perform minor procedures
pursuant to Section 3041.1 shall complete five hours of continuing
education on the diagnosis, treatment, and management of lesions
of the eyelid and adnexa as part of the 50 hours of continuing
education required every two years in Section 3059.

end insert

begin delete

SEC. 9.  

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

3041.5.  

(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 delete

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) The board shall grant to an optometrist a
certificate for the use of immunizations described in subdivision
(b), if the optometrist is certified pursuant to Section 3041.2 and
after the optometrist meets all of the following requirements:

(1) Completes an immunization training program endorsed by
the federal Centers for Disease Control (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.

(2) Is certified in basic life support.

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

(b) For the purposes of this section, “immunization” means the
administration of immunizations for influenza, herpes zoster virus,
and pneumococcus in compliance with individual Advisory
Committee on Immunization Practices (ACIP) vaccine
recommendations published by the CDC for persons 18 years of
age or older.

(c) The board, by regulation, shall set the fee for issuance and
renewal of a certificate for the use of immunizations at the
reasonable cost of regulating immunization certified optometrists
pursuant to this section. The fee shall not exceed one hundred
dollars ($100).

end insert

SEC. 10.  

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

3041.6.  

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

SEC. 11.  

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

3041.7.  

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.

SEC. 12.  

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

3041.8.  

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.

begin insert

begin insert SEC. 13. end insert   

end insert

begin insert Section 3110 of the end insert begin insert Business and Professions Code end insert
begin insert is amended to read: end insert

3110.  

The board may take action against any licensee who is
charged with unprofessional conduct, and may deny an application
for a license if the applicant has committed unprofessional conduct.
In addition to other provisions of this article, unprofessional
conduct includes, but is not limited to, the following:

(a) Violating or attempting to violate, directly or indirectly
assisting in or abetting the violation of, or conspiring to violate
any provision of this chapter or any of the rules and regulations
adopted by the board pursuant to this chapter.

(b) Gross negligence.

(c) Repeated negligent acts. To be repeated, there must be two
or more negligent acts or omissions.

(d) Incompetence.

(e) The commission of fraud, misrepresentation, or any act
involving dishonesty or corruption, that is substantially related to
the qualifications, functions, or duties of an optometrist.

(f) Any action or conduct that would have warranted the denial
of a license.

(g) The use of advertising relating to optometry that violates
Section 651 or 17500.

(h) Denial of licensure, revocation, suspension, restriction, or
any other disciplinary action against a health care professional
license by another state or territory of the United States, by any
other governmental agency, or by another California health care
professional licensing board. A certified copy of the decision or
judgment shall be conclusive evidence of that action.

(i) Procuring his or her license by fraud, misrepresentation, or
mistake.

(j) Making or giving any false statement or information in
connection with the application for issuance of a license.

(k) Conviction of a felony or of any offense substantially related
to the qualifications, functions, and duties of an optometrist, in
which event the record of the conviction shall be conclusive
evidence thereof.

(l) Administering to himself or herself any controlled substance
or using any of the dangerous drugs specified in Section 4022, or
using alcoholic beverages to the extent, or in a manner, as to be
dangerous or injurious to the person applying for a license or
holding a license under this chapter, or to any other person, or to
the public, or, to the extent that the use impairs the ability of the
person applying for or holding a license to conduct with safety to
the public the practice authorized by the license, or the conviction
of a misdemeanor or felony involving the use, consumption, or
self-administration of any of the substances referred to in this
subdivision, or any combination thereof.

(m) (1) Committing or soliciting an act punishable as a sexually
related crime, if that act or solicitation is substantially related to
the qualifications, functions, or duties of an optometrist.

(2) Committing any act of sexual abuse, misconduct, or relations
with a patient. The commission of and conviction for any act of
sexual abuse, sexual misconduct, or attempted sexual misconduct,
whether or not with a patient, shall be considered a crime
substantially related to the qualifications, functions, or duties of a
licensee. This paragraph shall not apply to sexual contact between
any person licensed under this chapter and his or her spouse or
person in an equivalent domestic relationship when that licensee
provides optometry treatment to his or her spouse or person in an
equivalent domestic relationship.

(3) Conviction of a crime that requires the person to register as
a sex offender pursuant to Chapter 5.5 (commencing with Section
290) of Title 9 of Part 1 of the Penal Code. A conviction within
the meaning of this paragraph means a plea or verdict of guilty or
a conviction following a plea of nolo contendere. A conviction
described in this paragraph shall be considered a crime substantially
related to the qualifications, functions, or duties of a licensee.

(n) Repeated acts of excessive prescribing, furnishing, or
administering of controlled substances or dangerous drugs specified
in Section 4022, or repeated acts of excessive treatment.

(o) Repeated acts of excessive use of diagnostic or therapeutic
procedures, or repeated acts of excessive use of diagnostic or
treatment facilities.

(p) The prescribing, furnishing, or administering of controlled
substances or drugs specified in Section 4022, or treatment without
a good faith prior examination of the patient and optometric reason.

(q) The failure to maintain adequate and accurate records
relating to the provision of services to his or her patients.

(r) Performing, or holding oneself out as being able to perform,
or offering to perform, any professional services beyond the scope
of the license authorized by this chapter.

(s) The practice of optometry without a valid, unrevoked,
unexpired license.

(t) The employing, directly or indirectly, of any suspended or
unlicensed optometrist to perform any work for which an optometry
license is required.

(u)  Permitting another person to use the licensee’s optometry
license for any purpose.

(v) Altering with fraudulent intent a license issued by the board,
or using a fraudulently altered license, permit certification or any
registration issued by the board.

(w) Except for good cause, the knowing failure to protect
patients by failing to follow infection control guidelines of the
board, thereby risking transmission of bloodborne infectious
diseases from optometrist to patient, from patient to patient, or
from patient to optometrist. In administering this subdivision, the
board shall consider the standards, regulations, and guidelines of
the State Department of Public Health developed pursuant to
Section 1250.11 of the Health and Safety Code and the standards,
guidelines, and regulations pursuant to the California Occupational
Safety and Health Act of 1973 (Part 1 (commencing with Section
6300) of Division 5 of the Labor Code) for preventing the
transmission of HIV, hepatitis B, and other bloodborne pathogens
in health care settings. As necessary, the board may consult with
the Medical Board of California, the Board of Podiatric Medicine,
the Board of Registered Nursing, and the Board of Vocational
Nursing and Psychiatric Technicians, to encourage appropriate
consistency in the implementation of this subdivision.

(x) Failure or refusal to comply with a request for the clinical
records of a patient, that is accompanied by that patient’s written
authorization for release of records to the board, within 15 days
of receiving the request and authorization, unless the licensee is
unable to provide the documents within this time period for good
cause.

(y)  Failure to refer a patient to an appropriate begin delete physician in either
of the following circumstances: end delete

begin delete (1) end delete begin delete   end delete begin delete Where end delete begin insert physician if end insert an examination of the eyes indicates a
substantial likelihood of any pathology that requires the attention
of that physician.

begin delete

(2) As required by subdivision (c) of Section 3041.

end delete

begin delete SEC. 13. end delete
begin insert SEC. 14. end 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.