BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 622|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
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THIRD READING
Bill No: SB 622
Author: Hernandez (D)
Amended: 5/4/15
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 4/27/15
AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/18/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Optometry
SOURCE: Author
DIGEST: This bill expands the scope of practice for
optometrists to include expanded ability to order the Clinical
Laboratory Improvement Amendments (CLIA)-waived tests, use
noninvasive, nonsurgical technology to treat a condition
authorized by the Optometric Act (Act), perform laser and minor
procedures, and administer certain vaccines.
ANALYSIS:
Existing law:
1) Establishes the State Board of Optometry (Board) within the
Department of Consumer Affairs, which licenses optometrists
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and regulates the practice of optometry. (Business and
Professions Code (BPC) § 3010.5)
2) Defines the practice of optometry as follows:
a) The prevention and diagnosis of disorders and
dysfunctions of the visual system;
b) Treatment and management of certain disorders and
dysfunctions of the visual systems;
c) Provision of rehabilitative optometric services;
d) Examination of the human eyes;
e) Determination of the powers or range of human vision;
f) The prescribing or directing the use of any optical
device in connection with ocular exercises, visual
training, vision training or orthoptics;
g) Prescribing of contact lenses and glasses; and
h) The use of topical pharmaceutical agents for the
purpose of the examination of the human eye or eyes for
any disease or pathological condition.
(BPC § 3041)
This bill:
1) Authorizes the Board to establish educational and
examination requirements by regulation for licensure to
ensure the competence of optometrists to practice pursuant to
the Act, except as specified in the sections related to
certification for minor procedures and lasers.
2) Adds "habilitative services" to the definition of the
practice of optometry.
3) Authorizes the Board to promulgate regulations authorizing
optometrists to use noninvasive, nonsurgical technology to
treat a condition authorized by the Act. To qualify to use
each new technology authorized, the Board shall require a
licensee to take a minimum of four hours' education and
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perform an appropriate number of complete clinical procedures
on live human patients.
4) Removes referral requirements related to the treatment of
ocular inflammation, as specified.
5) Allows an optometrist to treat hypotrichosis and
blepharitis.
6) Adds "conjunctival" to the types of surface diseases that an
optometrist who is certified to use therapeutic
pharmaceutical agents may diagnose and treat.
7) Removes exceptions to the types of infections of the
anterior segment and adnexa that an optometrist may treat.
8) Removes referral protocols for the use of certain drugs.
9) Expands ability to order CLIA waived tests.
10) Extends from three to five days the time that
codeine with compounds and hydrocodone with specified
compounds may be used.
11) Allows an optometrist to collect a blood specimen
by finger prick method.
12) Permits an optometrist to perform a skin test on
the superficial layer of the skin to diagnose ocular
allergies.
13) Allows an optometrist to prescribe biological or
technological corneal devices.
14) Allows an optometrist to use a needle to remove
objects from the cornea, eyelid, and conjunctiva.
15) Authorizes an optometrist to use mechanical lipid
extraction on meibomian glands and nonsurgical techniques.
16) Authorizes an optometrist, as part of additional
"minor procedures," to administer injections for the
diagnosis or treatment of conditions of the eye and adnexa
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authorized by the Act, excluding intraorbital injections and
injections administered for cosmetic effect.
17) Expands the definition of glaucoma by including
that caused by an "increase in intraocular pressure caused by
steroid medication," but specifies that an optometrist may
only treat this type of glaucoma if the optometrist has
prescribed the steroid, or has consulted with and received
approval from, the prescriber.
18) Establishes a certification process for an
optometrist to perform certain laser procedures, requiring 25
hours of education and 24 complete clinical procedures on
live human patients.
19) Expands the definition of glaucoma by including an
"increase in intraocular pressure caused by steroid
medication."
20) Establishes continuing education hours for
optometrists certified to perform laser procedures.
21) Establishes a certification course for an
optometrist to perform minor procedures. Minor procedures
are defined as 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, and closure of a wound, as specified. Specifies
that minor procedures do not include blepharoplasty or other
cosmetic surgery procedures that reshape normal structures of
the body in order to improve appearance and self-esteem.
Requires 25 hours of education and 32 complete clinical
procedures on live human patients.
22) Establishes continuing education requirements for
optometrists certified to perform minor procedures.
23) Authorizes an optometrist to earn a certificate to
administer immunizations for influenza, herpes zoster, and
pneumococcus if the optometrist does all of the following:
a) Completes an immunization training program endorsed by
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the Centers for Disease Control and Prevention, or the
Accreditation Council for Pharmacy Education that, at a
minimum, includes hands-on injection technique, clinical
evaluation of indications and contraindications of
vaccines, and the recognition and treatment of emergency
reactions to vaccines, and shall maintain that training.
b) Is certified in basic life support for health care
professionals.
c) Complies with all state and federal recordkeeping and
reporting requirements, including providing documentation
to the patient's primary care provider and entering
information in the appropriate immunization registry
designated by the immunization branch of the State
Department of Public Health.
24) Declares as unprofessional conduct the failure for
an optometrist to refer a patient to an appropriate physician
if an examination of the eyes indicates a substantial
likelihood of any pathology that requires the attention of
that physician.
Background
The practice of optometry. An optometrist (Doctor of Optometry
or O.D.) is an independent primary health care professional for
the eye. Optometrists examine, diagnose, treat, and manage
diseases, injuries, and disorders of the visual system, the eye,
and associated structures, as well as identify related systemic
conditions affecting the eye. O.D.s prescribe medications, low
vision rehabilitation, vision therapy, spectacle lenses, contact
lenses, and perform certain surgical procedures. Optometrists
have a narrower scope of practice than do ophthalmologists, but
are held to the identical standard of care for the same
treatments they provide.
An O.D. degree requires both an undergraduate education and four
years of professional education at a college of optometry. Some
optometrists also undertake an optional one year non-surgical
residency program to enhance their experience in a particular
area. Students graduate with 2,500-3,000 patient encounters,
which include a mix of post-surgical, medical and routine
visits.
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In order to be licensed to practice by the Board, an individual
must obtain an O.D. degree, pass the three part National Board
of Examiners in Optometry examination, and the California
Optometric State Law Examination. There are currently 9,100
optometrists practicing in California.
The practice of ophthalmology. An ophthalmologist is a
physician and surgeon who has specialty training in the anatomy,
function and diseases of the eye. The central focus of
ophthalmology is surgery and management of complex eye diseases.
An ophthalmologist specializes in the refractive, medical and
surgical care of the eyes and visual system, and in the
prevention of disease and injury.
To become an ophthalmologist, an individual must obtain an
undergraduate degree, complete four years of graduate education
at an accredited medical school and earn a Medical Degree,
complete a one year internship, and a three or four year
residency. There are currently 1,800-2,100 ophthalmologists in
California, not all of whom are in active practice.
FISCAL EFFECT: Appropriation: Yes Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee:
Costs of less than $150,000 to develop and update regulations
by the Board (State Optometry Fund).
Minor costs to grant certifications to certain optometrists
and enforce licensing regulations on those optometrists (State
Optometry Fund). The Board anticipates that a small number of
optometrists will seek additional, post-graduate certification
to perform additional procedures under this bill. Therefore,
the additional licensing cost to issue those certifications
and any additional enforcement activities relating to those
new duties are expected to be minor.
Minor costs for the Office of Statewide Health Planning and
Development to oversee a future Health Workforce Pilot Project
relating to optometry. Under current practice, the costs of
developing and managing a pilot project are borne by the
sponsoring academic institution. The costs to the Office to
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authorize and review any new pilot project are minor.
SUPPORT: (Verified5/19/15)
California Association of Health System Pharmacists
California Optometric Association
VSP Vision Care
Western University of Health Sciences
Numerous individuals
OPPOSITION: (Verified5/19/15)
American Federation of State, County and Municipal Employees
Blind Childrens Center
California Academy of Eye Physicians & Surgeons
California Academy of Family Physicians
California Medical Association
California Society of Plastic Surgeons
Latino Physicians of California
Medical Board of California
Ventura County American Chinese Medical Dental Association
Numerous Individuals
ARGUMENTS IN SUPPORT: The California Optometric Association
writes, "Doctors of optometry have a critical role to play in
providing primary care and making the promise of the Affordable
Care Act a reality. They already provide the vast majority of
eye care in the Medi-Cal program and they are located in all but
one California county (Alpine). In order to improve access to
health care in California, we must provide timely care where and
when it's needed by utilizing the full complement of our
clinical abilities."
ARGUMENTS IN OPPOSITION: The California Academy of Family
Physicians write, "Physicians see many benefits from working
collaboratively with other health care professionals to meet
patient care demand, but the framework of care delivery should
be within the scope of practice that each health care
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professional is qualified to perform. Arbitrarily allowing
allied health care professionals to render services that are
beyond a provider's scope can lead to increased costs through
over-utilization of tests, over prescribing of medications, and
excess referrals to specialists; and in this case, the potential
for incredible harm to patients."
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
5/20/15 11:44:31
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