BILL ANALYSIS Ó
SB 622
Page 1
Date of Hearing: July 7, 2015
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Susan Bonilla, Chair
SB 622(Hernandez) - As Amended May 4, 2015
SENATE VOTE: 33-4
SUBJECT: Optometry
SUMMARY: This bill expands the scope of practice for
optometrists to include the expanded ability to order 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.
EXISTING LAW:
1)Establishes the California Board of Optometry (Board), within
the Department of Consumer Affairs (DCA), which licenses
optometrists and regulates the practice of optometry. (BPC §
3010.5)
2)Authorizes the Board to establish educational and examination
requirements for licensure. (BPC § 3041.2)
SB 622
Page 2
3)Defines the practice of optometry as follows: (BPC § 3041)
a) 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) 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) Use of topical pharmaceutical agents for the purpose of
the examination of the human eye or eyes for any disease or
pathological condition.
4)Specifies that an optometrist who is certified to use
therapeutic pharmaceutical agents may also diagnose and treat
the human eye or eyes or any of its appendages for the
following conditions: (BPC § 3041(b)(1))
a) Infections;
b) Ocular allergies;
c) Ocular inflammation, non-surgical in cause except when
co-managed with the treating physician and surgeon;
d) Traumatic or recurrent conjunctival or corneal abrasions
and erosions;
e) Corneal surface disease and dry eyes;
SB 622
Page 3
f) Ocular pain, non-surgical in cause except when
co-managed with the treating physician and surgeon; and,
g) Glaucoma in patients over the age of 18.
5)Permits optometrists to use the following therapeutic
pharmaceutical agents: (BPC § 3041(c))
a) Topical miotics;
b) Topical lubricants;
c) Anti-allergy agents;
d) Topical and oral anti-inflammatories;
e) Topical antibiotic agents;
f) Topical hyperosmotics;
g) Topical and oral anti-glaucoma agents;
h) Non-prescription medications;
i) Oral antihistamines;
j) Prescription oral non-steroidal anti-inflammatory
agents;
aa) Oral antibiotics for treatment of ocular disease;
bb) Topical and oral antiviral medication for treatment of:
i) Herpes;
ii) Viral Keratitis;
iii) Herpes Simplex Viral conjunctivitis;
SB 622
Page 4
iv) Periocular herpes simplex viral dermatitis;
v) Varicella zoster viral keratitis;
vi) Varicella zoster viral conjunctivitis; and,
vii) Periocular varicella zoster viral dermatitis;
cc) Oral analgesics that are not controlled substances; and,
dd) Codeine with compounds and hydrocodone with compounds
with specific restrictions regarding usage timeframe.
6)Specifies that an optometrist who is certified to use
therapeutic pharmaceutical agents may also perform the
following: (BPC § 3401(e))
a) Corneal scraping with cultures;
b) Debridement of corneal epithelia;
c) Mechanical epilation;
d) Venipuncture for testing patients suspected of having
diabetes;
e) Suture removal, with prior consultation with the
treating physician and surgeon;
f) Treatment or removal of sebaceous cysts by expression;
g) Administration of oral fluorescein to patients suspected
as having diabetic retinopathy;
h) Use of an auto-injector to counter anaphylaxis;
i) Ordering of smears, cultures, sensitivities, complete
blood count, mycobacterial culture, acid fast stain,
urinalysis, tear fluid analysis and X-rays necessary for
SB 622
Page 5
the diagnosis of conditions or diseases of the eye or
adnexa;
j) A clinical laboratory test or examination classified as
waived under CLIA necessary for the diagnosis of conditions
and diseases of the eye or adnexa;
aa) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy or other means constituting surgery;
bb) The prescription of therapeutic contact lenses,
including lenses or devices that incorporate a medication
or therapy the optometrist is certified to prescribe or
provide;
cc) Removal of foreign bodies from the cornea, eyelid and
conjunctiva with any appropriate instrument other than a
scalpel or needle; and,
dd) Lacrimal irrigation and dilation, excluding probing of
the nasal lacrimal tract for patients over 12 years of age.
THIS BILL:
1) Requires 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.
SB 622
Page 6
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 of education and
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
SB 622
Page 7
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
authorized by the Act, excluding intraorbital injections and
injections administered for cosmetic effect.
17) Expands the definition of glaucoma to include 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) Expands the definition of glaucoma to include an
"increase in intraocular pressure caused by steroid
medication."
SB 622
Page 8
19) 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.
20) Establishes continuing education hours for
optometrists certified to perform laser procedures.
21) Establishes a certification course for an
optometrist to perform minor procedures.
22) Defines minor procedures as removal, destruction,
or drainage of lesions of the eyelid and adnexa clinically
evaluated by the optometrist to be non-cancerous, 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.
23) Requires 25 hours of education and 32 complete
clinical procedures on live human patients.
24) Establishes continuing education requirements for
SB 622
Page 9
optometrists certified to perform minor procedures.
25) 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
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; and,
c) Complies with all state and federal recordkeeping and
reporting requirements, including providing documentation
to the patient's primary care provider and entering
information in the appropriate immunization registry
designated by the immunization branch of the State
Department of Public Health.
26) Defines unprofessional conduct to include failure
for an optometrist to refer a patient to an appropriate
physician if an examination of the eyes indicates a
SB 622
Page 10
substantial likelihood of any pathology that requires the
attention of that physician.
FISCAL EFFECT: According to the May 4, 2015 Senate
Appropriations Committee analysis, this bill will result in
costs of less than $150,000 to develop and update regulations by
the Board. The bill will also result in minor costs to grant
certifications to certain optometrists and enforce licensing
regulations on those optometrists. The Board anticipates that a
small number of optometrists will seek additional, post-graduate
certification to perform additional procedures under the 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 are also anticipated for the Office of Statewide Health
Planning and Development (OSHPD) 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 OSHPD to authorize and review any new pilot project are
minor.
COMMENTS:
Purpose. This bill is sponsored by the author. According to
the author, "While merely 16 of California's 58 counties meet
the needed supply range for primary care physicians, we do have
a robust network of providers that are well-trained, evenly
distributed throughout the state, regulated by the [DCA] and
well positioned to pay particular attention to currently
underserved areas. Optometrists are one such provider group who
receive a doctorate level training preparing them to be primary
SB 622
Page 11
eye care providers, and independently diagnose and treat
conditions of the eye. [This bill] will remove restrictions in
current law to permit optometrists to examine, prevent,
diagnose, and treat conditions and disorders of the visual
system and the human eye to the full extent of their training.
This includes the use of two types of therapeutic lasers by
optometrists with postdoctoral advanced certification that have
been developed for treatment of glaucoma and post-surgical
cataract care, conditions that disproportionately affect patient
groups that generally lack sufficient access to physicians.
[This bill] is a limited expansion of scope for optometrists
that is consistent with their education and training, and is a
logical advancement of the profession that has been proven safe
in other states. Moreover, the educational requirements
contained in this bill are substantially greater than those
required of optometrists in other states and exceed the minimum
number of these procedures required for ophthalmologists by the
Accreditation Council for Graduate Medical Education."
Background. According to a report prepared by the Center for
the Health Professions at the University of California San
Francisco, the number of optometrist licenses in California has
declined, but the number of licensees with a secondary practice
location has increased. According to the Board, there are
approximately 7,565 licensed optometrists in California, the
largest population of optometrists in the United States.
Approximately 7,500 of these optometrists are certified to
administer diagnostic pharmaceutical agents. The majority of
the licensed optometrists are generally concentrated in coastal
counties, the Bay Area and counties in the Sacramento region.
Several counties have no licensed optometrists with an address
of record in those counties, and a number of other counties have
ratios that indicate there is approximately one optometrist for
every 10,000 people.
Optometrists' and Ophthalmologists' Education, Training and
Scope. This bill would expand the types of procedures an
SB 622
Page 12
optometrist is authorized to perform. This would include some
tasks that have been traditionally performed by
ophthalmologists. As such, the current education, training and
scope of each profession is outlined below.
Optometrists. Optometrists are trained to diagnose mild to
severe eye problems such as serious eye infections,
inflammations of the eye, trauma, foreign bodies and glaucoma.
They also examine the eye for vision prescription and corrective
lenses.
After completion of an undergraduate degree, optometrists
complete four years of and accredited optometry college after
which they are awarded the Doctor of Optometry degree. Some
optometrists also undertake an optional one year non-surgical
residency program to enhance their experience in a particular
area. Students graduate with 2500 to 3000 patient encounters;
these include a mix of post-surgical, medical and routine
visits.
Optometrists who graduated from an accredited school or college
of optometry on or after May 1, 2008 receive certifications to
use diagnostic pharmaceutical agents (DPA); to administer
therapeutic pharmaceutical agents (TPA); to perform lacrimal
irrigation and dilation (TPL); and to diagnose and treat primary
open angle glaucoma (TLG). Optometrists who did not receive
these certifications upon licensure may apply for these
certifications after meeting the necessary requirements. In
order to be certified, the optometrist must pass an exam, obtain
a license to practice optometry, be certified by and accredited
school of optometry that they are competent in the diagnosis,
treatment and management of ocular systemic disease and complete
10 hours of experience with an ophthalmologist.
SB 622
Page 13
Ophthalmologists. 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.
After obtaining an undergraduate degree, ophthalmologists
complete four years at an accredited medical school and earn a
Medical Degree. This is followed by a one year internship and a
three or four year surgical residency. Many ophthalmologists
pursue additional fellowship training in specialized areas such
as retina, glaucoma or cornea. Ophthalmologists may become
certified by the American Board of Ophthalmology, which
requires, serving as primary surgeon or first assistant to the
primary surgeon on a minimum of 364 eye surgeries.
Changes to Current Scope of Practice. This bill would expand
the scope of practice for optometrists. The following chart
illustrates some of the salient changes that would be made to
the current scope of practice for optometrists.
-----------------------------------------------------------------------------
| Current Scope | Proposed Scope |
| | |
| | |
|-------------------------------------+---------------------------------------|
|Defines the practice of optometry to |Adds the provision of habilitative |
|include, among other things, the |optometric services to the definition |
|prevention and diagnosis of |of the practice of optometry. |
|disorders and dysfunctions of the | |
|visual system, examination of the | |
|eyes, determination of the powers or | |
|range of human vision and | |
SB 622
Page 14
|prescribing of contact and spectacle | |
|lenses. | |
|-------------------------------------+---------------------------------------|
|Limits the conditions of the eye and |Allows TPA certified optometrists to |
|visual system that can be diagnosed |treat conjunctival surface disease, |
|and treated by a TPA certified |hypotrichosis (via Latisse) and |
|optometrist. |blepharitis. |
| | |
| |Authorizes optometrists to perform all |
| |CLIA waived in office testing if the |
| |optometrist becomes registered as a |
| |lab director with the Department of |
| |Public Health. |
|-------------------------------------+---------------------------------------|
|Specifies that an optometrist must |Deletes these requirements. |
|consult with an ophthalmologist if | |
|an ocular inflammation, non-surgical | |
|in cause, and other diseases recur | |
|within one year of initial | |
|occurrence. | |
|-------------------------------------+---------------------------------------|
|Limits treatment of ocular pain, |Allows for treatment of all ocular |
|non-surgical in cause, except when |pain, non-surgical in cause, except |
|co-managed with the treating |when co-managed with the treating |
|physician and surgeon, associated |physician and surgeon. |
|with conditions optometrists are | |
|authorized to treat. | |
|-------------------------------------+---------------------------------------|
|Allows removal of foreign bodies |Allows optometrists the use of a |
|from cornea, eyelid, and conjunctiva |needle to remove foreign bodies from |
|with any appropriate instrument |the eye. |
|other than a scalpel or needle. | |
|-------------------------------------+---------------------------------------|
|Limits prescriptions to Schedule III |Changes the use to 5 days. |
|drugs, codeine with compounds and | |
|hydrocodone and limits the use of | |
|these to 3 days with a referral to | |
|an ophthalmologist if the pain | |
|persists. | |
SB 622
Page 15
|-------------------------------------+---------------------------------------|
|Limits the definition of glaucoma. |Adds to the definition of glaucoma : |
| |"increase in intraocular pressure |
| |caused by steroid medication |
| |prescribed by optometrist or |
| |prescribing physician". |
|-------------------------------------+---------------------------------------|
|Specifies that an optometrist cannot |Deletes this requirement. |
|treat the lacrimal gland, the | |
|lacrimal drainage system and the | |
|sclera in patients younger than 12. | |
| | |
|-------------------------------------+---------------------------------------|
|Allows optometrists to perform |Amends the language to allow |
|venipuncture for testing patients |optometrists "to collect blood |
|suspected of having diabetes. |specimen by the finger prick method" |
| |to test for diabetes. |
|-------------------------------------+---------------------------------------|
|No post-graduate certifications are |Establishes three new post-graduate |
|required. |certifications: 1) anterior segment |
| |laser, 2) minor procedures and 3) |
| |immunization. |
|-------------------------------------+---------------------------------------|
|Specifies what diagnoses specify the |Deletes this requirement. |
|use of steroid medication and that | |
|an optometrist should consult with | |
|an ophthalmologist and/or | |
|appropriate physician and surgeon if | |
|a patient's condition worsens 72 | |
|hours after being diagnosed. | |
|-------------------------------------+---------------------------------------|
|Specifies that the optometrist shall |Deletes these requirements. |
|refer the patient to an | |
|ophthalmologist if requested by the | |
|patient or if angle closure glaucoma | |
|develops. If the glaucoma patient | |
|also has diabetes, the optometrist | |
|shall consult with the physician | |
|treating the patient's diabetes in | |
SB 622
Page 16
|developing the glaucoma treatment | |
|plan and shall inform the physician | |
|in writing of any changes in the | |
|patient's glaucoma medication. | |
|-------------------------------------+---------------------------------------|
|Specifies that if the patient has |Deletes these requirements. |
|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. | |
| | |
|Specifies that 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. | |
|-------------------------------------+---------------------------------------|
|Specifies that if the patient has |Deletes these requirements. |
|been diagnosed with herpes simplex | |
|keratitis or varicella zoster viral | |
|keratitis and the patient's | |
|condition has not improved seven | |
|days after diagnosis, or has not | |
|resolved three weeks after diagnosis | |
| the optometrist shall refer the | |
|patient to an ophthalmologist | |
| | |
|Specifies that 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, or has not | |
SB 622
Page 17
|resolved three weeks after | |
|diagnosis, the optometrist shall | |
|consult with and refer the patient | |
|to an ophthalmologist. | |
|-------------------------------------+---------------------------------------|
|Requires that in any case where an |Deletes this requirement. |
|optometrist is required to 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. | |
|-------------------------------------+---------------------------------------|
| |Allows the Board to authorize the use |
| |of new non-invasive technology, after |
| |completion of 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. |
|-------------------------------------+---------------------------------------|
| |Adds the ability for optometrists to |
| |perform skin tests to diagnose ocular |
| |allergies and limits these tests to |
| |the superficial lawyer of the skin. |
|-------------------------------------+---------------------------------------|
| |Adds the use of mechanical lipid |
| |extraction of meibomian glands and |
| |non-surgical techniques |
|-------------------------------------+---------------------------------------|
| |Defines minor procedures: "Minor |
| |procedures" does not include |
| |blepharoplasty or other cosmetic |
SB 622
Page 18
| |surgery procedures that reshape normal |
| |structures of the body in order to |
| |improve appearance and self-esteem. |
-----------------------------------------------------------------------------
Other States. Since 1997, there have been over 45 attempts in
over 20 states by optometry associations to expand the scope of
practice for optometrists including legislating surgery
privileges. However, with the exception of Oklahoma and West
Virginia, most states continue to prohibit optometrists from
performing surgery, and their statutes specify that the license
to practice optometry does not include the right to practice
medicine. States such as Colorado and North Carolina
specifically exclude surgery from their definition of the
practice of optometry. Other states have statutes that
delineate between laser and non-laser surgery. Optometrists are
authorized to prescribe oral medications in all 50 states, they
may prescribe oral steroids in 34 states, injections in 15
states and use lasers in 1 state.
Prior Related Legislation. SB 492 (Hernandez) of 2013, would
have permitted an optometrist to diagnose treat and manage
additional conditions with ocular manifestations, directed the
California Board of Optometry to establish educational and
examination requirements and would have permitted optometrists
to perform vaccinations and surgical and non-surgical primary
care procedures. NOTE: This bill died on the Assembly inactive
file.
SB 668 (Polanco) Chapter 13, Statutes of 1996, expanded the
scope of practice of optometrists to provide for the diagnosis
and treatment of specified conditions or diseases of the human
eye or its appendages, and to use other therapeutic
pharmaceutical agents.
SB 929 (Polanco) Chapter 676, Statutes of 2000, expanded the
scope of lawful practice for optometrists by specifying
SB 622
Page 19
additional diseases and conditions that optometrists may treat
(in particular certain types of glaucoma) with specified
medications, and by specifying the extent of physician
involvement that is required under various circumstances.
SB 1406 (Correa) Chapter 352, Statutes of 2008, specified
permissible procedures for certified optometrists, and created
the Glaucoma Diagnosis and Treatment Advisory Committee to
establish glaucoma certification requirements.
ARGUMENTS IN SUPPORT:
The Board of Optometry supports the bill and writes, "The Board
is supportive of the intent and direction of the bill,
specifically the utilization of the extensive training an
education of optometrists to expand access to health care for
millions of Californians."
The California Association for Nurse Practitioners supports the
bill and writes, "This bill would allow optometrists to practice
more consistently with their education and training by
authorizing them to treat and manage additional visual system
conditions, administer flue, pneumonia and shingles
vaccinations, and perform certain noninvasive procedures."
The United Nurses Associations of California/Union of Health
Care Professionals supports the bill and writes, "[This bill] is
a very modest expansion of the types of services that an
optometrist can provide and ensures that only qualified, trained
and competent O.D.s are permitted to offer the expanded
services. [This bill] specifically prohibits O.D.s from
performing surgery, and instead authorizes O.D.s only to perform
relatively minor procedures."
SB 622
Page 20
ARGUMENTS IN OPPOSITION:
The California Academy of Eye Physicians and Surgeons opposes
the bill and writes in their letter, "We are particularly
concerned that the bill has moved away from the 'comprehensive'
concept of a single certification in 'advanced procedures.' We
believe someone training to be a surgeon needs to develop the
surgical judgment common to performing all surgical procedures:
understanding when (and when not to) do surgery, being able to
anticipate, avoid, and recognize complications, and knowing how
to address these complications when they do happen. It is
unreasonable to expect these skills to be developed after the
minimal experience called for in [this bill]."
The California Medical Association opposes the bill and writes,
"The CMA opposes [this bill] because patient safety and quality
of care demand that patients be assured that individuals who
perform invasive procedures have appropriate medical education
and education. The safe use of lasers and scalpels requires
extensive medical education and training? In addition, the safe
administration of immunizations requires extensive education,
training, experience and the ability to monitor for side effects
that far exceed an optometrist's training in visual systems."
The Medical Board of California also opposes this measure. They
write in their opposition letter, "Although the services that
optometrists are authorized to provide have been narrowed down
compared to SB 492 from last year, the Board still has concerns
with the length of additional training and the number of
procedures required. The 25 hours of training and the specified
number of procedures required by this bill are not enough to
ensure that consumers are protected and that certified
optometrists are properly trained."
SB 622
Page 21
AMENDMENTS:
1. The following technical amendments should be made:
On page 7, line 34 strike: lawyer and insert: layer
On page 14, line 17, strike: "injections" and after
"intraorbital" insert: injections, intraocular injections
On page 7, lines 9, strike: a , strike: specimen , strike:
finger prick method and insert: skin puncture
2.In order to ensure that this bill will not expand the scope of
laboratory tests that an optometrist can order, the following
amendment should be made:
On page 7, line 30 after "CLIA" insert: and designated as
waived in paragraph (9)
3.A complete minor procedure includes: 1) injections of
medication, 2) removal or destruction of lesions and 3) any
required wound closures. This bill defines minor procedures
to be "either" of the 3 previously listed. The following
amendment should be made in order to ensure that a complete
procedure includes numbers 1 through 3 above:
On page 14, line 6, amend the bill as follows: For purposes of
this chapter, "minor procedure" means completion of all of the
following
SB 622
Page 22
4.In order to ensure that the courses outlined in this bill are
taken post-graduation, the following amendment should be made:
On page 12, line 38, amend the bill as follows:
(b) An optometrist certified to treat glaucoma pursuant to
Section 3041.2, after successful completion of a degree from
an approved school of optometry, 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. The board shall issue a certificate pursuant to
this section only to an optometrist that has graduated from an
approved school of optometry.
5.In order to ensure that inspection authority for the Board of
Optometry is consistent with other DCA healing arts boards'
inspection authority, the following should be added to the
bill:
The board may at any time inspect any place of practice in
which optometry is being practiced. The board's inspection
authority does not extend to premises that are not registered
with the board. Nothing in this section shall be construed to
affect the board's ability to investigate alleged unlicensed
activity or to inspect place of practice for which
registration has lapsed or is delinquent.
REGISTERED SUPPORT:
Blue Shield of California
SB 622
Page 23
Board of Optometry
California Association for Nurse Practitioners
California Optometric Association
United Nurses Associations of California/Union of Health Care
Professionals
REGISTERED OPPOSITION:
Academy of Eye Physicians and Surgeons
American Academy of Dermatology Association
American Academy of Ophthalmology
American Academy of Pediatrics
American Association of Orthopaedic Surgeons
American Association for Pediatric Ophthalmology and Strabismus
SB 622
Page 24
American College of Surgeons
American Glaucoma Society
American Medical Association
American Osteopathic Association
American Society of Cataract and Refractive Surgery
American Society of Ophthalmic Plastic and Reconstructive
Surgery
American Society of Retina Specialists
Blind Children's Center
California Academy of Eye Physicians and Surgeons
California Association for Medical Laboratory Technology
California Black Health Network
California Educators of Ophthalmology for Quality Care
California Medical Association
SB 622
Page 25
California Society of Plastic Surgeons
Latino Physicians of California
Lighthouse for Christ Mission
Medical Board of California
Union of American Physicians and Dentists
Ventura County American Chinese Medical Dental Association
Over 600 physicians and individuals
Analysis Prepared by:Le Ondra Clark Harvey, Ph.D. / B. & P. /
(916) 319-3301