Amended in Assembly August 19, 2014

Amended in Assembly August 4, 2014

Amended in Assembly July 1, 2014

Amended in Assembly June 16, 2014

Amended in Assembly August 5, 2013

Amended in Senate May 8, 2013

Amended in Senate April 24, 2013

Amended in Senate April 16, 2013

Amended in Senate April 1, 2013

Senate Bill No. 492

Introduced by Senator Hernandez

February 21, 2013

An act to amend begin delete Sections 3041, 3041.1, and 3110 end delete begin insert Section 3041 end insert of the Business and Professions Code, relating to optometry begin insert , and making an appropriation therefor end insert .

LEGISLATIVE COUNSEL’S DIGEST

SB 492, as amended, Hernandez. Optometrist: practice: licensure.

The Optometry Practice Act creates the State Board of Optometry, which licenses optometrists and regulates their practice. Existing law 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. Any violation of the act is a crime. begin insert 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 provisions of the act. end insert

begin delete

This bill would include the provision of habilitative optometric services within the scope of practice of optometry. The bill would expand the scope of practice of optometrists who are certified to use therapeutic pharmaceutical agents by, among other things, authorizing those optometrists to use all therapeutic pharmaceutical agents approved by the United States Food and Drug Administration and indicated for use in diagnosing and treating the eye conditions covered by these provisions. The bill would also modify the ability of an optometrist certified to use therapeutic pharmaceutical agents to diagnose and treat certain diseases. The bill would require the board to grant a certificate to an optometrist for the use of advanced procedures, as defined, if the optometrist meets certain educational and certification requirements. The board would also be required to grant a certificate to an optometrist for immunizations if the optometrist meets certain educational and certification requirements. The bill would authorize the board to allow optometrists to use any noninvasive technology to treat specified conditions.

end delete begin delete

Existing law requires optometrists in diagnosing or treating eye disease to be held to the same standard of care as physicians and surgeons and osteopathic physicians and surgeons.

end delete begin delete

This bill would expand this requirement to include diagnosing other diseases, and would require an optometrist to consult with and, if necessary, refer to a physician and surgeon or other appropriate health care provider if a situation or condition was beyond the optometrist’s scope of practice.

end delete begin insert

This bill would expand the scope of practice of optometrists to include administering immunizations and would require the board to grant a certificate to an optometrist for the use of immunizations if the optometrist meets certain requirements. The board would be required to set, by regulation, the fee for the issuance and renewal of a certificate for the use of immunizations, at the reasonable cost of regulating the certified optometrists, not to exceed $100. Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.

end insert

This bill would delete obsolete provisions and make conforming changes.

Because this bill would change the definition of a crime, it would create 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:  begin delete no end delete begin insert yes end insert . Fiscal committee: yes. State-mandated local program: yes.

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
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) (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 begin delete pain, end delete begin insert pain end insert nonsurgical in begin delete cause end delete begin insert cause, end insert 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 begin delete (j). end delete begin insert (k). end insert

(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 begin delete United States Uniform end delete
begin insert federal end insert 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 begin delete CLIA end delete begin insert the federal Clinical Laboratory Improvement
Amendments of 1988 (42 U.S.C. Sec. 263a) (CLIA) end insert 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, begin delete shall be end delete
begin insert is end insert 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 begin delete (j), end delete begin insert (k), end insert 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.

begin insert

(j) (1) The board shall grant to an optometrist, certified pursuant
to subdivision (f), a certificate for the use of immunizations, as
described in paragraph (2), after the optometrist meets all of the
following applicable requirements:

end insert begin insert

(A) 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.

end insert begin insert

(B) Is certified in basic life support.

end insert begin insert

(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.

end insert begin insert

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

end insert begin insert

(3) 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 chapter. The fee shall not exceed one hundred
dollars ($100).

end insert begin delete

(j)

end delete

begin insert (k) end insert  For purposes of this chapter, “glaucoma” means either of
the following:

(1) All primary open-angle glaucoma.

(2) Exfoliation and pigmentary glaucoma.

begin delete

(k)

end delete

begin insert ( end insert begin insert l end insert begin insert ) end insert  For purposes of this chapter, “adnexa” means ocular adnexa.

begin delete

(l)

end delete

begin insert (m) end insert  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.

begin insert

begin insert SEC. 2. 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 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) (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.

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

(C) Ocular inflammation of the anterior segment and adnexa
nonsurgical in cause, except when comanaged with the treating
physician and surgeon.

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

(E) Corneal surface disease and dry eyes. Treatment for purposes
of this subparagraph includes, but is not limited to, the use of
mechanical lipid extraction of meibomian glands using nonsurgical
techniques.

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

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

(H) Eyelid disorders, including hypotrichosis and blepharitis.

(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 therapeutic
pharmaceutical agents approved by the United States Food and
Drug Administration and indicated for use in diagnosing and
treating eye conditions set forth in this chapter, including 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.). The use of controlled substances shall be limited to five
days.

(d) In any case that an optometrist consults with a physician
and surgeon, the optometrist and the physician and surgeon shall
both maintain a written record in the patient’s file of the
information provided to the physician and surgeon, the physician
and surgeon’s response, and any other relevant information. Upon
the request of the optometrist or physician and surgeon and with
the patient’s consent, a copy of the record shall be furnished to the
requesting party.

(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, upon notification of the treating physician
and surgeon or optometrist.

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

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

(8) 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.

(9) A clinical laboratory test or examination classified as waived
under the federal Clinical Laboratory Improvement Amendments
of 1988 (42 U.S.C. Sec. 263a) (CLIA) and designated as waived
in paragraph (8) necessary for the diagnosis of conditions and
diseases of the eye or adnexa, or if otherwise specifically authorized
by this chapter.

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

(11) The prescription of therapeutic contact lenses, including
lenses or devices that incorporate a medication or therapy the
optometrist is certified to prescribe or provide.

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

(13) 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 or lacrimal irrigation
and dilation certified optometrist as confirmed by the
ophthalmologist or lacrimal irrigation and dilation certified
optometrist. Any optometrist who graduated from an accredited
school of optometry on or after May 1, 2000, is 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 (n), 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 pursuant to Section 3041.10.

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

(g) The board shall grant to an optometrist, certified pursuant
to subdivision (f), a certificate for the use of advanced procedures,
as described in subdivision (h), after the optometrist meets the
following applicable requirement:

(1) Licensees who graduated from an accredited school of
optometry, on or after May 1, 2016, shall submit proof of
completion at that school of a satisfactory curriculum on advanced
procedures, as determined by the board, including passage of a
test for competency and performance of the procedures contained
in subparagraph (F) of paragraph (2).

(2) Licensees who graduated from an accredited school before
May 1, 2016, are required to submit proof of completion of a
board-approved course that meets all of the requirements in
subparagraphs (A) to (G), inclusive. An optometrist certified
pursuant to Section 3041.3 may perform the training procedures
in their own practices under the supervision of a physician and
surgeon or an optometrist with an advanced procedure certification.

(A) Provided by an accredited school of optometry and
developed in consultation with an ophthalmologist who has
experience teaching optometric students.

(B) Taught by full-time or adjunct faculty members of an
accredited school of optometry.

(C) Sponsored by an organization that meets the standards of
Section 1536 of Title 16 of the California Code of Regulations.

(D) Included passage of a test for competency.

(E) Included all of the following didactic instruction:

(i) Laser physics, hazards, and safety.

(ii) Biophysics of laser.

(iii) Laser application in clinical optometry.

(iv) Laser tissue interactions.

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

(vi) Gonioscopy.

(vii) Laser therapy for open angle glaucoma.

(viii) Laser therapy for angle closure glaucoma.

(ix) Posterior capsulotomy.

(x) Common complications: lids, lashes, and lacrimal.

(xi) Medicolegal aspects of anterior segment procedures.

(xii) Peripheral iridotomy.

(xiii) Laser Trabeculoplasty.

(xiv) Minor surgical procedures.

(xv) Overview of surgical instruments, asepsis, and the federal
Occupational Safety and Health Administration.

(xvi) Surgical anatomy of the eyelids.

(xvii) Emergency surgical procedures.

(xviii) Chalazion management.

(xix) Epilumeninesence microscopy.

(xx) Suture techniques.

(xxi) Local anesthesia: techniques and complications.

(xxii) Anaphylaxsis and other office emergencies.

(xxiii) Radiofrequency surgery.

(xxiv) Postoperative wound care.

(F) Included all of the following clinical experience on live
human patients:

(i) Between 20 and 35 clinical eyelid or adnexa surgical training
procedures, between 18 and 25 laser training procedures, and
between 6 and 12 injection training procedures. The board shall
convene an advisory committee to establish the exact number of
training procedures required, including a minimum number of
training procedures for each procedure listed in subdivision (h).
The advisory committee shall be composed of the Director of
Consumer Affairs or his or her appointee, who shall also serve as
the chairperson, two practicing optometrists, two practicing
ophthalmologists, one faculty member of a school of optometry,
and one ophthalmologist that teaches at a school of optometry.
The members of the advisory committee shall be appointed by the
respective licensing boards. Recommendations from the advisory
committee shall be reported to the board within six months of
being convened.

(ii) Video demonstration.

(iii) A formal clinical practical examination.

(G) Required passage of a written test utilizing the National
Board of Examiners in Optometry format.

(h) For the purposes of this chapter, “advanced procedures”
means any of the following:

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

(2) Therapeutic lasers appropriate for treatment of glaucoma
and peripheral iridotomy for the prophylactic treatment of angle
closure glaucoma.

(3) Removal, destruction, or drainage of lesions of the eyelid
and adnexa clinically evaluated by the optometrist to be
noncancerous.

(4) Closure of a wound resulting from a procedure described in
paragraph (3).

(5) Injections for the treatment of conditions of the eye and
adnexa described in paragraph (1) of subdivision (b), excluding
intraorbital injections and injections administered for cosmetic
effect.

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

(j) The board shall grant to an optometrist, certified pursuant to
subdivision (f), a certificate for immunizations, as described in
subdivision (p), after the optometrist meets all of the following
applicable requirements:

(1) For licensees who graduated, on or after May 1, 2016, from
an accredited school of optometry that includes satisfactory
curriculum on immunizations, as determined by the board,
submission of proof of graduation from that institution.

(2) Licensees who graduated from an accredited school before
May 1, 2016, shall do all of the following:

(A) Submit proof of completion of a board-approved
immunization training program 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) Be certified in basic life support for health care
professionals.

(C) 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.

(k) 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.

(l) Except as authorized by this section, 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. Nothing in this section
shall limit an optometrist’s authority to utilize diagnostic laser and
ultrasound technology within his or her scope of practice.

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

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

(1) All primary open-angle glaucoma.

(2) Exfoliation and pigmentary glaucoma.

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

(p) For the purposes of this chapter, “immunization” means
administration of immunizations for influenza, Pertussis, herpes
zoster virus, and additional immunizations that may be necessary
to protect public health during a declared disaster or public health
emergency in compliance with individual Advisory Committee
on Immunization Practices (ACIP) vaccine recommendations
published by the federal Centers for Disease Control and
Prevention (CDC) for persons 18 years of age or older.

(q) 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.

(r) The board may authorize optometrists to use any noninvasive
technology to treat a condition listed in paragraph (1) of subdivision
(b).

SEC. 2.  

Section 3041.1 of the Business and Professions Code
is amended to read:

3041.1.  

With respect to the practices set forth in Section 3041,
optometrists diagnosing or treating eye disease or diagnosing other
diseases 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
if a situation or condition occurs that is beyond the optometrist’s
scope of practice.

SEC. 3.  

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

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 blood borne 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 blood borne 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 physician if an
examination of the eyes indicates a substantial likelihood of any
pathology that requires the attention of that physician.

SEC. 4.  

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

SEC. 5.  

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.

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