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 BillNo. 492


Introduced by Senator Hernandez

February 21, 2013


An act to amend Sectionsbegin delete 3041 and 3041.1end deletebegin insert 3041, 3041.1, and 3110end insert of the Business and Professions Code, relating to optometry.

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 delete

This bill would add the provision of habilitative optometric services to the definition of the practice of optometry. The bill would expand the practice parameters of optometrists who are certified to use therapeutic pharmaceutical agents by removing certain limitations on their practice and adding certain responsibilities, including, but not limited to, the ability to immunize and treat certain diseases, and deleting the specified drugs the optometrist would be authorized to use, and authorizing the optometrist to use all therapeutic pharmaceutical agents approved by the United States Food and Drug Administration, as provided. The bill would also delete limitations on certain kinds of diagnostic tests an optometrist can order and would authorize an optometrist to order appropriate laboratory and diagnostic imaging tests, as provided.

end delete
begin insert

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 for use in treating the eye conditions covered by these provisions. The bill would also expand the ability of an optometrist certified to use therapeutic pharmaceutical agents to diagnose and treat certain diseases, as provided. The bill would require the board to grant a certificate to an optometrist for the use of advanced procedures, which include the administration of certain immunizations, if the optometrist meets certain educational requirements.

end insert

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.

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.

begin insert

This bill would delete obsolete provisions and make conforming changes.

end insert

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: no. Fiscal committee: yes. State-mandated local program: yes.

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

P3    1

SECTION 1.  

Section 3041 of the Business and Professions
2Code
is amended to read:

3

3041.  

(a) The practice of optometry includes the prevention
4and diagnosis of disorders and dysfunctions of the visual system,
5and the treatment and management of certain disorders and
6dysfunctions of the visual system, as well as the provision of
7habilitative or rehabilitative optometric services, and is the doing
8of any or all of the following:

9(1) The examination of the human eye or eyes, or its or their
10appendages, and the analysis of the human vision system, either
11subjectively or objectively.

12(2) The determination of the powers or range of human vision
13and the accommodative and refractive states of the human eye or
14eyes, including the scope of its or their functions and general
15condition.

16(3) The prescribing or directing the use of, or using, any optical
17device in connection with ocular exercises, visual training, vision
18training, or orthoptics.

19(4) The prescribing of contact and spectacle lenses for, or the
20fitting or adaptation of contact and spectacle lenses to, the human
21eye, including lenses that may be classified as drugs or devices by
22any law of the United States or of this state.

23(5) The use of topical pharmaceutical agents for the purpose of
24the examination of the human eye or eyes for any disease or
25pathological condition.

26(b) (1) An optometrist who is certified to use therapeutic
27pharmaceutical agents, pursuant to Section 3041.3, may also
28diagnose and treat the human eye or eyes, or any of its or their
29appendages, for all of the following conditions:

P4    1(A) Through medical treatment, infections of the anterior
2segment and adnexa.

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

4(C) Ocularbegin delete inflammation,end deletebegin insert inflammationend insert nonsurgical inbegin delete causeend delete
5begin insert cause,end insert except when comanaged with the treating physician and
6surgeon.

7(D) Traumatic or recurrent conjunctival or corneal abrasions
8and erosions.

9(E) Corneal surface disease and dry eyes.begin insert Treatment for purposes
10of this subparagraph includes, but is not limited to, the use of
11mechanical lipid extraction of meibomian glands using nonsurgical
12techniques.end insert

13(F) Ocularbegin delete pain,end deletebegin insert painend insert nonsurgical inbegin delete causeend deletebegin insert cause,end insert except when
14comanaged with the treating physician and surgeon.

15(G) Pursuant to subdivision (f), glaucoma in patients over 18
16years of age, as described in subdivisionbegin delete (j).end deletebegin insert (l).end insert

17(H) Eyelid disorders, including hypotrichosis and blepharitis.

18(2) For purposes of this section, “treat” means the use of
19therapeutic pharmaceutical agents, as described in subdivision (c),
20and the procedures described in subdivision (e).

21(c) In diagnosing and treating the conditions listed in subdivision
22(b), an optometrist certified to use therapeutic pharmaceutical
23agents pursuant to Section 3041.3 may use all therapeutic
24pharmaceutical agents approved by the United States Food and
25Drug Administration for use in treating eye conditions set forth in
26this chapter, including codeine with compounds and hydrocodone
27with compounds as listed in the California Uniform Controlled
28Substances Act (Division 10 (commencing with Section 11000)
29of the Health and Safety Code) and thebegin delete United Statesend deletebegin insert federalend insert
30 Controlled Substances Act (21 U.S.C. Sec. 801 et seq.). The use
31ofbegin delete these agentsend deletebegin insert controlled substances end insert shall be limited to three
32days.

33(d) In any case that an optometrist consults with a physician
34and surgeon, the optometrist and the physician and surgeon shall
35both maintain a written record in the patient’s file of the
36information provided to the physician and surgeon, the physician
37and surgeon’s response, and any other relevant information. Upon
38the request of the optometrist or physician and surgeon and with
39the patient’s consent, a copy of the record shall be furnished to the
40requesting party.

P5    1(e) An optometrist who is certified to use therapeutic
2pharmaceutical agents pursuant to Section 3041.3 may also perform
3all of the following:

4(1) Corneal scraping with cultures.

5(2) Debridement of corneal epithelia.

6(3) Mechanical epilation.

7(4) Venipuncture for testing patients suspected of having
8diabetes.

9(5) Suture removal, upon notification of the treating physician
10andbegin delete surgeon .end deletebegin insert surgeon or optometrist.end insert

11(6) Treatment or removal of sebaceous cysts by expression.

begin delete

12(7) Administration of oral fluorescein .

end delete
begin delete

13(8)

end delete

14begin insert(end insertbegin insert7)end insert Use of an auto-injector to counter anaphylaxis.

begin delete

15(9)

end delete

16begin insert(end insertbegin insert8)end insert Ordering of appropriate laboratory and diagnostic imaging
17tests for conditions authorized to be treated pursuant to this section.

begin delete

18(10)

end delete

19begin insert(end insertbegin insert9)end insert A clinical laboratory test or examination classified as waived
20underbegin delete CLIA and designated as waived in paragraph (9) necessary
21for the diagnosis of conditions and diseases of the eye or adnexa,
22or if otherwise specifically authorized by this chapter.end delete
begin insert the federal
23Clinical Laboratory Improvement Amendments of 1988 (42 U.S.C.
24Sec. 263a) (CLIA). These laboratory tests are required to be
25performed in compliance with both CLIA and all clinical
26laboratory licensing requirements in Chapter 3 (commencing with
27Section 1200), and any ancillary personnel utilized shall be in
28compliance with those same requirements.end insert

begin delete

29(11)

end delete

30begin insert(10)end insert Punctal occlusion by plugs, excluding laser, diathermy,
31cryotherapy, or other means constituting surgery as defined in this
32chapter.

begin delete

33(12)

end delete

34begin insert(1end insertbegin insert1)end insert The prescription of therapeutic contact lenses, including
35lenses or devices that incorporate a medication or therapy the
36optometrist is certified to prescribe or provide.

begin delete

37(13)

end delete

38begin insert(1end insertbegin insert2)end insert Removal of foreign bodies from the cornea, eyelid, and
39conjunctiva with any appropriate instrument other than abegin delete scalpel
40.end delete
begin insert scalpel.end insert Corneal foreign bodies shall be nonperforating, be no
P6    1deeper than the midstroma, and require no surgical repair upon
2removal.

begin delete

3(14)

end delete

4begin insert(1end insertbegin insert3)end insert For patients over 12 years of age, lacrimal irrigation and
5dilation, excluding probing of the nasal lacrimal tract. The board
6shall certify any optometrist who graduated from an accredited
7school of optometry before May 1, 2000, to perform this procedure
8after submitting proof of satisfactory completion of 10 procedures
9under the supervision of an ophthalmologistbegin insert end insertbegin insertor lacrimal irrigation
10and dilation certified optometristend insert
as confirmed by the
11ophthalmologistbegin insert end insertbegin insertor lacrimal irrigation and dilation certified
12optometristend insert
. Any optometrist who graduated from an accredited
13school of optometry on or after May 1, 2000,begin delete shall beend deletebegin insert is end insert exempt
14from the certification requirement contained in this paragraph.

begin delete

15(15)  Administration of immunizations for influenza, Herpes
16Zoster Virus, and additional immunizations that may be necessary
17to protect public health during a declared disaster or public health
18emergency.

end delete
begin delete

19(16)

end delete

20begin insert(1end insertbegin insert4)end insert In addition to diagnosing and treating conditions of the
21visual system pursuant to this section, testing forbegin delete and, diagnosesend delete
22begin insert and diagnosisend insert of diabetes mellitus, hypertension, and
23 hypercholesterolemia.

24(f) The board shall grant a certificate to an optometrist certified
25pursuant to Section 3041.3 for the treatment of glaucoma, as
26described in subdivisionbegin delete (j),end deletebegin insert (l),end insert in patients over 18 years of age
27after the optometrist meets the following applicable requirements:

28(1) For licensees who graduated from an accredited school of
29optometry on or after May 1, 2008, submission of proof of
30graduation from that institution.

31(2) For licensees who were certified to treat glaucoma under
32this section prior to January 1, 2009, submission of proof of
33completion of that certification program.

begin delete

34(3) For licensees who have substantially completed the
35certification requirements pursuant to this section in effect between
36January 1, 2001, and December 31, 2008, submission of proof of
37completion of those requirements on or before December 31, 2009.
38“Substantially completed” means both of the following:

P7    1(A) Satisfactory completion of a didactic course of not less than
224 hours in the diagnosis, pharmacological, and other treatment
3and management of glaucoma.

4(B) Treatment of 50 glaucoma patients with a collaborating
5ophthalmologist for a period of two years for each patient that will
6conclude on or before December 31, 2009.

7(4)

end delete

8begin insert(end insertbegin insert3)end insert For licensees who completed a didactic course of not less
9than 24 hours in the diagnosis, pharmacological, and other
10treatment and management of glaucoma, submission of proof of
11satisfactory completion of the case management requirements for
12certification established by the board pursuant to Section 3041.10.

begin delete

13(5)

end delete

14begin insert(end insertbegin insert4)end insert For licensees who graduated from an accredited school of
15optometry on or before May 1, 2008, and not described in
16paragraphbegin delete (2), (3), or (4),end deletebegin insert (2) or (3),end insert submission of proof of
17satisfactory completion of the requirements for certification
18 established by the board pursuant to Section 3041.10.

19begin insert(g)end insertbegin insertend insertbegin insertThe board shall grant a certificate to an optometrist certified
20pursuant to subdivision (f) for the use of advanced procedures, as
21described in subdivision (h), after the optometrist meets the
22following applicable requirement:end insert

begin insert

23(1) For licensees who graduated from an accredited school of
24optometry that includes satisfactory curriculum on advanced
25procedures, as determined by the board, on or after May 1, 2016,
26submission of proof of graduation from that institution.

end insert
begin insert

27(2) For licensees who graduated from an accredited school
28before May 1, 2016, submission of proof of completion of a 32-hour
29course that includes clinical training in advanced procedures and
30is approved the board.

end insert
begin insert

31(h) For the purposes of this chapter, “advanced procedures’
32means any of the following:

end insert
begin insert

33(1) Therapeutic lasers used for posterior capsulotomy secondary
34to cataract surgery.

end insert
begin insert

35(2) Therapeutic lasers appropriate for treatment of glaucoma
36and peripheral iridotomy for the prophylactic treatment of angle
37closure glaucoma.

end insert
begin insert

38(3) Excision, scraping, and biopsy, or any combination of those,
39of superficial lesions of the eyelid and adnexa.

end insert
begin insert

40(4) Cauterization or suture repairs of the eyelid and conjunctiva.

end insert
begin insert

P8    1(5) Injections for the treatment of conditions of the eye and
2adnexa described in paragraph (1) of subdivision (b), excluding
3intraorbital injections and injections administered for cosmetic
4effect.

end insert
begin insert

5(6) Administration of immunizations for influenza, Herpes Zoster
6Virus, and additional immunizations that may be necessary to
7protect public health during a declared disaster or public health
8emergency in compliance with individual Advisory Committee on
9Immunization Practices (ACIP) vaccine recommendations
10published by the federal Centers for Disease Control and
11Prevention (CDC) for persons three years of age or older.

end insert
begin insert

12(7) Any noninvasive technology authorized by the board for the
13treatment of conditions described in paragraph (1) of subdivision
14(b).

end insert
begin delete

15(g)

end delete

16begin insert(end insertbegin inserti)end insert Other than for prescription ophthalmic devices described in
17subdivision (b) of Section 2541, any dispensing of a therapeutic
18pharmaceutical agent by an optometrist shall be without charge.

begin delete

19(h) The

end delete

20begin insert(j)end insertbegin insertend insertbegin insertExcept as authorized by this section, theend insert practice of optometry
21does not include performing surgery. “Surgery” means any
22procedure in which human tissue is cut, altered, or otherwise
23infiltrated by mechanical or laser means.begin delete “Surgery” does not
24include those procedures specified in subdivision (e).end delete
Nothing in
25this section shall limit an optometrist’s authority to utilize
26diagnostic laser and ultrasound technology within his or her scope
27of practice.

begin delete

28(i)

end delete

29begin insert(end insertbegin insertk)end insert An optometrist licensed under this chapter is subject to the
30provisions of Section 2290.5 for purposes of practicing telehealth.

begin delete

31(j)

end delete

32begin insert(end insertbegin insertl)end insert For purposes of this chapter, “glaucoma” means either of the
33following:

34(1) All primary open-angle glaucoma.

35(2) Exfoliation and pigmentary glaucoma.

begin delete

36(k)

end delete

37begin insert(end insertbegin insertm)end insert For purposes of this chapter, “adnexa” means ocular adnexa.

begin delete

38(l)

end delete

P9    1begin insert(end insertbegin insertn)end insert In an emergency, an optometrist shall stabilize, if possible,
2and immediately refer any patient who has an acute attack of angle
3closure to an ophthalmologist.

4

SEC. 2.  

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

6

3041.1.  

With respect to the practices set forth in Section 3041,
7optometrists diagnosing or treating eye disease or diagnosing other
8diseases shall be held to the same standard of care to which
9physicians and surgeons and osteopathic physicians and surgeons
10are held. An optometrist shall consult with and, if necessary, refer
11to a physician and surgeon or other appropriate health care provider
12if a situation or condition occurs that is beyond the optometrist’s
13 scope of practice.

14begin insert

begin insertSEC. 3.end insert  

end insert

begin insertSection 3110 of the end insertbegin insertBusiness and Professions Codeend insertbegin insert is
15amended to read:end insert

16

3110.  

The board may take action against any licensee who is
17charged with unprofessional conduct, and may deny an application
18for a license if the applicant has committed unprofessional conduct.
19In addition to other provisions of this article, unprofessional
20conduct includes, but is not limited to, the following:

21(a) Violating or attempting to violate, directly or indirectly
22assisting in or abetting the violation of, or conspiring to violate
23any provision of this chapter or any of the rules and regulations
24adopted by the board pursuant to this chapter.

25(b) Gross negligence.

26(c) Repeated negligent acts. To be repeated, there must be two
27or more negligent acts or omissions.

28(d) Incompetence.

29(e) The commission of fraud, misrepresentation, or any act
30involving dishonesty or corruption, that is substantially related to
31the qualifications, functions, or duties of an optometrist.

32(f) Any action or conduct that would have warranted the denial
33of a license.

34(g) The use of advertising relating to optometry that violates
35Section 651 or 17500.

36(h) Denial of licensure, revocation, suspension, restriction, or
37any other disciplinary action against a health care professional
38license by another state or territory of the United States, by any
39other governmental agency, or by another California health care
P10   1professional licensing board. A certified copy of the decision or
2judgment shall be conclusive evidence of that action.

3(i) Procuring his or her license by fraud, misrepresentation, or
4mistake.

5(j) Making or giving any false statement or information in
6connection with the application for issuance of a license.

7(k) Conviction of a felony or of any offense substantially related
8to the qualifications, functions, and duties of an optometrist, in
9which event the record of the conviction shall be conclusive
10evidence thereof.

11(l) Administering to himself or herself any controlled substance
12or using any of the dangerous drugs specified in Section 4022, or
13using alcoholic beverages to the extent, or in a manner, as to be
14dangerous or injurious to the person applying for a license or
15holding a license under this chapter, or to any other person, or to
16the public, or, to the extent that the use impairs the ability of the
17person applying for or holding a license to conduct with safety to
18the public the practice authorized by the license, or the conviction
19of a misdemeanor or felony involving the use, consumption, or
20self administration of any of the substances referred to in this
21subdivision, or any combination thereof.

22(m) Committing or soliciting an act punishable as a sexually
23related crime, if that act or solicitation is substantially related to
24the qualifications, functions, or duties of an optometrist.

25(n) Repeated acts of excessive prescribing, furnishing or
26administering of controlled substances or dangerous drugs specified
27in Section 4022, or repeated acts of excessive treatment.

28(o) Repeated acts of excessive use of diagnostic or therapeutic
29procedures, or repeated acts of excessive use of diagnostic or
30treatment facilities.

31(p) The prescribing, furnishing, or administering of controlled
32substances or drugs specified in Section 4022, or treatment without
33a good faith prior examination of the patient and optometric reason.

34(q) The failure to maintain adequate and accurate records
35relating to the provision of services to his or her patients.

36(r) Performing, or holding oneself out as being able to perform,
37or offering to perform, any professional services beyond the scope
38of the license authorized by this chapter.

39(s) The practice of optometry without a valid, unrevoked,
40unexpired license.

P11   1(t) The employing, directly or indirectly, of any suspended or
2unlicensed optometrist to perform any work for which an optometry
3license is required.

4(u)  Permitting another person to use the licensee’s optometry
5license for any purpose.

6(v) Altering with fraudulent intent a license issued by the board,
7or using a fraudulently altered license, permit certification or any
8registration issued by the board.

9(w) Except for good cause, the knowing failure to protect
10patients by failing to follow infection control guidelines of the
11board, thereby risking transmission of blood borne infectious
12diseases from optometrist to patient, from patient to patient, or
13from patient to optometrist. In administering this subdivision, the
14board shall consider the standards, regulations, and guidelines of
15the State Department of Health Services developed pursuant to
16Section 1250.11 of the Health and Safety Code and the standards,
17guidelines, and regulations pursuant to the California Occupational
18Safety and Health Act of 1973 (Part 1 (commencing with Section
196300) of Division 5 of the Labor Code) for preventing the
20transmission of HIV, hepatitis B, and other blood borne pathogens
21in health care settings. As necessary, the board may consult with
22the Medical Board of California, the Board of Podiatric Medicine,
23the Board of Registered Nursing, and the Board of Vocational
24Nursing and Psychiatric Technicians, to encourage appropriate
25consistency in the implementation of this subdivision.

26(x) Failure or refusal to comply with a request for the clinical
27records of a patient, that is accompanied by that patient’s written
28authorization for release of records to the board, within 15 days
29of receiving the request and authorization, unless the licensee is
30unable to provide the documents within this time period for good
31cause.

32(y)  Failure to refer a patient to an appropriate physicianbegin delete in either
33of the following circumstances:end delete
begin insert if end insertbegin insertan examination of the eyes
34indicates a substantial likelihood of any pathology that requires
35the attention of that physician.end insert

begin delete

36(1) Where an examination of the eyes indicates a substantial
37likelihood of any pathology that requires the attention of that
38physician.

end delete
begin delete

39(2) As required by subdivision (c) of Section 3041.

end delete
P12   1begin insert

begin insertSEC. 4.end insert  

end insert

begin insertIt is the intent of the Legislature that the Office of
2Statewide Health Planning and Development, under the Health
3Workforce Pilot Projects Program, designate a pilot project
4intended to test, demonstrate, and evaluate expanded roles for
5optometrists in the performance of management and treatment of
6diabetes mellitus, hypertension, and hypercholesterolemia.end insert

7

begin deleteSEC. 3.end delete
8begin insertSEC. 5.end insert  

No reimbursement is required by this act pursuant to
9Section 6 of Article XIII B of the California Constitution because
10the only costs that may be incurred by a local agency or school
11district will be incurred because this act creates a new crime or
12infraction, eliminates a crime or infraction, or changes the penalty
13for a crime or infraction, within the meaning of Section 17556 of
14the Government Code, or changes the definition of a crime within
15the meaning of Section 6 of Article XIII B of the California
16Constitution.



O

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