Bill Text: CA AB2236 | 2021-2022 | Regular Session | Amended

California Assembly Bill 2236 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Optometry: certification to perform advanced procedures.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2022-09-28 - Vetoed by Governor. [AB2236 Detail]

Download: California-2021-AB2236-Amended.html

Amended IN Senate June 29, 2022

Amended IN Senate June 22, 2022

Amended IN Assembly March 17, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill

No. 2236

Introduced by Assembly Member Low

February 16, 2022

An act to add Section 3041.4 to the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL'S DIGEST

AB 2236, as amended, Low. Optometry: certification: use of anterior segment lasers and performing minor procedures.

Existing law, the Optometry Practice Act, establishes the State Board of Optometry in the Department of Consumer Affairs for the licensure and regulation of the practice of optometry. Existing law makes a violation of the act a misdemeanor. Existing law requires an optometrist to obtain a therapeutic pharmaceutical agents certification from the board to diagnose and treat certain conditions, and provides that an optometrist who holds a therapeutic pharmaceutical agents certification is certified to medically treat glaucomas, subject to satisfaction of specified requirements.

This bill would authorize an optometrist certified to treat glaucoma to use anterior segment lasers and to perform minor procedures, as defined, if the optometrist obtains an additional certification for those purposes from the board, and would set forth education, training, examination, and other requirements for obtaining that certification. The bill would require the board to set a ~~fee, not to exceed $150,~~ fee for the issuance and renewal of the certificate, and would require an optometrist who performs procedures pursuant to these provisions to annually report certain information to the board, including any adverse treatment outcomes associated with the procedure that required a referral to an ophthalmologist. Under the bill, a false report or a failure to report pursuant to that provision would not be a crime. The bill would require the board to ~~report the information to the Governor and the Secretary of Health and Human Services and to~~ make the report available on the board’s internet website, and would authorize the board to adopt regulations to implement the bill’s provisions. ~~By expanding the scope of a crime under the Optometry Practice Act, the bill would impose 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 Local Program: ~~YES~~NO

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

SECTION 1.

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

3041.4.

(a) For purposes of this section, the following shall apply:

(1) “Anterior segment laser” means any of the following:

(A) Therapeutic lasers appropriate for treatment of glaucoma.

(B) Peripheral iridotomy for the prophylactic treatment of angle closure glaucoma.

(2) (A) “Minor procedure” means any of the following:

(i) Removal, destruction, or drainage of lesions of the adnexa clinically evaluated by the optometrist to be noncancerous, not involving the eyelid margin, lacrimal supply, or drainage systems, no deeper than the orbicularis muscle, and smaller than five millimeters in diameter.

(ii) Closure of a wound resulting from a procedure described in clause (i).

(iii) Subcutaneous, intramuscular, subconjunctival, and intralesional injections for the diagnosis or treatment of conditions of the eye and adnexa authorized by this chapter.

(iv) Corneal crosslinking procedure, or the use of medication and ultraviolet light to make the tissues of the cornea stronger.

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

(b) An optometrist certified to treat glaucoma pursuant to subdivision (c) of Section 3041 may use anterior segment lasers and may preform minor procedures if the optometrist is additionally certified pursuant to this section. To apply for certification, an optometrist shall meet all the following requirements:

(1) The optometrist shall complete a board-approved course that is at least 16 32 hours in length and includes education and testing for competency on specific subjects regarding the use of anterior segment lasers, including placement of the laser, focus of the laser, and application of the laser, and on minor procedures, including, but not limited to, suturing, eyelid surgery, injections, anesthesia, and chalazion excision, as well as medical decisionmaking. The course shall include hands-on instruction on no less than 15 5 simulated eyes for each laser procedure and 15 simulated eyes to learn ~~surgical skills,~~ the skills necessary to perform minor procedures, a practical assessment of the optometrist’s technique, and a written examination.

(2) The optometrist shall pass the National Board of Examiners in Optometry’s “Laser and Surgical Procedures Examination,” or, in the event this examination is no longer offered, its equivalent, as determined by the board.

(3) (A) The optometrist shall complete a ~~clinical rotation~~ training by an accredited school of optometry that relates to the use of both anterior segment lasers and minor procedures. This training shall require a cohort of optometrists to independently assess each patient, develop a treatment plan, evaluate the clinical outcome post-treatment, and address adverse or unintended clinical outcomes. The cohort shall discuss and defend their medical decisionmaking for each patient and The training shall include direct experience with as many live human patients as needed to ensure competency. The training shall include the performance of at least_____ procedures of each type of laser procedure on live humans, and shall include the performance of at least_____chalazion and __ other type of lesion procedures authorized by this section on live humans. at least the following number of the following complete procedures:

(i) Five laser trabeculoplasty procedures.
(ii) Five laser posterior capsulotomy procedures.
(iii) Four laser peripheral iridotomy procedures.
(iv) Three chalazia.
(v) Five other types of lesion procedures authorized by this section.
(vi) One of each other type of injection authorized by this section on live humans.
(B) The training required by subparagraph (A) may be completed either by a clinical rotation or a preceptorship.
(i) The clinical rotation shall require a cohort of optometrists to, for each patient, independently assess the patient, develop a treatment plan, evaluate the clinical outcome post-treatment, address adverse or unintended clinical outcomes, and discuss and defend their medical decisionmaking.
(ii) The preceptorship shall be with either an optometrist in good standing certified to perform anterior segment laser and minor procedures or a physician and surgeon board certified in ophthalmology in good standing. The preceptor shall certify completion of the preceptorship, including the performance of the complete procedures required pursuant to subparagraph (A) and the competency of the optometrist performing the procedures, using a form approved by the board.

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

(d) An optometrist certified to use anterior segment lasers and perform minor procedures pursuant to this section shall complete 5 hours of continuing education on anterior segment lasers and the diagnosis, treatment, and management of lesions of the adnexa as part of the 50 hours of continuing education required every two years pursuant to Section 3059.

(e) An optometrist who removes a lesion pursuant to a minor procedure performed pursuant to this section shall have the lesion biopsied. If, during a minor procedure, a lesion is determined to be outside of the parameters described in clause (i) of subparagraph (A) of paragraph (2) of subdivision (a), the optometrist shall stabilize the patient to the greatest extent possible and refer the patient to an appropriate medical professional.

(f) (1) An optometrist who performs a procedure using an anterior segment laser or performs a minor procedure shall monitor and report all of the following information to the board on a yearly basis:

(A) The number and type of anterior segment laser procedures and minor procedures performed.

(B) The diagnosis of the patient at the time the procedure was performed.

(C) Any adverse treatment outcomes associated with the anterior segment laser procedure or minor procedure that required a referral to an ophthalmologist.

(2) The board shall ~~report this information to the Governor and the Secretary of Health and Human Services and shall~~ make the report available on ~~the board’s~~ its internet website.

(g) An optometrist certified pursuant to this section shall comply with the reporting requirements set forth by the board with respect to unprofessional conduct, malpractice settlements and judgments, criminal charges and convictions, and any disciplinary action taken by another licensing entity or authority of this state or of another state or an agency of the federal government or the Armed Forces of the United States that is related to the practice of optometry.

(h) The board may adopt rules and regulations to implement this section.

(i) Notwithstanding Section 3120 or any other provision of law, a false report or a failure to report pursuant to subdivision (f) shall not be a crime.

SEC. 2.
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.