Bill Text: CA SB622 | 2015-2016 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Optometry.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2016-11-30 - From Assembly without further action. [SB622 Detail]
Download: California-2015-SB622-Amended.html
Bill Title: Optometry.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2016-11-30 - From Assembly without further action. [SB622 Detail]
Download: California-2015-SB622-Amended.html
BILL NUMBER: SB 622 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 9, 2015
INTRODUCED BY Senator Hernandez
FEBRUARY 27, 2015
An act to amend Section 2842 of the Business and
Professions Code, relating to vocational nursing. An
act to amend Section 3041 of, to add Sections 3041.4, 3041.5, 3041.6,
3041.7, and 3041.8 to, and to repeal and add Sections 3041.1,
3041.2, and 3041.3 of, the Business and Professions Code, relating
to optometry, and making an appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
SB 622, as amended, Hernandez. Vocational nursing.
Optometry.
The Optometry Practice Act provides for the licensure and
regulation of the practice of optometry by the State Board of
Optometry, and 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. The act requires optometrists treating or diagnosing eye
disease, as specified, to be held to the same standard of care to
which physicians and surgeons and osteopathic physician and surgeons
are held. The act makes a violation of any of its provisions a crime.
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 act.
This bill would revise and recast those provisions. The bill would
additionally define the practice of optometry as the provision of
habilitative optometric services, and would authorize the board to
allow optometrists to use nonsurgical technology to treat any
authorized condition under the act. The bill would authorize an
optometrist to use diagnostic pharmaceutical agents, as specified,
including, but not limited to, oral and topical diagnostic
pharmaceutical agents that are not controlled substances. The bill
would authorize an optometrist to independently initiate and
administer vaccines, as specified, for a person 3 years of age and
older, if the optometrist meets certain requirements, including, but
not limited to, that he or she is certified in basic life support for
health care professionals. The bill would additionally authorize an
optometrist certified to use therapeutic pharmaceutical agents to,
among other things, be certified to use anterior segment lasers, as
specified, and to be certified to perform specified minor procedures,
as specified, if certain requirements are met.
The bill would require the board to charge a fee of not more than
$150 to cover the reasonable regulatory cost of certifying an
optometrist to use anterior segment lasers. Because this bill would
increase those moneys deposited in a continuously appropriated fund,
it would make an appropriation.
Because a violation of the act is a crime, this bill would expand
the scope of an existing crime and would, therefore, result in 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.
The Vocational Nursing Practice Act provides for the licensure and
regulation of the practice of vocational nursing by the Board of
Vocational Nursing and Psychiatric Technicians within the Department
of Consumer Affairs. The act requires the board to consist of 11
members, including one member that is a licensed vocational nurse or
registered nurse who has had no less than 5 years' experience as a
teacher or administrator in an accredited school of vocational
nursing.
This bill would require that the vocational nurse or registered
nurse's experience be in an accredited school of vocational nursing
approved by the board.
Vote: majority. Appropriation: no yes
. Fiscal committee: no yes .
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
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, 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 pain, nonsurgical in cause 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 (j).
(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 United States Uniform 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 CLIA 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, shall be 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 (j), 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.
(j) For purposes of this chapter, "glaucoma" means either of the
following:
(1) All primary open-angle glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(k) For purposes of this chapter, "adnexa" means ocular adnexa.
(l) 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.
(b) The State Board of Optometry shall, by regulation, establish
educational and examination requirements for licensure to ensure the
competence of optometrists to practice pursuant to this chapter.
Satisfactory completion of the required educational and examination
requirements shall be a condition for the issuance of an original
optometrist license or required certifications pursuant to this
chapter.
(c) The board may authorize optometrists to use nonsurgical
technology to treat a condition authorized by this chapter.
SEC. 2. Section 3041.1 of the Business
and Professions Code is repealed.
3041.1. With respect to the practices set forth in subdivisions
(b), (d), and (e) of Section 3041, optometrists diagnosing or
treating eye disease shall be held to the same standard of care to
which physicians and surgeons and osteopathic physicians and surgeons
are held.
SEC. 3. Section 3041.1 is added to the
Business and Professions Code , to read:
3041.1. (a) (1) An optometrist who is certified to use
therapeutic pharmaceutical agents pursuant to this section 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 that is nonsurgical in cause, except when
comanaged with the treating physician and surgeon.
(D) Traumatic or recurrent conjunctival or corneal abrasions and
erosions.
(E) Corneal and conjunctival surface disease and dry eyes disease.
(F) Ocular pain that is nonsurgical in cause, except when
comanaged with the treating physician and surgeon.
(G) Eyelid disorders, including, but not limited to, hypotrichosis
and blepharitis.
(2) For purposes of this section, "treat" means the use of
therapeutic pharmaceutical agents, as described in subdivision (b),
and the procedures described in subdivision (c).
(3) For purposes of this chapter, "adnexa" means ocular adnexa.
(b) In diagnosing and treating the conditions listed in
subdivision (a), an optometrist certified to use therapeutic
pharmaceutical agents pursuant to this section may use all of the
following diagnostic and therapeutic pharmaceutical agents:
(1) Oral and topical diagnostic and therapeutic pharmaceutical
agents that are not controlled substances. The use of pharmaceutical
agents shall be limited to the use for which the drug has been
approved for marketing by the federal Food and Drug Administration
(FDA).
(2) Notwithstanding paragraph (1), an optometrist certified to use
therapeutic pharmaceutical agents may use a drug in a way for which
the drug has not been approved for marketing by the FDA if all of the
following requirements are met:
(A) The drug is approved by the FDA.
(B) The drug has been recognized for treatment of the condition by
either of the following:
(i) The American Hospital Formulary Service's Drug Information.
(ii) Two articles from major peer reviewed medical journals that
present data supporting the proposed off-label use or uses as
generally safe and effective, unless there is clear and convincing
contradictory evidence presented in a major peer reviewed medical
journal.
(3) Notwithstanding paragraph (1), 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.) may be used. The use of
these controlled substances shall be limited to five days.
(c) An optometrist who is certified to use therapeutic
pharmaceutical agents pursuant to this section may also perform all
of the following:
(1) Corneal scraping with cultures.
(2) Debridement of corneal epithelia.
(3) Mechanical epilation.
(4) Collection of a blood specimen by finger prick method or
venipuncture for testing patients suspected of having diabetes.
(5) Suture removal, with prior consultation with the treating
health care provider.
(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 clinical laboratory and imaging tests related to
the practice of optometry.
(10) A clinical laboratory test or examination classified as
waived under CLIA and related to the practice of optometry.
(11) Skin test to diagnose ocular allergies. Skin tests shall be
limited to the superficial lawyer of the skin.
(12) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.
(13) The prescription of therapeutic contact lenses, diagnostic
contact lenses, or biological or technological corneal devices.
(14) 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.
(15) 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 and confirmation of 10
procedures under the supervision of an ophthalmologist or optometrist
who is certified in lacrimal irrigation and dilation. Any
optometrist who graduated from an accredited school of optometry on
or after May 1, 2000, shall be exempt from the certification
requirement contained in this paragraph.
(16) Use of mechanical lipid extraction of meibomian glands and
nonsurgical techniques.
(17) Notwithstanding subdivision (b), administration of injections
for the diagnoses or treatment of conditions of the eye and adnexa,
excluding intraorbital injections and injections administered for
cosmetic effect, provided that the optometrist has satisfactorily
received four hours of continuing education on performing all
injections authorized by this paragraph.
(d) In order to be certified to use therapeutic pharmaceutical
agents and authorized to diagnose and treat the conditions listed in
this section, an optometrist shall apply for a certificate from the
board and meet all requirements imposed by the board.
(e) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry prior to January 1, 1996,
is licensed as an optometrist in California, and meets all of the
following requirements:
(1) Satisfactorily completes a didactic course of no less than 80
classroom hours in the diagnosis, pharmacological, and other
treatment and management of ocular disease provided by either an
accredited school of optometry in California or a recognized
residency review committee in ophthalmology in California.
(2) Completes a preceptorship of no less than 65 hours, during a
period of not less than two months nor more than one year, in either
an ophthalmologist's office or an optometric clinic. The training
received during the preceptorship shall be on the diagnosis,
treatment, and management of ocular, systemic disease. The preceptor
shall certify completion of the preceptorship. Authorization for the
ophthalmologist to serve as a preceptor shall be provided by an
accredited school of optometry in California, or by a recognized
residency review committee in ophthalmology, and the preceptor shall
be licensed as an ophthalmologist in California, board-certified in
ophthalmology, and in good standing with the Medical Board of
California. The individual serving as the preceptor shall schedule no
more than three optometrist applicants for each of the required 65
hours of the preceptorship program. This paragraph shall not be
construed to limit the total number of optometrist applicants for
whom an individual may serve as a preceptor, and is intended only to
ensure the quality of the preceptorship by requiring that the
ophthalmologist preceptor schedule the training so that each
applicant optometrist completes each of the 65 hours of the
preceptorship while scheduled with no more than two other optometrist
applicants.
(3) Successfully completes a minimum of 20 hours of self-directed
education.
(4) Passes the National Board of Examiners in Optometry's
"Treatment and Management of Ocular Disease" examination or, in the
event this examination is no longer offered, its equivalent, as
determined by the State Board of Optometry.
(5) Passes the examination issued upon completion of the 80-hour
didactic course required under paragraph (1) and provided by the
accredited school of optometry or residency program in ophthalmology.
(6) When any or all of the requirements contained in paragraph
(1), (4), or (5) have been satisfied on or after July 1, 1992, and
before January 1, 1996, an optometrist shall not be required to
fulfill the satisfied requirements in order to obtain certification
to use therapeutic pharmaceutical agents. In order for this paragraph
to apply to the requirement contained in paragraph (5), the didactic
examination that the applicant successfully completed shall meet
equivalency standards, as determined by the board.
(7) Any optometrist who graduated from an accredited school of
optometry on or after January 1, 1992, and before January 1, 1996,
shall not be required
to fulfill the requirements contained in paragraphs (1), (4), and
(5).
(f) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry on or after January 1,
1996, who is licensed as an optometrist in California, and who meets
all of the following requirements:
(1) Passes the National Board of Examiners in Optometry's national
board examination, or its equivalent, as determined by the State
Board of Optometry.
(2) Of the total clinical training required by a school of
optometry's curriculum, successfully completed at least 65 of those
hours on the diagnosis, treatment, and management of ocular, systemic
disease.
(3) Is certified by an accredited school of optometry as competent
in the diagnosis, treatment, and management of ocular, systemic
disease to the extent authorized by this section.
(4) Is certified by an accredited school of optometry as having
completed at least 10 hours of experience with a board-certified
ophthalmologist.
(g) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who is an optometrist who
obtained his or her license outside of California if he or she meets
all of the requirements for an optometrist licensed in California to
be certified to use therapeutic pharmaceutical agents.
(1) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and graduated from an accredited school
of optometry prior to January 1, 1996, shall be required to fulfill
the requirements set forth in subdivision (e). In order for the
applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received at the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry in
California for persons who graduated before January 1, 1996. For
those out-of-state applicants who request that any of the
requirements contained in subdivision (e) be waived based on
fulfillment of the requirement in another state, if the board
determines that the completed requirement was equivalent to that
required in California, the requirement shall be waived.
(2) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and who graduated from an accredited
school of optometry on or after January 1, 1996, shall be required to
fulfill the requirements set forth in subdivision (f). In order for
the applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received by the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry for
persons who graduated on or after January 1, 1996. For those
out-of-state applicants who request that any of the requirements
contained in subdivision (f) be waived based on fulfillment of the
requirement in another state, if the board determines that the
completed requirement was equivalent to that required in California,
the requirement shall be waived.
(3) The State Board of Optometry shall decide all issues relating
to the equivalency of an optometrist's education or training under
this subdivision.
(h) 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.
(i) Except as authorized by this chapter, 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 (c). This section does not
limit an optometrist's authority to utilize diagnostic laser and
ultrasound technology within his or her scope of practice.
(j) 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.
SEC. 4. Section 3041.2 of the Business
and Professions Code is repealed.
3041.2. (a) The State Board of Optometry shall, by regulation,
establish educational and examination requirements for licensure to
ensure the competence of optometrists to practice pursuant to
subdivision (a) of Section 3041. Satisfactory completion of the
educational and examination requirements shall be a condition for the
issuance of an original optometrist license under this chapter, on
and after January 1, 1980. Only those optometrists who have
successfully completed educational and examination requirements as
determined by the State Board of Optometry shall be permitted the use
of pharmaceutical agents specified by subdivision (a) of Section
3041.
(b) Nothing in this section shall authorize an optometrist issued
an original optometrist license under this chapter before January 1,
1996, to use or prescribe therapeutic pharmaceutical agents specified
in subdivision (d) of Section 3041 without otherwise meeting the
requirements of Section 3041.3.
SEC. 5. Section 3041.2 is added to the
Business and Professions Code , to read:
3041.2. (a) For purposes of this chapter, "glaucoma" means any of
the following:
(1) All primary open-angle glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(3) Increase in intraocular pressure caused by steroid medication.
(b) An optometrist certified pursuant to Section 3041.1 shall be
certified for the treatment of glaucoma, as described in subdivision
(a), 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.
(4) For licensees who graduated from an accredited school of
optometry on or before May 1, 2008, and are not described in
paragraph (2) or (3), submission of proof of satisfactory completion
of the requirements for certification established by the board.
SEC. 6. Section 3041.3 of the Business
and Professions Code is repealed.
3041.3. (a) In order to be certified to use therapeutic
pharmaceutical agents and authorized to diagnose and treat the
conditions listed in subdivisions (b), (d), and (e) of Section 3041,
an optometrist shall apply for a certificate from the board and meet
all requirements imposed by the board.
(b) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry prior to January 1, 1996,
is licensed as an optometrist in California, and meets all of the
following requirements:
(1) Satisfactorily completes a didactic course of no less than 80
classroom hours in the diagnosis, pharmacological, and other
treatment and management of ocular disease provided by either an
accredited school of optometry in California or a recognized
residency review committee in ophthalmology in California.
(2) Completes a preceptorship of no less than 65 hours, during a
period of not less than two months nor more than one year, in either
an ophthalmologist's office or an optometric clinic. The training
received during the preceptorship shall be on the diagnosis,
treatment, and management of ocular, systemic disease. The preceptor
shall certify completion of the preceptorship. Authorization for the
ophthalmologist to serve as a preceptor shall be provided by an
accredited school of optometry in California, or by a recognized
residency review committee in ophthalmology, and the preceptor shall
be licensed as an ophthalmologist in California, board-certified in
ophthalmology, and in good standing with the Medical Board of
California. The individual serving as the preceptor shall schedule no
more than three optometrist applicants for each of the required 65
hours of the preceptorship program. This paragraph shall not be
construed to limit the total number of optometrist applicants for
whom an individual may serve as a preceptor, and is intended only to
ensure the quality of the preceptorship by requiring that the
ophthalmologist preceptor schedule the training so that each
applicant optometrist completes each of the 65 hours of the
preceptorship while scheduled with no more than two other optometrist
applicants.
(3) Successfully completes a minimum of 20 hours of self-directed
education.
(4) Passes the National Board of Examiners in Optometry's
"Treatment and Management of Ocular Disease" examination or, in the
event this examination is no longer offered, its equivalent, as
determined by the State Board of Optometry.
(5) Passes the examination issued upon completion of the 80-hour
didactic course required under paragraph (1) and provided by the
accredited school of optometry or residency program in ophthalmology.
(6) When any or all of the requirements contained in paragraph
(1), (4), or (5) have been satisfied on or after July 1, 1992, and
before January 1, 1996, an optometrist shall not be required to
fulfill the satisfied requirements in order to obtain certification
to use therapeutic pharmaceutical agents. In order for this paragraph
to apply to the requirement contained in paragraph (5), the didactic
examination that the applicant successfully completed shall meet
equivalency standards, as determined by the board.
(7) Any optometrist who graduated from an accredited school of
optometry on or after January 1, 1992, and before January 1, 1996,
shall not be required to fulfill the requirements contained in
paragraphs (1), (4), and (5).
(c) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who graduated from a
California accredited school of optometry on or after January 1,
1996, who is licensed as an optometrist in California, and who meets
all of the following requirements:
(1) Passes the National Board of Examiners in Optometry's national
board examination, or its equivalent, as determined by the State
Board of Optometry.
(2) Of the total clinical training required by a school of
optometry's curriculum, successfully completed at least 65 of those
hours on the diagnosis, treatment, and management of ocular, systemic
disease.
(3) Is certified by an accredited school of optometry as competent
in the diagnosis, treatment, and management of ocular, systemic
disease to the extent authorized by this section.
(4) Is certified by an accredited school of optometry as having
completed at least 10 hours of experience with a board-certified
ophthalmologist.
(d) The board shall grant a certificate to use therapeutic
pharmaceutical agents to any applicant who is an optometrist who
obtained his or her license outside of California if he or she meets
all of the requirements for an optometrist licensed in California to
be certified to use therapeutic pharmaceutical agents.
(1) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and graduated from an accredited school
of optometry prior to January 1, 1996, shall be required to fulfill
the requirements set forth in subdivision (b). In order for the
applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received at the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry in
California for persons who graduate before January 1, 1996. For those
out-of-state applicants who request that any of the requirements
contained in subdivision (b) be waived based on fulfillment of the
requirement in another state, if the board determines that the
completed requirement was equivalent to that required in California,
the requirement shall be waived.
(2) In order to obtain a certificate to use therapeutic
pharmaceutical agents, any optometrist who obtained his or her
license outside of California and who graduated from an accredited
school of optometry on or after January 1, 1996, shall be required to
fulfill the requirements set forth in subdivision (c). In order for
the applicant to be eligible for the certificate to use therapeutic
pharmaceutical agents, the education he or she received by the
accredited out-of-state school of optometry shall be equivalent to
the education provided by any accredited school of optometry for
persons who graduate on or after January 1, 1996. For those
out-of-state applicants who request that any of the requirements
contained in subdivision (c) be waived based on fulfillment of the
requirement in another state, if the board determines that the
completed requirement was equivalent to that required in California,
the requirement shall be waived.
(3) The State Board of Optometry shall decide all issues relating
to the equivalency of an optometrist's education or training under
this subdivision.
SEC. 7. Section 3041.3 is added to the
Business and Professions Code , to read:
3041.3. (a) For the purposes of this chapter, "anterior segment
laser" means any of the following:
(1) Therapeutic lasers appropriate for treatment of glaucoma.
(2) Notwithstanding subdivision (a) of Section 3041.2, peripheral
iridotomy for the prophylactic treatment of angle closure glaucoma.
(3) Therapeutic lasers used for posterior capsulotomy secondary to
cataract surgery.
(b) An optometrist certified to treat glaucoma pursuant to Section
3041.2 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.
(1) The board-approved course shall be a minimum of 16 hours in
length, and include a test for competency of the following:
(A) Laser physics, hazards, and safety.
(B) Biophysics of laser.
(C) Laser application in clinical optometry.
(D) Laser tissue interactions.
(E) Laser indications, contraindications, and potential
complications.
(F) Gonioscopy.
(G) Laser therapy for open-angle glaucoma.
(H) Laser therapy for angle closure glaucoma.
(I) Posterior capsulotomy.
(J) Common complications of the lids, lashes, and lacrimal system.
(K) Medicolegal aspects of anterior segment procedures.
(L) Peripheral iridotomy.
(M) Laser trabeculoplasty.
(2) The school of optometry shall require each applicant for
certification to perform a sufficient number of anterior segment
laser procedures to verify that the applicant has demonstrated
competency to practice independently. At a minimum, each applicant
shall complete 14 anterior segment laser procedures on live humans.
(c) The board, by regulation, shall set the fee for issuance and
renewal of a certificate authorizing the use of anterior segment
lasers at an amount no higher than the reasonable cost of regulating
anterior segment laser certified optometrists pursuant to this
section. The fee shall not exceed one hundred fifty dollars ($150).
SEC. 8. Section 3041.4 is added to the
Business and Professions Code , to read:
3041.4. (a) For the purposes of this chapter, "minor procedure"
means either of the following:
(1) Removal, destruction, or drainage of lesions of the eyelid and
adnexa clinically evaluated by the optometrist to be noncancerous,
not involving the eyelid margin, lacrimal supply or drainage systems,
no deeper than the orbicularis muscle, and smaller than five
millimeters in diameter.
(2) Closure of a wound resulting from a procedure described in
paragraph (1).
(b) An optometrist certified to treat glaucoma pursuant to Section
3041.2 shall be additionally certified to perform minor procedures
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 teaching optometric students.
(1) The board-approved course shall be a minimum of 32 hours in
length and include a test for competency of the following:
(A) Minor surgical procedures.
(B) Overview of surgical instruments, asepsis, and the state and
federal Occupational Safety and Health Administrations.
(C) Surgical anatomy of the eyelids.
(D) Emergency surgical procedures.
(E) Chalazion management.
(F) Epilumeninesence microscopy.
(G) Suture techniques.
(H) Local anesthesia techniques and complications.
(I) Anaphylaxsis and other office emergencies.
(J) Radiofrequency surgery.
(K) Postoperative wound care.
(2) The school of optometry shall require each applicant for
certification to perform a sufficient number of minor procedures to
verify that the applicant has demonstrated competency to practice
independently. At a minimum, each applicant shall complete five minor
procedures on live humans.
SEC. 9. Section 3041.5 is added to the
Business and Professions Code , to read:
3041.5. (a) An optometrist may independently initiate and
administer vaccines listed on the routine immunization schedules
recommended by the federal Advisory Committee on Immunization
Practices (ACIP), in compliance with individual ACIP vaccine
recommendations, and published by the federal Centers for Disease
Control and Prevention (CDC) for persons three years of age and
older.
(b) In order to initiate and administer an immunization described
in subdivision (a), an optometrist shall do all of the following:
(1) Complete an immunization training program endorsed by the CDC
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.
(2) Be certified in basic life support for health care
professionals.
(3) 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.
SEC. 10. Section 3041.6 is added to the
Business and Professions Code , to read:
3041.6. An optometrist licensed under this chapter is subject to
the provisions of Section 2290.5 for purposes of practicing
telehealth.
SEC. 11. Section 3041.7 is added to the
Business and Professions Code , to read:
3041.7. Optometrists diagnosing or treating eye disease 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 when a situation or
condition occurs that is beyond the optometrist's scope of practice.
SEC. 12. Section 3041.8 is added to the
Business and Professions Code , to read:
3041.8. 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 to test,
demonstrate, and evaluate expanded roles for optometrists in the
performance of management and treatment of diabetes mellitus,
hypertension, and hypercholesterolemia.
SEC. 13. 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.
SECTION 1. Section 2842 of the Business and
Professions Code is amended to read:
2842. (a) Each member of the board shall be a citizen of the
United States and a resident of the State of California. The board
shall have the following composition:
(1) Two members shall be duly licensed vocational nurses who have
been licensed for a period of not less than three years prior to
appointment.
(2) Two members shall be licensed psychiatric technicians, each of
whom shall have had not less than five years' experience in a
psychiatric hospital, or in a psychiatric unit of a hospital licensed
by the State Department of Health Services, or a private institution
licensed by the State Department of Health Services.
(3) One member shall be a licensed vocational nurse or registered
nurse who shall have had not less than five years' experience as a
teacher or administrator in an accredited school of vocational
nursing approved by the board.
(4) Six members shall be public members who are not licentiates of
the board or any other board under this division or of any board
referred to in Sections 1000 and 3600.
(b) No person may serve as a member of the board for more than two
consecutive terms.
(c) Per diem and expenses of members of the board who are licensed
psychiatric technicians shall be paid solely from revenues received
pursuant to Chapter 10 (commencing with Section 4500) of Division 2.
